Chapter 015

Potter & Perry: Fundamentals of Nursing, 7th Edition
Test Bank
Chapter 15: Critical Thinking in Nursing Practice
MULTIPLE CHOICE
1. Which of the following best reflects the philosophy of critical thinking as taught by a
nurse educator to a nursing student?
1. Think about several interventions that you could use with this client.
2. Dont draw subjective inferences about your clientbe more objective.
3. Please think harderthere is a single solution for which I am looking.
4. Trust your feelingsdont be concerned about trying to find a rationale to support
your decision.
ANS: 1
The nurse educator is asking the student to synthesize critical thinking skills by
encouraging the student to examine alternatives to meet the clients unique needs within
the context of the nursing process. Drawing inferences is a specific critical thinking
competency used in diagnostic reasoning. The educator who tells the student not to draw
inferences is not allowing the student to practice competencies necessary for specific
critical thinking in clinical situations. The critical thinker will look beyond a single
solution to a problem. Intuition develops as ones clinical experience increases. The
nursing student should examine
rationales in order to make good decisions.
DIF: C
REF: 216
OBJ: Analysis
TOP: Nursing Process: Assessment
MSC: NCLEX test plan designation: Safe, Effective Care Environment
2. The second component of critical thinking in the critical thinking model is:
1. Experience
2. Competencies
3. Specific knowledge
4. Diagnostic reasoning
ANS: 1
Experience is the second component of critical thinking in the critical thinking model.
The third component of the critical thinking model is competencies. Specific
knowledge base is the first component of the critical thinking model. Diagnostic
reasoning is a specific critical thinking competency in clinical situations.
DIF: A
REF: 222
OBJ: Knowledge
Mosby items and derived items 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Test Bank
15-2
3. The nurse enters the room of a client who has a history of heart disease. On looking at the
client, the nurse feels that something is not right with the client and proceeds to take
the vital signs. This is the nurse acting on:
1. Intuition
2. Reflection
3. Knowledge
4. Scientific methodology
ANS: 1
Intuition is an inner sensing that something is so, as in this example. Reflection is the
process of purposefully thinking back or recalling a situation to discover its purpose or
meaning. Knowledge of the nurse includes information and theory from the basic
sciences, humanities, behavioral sciences, and nursing. Scientific methodology is an
approach to seeking the truth or verifying that a set of facts agrees with reality.
DIF: A
OBJ: Comprehension
4. The nurse manager has developed a staff protocol for peer evaluation. The nurses on her
surgical unit are nervous about using her instrument. If the nurse manager continues to
implement the new strategy, which of the following critical thinking attitudes is she
portraying?
1. Humility
2. Risk-taking
3. Accountability
4. Independent thinking
ANS: 2
This is an example of the critical thinking attitude of risk-taking. A critical thinker is
willing to take risks in trying different approaches to solving problems. Humility is a
critical thinking attitude in which a person admits what they do not know and tries to
acquire the knowledge needed to make proper decisions. To be accountable means to be
answerable for the outcomes of your actions. To think independently, one questions
others ways of interpreting knowledge and looks for rational and logical answers to
problems.
DIF: A
REF: 224
OBJ: Comprehension
TOP: Nursing Process: Planning
5. The nurse is working with a client who has recently had a colostomy and is having
difficulty using the provided supplies. The nurse works with the client to see which
alternative supplies are easier for the client to use. This is an example of the critical
thinking strategy of:
1. Inference
2. Management
Test Bank
15-3
3. Problem-solving
4. Diagnostic reasoning
ANS: 3
This is an example of the critical thinking strategy of problem-solving. The nurse gathers
information from the client and combines that information with what the nurse already
knows about ostomy care to find a solution. Effective problem-solving involves the
examination of alternatives. Inference is the process of drawing conclusions.
Management is not a critical thinking strategy. Diagnostic reasoning is a process of
determining a clients health status after the nurse assigns meaning to the behaviors,
physical signs, and symptoms presented by the client.
DIF: A
REF: 219
OBJ: Comprehension
TOP: Nursing Process: Assessment/Implementation
6. Which of the following is an example of a nurses statement that reflects using the
scientific method in the nursing process?
