NUR 114 – Clinical Judgment in Nursing |
Clinical Decision-Making Study Guide, Critical
Thinking, Nursing Process, Patient Safety, and
Practice Questions
1. A nurse is caring for a patient who reports severe abdominal pain. The
nurse notes the patient is diaphoretic, has a heart rate of 110 bpm, and blood
pressure of 100/60 mmHg. Which action demonstrates the highest level of
clinical judgment?
A. Document the findings in the patient's chart.
B. Notify the healthcare provider immediately and prepare for possible
emergency intervention.
C. Administer the prescribed PRN pain medication.
D. Reassess the patient in 30 minutes.
Rationale: Clinical judgment involves recognizing a change in patient status and
acting on it. The patient is showing signs of potential shock or acute abdominal
emergency (tachycardia, hypotension, diaphoresis). The most appropriate action is
to notify the healthcare provider immediately while preparing for emergency
interventions. This demonstrates prioritization and recognition of a critical
situation.
2. Which of the following best describes the relationship between critical
thinking and clinical judgment in nursing?
A. Critical thinking is a component of clinical judgment.
B. Clinical judgment is the observable outcome of critical thinking.
C. Critical thinking and clinical judgment are the same thing.
D. Clinical judgment replaces the need for critical thinking.
Rationale: Clinical judgment is the observable outcome or decision that results
from the critical thinking process. Critical thinking involves analyzing,
evaluating, and reasoning, while clinical judgment is the application of that
reasoning to make a clinical decision. It is the "thinking" that leads to the "doing."
3. A nurse is using the nursing process to care for a patient. After identifying
that the patient has impaired gas exchange, the nurse develops goals and
interventions. Which phase of the nursing process is the nurse currently in?
,A. Assessment
B. Diagnosis
C. Planning
D. Implementation
Rationale: The planning phase of the nursing process occurs after the nursing
diagnosis is established. During this phase, the nurse develops goals, outcomes,
and interventions to address the identified problem. The nursing process follows
the sequence: Assessment, Diagnosis, Planning, Implementation, and Evaluation
(ADPIE).
4. A patient with heart failure has an order for furosemide (Lasix). Which
assessment finding would prompt the nurse to hold the medication and notify
the provider?
A. Heart rate of 80 bpm.
B. Potassium level of 3.0 mEq/L.
C. Blood pressure of 130/80 mmHg.
D. Weight gain of 1 kg.
Rationale: Furosemide is a loop diuretic that causes potassium loss. A potassium
level of 3.0 mEq/L is hypokalemia and increases the risk of cardiac dysrhythmias,
especially in patients on digoxin. The nurse should hold the medication and notify
the provider. This demonstrates clinical judgment in recognizing a
contraindication.
5. The nurse is assessing a patient with pneumonia who has crackles in the
lung bases and an oxygen saturation of 88% on room air. Which nursing
intervention has the highest priority?
A. Administer the prescribed antibiotic.
B. Apply supplemental oxygen.
C. Encourage oral fluid intake.
D. Ambulate the patient in the hallway.
Rationale: Oxygen saturation of 88% indicates hypoxemia, which is a life-
threatening emergency. The priority intervention is to apply supplemental
oxygen to improve oxygenation. Antibiotics address the underlying infection but
do not immediately improve oxygenation. This demonstrates prioritization using
Maslow's hierarchy.
,6. A nurse is caring for a patient who is 1 day post-operative. The patient
complains of sudden chest pain and shortness of breath. The nurse notes the
patient's oxygen saturation has dropped from 96% to 89%. Which action
should the nurse take first?
A. Encourage deep breathing.
B. Assess the patient's vital signs and call for assistance.
C. Administer a PRN pain medication.
D. Document the findings and continue monitoring.
Rationale: Sudden chest pain, shortness of breath, and a drop in oxygen saturation
are red flags for a pulmonary embolism or other life-threatening complication.
The nurse should first assess the patient's vital signs and call for assistance to
ensure a rapid response. This demonstrates recognition of a deteriorating patient.
7. A patient is refusing to take a prescribed medication because of
gastrointestinal side effects. The nurse discusses alternative options with the
patient and offers to administer the medication with food. Which clinical
judgment skill is the nurse using?
A. Recognizing cues
B. Generating solutions
C. Evaluating outcomes
D. Prioritizing hypotheses
Rationale: When the nurse identifies a problem (medication refusal) and develops
a solution (taking the medication with food), the nurse is generating solutions.
This is part of the clinical judgment process where the nurse develops alternatives
to achieve the desired outcomes.
