NUR 205 FUNDAMENTALS OF NURSING I

EXAM 1 STUDY GUIDE

Exam 1 contains 50 questions, mostly multiple choice, with some questions seeking more than
one choice (choose all that apply). This examination contains no True/False questions. As with
all examinations in this course, there are some dosage calculation essay questions, and these will
be hand-graded. These will be in the same format as on Quiz 1, The Math Quiz.

Chapters 15, 16, and 17

1) What is critical thinking? What does it mean to think critically about something? See
page 193.
Critical thinking is a continuous process characterized by open-mindedness, continual
inquiry, and perseverance, combined with a willingness to look at each unique patient
situation and determine which identified assumptions are true and relevant. A critical
thinker considers what is important in each clinical situation, imagines and explores
alternatives, considers ethical principles and makes informed decisions about the care of
patients.

2) A nurse who practices critical thinking reminds one of a three-year-old child who wants
to know and understand the reason for everything. Their favorite word is why? Be
able to pick the why? out of a group of responses.
What are my options? What am I missing? What do I really know about this patients
situation?

3) Why is critical thinking important for the nurse? Look at page 192.
Clinical decision making separates professional nurses from technical personnel. Clinical
decision making is a judgment that includes critical and reflective thinking and action and
application of scientific and practical logic. A professional nurse observes for changes in
patients, recognizes potential problems, identifies new problems as they arise, and takes
immediate action when a patients clinical condition worsens.

4) A critically thinking nurse always gathers his/her own information, rather than only
relying on the observations of others. Know that critical thinking means that it is critical
that we think before we act.

5) What is meant by self-reflection? How does this apply to nursing care? Look at page
202.
Reflection is the process of purposefully thinking back or recalling a situation to discover
its purpose or meaning. It involves playing back a situation in your head and taking time to
honestly review everything you remember about it. Its a conscious process of thinking,
analyzing, and learning from your work situations by way of journaling or regularly meeting
with colleagues to explore work situations and self-evaluate.

6) What is a concept map? How does this differ from a geographic map? Look at page
202.
Concept map a visual representation of patient problems and interventions that shows
their relationships to one another. This map offers a nonlinear picture of a patient that can be
used for comprehensive care planning. Purpose is to better synthesize relevant data about a
patient, including health assessment data, nursing diagnosis, health needs, nursing interventions,
and evaluation measures.
The advantage of a concept map is its central focus on the patient rather than the
patients disease or health alteration. Also promotes patient participation with the eventual
plan of care.

7) What are the components of critical thinking in nursing? See Box 15-3 on page 199.
1. Specific knowledge base in nursing
2. Experience
3. Critical Thinking Competencies
- General critical thinking
o Scientific Method
Identifying the problem
Collecting data
Formulating a question or hypothesis
Testing the question and hypothesis
Evaluating results of the test or study
o Problem Solving
o Decision Making
- Specific critical thinking
o Diagnostic Reasoning and Inference
o Clinical Decision Making a problem-solving activity that focuses on
defining a problem and selecting an appropriate action.
Identify nursing diagnosis and collaborative problems of each
patient
Analyze diagnoses/problems and decide which are most urgent
on a basis of basic needs
Consider the time it will take to care for patients whose
problems are highest priority
Consider the resources you have to manage each problem,
nursing assistive personnel assigned with you
Consider how to involve the patients as decision makers and
participants in care
Decide how to combine activities to resolve more than one
patient problem at a time
Decide which, if any, nursing care procedures to delegate to
assistive personnel so you are able to spend your time on
activities requiring professional nursing knowledge
Discuss complex cases with other members of the health care
team to ensure a smooth transition in care requirements
- Specific critical thinking in nursing: nursing process
o Nursing process as a competency
4. Attitudes for critical thinking
- Confidence, Independence, Fairness, Responsibility, Risk taking, Discipline,
Perseverance, Creativity, Curiosity, Integrity, Humility
5. Standards for critical thinking
- Intellectual Standards
Clear - Could you elaborate further on that point?
Precise - Could you give more details?
Specific
Accurate - Is that really true?
Relevant - How is that connected to the question?
Plausible
Consistent
Logical - Does this really make sense?
Deep - How does your answer address the complexities in the question?
Broad - Do we need to consider another point of view?
Complete - means that we engage in deep and thorough thinking and
evaluation, avoiding shallow and superficial thought and criticism.
Significant - Which of these facts are most important? Is this the most
important problem to consider?
Adequate (for purpose)
Fair - Do I have a vested interest in this issue? Involves seeking to be
open-minded, impartial, and free of biases and preconceptions that distort
our thinking.
- Professional Standards
Ethical criteria for nursing judgment, criteria for evaluation, professional
responsibility.