1. I believe that this client is getting depressed.
2. The client doesnt look right to me; I think something is wrong.
3. The clients husband told me that she is feeling very uncomfortable.
4. The client reports more pain than yesterday and her blood pressure is elevated.
ANS: 4
Reporting more pain than yesterday and elevated blood pressure reflects using the
scientific method in the nursing process. The nurse identified a problem of pain,
hypothesized that it was greater than the day before, and collected data to evaluate its
reality. Believing the client is depressed or thinking something is wrong reflect intuition.
Speaking with the husband reflects information gathering, which may be used in
diagnostic reasoning.
DIF: A
REF: 218
OBJ: Comprehension
7. The nurse decides to administer tablets of Tylenol instead of the intramuscular Demerol
she has previously been providing her orthopedic client. Which step of the nursing
process does this address?
1. Assessment
2. Nursing diagnosis
3. Planning
4. Implementation
ANS: 4
Test Bank
15-4
Taking appropriate action demonstrates the implementation step of the nursing process.
Assessment involves the gathering of data. When formulating a nursing diagnosis, the
nurse critically examines and analyzes the data, and identifies the clients response to a
problem. The nurse may then determine priorities. Planning involves establishing goals
and expected outcomes of care.
DIF: A
REF: 221
OBJ: Comprehension
TOP: Nursing Process: Implementation
8. The nurse has a multiple client assignment on the surgical unit. On beginning the shift,
the nurse needs to determine which postoperative client should be seen first. Of the
following, the nurse should go to see the client who:
1. Has a documented blood pressure of 90/50
2. Was medicated for back pain 10 minutes ago
3. Has an order to be out of bed and ambulated
4. Requires instructions for wound care before discharge
ANS: 1
The nurse prioritizes actions and determines to see this client first because of a lower than
normal blood pressure for a postoperative patient. This nurse is using scientifically and
practice-based criteria for making clinical judgment. This is an example of following
standards. The nurse uses criteria such as the clinical condition of the client, Maslows
hierarchy of needs, and risks involved in treatment delays to determine which clients
have the greatest priority for care.
In answers 2 through 4, the client is not reported to be having any problems and therefore
is not the priority.
DIF: C
REF: 221
OBJ: Analysis
MSC: NCLEX test plan designation: Safe, Effective Care
Environment/Coordination/Setting Priorities
9. There are a variety of levels of critical thinking. An example of critical thinking at the
complex level is:
1. Giving medication at the time ordered
2. Following a procedure for catheterization step-by-step
3. Reviewing all clients medical records thoroughly
4. Discussing various alternative pain management techniques
ANS: 4
Discussing alternative pain management techniques is an example of critical thinking at
the complex level. The nurse analyzes and examines alternatives more independently.
Giving medication at the time ordered is an example of the basic level of critical thinking.
Following a procedure step-by-step is an example of the basic level of critical thinking.
Reviewing the clients medical records thoroughly is an example of gathering data and
may be used in evaluation of a clients care.
Test Bank
15-5
DIF: C
REF: 218
OBJ: Analysis
10. The nurse is deciding on the type of dressing to use for a client. Which step of the
decision-making process is being used when the nurse observes the absorbency of
different dressing brands?
1. Defining the problem
2. Making final decisions
3. Testing possible options
4. Considering consequences
ANS: 3
The nurse who observes the absorbency of different brands of dressing is demonstrating
testing of possible options. This is not an example of defining the problem. The nurse has
not yet made a final decision. The nurse is not examining pros and cons, and therefore is
not considering consequences.
DIF: A
REF: 219
OBJ: Comprehension
11. Which one of the following examples demonstrates the critical thinking attitude of
responsibility and authority?
1. Reporting client difficulties
2. Offering an alternative approach
3. Looking for a different treatment option
4. Sharing ideas about nursing interventions
ANS: 1
Reporting client difficulties demonstrates the critical thinking attitude of responsibility
and authority. Asking for help if uncertain and following standards of practice also
demonstrate the critical thinking attitudes of responsibility and authority. Offering an
alternative approach would demonstrate the critical thinking attitude of risk-taking.
Looking for a different treatment option demonstrates the critical thinking attitude of
creativity. Sharing ideas about nursing interventions demonstrates the critical thinking
attitude of thinking independently.
