NR 226 Exam 1 - Review Questions/Answers well
elaborated.
While assessing a patient, the nurse observes that the patient's intravenous (IV) line is
not infusing at the ordered rate. The nurse assesses the patient for pain at the IV site,
checks the flow regulator on the tubing, looks to see if the patient is lying on the tubing,
checks the point of connection between the tubing and the IV catheter, and then checks
the condition of the site where the intravenous catheter enters the patient's skin. After
the nurse readjusts the flow rate, the infusion begins at the correct rate. This is an
example of:
A. Inference.
B. Diagnostic reasoning.
C. Competency.
D. Problem solving.
D. Problem solving
-This is an example of problem solving. The nurse collects information and tries options
until she is able to find a solution to the slowed infusion rate. The focus is on solving the
problem with the patient's IV and not on solving the patient's health problem; thus this is
not the diagnostic reasoning process.
The nurse sits down to talk with a patient who lost her sister 2 weeks ago. The patient
reports she is unable to sleep, feels very fatigued during the day, and is having trouble
at work. The nurse asks her to clarify the type of trouble. The patient explains she can't
concentrate or even solve simple problems. The nurse records the results of the
assessment, describing the patient as having ineffective coping. This is an example of:
A. Diagnostic reasoning.
B. Competency.
C. Inference.
D. Problem solving.
A. Diagnostic reasoning
-In this example the nurse collects information about the patient, sees patterns in the
data collected, and makes a nursing diagnosis. This is an example of the diagnostic
process.
A nurse has worked on an oncology unit for 3 years. One patient has become visibly
weaker and states, "I feel funny." The nurse knows how patients often have behavior
changes before developing sepsis when they have cancer. The nurse asks the patient
questions to assess thinking skills and notices the patient shivering. The nurse goes to
the phone, calls the physician, and begins the conversation by saying, "I believe that
your patient is developing sepsis. I want to report symptoms I'm seeing." What
examples of critical thinking concepts does the nurse show? (Select all that apply.)
A. Experience
B. Ethical
C. Analyticity
D. Self-confidence
E. Risk taking
,C & D.
-Among critical thinking concepts, the nurse shows analyticity (analyzing information,
gathering additional findings, and sensing a problem), and self-confidence (calling the
physician, which shows trust in his own reasoning). The nurse's experience would have
influenced the familiarity of patient symptoms, but in this text experience is considered a
component of the critical thinking model and not a concept. Acting ethically is a critical
thinking standard.
.A nurse who is working on a surgical unit is caring for four different patients. Patient A
will be discharged home and is in need of instruction about wound care. Patients B and
C have returned from the operating room within an hour of each other, and both require
vital signs and monitoring of their intravenous (IV) lines. Patient D is resting following a
visit by physical therapy. Which of the following activities by the nurse represent(s) use
of clinical decision making for groups of patients? (Select all that apply.)
A. Consider how to involve patient A in deciding whether to involve the family caregiver
in wound care instruction.
B. Think about past experience with patients who develop postoperative complications.
C. Decide which activities can be combined for patients B and C.
D. Carefully gather any assessment information and identify patient problems.
A&C
-Considering how to involve patients in decisions and how to combine nursing activities
to be more organized and allow for resolving more than one problem at a time are
examples of clinical decision making for groups of patients. Thinking about past
experience with patients is an example of reflection, an approach to strengthen critical
thinking skills. Gathering assessment information is part of the process of diagnostic
reasoning, which should be applied to each patient.
The surgical unit has initiated the use of a pain-rating scale to assess patients' pain
severity during their postoperative recovery. The registered nurse (RN) looks at the pain
flow sheet to see the pain scores recorded for a patient over the last 24 hours. Use of
the pain scale is an example of which intellectual standard?
A. Deep
B. Relevant
C. Consistent
D. Significant
C. Consistent
-Use of the same pain scale for assessing pain acuity is an example of being consistent.
During a home health visit the nurse prepares to instruct a patient in how to perform
range-of-motion (ROM) exercises for an injured shoulder. The nurse verifies that the
patient took an analgesic 30 minutes before arrival at the patient's home. After
discussing the purpose for the exercises and demonstrating each one, the nurse has
the patient perform them. After two attempts with only the second of three exercises, the
patient stops and says, "This hurts too much. I don't see why I have to do this so many
times." The nurse applies the critical thinking attitude of integrity in which of the
following actions?
A. "I understand your reluctance, but the exercises are necessary for you to regain
function in your shoulder. Let's go a bit more slowly and try to relax."
B. "I see that you're uncomfortable. I'll call your doctor to decide the next step."
, C. "Show me exactly where your pain is and rate it for me on a scale of 0 to 10."
D. "Is anything else bothering you? Other than the pain, is there any other reason you
might not want to do the exercises?"