8) What kinds of skills are used in critical thinking? Look at Box 15-1 on page 193.
Interpretation be orderly in data collection. Look for patterns to categorize data (e.g.
nursing diagnosis). Clarify any data you are uncertain about.
Analysis be open-minded as you look at information about a patient. Do not make
careless assumptions. Does the data reveal what you believe is true, or are there other options?
Inference look at the meaning and significance of findings. Are there relationships
between findings? Does the data about the patient help you see that a problem exists?
Evaluation Look at all situations objectively. Use criteria (e.g. expected outcomes,
pain characteristics, and learning objectives) to determine results of nursing actions. Reflect on
your own behavior.
Explanation Support your findings and conclusions. Use knowledge and experience to
choose strategies to use in the care of patients.
Self-Regulation Reflect on your own experiences. Identify the ways you can improve
your own performance. What will make you believe that you have been successful?

9) Okay, now that you have some idea of what is meant by critical thinking, this question
asks the student to apply this knowledge to a patient situation. This type of question will be
used for all exams in this course, this program, as well as state nursing license exams

10) This question asks how the nurse would respond using critical thinking in practice.
Know the difference between open-ended questions and closed-ended questions. See page
213.
Open-Ended Questions Used in a patient-centered interview, this type of question
does not presuppose a specific answer. It prompts patients to describe a situation in more than
one or two words. This technique leads to discussion in which patients actively describe their
health status. Strengthens your relationship with the patient because it shows you want to hear
the patients thoughts and feelings.
Closed-Ended Questions Problem-seeking interview technique. This approach takes
information provided in the patients story and more fully describes and identifies specific
problem areas. These questions limit the answer to one to two words, often yes or no.
Require short answers and clarify previous information or provide additional information.

11) There are certain attitudes that a person should develop if one is going to be a critical
thinker. These are listed in Table 15-3 on page 200.
Confidence learn how to introduce yourself to the patient. Speak with conviction when
you begin a treatment or procedure. Do not lead the patient to think that you are unable to
perform care safely. Always be well prepared before performing a nursing activity. Encourage a
patient to ask questions.
Thinking independently read the nursing literature, especially when there are different
views on the same subject. Talk with other nurses and share ideas about nursing interventions.
Fairness listen to both sides of any discussion.
Responsibility and Authority ask for help if you are uncertain about how to perform a
nursing skill. Refer to a policy and procedure manual to review steps of a skill. Report any
problems immediately. Follow standards of practice in your care.
Risk Taking If you knowledge causes you to question a health care providers order,
do so. Be willing to recommend alternative approaches to nursing care when colleagues are
having little success with patients.
Discipline Be thorough in whatever you do. Use known scientific and practice-based
criteria for activities such as assessment and evaluation. Take time to be thorough and manage
your time effectively.
Perseverance Be cautious of an easy answer. If co-workers give you information about
a patient and some fact seems to be missing, clarify the information or talk to the patient directly.
If problems of the same type continue to occur on a nursing division, bring co-workers together,
look for a pattern, and find a solution.
Creativity Look for different approaches if interventions are not working for a patient.
Curiosity Always ask why. A clinical sign or symptom often indicates a variety of
problems. Explore and learn more about the patient so as to make appropriate clinical judgments.
Integrity Recognize when your opinions conflict with those of a patient; review your
position, and decide how best to proceed to reach outcomes that will satisfy everyone. Do not
compromise nursing standards or honesty in delivering nursing care.
Humility Recognize when you need more information to make a decision. When you
are new to a clinical division, ask for an orientation to the area. Ask registered nurses regularly
assigned to the area for assistance with approaches to care.