DIF: A
REF: 223
OBJ: Comprehension
12. Use of the intellectual standard of critical thinking implies that the nurse:
1. Questions the physicians order
2. Recognizes conflicts of interest
3. Listens to both sides of the story
Test Bank
15-6
4. Approaches assessment logically

ANS: 4
Use of the intellectual standard of critical thinking implies that the nurse approaches
assessment logically and consistently. Questioning the physicians order is an example of
the critical thinking attitude of risk-taking. Recognizing conflicts of interest demonstrates
the critical thinking attitude of integrity. Listening to both sides of the story demonstrates
the critical thinking attitude of fairness.
DIF: A
REF: 225
OBJ: Comprehension
13. A client requires urinary catheterization but has difficulty keeping her legs in the usual
position needed for this procedure. The nurse has worked for many years and adapts the
procedure to allow the client to lie on her side. This action is based on the critical
thinking element of:
1. Curiosity
2. Experience
3. Perseverance
4. Scientific knowledge
ANS: 2
Having worked for many years and being able to adapt a procedure to meet the clients
needs is an example of the second component of the critical thinking modelexperience.
Curiosity is a critical thinking attitude where the nurse asks why, and continues to learn
more about the client to make appropriate clinical judgments. Perseverance is a critical
thinking attitude where the nurse does not readily accept the easy answer but does look
further to find necessary information and appropriate solutions. Scientific knowledge is
knowledge acquired from the study of science. It may be acquired through education,
such as coursework, or by reading nursing literature to remain current in nursing science.
DIF: A
REF: 222
OBJ: Comprehension
14. Which of the following statements made by a nursing student concerning the use of
critical thinking and client care requires follow-up by the nursing instructor?
1. I feel its good practice to always have alternative interventions in mind.
2. I trust my feelings about a clients needs since I work hard at knowing my client.
3. I always try to keep an open mind about what interventions my client will
require.
4. I will wait until my assessment is completed before determining the clients
needs.
ANS: 2
Test Bank
15-7
Intuition develops as ones clinical experience increases. The nursing instructor should
instruct the student to examine rationales in order to make good decisions regarding
client needs. The instructor would encourage the student to examine alternatives to meet
the clients unique needs, so this statement would not require follow-up. Basing client
care on identified client needs is the appropriate use of critical thinking, and so would not
require follow-up. Basing client care on client needs identified by thorough nursing
assessments is the appropriate use of critical thinking, and so would not require followup.
DIF: C
OBJ: Analysis
15. Which of the following is the best example of a nurses use of reflection?
1. The nurse places a client experiencing respiratory difficulties in a high-Fowlers
position.
2. The nurse calls the provider when a client reports feeling chilled and achy while
having an oral temperature of 100.2 F.
3. While caring for a client with a history of asthma, the nurse assesses the clients
pulse oximetry reading when he doesnt sound right.
4. A nurse tells a client; When you refused to go to physical therapy earlier today I
believe you were upset about something else besides the appointment time.
ANS: 4
Reflection is the process of purposefully thinking back or recalling a situation to discover
its purpose or meaning. Knowledge of the nurse includes information and theory from the
basic sciences, humanities, behavioral sciences, and nursing. Scientific methodology is an
approach to seeking the truth or verifying that a set of facts agrees with reality. Intuition
is an inner sensing that something is so, as in this example.
DIF: C
REF: 226
OBJ: Analysis
16. Which of the following nursing situations best reflects accountability?
1. The nurse takes the oncology nursing certification examination.
2. The nurse files an incident report regarding a medication error.
3. The nurse assesses the client for the possible cause of his pain.
4. The nurse tells the client, I dont know but I will find out for you.
ANS: 2
To be accountable means to be answerable for the outcomes of your actions. Answer 2 is
an example of the critical thinking attitude of risk-taking. A critical thinker is willing to
take risks in trying different approaches to solving problems. To think independently, one
questions others ways of interpreting knowledge and looks for rational and logical
answers to problems. Humility is a critical thinking attitude where a person admits what
they do not know and tries to acquire the knowledge needed to make proper decisions.
