CHAPTER 1: Critical thinking and the nursing process

MULTIPLE CHOICE

	1.	Application of knowledge and examination of patient response to support future decision-making is called:
a.	critical thinking.	
b.	patient interaction.	
c.	reflection.	
d.	nursing process.	

ANS:	 C         PTS:	1	       DIF:  Easy	  TOP:  Background

2. Professional intuition
a.	does not have a role in modern nursing.	
b.	is a creative approaches to patient problems.	
c.	develops over time with experience.	
d.	is subjective data.	

ANS:	C          PTS: 1	           DIF:  Easy	  TOP:  Background

	3.	A patient at 34 weeks’ gestation presents to labour and delivery with a complaint of burning on urination. The nurse then inquires about the presence of other signs and symptoms, such as frequency of urination, a backache that comes and goes in a regular manner, unusual vaginal discharge, increased pelvic pressure, and any menstrual-like cramping. She is assessing the patient for the possibility of preterm labour. This is an example of which component of critical thinking?
a.	inference	
b.	evaluation	
c.	interpretation	
d.	analysis	

ANS:	A          PTS:	1	  DIF:  Difficult	 TOP:  Components of critical thinking and clinical reasoning

	4.	Using the Universal Intellectual Standards (UIS) for critical thinking, establishing a history of substance abuse in the family is an example of:
a.	clarity.	
b.	accuracy.	
c.	precision.	
d.	relevance.	

ANS:	D          PTS:	1          DIF:	Difficult	TOP:	Universal Intellectual Standards for critical thinking

	5.	The planning phase of the nursing process is important because?
a.	It can provide a baseline for future comparisons.	
b.	It can be used to challenge the patient’s uninformed views.	
c.	It can be used to help provide a focus collection of physical examination data.	
d.	It can demonstrate nursing competency.	

ANS:	C	PTS:	1	DIF:	Difficult	TOP: Critical thinking and the nursing process

	6.	Which source provides the nurse objective information?
a.	physical assessment	
b.	the patient as a primary source of data	
c.	family and patient meetings	
d.	bystander reports at a traffic accident	

ANS:	A	PTS:	1	DIF:	Moderate		TOP:	Assessment

	7.	The need for educating a patient with diabetes is an example of what type of nursing identification?
a.	actual	
b.	potential	
c.	health promotion	
d.	chronic	

ANS:	C	PTS:	1	DIF:	Moderate		TOP:  Prioritisation

	8.	One of Mr P’s nursing problem is pain related to his surgical wound. It: 
a.	is a potential risk to health.	
b.	has an organic cause.	
c.	is an actual problem that can lead to nursing interventions.	
d.	requires medical intervention.	

ANS:	C	PTS:	1	DIF:	Difficult	     TOP:	Prioritisation

	9.	 Physical assessment findings are information that is:
a.	a human response.	
b.	a health problem.	
c.	related factors.	
d.	observable and measurable.	

ANS:	D	PTS:	1	DIF:	Moderate	TOP:	 Physical assessment findings

	10.	Health history is:
a.	from the patient only. 	
b.	from relatives and friends. 	
c.	from the healthcare team and medical notes.	
d.	from the patient, relatives, friends and bystanders.	

ANS:	D 	 PTS:	1	DIF:	Easy	TOP:	Health history

	11.	Diagnostic and laboratory data:
a.	is not necessary for clinical decisions.	
b.	is meant for doctors to comprehend.	
c.	contributes to a patient’s health status.	
d.	uses medical diagnoses for nursing interventions.	

ANS:	C	PTS:	1	DIF:	Difficult TOP:	 Diagnostic and laboratory data

	12.	Planning is the fourth step of the nursing process. It involves the prioritisation of nursing diagnoses and care and the selection of nursing interventions. According to Maslow’s Hierarchy of Needs, which situation exemplifies a physiological need?
a.	a child experiencing an asthma episode	
b.	an infant whose side rails are left down on her crib	
c.	a high school girl who is not selected to be on the dance team	
d.	a child whose parents constantly call him ‘stupid’	

ANS:	A 	PTS:	1	DIF:	Difficult	TOP:	Prioritisation

	13.	Patients are most likely to be motivated and agreeable to following their plan of care when:
a.	their health care provider explains the plan in terms they can understand.	
b.	they participate in the decision-making process as the plan is developed.	
c.	they establish their own nursing diagnoses.	
d.	their physician and nurse collaborate in developing the plan.	