12) Why is it a good idea to have professional standards for nursing care? See page 201.
Professional standards for critical thinking refer to ethical criteria for nursing judgments,
evidence-based criteria used for evaluation, and criteria for professional responsibility.
Application of professional standards requires you to use critical thinking for the good of
individuals or groups. Professional Standards promote the highest level of quality nursing care.

13) You will read about national and state nursing scopes of practice. You must also know
that each hospital or clinic or place where you choose to practice will have policies and
procedures that will guide safe nursing practices. What do you suppose are the legal
consequences of a nurse not following these practice guidelines?

14) What is the difference between a complete nursing assessment, and a problem-focused
patient assessment? Look at Table 16.1 on page 209.
Problem-focused Patient Assessment focuses on the patients presenting situation and
begin with problematic areas. Ask the patient follow-up questions to clarify and expand your
assessment so you can understand the full nature of the problem.
Complete Nursing Assessment covers the 11 functional health patterns. Once assessed,
these will identify patient strengths and nursing diagnosis that help you develop a nursing care
plan.

15) What is the difference between subjective data, and objective data? Be able to provide
examples of each. Read page 210.
Subjective patients verbal descriptions of their health problems; usually includes
feelings, perceptions, and self-report of symptoms
Objective observations or measurements of a patients health status; includes inspection
findings, observed behavior, measurements

16) The nurse gathers information from many sources when building a nursing patient
data base. Be able to recognize one of them in a list. Read p. 214-217.
Nurses obtain data from a variety of sources that provide information about the patients
current level of wellness and functional status, anticipated prognosis, risk factors, health
practices and goals, responses to previous treatments and patterns of health and illness.
Patient: best source of information
Family and Significant Others: primary sources for infants or children, critically ill adults
and patients who are mentally handicapped, disoriented, or unconscious.
Health Care Team: Change-of-shift reports, communicate regularly with other members
of team in gathering patient information
Medical Records: source for patients medical history, laboratory and diagnostic test
results, current physical findings, and the primary health care providers treatment plan
Other Records and Scientific Literature: educational, military, and employment records
sometimes contain significant healthcare information (immunizations)
Nurses Experience: a nurses expertise develops after testing and refining inferences,
questions, and principle- or standard-based expectations

17) What kinds of information go into a nursing health history? Read page 214.
Biographical Information factual demographic data about the patient (age, address,
occupation, marital status)
Reason for Seeking Health Care information you gather when you initially set an
agenda during the patient-centered interview Learn chief concerns or problems, compare with
chief complaint.
Patient Expectations assess the patients understanding of why they are seeking health
care (patient expectations)
Present Illness or Health Concerns collect essential and relevant data about symptoms
and their effects on the patients health
- Concomitant symptoms: does the patient experience other symptoms along
with the primary symptoms?
Health History patients health care experiences and current health habits
Family History obtains data about immediate and blood relatives
Personal and Social History:
Environmental History patients home and working environments
Psychosocial History patients support system, which often includes spouse,
children, other family members, and close friends
Spiritual Health patients beliefs, source of guidance in acting on beliefs
Review of Systems systematic approach for collecting the patients self-reported data
on all body systems

18) Nurses (and others working with the public) should keep in mind that their patients
may belong to cultures that are different than the nurse, and that a persons culture may
have a profound impact upon how they view illness, health, and healthcare. Therefore,
when taking a patients history, keep cultural influences in mind. Read page 214.
Conduct all assessments with cultural competence. Nurses need to consider a patients
cultural background. When differences exist, respect the unfamiliar and be sensitive to patients
uniqueness. Avoid making stereotypes. Instead draw on knowledge from your assessment and
ask questions in a constructive and probing way to allow you to truly know who the patient is.

19) Again, when gathering patient data, the nurse uses open-ended questions to get the
patient to explain what is happening. See Box 16-3 on page 213 for examples of open-ended
questions.
Open-Ended Questions Used in a patient-centered interview, this type of question
does not presuppose a specific answer. It prompts patients to describe a situation in more than
one or two words. This technique leads to discussion in which patients actively describe their
health status. Strengthens your relationship with the patient because it shows you want to hear
the patients thoughts and feelings.