Test Bank
15-8
DIF: C
REF: 224
OBJ: Analysis
17. Which of the following nursing actions is the best example of problem solving?
1. Requesting the IV team to start an antibiotic drip on a client with a history of being
a difficult stick
2. Offering to call the kitchen to provide an alternate breakfast for a client who does
not like cooked cereal
3. Trying several difficult wound dressings to determine which one the client can
apply the most effectively
4. Calling for another pain medication order when the current drug results in the client
experiencing nausea
ANS: 3
This is an example of the critical thinking strategy of problem solving. The nurse gathers
information by using several different products and then uses this information to
determine which will work best for the client. Effective problem solving involves the
examination of alternatives. While requesting the IV team solves a problem, there is little
critical thinking needed because it would be understood that the IV team would be called
under these circumstances. Although calling the kitchen solves a problem, there is little
critical thinking needed because it would be understood that the kitchen would be called
under these circumstances. Calling for another pain medication order solves a problem,
but there is little critical thinking needed because it would be understood that the provider
would be called for a new drug order under these circumstances.
DIF: C
REF: 219
OBJ: Analysis
TOP: Nursing Process: Assessment/Implementation
18. Which of the following clients should be prioritized with the most urgent need for a
nursing assessment?
1. A new admission admitted for swelling in the right ankle and knee
2. A second day postoperative client who received pain medication 30 minutes ago
3. A client who the nursing assistant found crying in the bathroom
4. A client ready for discharge who requires a final assessment and documentation
ANS: 3
This client has an acute need that requires the nurses attention. The facility has a policy
regarding the amount of time available in which to complete such an assessment and this
client is in no acute distress, so the assessment does not have priority. While a pain
assessment is required to evaluate the effectiveness of pain medication, it does not the
have the priority of the other presented options. This client has no acute problems and so
the assessment does not have the priority of some of the other options.
DIF: C
REF: 221
OBJ: Analysis
Test Bank
15-9

19. Which of the following nursing interventions is the best example of the implementation
step of the nursing process?
1. Determining that the clients ankle edema is worse after he ambulates
2. Asking the client to rate his ankle pain after receiving oral pain medication
3. Arranging for the client to receive pain medication 30 minutes before his ordered
ambulation
4. Crushing the clients pain medication to facilitate easier swallowing and thus
minimize the risk of choking
ANS: 4
Taking appropriate action demonstrates the implementation step of the nursing process.
Assessment involves the gathering of data. Assessment involves the gathering of data.
Planning involves establishing goals and expected outcomes of care.
DIF: C
REF: 221
OBJ: Analysis
20. Which of the following nursing actions best reflects the consequence stage of the
decision-making process?
1. Being physically present when a client is given the results of a tissue biopsy
2. Witnessing the client sign consent for surgery forms before cardiac surgery
3. The client is informed of the various treatments available for his condition.
4. The nurse explains to the client the risks of leaving the hospital against medical
advice.
ANS: 4
The nurse is presenting the possible outcomes, and therefore is presenting consequences.
Being physically present is not an example of defining the problem. Witnessing the client
sign consent is an example of a final decision. In Answer 3 the client is being given
various options.
DIF: C
REF: 219
OBJ: Analysis
21. The concept of nursing responsibility is best reflected in which of the following nursing
actions?
1. Providing accurate and timely documentation regarding an incident resulting in a
client fall
2. Suggesting that a client might prefer taking a particular medication at bedtime
instead of in the morning
3. Posting a note on the unit Kardex how to best apply a dressing to a skin wound on a
particular client
4. Referring to the institutions policy manual when unsure of how to handle a clients
Test Bank
15-10
complaint regarding a social services consult

ANS: 4
Asking for help if uncertain and following standards of practice best demonstrate the
critical thinking attitudes of responsibility because failure to do so could result in client
injury. Reporting client difficulties demonstrates the critical thinking attitude of
responsibility but is not the best option of those available because it would not result in
client injury/harm. Offering an alternative approach would best demonstrate the critical
thinking attitude of risk-taking. Sharing ideas about nursing interventions best
demonstrates the critical thinking attitude of thinking independently.
DIF: C
REF: 224
OBJ: Analysis
22. Which of the following situations is the best example of a nurse using intellectual
standards as a critical thinking tool?
