Critical Thinking
. A nurse is caring for a client who is 24 hr postoperative following an inguinal hernia repair. The client is tolerating clear liquids well, has active bowel sounds, and is expressing a desire for “real food.” The nurse tells the client, “I will call the surgeon and ask for a change in diet.” The surgeon hears the nurse’s report and prescribes a full liquid diet. The nurse used which of the following levels of critical thinking?
A. Basic
B. Commitment
C. Complex
D. Integrity
A. CORRECT: At the basic level, thinking is concrete and based on a set of rules (obtaining the prescription for diet progression)
1. A nurse in an ambulatory care clinic is caring for a client who had a mastectomy 6 months ago. The client tells the nurse that there has been a decreased desire for sexual relations since the surgery, stating, “My body is so different now.” Which of the following responses should the nurse make?
A. “Really, you look just fine to me. There’s no need to feel undesirable.”
B. “I’m interested in finding out more about how your body feels to you.”
C. “Consider an afternoon at a spa. A facial will make you feel more attractive.”
D. “It’s still too soon to expect to feel normal. Give it a little more time.”
B. CORRECT: Showing interest in the client is applying the therapeutic communication technique of offering self. Asking more about how the client feels is applying the therapeutic communication technique of encouraging a description of perception.
A nurse is caring for a client whose partner passed away 4 months ago. The client has a recent diagnosis of diabetes mellitus. The client is tearful and states, “How could you possibly understand what I am going through?” Which of the following responses should the nurse make?
A. “It takes time to get over the loss of a loved one.”
B. “You are right. I cannot really understand. Perhaps you’d like to tell me more about what you’re feeling.”
C. “Why don’t you try something to take your mind off your troubles, like watching a funny movie.”
D. “I might not share your exact situation, but I do know what people go through when they deal with a loss.”
B. CORRECT: By stating there is a lack of understanding, the nurse is using the therapeutic communication technique of validation, whereby a person shows sensitivity to the meaning behind a behavior. The nurse is also creating a supportive and nonjudgmental environment, and inviting the client to express frustrations.
. A nurse is using an interpreter to communicate with a client. Which of the following actions should the nurse use when communicating with a client and family members? (Select all that apply.)
A. Talk to the interpreter about the family while the family is in the room.
B. Determine client understanding several times during the conversation.
C. Look at the interpreter when asking the family questions.
D. Use lay terms if possible.
E. Do not interrupt the interpreter and the family as they talk.
B. CORRECT: Determining client understanding throughout the conversation ensures the client comprehends the information and the nurse will know how to direct the conversation.
D. CORRECT: Using lay terms will promote effective communication between the family and the nurse/interpreter.
E. CORRECT: Not interrupting will promote effective communication between the family and the nurse/interpreter.
A nurse is caring for a client who has terminal lung cancer. The nurse observes the client’s family assisting with all ADLs. Which of the following rationales for self‑care should the nurse communicate to the family?
A. Allowing the client to function independently will strengthen muscles and promote healing.
B. The client needs privacy at times for self‑reflecting and organizing life.
C. The client’s sense of loss can be lessened through retaining control of some areas of life.
D. Performing ADLs is a requirement prior to discharge from an acute care facility
C. CORRECT: Allowing the client as much control as possible maintains dignity and self‑esteem.
A nurse receives a prescription for an antibiotic for a client who has cellulitis. The nurse checks the client’s medical record, discovers that the client is allergic to the antibiotic, and calls the provider to request a prescription for a different antibiotic. Which of the following critical thinking attitudes did the nurse demonstrate?
A. Fairness
B. Responsibility
C. Risk-taking
D. Creativity
B. CORRECT: The nurse is responsible for administering medications in a safe manner and according to standards of practice. Checking the medical record for allergies helps ensure safety
A nurse is caring for a group of clients on a medical‑surgical unit. Which of the following clients are at increased risk for body-image disturbances? (Select all that apply.) A. A client who had a laparoscopic appendectomy
B. A client who had a mastectomy C. A client who had a left above‑the‑knee amputation
D. A client who had a cardiac catheterization
E. A client who had a stroke with right‑sided hemiplegia
B. CORRECT: Having a mastectomy involves a change in the physical appearance and can lead to body image disturbances related to sexuality.
C. CORRECT: Having an above‑the‑knee amputation involves a change in physical appearance and can lead to body-image disturbances related to function, health, and strength.
E. CORRECT: Having right‑sided hemiplegia involves a change in physical appearance and can lead to body-image disturbances related to function, health, and strength.
A nurse is caring for a client awaiting transport to the surgical suite for a coronary artery bypass graft. Just as the transport team arrives, the nurse takes the client’s vital signs and notes an elevation in blood pressure and heart rate. The nurse should recognize this response as which part of the general adaptation syndrome (GAS)?