20) Patients have the right to choose where they receive health care, and which
recommendations they will or will not follow. In order for the nurse to gain the
cooperation of the patient, the nurse needs to involve the patient in the planning of their
care. It is essential that nurses (and others) practice patient-centered care. See page 214.
Patient-Centered Care: concept to improve work efficiency by changing the way that
patient care is delivered. Get the patients whole story. A good interviewer leaves with a
complete story that contains enough details for understanding a patients perceptions of his or her
health status and the information needed to help identify nursing diagnosis and/or collaborative
health problems. Always clarify or validate any information about which you are unclear.

21) Part of critical thinking is the ability to connect the dots as it were, amongst
seemingly random bits of information. See Box 16-4 on page 217.
Recognizing data clusters: interpret how data form patterns or trends.
Interpretation: assessment involves the continuous interpretation of information. You
determine the presence of abnormal findings, recognize that further observations are needed to
clarify information, and begin to identify the patients health problems. As you form a database,
you begin to see patterns of data that direct you to collect more information and clarify what you
have. The patterns of data reveal meaningful and usable clusters. A data cluster is a set of signs
or symptoms that you group together in a logical way. The clusters begin to clearly identify the
patients health problems.

22) Many people are allergic to certain substances, including medications, pollen, dust,
molds, etc. An important part of the nursing health history is to determine allergies or
sensitivities, and details about the reactions exposure to these substances cause for the
patient. While not specifically mentioned, allergies belong with the functional health
patterns described in Box 16-1 on page 209.
Typology of 11 Functional Health Patterns
- Health perception-health management pattern: describes patients self-report
of health and well-being; how the patient manages health
- Nutritional-metabolic pattern: describes patients daily/weekly pattern of food
and fluid intake; actual weight; weight loss/gain
- Elimination pattern: describes patterns of excretory function (bowel, bladder,
and skin)
- Activity-exercise pattern: describes patterns of exercise, activity, leisure, and
recreation. Ability to perform ADLs
- Sleep-rest pattern: describes patterns of sleep, rest, and relaxation
- Cognitive-perceptual pattern: describes sensory-perceptual patterns; language
adequacy, memory, decision-making ability
- Self-perception-self-concept pattern: describes patients self-concept pattern
and perceptions of self (body image, self-worth)
- Role-relationship pattern: describes patients patterns of role engagements and
relationships.
- Sexuality-reproductive pattern: describes patients patterns of satisfaction and
dissatisfaction with sexuality pattern; patients reproductive patterns
- Coping-stress tolerance pattern: describes patients ability to manage stress,
sources of support
- Value-belief pattern: describes patterns of values, beliefs (including spiritual
practices), and goals that guide patients choices/decisions

23) There are times when the nurse will ask the patient something, and what they answer
is not consistent with what behavior the patient is displaying; like saying they are not in
pain when they are holding their stomach and rocking back and forthwhats up with
that? This is critical thinking.

24) Just as it is important for the nurse to keep a persons culture in mind, the nurse
should also keep the patients age and developmental level in mind when taking a nursing
health history. Again, read page 211 through 216, there is some really important stuff in
there.

25) This question is quite similar to the one just above it. Look at page 207 and the section
called Data Collection. Notice that the patient is listed first.

26) What is the fundamental difference between the medical and the nursing approaches
to health and illness? See page 222.
The nursing diagnostic process is unique due to including patients, and having them be
involved when possible in this process.

27) What is the difference between a medical diagnosis and a nursing diagnosis? See page
222.
It may also prove helpful to you to start looking through your care plan books, and seeing
how nursing diagnoses are phrased, as well as planned interventions, and evaluations. You
might also keep in mind that the drug book for this course lists nursing diagnoses, too.
Medical Diagnosis: the identification of a disease condition based on a specific
evaluation of physical signs, symptoms, the patients medical history and the results of
diagnostic tests and procedures. Physicians are licensed to treat diseases and conditions
described in medical diagnosis statements.
Nursing Diagnosis: a clinical judgment about individual, family, or community
responses to actual and potential health problems or life processes that the nurse is licensed and
competent to treat.

28) This question gives the student practice at writing a nursing diagnosis. I cannot tell
you more than that.