1. Performing a head-to-toe assessment on a new admission
2. Placing a client experiencing shortness of breath on oxygen
3. Arbitrating a complaint between roommates over the television
4. Notifying a provider of a clients allergy to an ordered medication
ANS: 2
Use of the intellectual standard of critical thinking implies that the nurse approaches
nursing care logically, consistently, and appropriately. This option reflects the use of such
standards in a situation that addresses client distress. While performing a head-to-toe
assessment is an example of intellectual standards, it is not the best example because it
does not involve a clients immediate distress. Listening to both sides of the story
demonstrates the critical thinking attitude of fairness. Notifying a provider of a clients
allergy is an example of nursing responsibility.
DIF: C
REF: 225
OBJ: Analysis
23. The nurse is best demonstrating perseverance by:
1. Having a perfect attendance record
2. Completing a lengthy course on current chemotherapies
3. Repeatedly irrigating the nasogastric tube until it is patent
4. Sitting with a client until she is ready to discuss why she is crying
ANS: 4
Test Bank
15-11
Perseverance is a critical thinking attitude in which the nurse does not readily accept the
easy answer but does look further to find necessary information and appropriate
solutions. While perfect attendance shows a nurses willingness to complete the work
responsibilities regardless of barriers, it is a better representation of responsibility. While
completing a course on current chemotherapies shows the nurses willingness to pursue
knowledge, it is more representative of the acquiring of scientific knowledge to remain
current in nursing science. While repeatedly irrigating the nasogastric tube shows a
willingness to repeat a procedure as often as is appropriate, it is a better representation of
possessing knowledge of the procedure.
DIF: C
REF: 224
OBJ: Analysis
24. With regards to client care, the most likely reason that a veteran nurse tends to be a more
skillful critical thinker than a new graduate nurse is because:
1. The veteran nurse has a varied history of client care experiences
2. Critical thinking improves with experience, longevity, and interest
3. Todays short hospital stays minimize the opportunity to develop critical thinking
skills
4. New graduates often lack the self-confidence to take the risks often required of
critical decision making
ANS: 2
Critical thinking is not a simple step-by-step, linear process that you learn overnight. It is
a process acquired only through experience, commitment, and an active curiosity toward
learning. While experience is a factor in the development of critical thinking skills, it is
not the only factor. While having extended periods of time with clients has a positive
effect on the development of critical thinking, it is not the primary or sole factor. While
lack of self-confidence may have a negative effect on the development of critical thinking
skills, it is not the primary or sole factor.
DIF: C
REF: 216
OBJ: Analysis
25. The primary factor that distinguishes a professional nurses care from care provided by
ancillary nursing staff is:
1. Critical thinking
2. Years of education
3. Professional licensure
4. Complexity of the task
ANS: 1
Test Bank
15-12
Clinical decision making separates professional nurses from technical personnel. While
advanced education is a distinction, the primary factor regarding client care is the
professional nurse is responsible for actions that require critical thinking decision
making. Although licensure is a distinction, the primary factor regarding client care is the
professional nurse is responsible for actions that require critical thinking decision
making. 4. While complexity is a distinction, the primary factor regarding client care is
that the professional nurse is responsible for actions that require critical thinking decision
making.
DIF: C
REF: 216
OBJ: Analysis
26. A clinical nursing instructor asks the nursing students to describe a critical thinker. Which
of the following represents the best response?
1. A person with the educational background to solve problems.
2. A person who finds the problem and does what is best to fix it.
3. Its someone who uses the scientific method to solve problems.
4. Someone who uses a system to work through and solve a problem.
ANS: 2
A critical thinker considers what is important in a situation, imagines and explores
alternatives, considers ethical principles, and then makes informed decisions. Educational
background may have an impact on critical thinking but it is not the primary or sole
factor to consider. Although the scientific method is often used in critical thinking it is
neither the only method nor the sole factor to consider. While an orderly method is used
in critical thinking, it is not the only factor to consider.
DIF: C
REF: 216
OBJ: Analysis
27. Which of the following statements made by a new graduate nurse regarding a clients
care needs requires follow-up by the mentor?