ANS:	B  PTS:	1	DIF:	Moderate		TOP:	 Prioritisation

	14.	According to Maslow’s Hierarchy of Needs, which nursing problem should take priority over the others?
a.	altered nutrition; less than body requirements, related to difficulty swallowing	
b.	alteration to gas exchange related to pneumonia   	
c.	ineffective individual coping related to uncertainty of course of disease and treatment	
d.	deficient knowledge related to lack of interest in learning	

ANS:	B  PTS:	1	DIF:	Moderate		TOP:	 Prioritisation

	15.	A nursing decision to include a specific examination technique as a result of information gathered during the patient and family interview is which part of the nursing process? 
a.	implementation	
b.	assessment	
c.	planning	
d.	evaluation	

ANS:	A  PTS:	1	DIF:	Moderate		TOP:	Evaluation
	
 16.	The sequence of the components of critical thinking according to Wilkinson (2007) are:
a.	self-regulation, inference, explanation	
b.	interpretation, analysis, inference, explanation, evaluation and self-regulation	
c.	inference, analysis, self-regulation, explanation, interpretation and evaluation	
d.	no specific sequence as it is dynamic in nature	

ANS:	B  PTS:	1	DIF:	Difficult		TOP:	Components of critical thinking and clinical reasoning

	17.	The implementation phase of the nursing process is best described as the time in which the nurse:
a.	sequentially executes the planned interventions for each nursing diagnosis.	
b.	coordinates the implementation of planned interventions so that all patient outcomes are achieved at the same time.	
c.	simultaneously implements the interventions developed for multiple nursing diagnoses and makes modifications as needed.	
d.	organises and delegates assignments so that all patient outcomes are met by the established deadline.	

ANS:	C  PTS:	1	DIF:	Moderate		TOP:	Implementation

	18.	In the care of an intubated ventilated patient the physician has ordered enteral nutrition. The nurse will insert and monitor the nasogastric tube and the dietician will order the required diet. This is an example of:
a.	conducted weekly to monitor the effectiveness of the interventions and progress toward outcomes.	
b.	A collaborative patient problem that requires a team approach.	
c.	a 	
d.	a continual process focused on the progress patients make toward achieving established outcomes.	

ANS:	D  PTS:	1	DIF:	Moderate		TOP:	Evaluation

	19.	In addition to the nurse, what other key people are involved in the evaluation phase of the nursing process?
a.	the nurse managers	
b.	the patient and the family	
c.	the patient and the physician	
d.	all the health care professionals involved with the patient's care	

ANS:	B   PTS:	1	DIF:	Moderate	TOP:	Evaluation

	20.	Critical pathways, used in the case management approach, consist of:
a.	rating scales for outcomes.	
b.	lists of good and bad outcomes.	
c.	maps that show the outcome of predetermined patient goals over a period of time.	
d.	recommended activities for achieving patient care goals.	

ANS:	C   PTS:	1	DIF:	Moderate	TOP:	Clinical pathways	

	21.	A patient complains of feeling hungry but does not eat when the food is served. Which of the following demonstrates that the nurse is using critical thinking skills?
a.	The nurse assesses why the patient is not consuming the meal provided.	
b.	The nurse leaves the food with the patient for later. 	
c.	The nurse notifies the doctor that a feeding tube may be needed.	
d.	The nurse assumes that the patient is not hungry.	

ANS:	A  PTS:	1	DIF:	Moderate  TOP:	Components of critical thinking and clinical reasoning

	22.	The main purpose of the nursing care plan is to:
a.	apply critical thinking to patient care.	
b.	present nursing objectives to the patient and the family.	
c.	help the nurse decide which interventions to use.	
d.	communicate the patient’s progress in a standard way.	

ANS:	D   PTS:	1	DIF:	moderate    TOP:	Documenting the nursing process

COMPLETION

	1.	A purposeful, goal-directed process that strives to problem-solve patient care issues through the use of clinical reasoning is called ____________________ thinking.

ANS:	critical

PTS:	1	DIF:	Moderate	TOP:	Components of critical thinking and clinical reasoning

	2.	The nursing profession use ________ as tool to support further opportunities for learning and help develop a personal body of applied knowledge.
      
      ANS: reflection

PTS:	1	DIF:	Easy	TOP:	Critical thinking and the nursing process

	3.	_______________________ are planned strategies based on scientific rationale and devised by the nurse to assist the patient in meeting the patient outcomes.

ANS:  Interventions
PTS:	1	DIF:	Easy	TOP:	Critical thinking and the nursing process

OTHER

	1.	The nursing process used throughout this text includes four phases:
 		(1) ____________________, (2) ____________________, (3) ______________________, (4) ______________________.

ANS:	
1. assessment
2. planning
3. implementation
4. evaluation

PTS:	1	DIF:	Moderate	TOP:	Critical thinking and the nursing process

	2.	Collaborative interventions refer to actions that are prescribed by the ____________________ and implemented by the ____________________.

ANS:	physician or doctor, nurse

PTS:	1	DIF:	Difficult	TOP:	Intervention selection	

3. APIE (assessment, planning, intervention, evaluation) is a framework for critical thinking. Such frameworks are also called _________________. 

  ANS:	clinical reasoning

PTS:	1	DIF:	Moderate	TOP:	Critical thinking and reasoning

	4.	List four key elements of clinical reasoning.

ANS: Any four from below.	
Purpose, find a solution, based on assumptions, a particular point of view, evidenced by data, conceptually expressed, inferential and consequential. 

PTS:	4	DIF:	Difficult	TOP:	Critical thinking and reasoning

   5. What steps are involved in the planning phase of the nursing process?

ANS: Evaluating subjective data, collection and validation of objective data. 

PTS:	3	DIF:	Difficult	TOP:	Critical thinking and reasoning