29) There are three major parts of a nursing diagnosis; a diagnostic statement; like acute
pain, stated as being related to an etiology or cause for this acute pain phrased as a
condition a nurse can treat not a medical diagnosis, like a fracture, or laceration, or
pneumonia, followed by supportive information that is measurable and verifiable; like
abdominal distention or urine output less than 30 mL/hour for two hours. So the formula
looks like this: Nursing diagnosis, related to a condition a nurse can treat, as evidenced by a
measurable finding. Clear as mud? Read Chapter 17. Please, call me or email me if I can
clear this up.

30) This question asks you to practice writing a nursing diagnosis. You might find it
helpful to look at Box 17-2 on pages 225-226 for examples.

At this point in your reading, you should have run across the nursing process, Assessment,
(Nursing) Diagnosis, Planning, Intervention, and Evaluation, or (ADPIE). This concept is
something that will continue to be in your toolbox and on your table of contents for your
nursing career. Understand how each step of the nursing process drives the next step, and
that the steps are cyclical, rather than linear.
Assessment: identify a patients health care needs by collecting thorough information
Diagnosis: clearly defining all nursing diagnosis or collaborative problems
Planning: Plan care by determining priorities, setting goals and expected outcomes of
care, and collaborating with family and health care team members
Implementation: deliver nursing interventions competently
Evaluation: evaluate the effects of your care

Also, at this point, you should be practicing writing nursing diagnostic statements as, as
you can see from the above, diagnosis drives planning of interventions, and how
evaluations of outcomes are going to be written. These are hugely important concepts to
this course and this program, so any extra time you have for studying could be wisely spent
here; )

31) If the nurse has accomplished one or more steps of the nursing process, the student
should be able to tell what the next step is. See Chapters 16, 17, 18, 19, and 20.

32) You should be able to recognize a step of the nursing process by how it is described.
What do you suppose can happen to the patient if one or more steps of the nursing process
are omitted?
Assessment: identify a patients health care needs by collecting thorough information
Diagnosis: clearly defining all nursing diagnosis or collaborative problems
Planning: Plan care by determining priorities, setting goals and expected outcomes of
care, and collaborating with family and health care team members
Implementation: deliver nursing interventions competently
Evaluation: evaluate the effects of your care

33) Recall that a nursing diagnostic statement contains the elements of a nursing diagnosis
label, related to an etiology or cause for this label that a nurse can treat, as evidenced by a
defining characteristic or supportive element, which is measurable and verifiable (objective
or subjective). Look at page 226.

34) After you understand my suggestions for question 33, you should be better able to
answer question 34. Be able to differentiate between a diagnostic label, an etiology or
cause, and a defining characteristic or supportive statement.

35) Again, be able to differentiate between a defining characteristic and an etiology or
cause for the diagnostic label. Be sure to check out the section of Chapter 17, sources of
diagnostic errors, on pages 231 to 233.

36) If you are provided two parts of a nursing diagnostic statement, you should be able to
supply the third part, based on the description provided in the exam question. Again, if
you have trouble understanding any part of this course, please call me or email me.

37) Again, you should be able to tell what step of the nursing process comes next no matter
where you are at in the process. See question 31.

By now you should be using critical thinking to recognize that the amount of time we are
spending on both critical thinking and the nursing process means that these are important
concepts; ). Critical thinking and the nursing process, and nursing diagnostic statements
are all major parts of a patient plan of care, which you will be building as part of your
clinical experience.

38) A very important part of critical thinking is also hard to describe. Critical thinking is
the ability to recognize what you already know, and differentiate that from what you do not
know, and then patient safety demands that you make a commitment that you will find out
what you do not know. I have heard nurses who have been in practice for as long as 20
years asking someone else does this look right to you?

39) By now you should be able to select a nursing diagnostic label given a scenario wherein
several symptoms are listed.

40) Similar to the question above, if you are trying to establish a nursing diagnosis as a
hypothesis, you need to know what information you need to support or rule out that
diagnosis. Given a scenario, be able to know what question to ask the patient next.

41) This question is a different scenario than the previous question, but the concept is the
same.

42) This is a question that has you select all that apply. I cannot get more specific than
that.

43) Questions 43 through 50 are math and dosage calculation questions.

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