A. "I understand your reluctance, but the exercises are necessary for you to regain
function in your shoulder. Let's go a bit more slowly and try to relax."
-The nurse reviews the position of requiring exercises to restore function and decides to
try a different approach to proceed, which is an example of integrity. In calling the doctor
for the next step, the nurse does not reinforce the importance of exercises, which is
likely the standard of care for this type of patient. In asking the location and strength of
the pain the nurse is interpreting further to determine if any other physical problems are
developing. In attempting to learn if any other underlying problems exist, the nurse is
showing curiosity.
The nurse cared for a 14-year-old with renal failure who died near the end of the work
shift. The health care team tried for 45 minutes to resuscitate the child with no success.
The family was devastated by the loss, and, when the nurse tried to talk with them, the
mother said, "You can't make me feel better; you don't know what it's like to lose a
child." Which of the following examples of journal entries might best help the nurse
reflect and think about this clinical experience? (Select all that apply.)
A. Data entry of time of day, who was present, and condition of the child
B. Description of the efforts to restore the child's blood pressure, what was used, and
questions about the child's response
C. The meaning the experience had for the nurse with respect to her understanding of
dealing with a patient's death
D. A description of what the nurse said to the mother, the mother's response, and how
the nurse might approach the situation differently in the future
B, C, & D
-The nurse can reflect on the effects of the treatment and what was difficult or confusing
about the outcome. The nurse reviews the meaning of the experience to help improve
understanding of personal comfort and competence in dealing with death and how to
respond in the future. The nurse reflects on the communication approach used with the
mother to consider if it was appropriate.
A nurse has been working on a surgical unit for 3 weeks. A patient requires a Foley
catheter to be inserted, so the nurse reads the procedure manual for the institution to
review how to insert it. The level of critical thinking the nurse is using is:
A. Commitment.
B. Scientific method.
C. Basic critical thinking.
D. Complex critical thinking.
C. Basic critical thinking
-This is an example of basic critical thinking, in which the nurse trusts that experts have
the right answers for how to insert the Foley catheter and thus goes to the procedure
manual. Thinking is concrete and based on a set of rules or principles.
A patient had hip surgery 16 hours ago. During the previous shift the patient had 40 mL
of drainage in the surgical drainage collection device for an 8-hour period. The nurse
refers to the written plan of care, noting that the health care provider is to be notified
when drainage in the device exceeds 100 mL for the day. On entering the room, the
elaborated.
While assessing a patient, the nurse observes that the patient's intravenous (IV) line is
not infusing at the ordered rate. The nurse assesses the patient for pain at the IV site,
checks the flow regulator on the tubing, looks to see if the patient is lying on the tubing,
checks the point of connection between the tubing and the IV catheter, and then checks
the condition of the site where the intravenous catheter enters the patient's skin. After
the nurse readjusts the flow rate, the infusion begins at the correct rate. This is an
example of:
A. Inference.
B. Diagnostic reasoning.
C. Competency.
D. Problem solving.
D. Problem solving
-This is an example of problem solving. The nurse collects information and tries options
until she is able to find a solution to the slowed infusion rate. The focus is on solving the
problem with the patient's IV and not on solving the patient's health problem; thus this is
not the diagnostic reasoning process.
The nurse sits down to talk with a patient who lost her sister 2 weeks ago. The patient
reports she is unable to sleep, feels very fatigued during the day, and is having trouble
at work. The nurse asks her to clarify the type of trouble. The patient explains she can't
concentrate or even solve simple problems. The nurse records the results of the
assessment, describing the patient as having ineffective coping. This is an example of:
A. Diagnostic reasoning.
B. Competency.
C. Inference.
D. Problem solving.
A. Diagnostic reasoning
-In this example the nurse collects information about the patient, sees patterns in the
data collected, and makes a nursing diagnosis. This is an example of the diagnostic
process.
A nurse has worked on an oncology unit for 3 years. One patient has become visibly
weaker and states, "I feel funny." The nurse knows how patients often have behavior
changes before developing sepsis when they have cancer. The nurse asks the patient
questions to assess thinking skills and notices the patient shivering. The nurse goes to
the phone, calls the physician, and begins the conversation by saying, "I believe that
your patient is developing sepsis. I want to report symptoms I'm seeing." What
examples of critical thinking concepts does the nurse show? (Select all that apply.)
A. Experience
B. Ethical
C. Analyticity
D. Self-confidence
E. Risk taking
,C & D.
-Among critical thinking concepts, the nurse shows analyticity (analyzing information,
gathering additional findings, and sensing a problem), and self-confidence (calling the
physician, which shows trust in his own reasoning). The nurse's experience would have
influenced the familiarity of patient symptoms, but in this text experience is considered a
component of the critical thinking model and not a concept. Acting ethically is a critical
thinking standard.