8. A nurse is caring for a patient with diabetes who has a blood glucose of 65
mg/dL. The patient is alert and oriented. Which action should the nurse take
first?
A. Notify the healthcare provider.
B. Give the patient 4 ounces of orange juice.
C. Administer glucagon IM.
D. Hold the patient's insulin.
Rationale: The patient is experiencing hypoglycemia (blood glucose < 70 mg/dL).
Since the patient is alert and oriented, the initial intervention is the "Rule of 15" :
give 15 grams of fast-acting carbohydrate (e.g., 4 oz of juice). This is the correct
clinical judgment based on the patient's level of consciousness.
, 9. The nurse is evaluating the effectiveness of a pain management
intervention. The patient reports pain decreased from 8/10 to 3/10. This
indicates:
A. The intervention was partially effective.
B. The intervention was effective.
C. The intervention was ineffective.
D. The patient requires a higher dose.
Rationale: Evaluation is the final phase of the nursing process where the nurse
determines if the goals and outcomes were achieved. A pain score decreasing from
8/10 to 3/10 indicates the intervention was effective. The goal of pain management
is typically to achieve a pain score of 3 or less.
10. A new graduate nurse is caring for a patient with a complex medical
history. The nurse is unsure about a medication order. Which action
demonstrates appropriate clinical judgment?
A. Administer the medication as ordered.
B. Consult with the charge nurse or healthcare provider for clarification.
C. Ask the patient's family member what they think.
D. Document the order and administer the medication.
Rationale: When unsure about a medication order, the nurse should consult with
the charge nurse or healthcare provider for clarification. This demonstrates safe
practice and appropriate clinical judgment. It is better to ask questions than to risk
a medication error.
11. A patient is admitted with a urinary tract infection and confusion. The
nurse suspects that the confusion may be related to the infection rather than
dementia. Which cognitive skill is the nurse using?
A. Recognizing cues
B. Analyzing cues
C. Prioritizing hypotheses
D. Evaluating outcomes
Rationale: The nurse is recognizing cues by identifying that confusion in an older
adult with a UTI may be a sign of delirium rather than dementia. This is the first
step in the clinical judgment process, where the nurse observes and collects data.
12. A patient with heart failure reports increasing shortness of breath and has
2+ edema in the lower extremities. The nurse notes crackles in the lung bases.
Clinical Decision-Making Study Guide, Critical
Thinking, Nursing Process, Patient Safety, and
Practice Questions
1. A nurse is caring for a patient who reports severe abdominal pain. The
nurse notes the patient is diaphoretic, has a heart rate of 110 bpm, and blood
pressure of 100/60 mmHg. Which action demonstrates the highest level of
clinical judgment?
A. Document the findings in the patient's chart.
B. Notify the healthcare provider immediately and prepare for possible
emergency intervention.
C. Administer the prescribed PRN pain medication.
D. Reassess the patient in 30 minutes.
Rationale: Clinical judgment involves recognizing a change in patient status and
acting on it. The patient is showing signs of potential shock or acute abdominal
emergency (tachycardia, hypotension, diaphoresis). The most appropriate action is
to notify the healthcare provider immediately while preparing for emergency
interventions. This demonstrates prioritization and recognition of a critical
situation.
2. Which of the following best describes the relationship between critical
thinking and clinical judgment in nursing?
A. Critical thinking is a component of clinical judgment.
B. Clinical judgment is the observable outcome of critical thinking.
C. Critical thinking and clinical judgment are the same thing.
D. Clinical judgment replaces the need for critical thinking.
Rationale: Clinical judgment is the observable outcome or decision that results
from the critical thinking process. Critical thinking involves analyzing,
evaluating, and reasoning, while clinical judgment is the application of that
reasoning to make a clinical decision. It is the "thinking" that leads to the "doing."
3. A nurse is using the nursing process to care for a patient. After identifying
that the patient has impaired gas exchange, the nurse develops goals and
interventions. Which phase of the nursing process is the nurse currently in?
,A. Assessment
B. Diagnosis
C. Planning
D. Implementation
Rationale: The planning phase of the nursing process occurs after the nursing
diagnosis is established. During this phase, the nurse develops goals, outcomes,
and interventions to address the identified problem. The nursing process follows
the sequence: Assessment, Diagnosis, Planning, Implementation, and Evaluation
(ADPIE).
4. A patient with heart failure has an order for furosemide (Lasix). Which
assessment finding would prompt the nurse to hold the medication and notify
the provider?