A. Exhaustion stage
B. Resistance stage
C. Alarm stage
D. Recovery stage
C. CORRECT: In the alarm stage of GAS, body functions (blood pressure and heart rate) are heightened in order to respond to stressors
A nurse is caring for two clients who report following the same religion. Which of the following information should the nurse consider when planning care for these clients?
A. Members of the same religion share similar feelings about their religion.
B. A shared religious background generates mutual regard for one another.
C. The same religious beliefs can influence individuals differently.
D. The nurse and client should discuss the differences and commonalities in their beliefs
C. CORRECT: Members of any particular religion should be assessed for individual feelings and ideas.
A nurse is caring for a client who has stage IV lung cancer and is 3 days postoperative following a wedge resection. The client states, “I told myself that I would go through with the surgery and quit smoking, if I could just live long enough to attend my child’s wedding.” Based on the Kübler‑Ross model, which stage of grief is the client experiencing?
A. Anger
B. Denial
C. Bargaining
D. Acceptance
C. CORRECT: The client is bargaining by attempting to negotiate more time to live to see the child get married
A newly licensed nurse is considering strategies to improve critical thinking. Which of the following actions should the nurse take? (Select all that apply.)
A. Find a mentor.
B. Use a journal to write about the outcomes of clinical judgments.
C. Review articles about evidence-based practice.
D. Limit consultations with other professionals involved in a client’s care.
E. Make quick decisions when unsure about a client’s needs.
B. CORRECT: Journaling about decision-making can assist the nurse with self-reflections and improve critical thinking.
C. CORRECT: Improving knowledge by learning new information about evidence-based practice improves the nurse’s ability to think critically.
E. CORRECT: Quick decision-making can lead to errors. A nurse’s intuition might cause feelings of uncertainty, which should lead the nurse to ask questions about whether the plan of care makes sense and to gather more information.
A nurse is caring for a client who is 3 days postoperative following a below‑the‑knee amputation as a result of a motor-vehicle crash. Which of the following statements indicates that the client has a distorted body image?
A. “I’ll be able to function exactly as I did before the accident.”
B. “I just can’t stop crying.”
C. “I am so mad at that guy who hit us. I wish he lost a leg.”
D. “I don’t even want to look at my leg. You can check the dressing.”
D. CORRECT: Refusing to look at the leg or the dressing indicates that the client is having difficulty acknowledging the fact that the leg has been amputated. This would imply a distorted body image.
A nurse is caring for a client who has left‑sided hemiplegia resulting from a cerebrovascular accident. The client works as a carpenter and is now experiencing a situational role change based on physical limitations. The client is the primary wage earner in the family. Which of the following describes the client’s role problem? A. Role conflict
B. Role overload
C. Role ambiguity
D. Role strain
A. CORRECT: The client is experiencing role conflict because their career is extremely physical, and they can no longer perform the job duties. However, the client is the primary wage earner in the family.
A nurse enters the room of a client who is crying while reading from a religious book and asks to be left alone. Which of the following actions should the nurse take?
A. Contact the hospital’s spiritual services.
B. Ask what is making the client cry.
C. Ensure no visitors or staff enter the room for a short time period.
D. Turn on the television for a distraction.
C. CORRECT: Providing privacy and time for the reading of religious materials supports the client’s spiritual health.
A nurse is consoling the partner of a client who just died after a long battle with liver cancer. The grieving partner states, “I hate them for leaving me.” Which of the following statements should the nurse make to facilitate mourning for the partner? (Select all that apply.)
A. “Would you like me to contact the chaplain to come and speak with you?”
B. “You will feel better soon. You have been expecting this for a while now.”
C. “Let’s talk about your children and how they are going to react.”
D. “You know, it is quite normal to feel anger toward your loved one at this time.” E. “Tell me more about how you are feeling.”
. A. CORRECT: Asking whether the grieving individual desires spiritual support at this time is an acceptable nursing intervention to facilitate mourning.
D. CORRECT: Educate the grieving individual about the grieving process and emotions to expect at this time.
E. CORRECT: Encourage the open communication of feelings by using therapeutic communication to facilitate mourning.
A nurse is caring for a client who has a new prescription for antihypertensive medication. Prior to administering the medication, the nurse uses an electronic database to gather information about the medication and the effects it might have on this client. Which of the following components of critical thinking is the nurse using when he reviews the medication information?
A. Knowledge
B. Experience
C. Intuition
D. Competence
4. A. CORRECT: By using the electronic database, the nurse takes the initiative to increase their knowledge base, which is the first component of critical thinking
. A nurse is caring for a client who is recovering from a myocardial infarction and a cardiac catheterization. The client states, “I am concerned that things might be a little, you know, ‘different’ with my partner when I get home.” Which of the following statements should the nurse make?