.A nurse who is working on a surgical unit is caring for four different patients. Patient A
will be discharged home and is in need of instruction about wound care. Patients B and
C have returned from the operating room within an hour of each other, and both require
vital signs and monitoring of their intravenous (IV) lines. Patient D is resting following a
visit by physical therapy. Which of the following activities by the nurse represent(s) use
of clinical decision making for groups of patients? (Select all that apply.)
A. Consider how to involve patient A in deciding whether to involve the family caregiver
in wound care instruction.
B. Think about past experience with patients who develop postoperative complications.
C. Decide which activities can be combined for patients B and C.
D. Carefully gather any assessment information and identify patient problems.
A&C
-Considering how to involve patients in decisions and how to combine nursing activities
to be more organized and allow for resolving more than one problem at a time are
examples of clinical decision making for groups of patients. Thinking about past
experience with patients is an example of reflection, an approach to strengthen critical
thinking skills. Gathering assessment information is part of the process of diagnostic
reasoning, which should be applied to each patient.
The surgical unit has initiated the use of a pain-rating scale to assess patients' pain
severity during their postoperative recovery. The registered nurse (RN) looks at the pain
flow sheet to see the pain scores recorded for a patient over the last 24 hours. Use of
the pain scale is an example of which intellectual standard?
A. Deep
B. Relevant
C. Consistent
D. Significant
C. Consistent
-Use of the same pain scale for assessing pain acuity is an example of being consistent.
During a home health visit the nurse prepares to instruct a patient in how to perform
range-of-motion (ROM) exercises for an injured shoulder. The nurse verifies that the
patient took an analgesic 30 minutes before arrival at the patient's home. After
discussing the purpose for the exercises and demonstrating each one, the nurse has
the patient perform them. After two attempts with only the second of three exercises, the
patient stops and says, "This hurts too much. I don't see why I have to do this so many
times." The nurse applies the critical thinking attitude of integrity in which of the
following actions?
A. "I understand your reluctance, but the exercises are necessary for you to regain
function in your shoulder. Let's go a bit more slowly and try to relax."
B. "I see that you're uncomfortable. I'll call your doctor to decide the next step."
, C. "Show me exactly where your pain is and rate it for me on a scale of 0 to 10."
D. "Is anything else bothering you? Other than the pain, is there any other reason you
might not want to do the exercises?"
A. "I understand your reluctance, but the exercises are necessary for you to regain
function in your shoulder. Let's go a bit more slowly and try to relax."
-The nurse reviews the position of requiring exercises to restore function and decides to
try a different approach to proceed, which is an example of integrity. In calling the doctor
for the next step, the nurse does not reinforce the importance of exercises, which is
likely the standard of care for this type of patient. In asking the location and strength of
the pain the nurse is interpreting further to determine if any other physical problems are
developing. In attempting to learn if any other underlying problems exist, the nurse is
showing curiosity.
The nurse cared for a 14-year-old with renal failure who died near the end of the work
shift. The health care team tried for 45 minutes to resuscitate the child with no success.
The family was devastated by the loss, and, when the nurse tried to talk with them, the
mother said, "You can't make me feel better; you don't know what it's like to lose a
child." Which of the following examples of journal entries might best help the nurse
reflect and think about this clinical experience? (Select all that apply.)
A. Data entry of time of day, who was present, and condition of the child
B. Description of the efforts to restore the child's blood pressure, what was used, and
questions about the child's response
C. The meaning the experience had for the nurse with respect to her understanding of
dealing with a patient's death
D. A description of what the nurse said to the mother, the mother's response, and how
the nurse might approach the situation differently in the future
B, C, & D
-The nurse can reflect on the effects of the treatment and what was difficult or confusing
about the outcome. The nurse reviews the meaning of the experience to help improve
understanding of personal comfort and competence in dealing with death and how to
respond in the future. The nurse reflects on the communication approach used with the
mother to consider if it was appropriate.
A nurse has been working on a surgical unit for 3 weeks. A patient requires a Foley
catheter to be inserted, so the nurse reads the procedure manual for the institution to
review how to insert it. The level of critical thinking the nurse is using is:
A. Commitment.
B. Scientific method.
C. Basic critical thinking.
D. Complex critical thinking.
C. Basic critical thinking
-This is an example of basic critical thinking, in which the nurse trusts that experts have
the right answers for how to insert the Foley catheter and thus goes to the procedure
manual. Thinking is concrete and based on a set of rules or principles.
A patient had hip surgery 16 hours ago. During the previous shift the patient had 40 mL
of drainage in the surgical drainage collection device for an 8-hour period. The nurse
refers to the written plan of care, noting that the health care provider is to be notified
when drainage in the device exceeds 100 mL for the day. On entering the room, the