1. No one really enjoys being hospitalized.
2. Every client is offered a back rub at bedtime.
3. All post surgery clients are reluctant to ambulate.
4. I always spend extra time with new clients to help them relax.
ANS: 3
Because no two clients respond exactly alike to similar health problems, you always have
to observe each client closely in order to make critically sound decisions regarding that
clients needs. Answer 1 does not require follow-up because even if it is not true, it does
not have an impact on the nurses perception of the clients care needs. Answer 2 does not
require follow-up because it is a nursing action that should be offered to all clients at
bedtime.
Test Bank
15-13
Answer 4 does not require follow-up because it is a nursing action that should be offered
to all clients.
DIF: C
REF: 216
OBJ: Analysis
28. A nurse is caring for an immobile client with a large pressure ulcer on her left ankle.
Which of the following statements by the nurse best reflects critical thinking regarding
client care?
1. Im sure that friction and pressure have caused this problem.
2. Please be sure that her ankles are well padded when you place her in bed.
3. Do you have any suggestions on how we can minimize the pressure to her
ankles?
4. It was an ineffective turning schedule that allowed this to happen so now we will
reposition every hour.
ANS: 3
Nurses who apply critical thinking in their work focus on options for solving problems
and making decisions, rather than quickly and carelessly forming quick solutions. Asking
for staff input regarding interventions shows critical thinking. While Answer 1 may be
true, it is knowledge or experience, not critical thinking, that brought about this
conclusion. Although Answer 2 may represent an appropriate intervention, it is
knowledge or experience, not critical thinking, that brought about this conclusion. While
Answer 4 may be true and an example of an appropriate intervention, it is knowledge or
experience, not critical thinking, that brought about this conclusion.
DIF: C
REF: 217
OBJ: Analysis
29. A nurse is caring for a 35-year-old client who is 12 hours post mastectomy. The care
assistant reports that the client is crying. Which of the following responses by the nurse
best reflects the use of analysis regarding this clients care needs?
1. That surgery is painful. Ill get her pain medication ready.
2. She was sleeping when I checked 15 minutes ago. Ill go back in right now.
3. Ill be responsible for her PM care so I can spend some uninterrupted time with
her.
4. A mastectomy is a blow to a womans self image. Ill notify her provider that she
is depressed.
ANS: 2
Test Bank
15-14
Analysis requires being opened-minded as you look at information about a client. Do not
make careless assumptions. Do the data reveal what you believe is true, or are there other
options? Although pain may be the cause of this clients tears, there are other possible
reasons, so making an assumption is not appropriate. Although Answer 3 shows the
nurses intention to analyze the clients needs, the delay is not appropriate. While the
client may be experiencing some depression, there are other possible reasons for the tears
and so the nurse should not assume.
DIF: C
REF: 217
OBJ: Analysis
30. Which of the following statements made by a nurse regarding personal reflection related
to client care requires follow-up by the units nurse manager?
1. Mary and I were comparing foot wound dressing techniques.
2. Ive been caring for orthopedic clients for 10 years and I think Ive seen it all.
3. I cant believe that my client isnt improving after 2 weeks of physical therapy.
4. I always wean my orthopedic surgery clients onto oral pain medication on
postoperative day 4.
ANS: 4
Reflect on your experiences. Identify the ways you can improve your own performance.
This option presents a rigid attitude concerning client pain needs. Answer 1 needs followup because it shows a willingness to explore others opinions. Answer 2 requires no
follow-up because it does not reflect an inflexible attitude toward client care need.
Answer 3 requires no follow-up because it does not reflect an inflexible attitude toward
client care needs.
DIF: C
REF: 217
OBJ: Analysis
MULTIPLE RESPONSE
1. The scope of a clients health problem is a result of which of the following factors?
(Select all that apply.)
1. Religious beliefs
2. Life experiences
3. Lifestyle choices
4. Work environment
5. Family relationships
6. Educational background
ANS: 2, 3, 4, 5
Each clients problems are unique and a product of many factors, including the clients
physical health, lifestyle, culture, relationship with family and friends, living
environment, and experiences.
Test Bank
DIF: C
REF: 216
OBJ: Analysis
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Potter & Perry: Fundamentals of Nursing, 7th Edition

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complaint regarding a social services consult

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