A. “Sounds like something you should discuss with them when you get home.”
B. “It sounds like you are concerned about sexual functioning. Let’s discuss your concerns.”
C. “Oh, I wouldn’t be too concerned. Things will be fine as soon as we get you home.”
D. “Just make sure you take your medication as directed, and you should be fine.”
B. CORRECT: Acknowledge and allow the client to discuss their concerns regarding sexual functioning
A nurse is caring for a client who has a new diagnosis of type 2 diabetes mellitus. Which of the following nursing interventions for stress, coping, and adherence to the treatment plan should the nurse initiate at this time? (Select all that apply.)
A. Suggest coping skills for the client to use in this situation.
B. Allow the client to provide input in the treatment plan.
C. Assist the client with time management, and address the client’s priorities.
D. Provide extensive instructions on the client’s treatment regimen. E. Encourage the client in the expression of feelings and concerns.
B. CORRECT: Allowing the client to contribute to the treatment plan allows for greater adherence to the plan.
C. CORRECT: Helping the client to prioritize is an intervention that can reduce levels of stress for the client because many times time management is extremely difficult in times of stress.
E. CORRECT: By using effective communication techniques, encouraging the client to verbalize feelings is an intervention for stress, coping, and adherence that allows the client to reduce stress, validate emotions, and start planning for valid concerns.
A nurse is discussing the plan of care for a client who reports following Islamic practices. Which of the following statements by the nurse indicates culturally responsive care to the client?
A. “I will make sure the menu includes kosher options.”
B. “I will ask the client if they want to schedule some times to pray during the day.”
C. “I will avoid discussing care when the client’s family is around.”
D. “I will make sure daily communion is available for this client.”
B. CORRECT: Islamic practices include praying five times per day. Work with the client to establish a schedule for the day, noting which times the client prefers to pray, and scheduling treatments around those times when possible
A nurse is caring for a client who has a terminal illness. Death is expected within 24 hr. The client’s family is at the bedside and asks the nurse what to expect at this time. Which of the following findings should the nurse include? A. Regular breathing patterns
B. Warm extremities
C. Increased urine output
D. Decreased muscle tone
D. CORRECT: Muscle relaxation is an expected finding when a client is approaching death.
A nurse uses a head‑to‑toe approach to conduct a physical assessment of a client who will undergo surgery the following week. Which of the following critical thinking attitudes did the nurse demonstrate?
A. Confidence
B. Perseverance
C. Integrity
D. Discipline
D. CORRECT: Discipline includes using a systematic approach to thinking. Using a head-to-toe approach ensures the nurse is thorough and calculated in getting information about the client’s physical status
A nurse is teaching a group of clients how to care for their colostomies. Which of the following statements indicates an issue with self‑concept?
A. “I was having difficulty with attaching the appliance at first, but my partner was able to help.”
B. “I’ll never be able to care for this at home. Can’t you just send a nurse to the house?”
C. “I met a neighbor who also has a colostomy, and they taught me a few things.”
D. “It can take me a while to get the hang of this. I have to admit, I am pretty nervous.
B. CORRECT: This client is displaying a lack of interest in learning how to care for the colostomy and preferring dependence on others to perform the care. Suspect issues with self‑concept with this client
A nurse is caring for a family who is experiencing a crisis. Which of the following approaches should the nurse use when working with a family using an open structure for coping with crisis?
A. Prescribing tasks unilaterally
B. Delegating care to one member C. Speaking to the primary client privately
D. Convening a family meeting
D. CORRECT: An open structure is loose, and convening a family meeting would give all family members input and an opportunity to express their feelings.
A nurse is caring for a client who tells the nurse that based on religious values and mandates, a blood transfusion is not an acceptable treatment option. Which of the following responses should the nurse make?
A. “I believe in this case you should really make an exception and accept the blood transfusion.” B. “I know your family would approve of your decision to have a blood transfusion.”
C. “Why does your religion mandate that you cannot receive any blood transfusions?”
D. “Let’s discuss the necessity for a blood transfusion with your religious and spiritual leaders and come to a reasonable solution.”
D. CORRECT: Involving the client’s religious and spiritual leaders is a culturally responsive action at this point. Alternative forms of blood products can be discussed, and a plan reasonable to all can be reached.
A nurse is about to perform postmortem care of a client. The family wishes to view the body. Which of the following actions should the nurse take? (Select all that apply.)
A. Remove the dentures from the body.
B. Make sure the body is lying completely flat.
C. Apply fresh linens and place a clean gown on the body.
D. Remove all equipment from the bedside.
E. Dim the lights in the room
C. CORRECT: The body and the environment should be as clean as possible. This includes washing soiled areas of the body and applying fresh linens and a clean gown.
D. CORRECT: The environment should be as clutter‑free as possible. The nurse should remove all equipment and supplies from the bedside.
E. CORRECT: Dimming the lights helps provide a calm environment for the family.