A. Heart rate of 80 bpm.
B. Potassium level of 3.0 mEq/L.
C. Blood pressure of 130/80 mmHg.
D. Weight gain of 1 kg.
Rationale: Furosemide is a loop diuretic that causes potassium loss. A potassium
level of 3.0 mEq/L is hypokalemia and increases the risk of cardiac dysrhythmias,
especially in patients on digoxin. The nurse should hold the medication and notify
the provider. This demonstrates clinical judgment in recognizing a
contraindication.
5. The nurse is assessing a patient with pneumonia who has crackles in the
lung bases and an oxygen saturation of 88% on room air. Which nursing
intervention has the highest priority?
A. Administer the prescribed antibiotic.
B. Apply supplemental oxygen.
C. Encourage oral fluid intake.
D. Ambulate the patient in the hallway.
Rationale: Oxygen saturation of 88% indicates hypoxemia, which is a life-
threatening emergency. The priority intervention is to apply supplemental
oxygen to improve oxygenation. Antibiotics address the underlying infection but
do not immediately improve oxygenation. This demonstrates prioritization using
Maslow's hierarchy.
,6. A nurse is caring for a patient who is 1 day post-operative. The patient
complains of sudden chest pain and shortness of breath. The nurse notes the
patient's oxygen saturation has dropped from 96% to 89%. Which action
should the nurse take first?
A. Encourage deep breathing.
B. Assess the patient's vital signs and call for assistance.
C. Administer a PRN pain medication.
D. Document the findings and continue monitoring.
Rationale: Sudden chest pain, shortness of breath, and a drop in oxygen saturation
are red flags for a pulmonary embolism or other life-threatening complication.
The nurse should first assess the patient's vital signs and call for assistance to
ensure a rapid response. This demonstrates recognition of a deteriorating patient.
7. A patient is refusing to take a prescribed medication because of
gastrointestinal side effects. The nurse discusses alternative options with the
patient and offers to administer the medication with food. Which clinical
judgment skill is the nurse using?
A. Recognizing cues
B. Generating solutions
C. Evaluating outcomes
D. Prioritizing hypotheses
Rationale: When the nurse identifies a problem (medication refusal) and develops
a solution (taking the medication with food), the nurse is generating solutions.
This is part of the clinical judgment process where the nurse develops alternatives
to achieve the desired outcomes.
8. A nurse is caring for a patient with diabetes who has a blood glucose of 65
mg/dL. The patient is alert and oriented. Which action should the nurse take
first?
A. Notify the healthcare provider.
B. Give the patient 4 ounces of orange juice.
C. Administer glucagon IM.
D. Hold the patient's insulin.
Rationale: The patient is experiencing hypoglycemia (blood glucose < 70 mg/dL).
Since the patient is alert and oriented, the initial intervention is the "Rule of 15" :
give 15 grams of fast-acting carbohydrate (e.g., 4 oz of juice). This is the correct
clinical judgment based on the patient's level of consciousness.
, 9. The nurse is evaluating the effectiveness of a pain management
intervention. The patient reports pain decreased from 8/10 to 3/10. This
indicates:
A. The intervention was partially effective.
B. The intervention was effective.
C. The intervention was ineffective.
D. The patient requires a higher dose.
Rationale: Evaluation is the final phase of the nursing process where the nurse
determines if the goals and outcomes were achieved. A pain score decreasing from
8/10 to 3/10 indicates the intervention was effective. The goal of pain management
is typically to achieve a pain score of 3 or less.
10. A new graduate nurse is caring for a patient with a complex medical
history. The nurse is unsure about a medication order. Which action
demonstrates appropriate clinical judgment?
A. Administer the medication as ordered.
B. Consult with the charge nurse or healthcare provider for clarification.
C. Ask the patient's family member what they think.
D. Document the order and administer the medication.
Rationale: When unsure about a medication order, the nurse should consult with
the charge nurse or healthcare provider for clarification. This demonstrates safe
practice and appropriate clinical judgment. It is better to ask questions than to risk
a medication error.
11. A patient is admitted with a urinary tract infection and confusion. The
nurse suspects that the confusion may be related to the infection rather than
dementia. Which cognitive skill is the nurse using?
A. Recognizing cues
B. Analyzing cues
C. Prioritizing hypotheses
D. Evaluating outcomes
Rationale: The nurse is recognizing cues by identifying that confusion in an older
adult with a UTI may be a sign of delirium rather than dementia. This is the first
step in the clinical judgment process, where the nurse observes and collects data.
12. A patient with heart failure reports increasing shortness of breath and has
2+ edema in the lower extremities. The nurse notes crackles in the lung bases.
