INDIAN RIVER STATE COLLEGE NUR 1021C CHAPTER 14 QUESTIONS |
INTRODUCTION TO NURSING CONCEPTS 1 STUDY GUIDE
1. A nurse is providing care to several clients. Which situation(s) reflects the nurse using clinical
judgment? Select all that apply.
A. deciding on appropriate actions based on the facility's approved algorithm
B. providing evidence to revise a current protocol for intravenous insertion
C. gathering additional assessment findings to support changes in a client's status
D. referring to any female client using the "she" pronoun
E. holding off on notifying a health care provider about the deterioration in a client's status until family
members arrive - ANS ✔✔A, B, C
Rationale: Critical thinking, clinical reasoning, and clinical judgment occur in the quiet moments. Framing
the approach to a client using their identified pronouns rather than making a generalization (e.g.,
referring to any female client as "she") requires a measure of clinical judgment. Identifying and then
using an algorithm or protocol based on clinical findings requires clinical judgment. Reviewing the
evidence and contributing to the development or revision of that algorithm or protocol requires clinical
judgment. Nurses also use clinical judgment to determine whether to immediately call the health care
provider or to determine if there are additional assessments that are needed to formulate a
recommendation. However, waiting to notify the provider about a deterioration in the client's condition
until family members arrive would be inappropriate.
Question format: Multiple Select
Chapter 14: Clinical Judgment
Cognitive Level: Understand
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Nursing Process
Reference: p. 382
2. A nurse educator is conducting an in-service program for a group of newly hired nurses at the facility.
The topic addresses the use of critical thinking in the clinical area. The nurse educator determines that
additional instruction is needed based on which statement made by the group?
A. "There is one universal definition of critical thinking."
B. "Critical thinking requires intentional focus."
C. "The ability to think critically can be learned."
D. "Creativity, intuition, and logic are needed for critical thinking." - ANS ✔✔A
Rationale: Critical thinking has been defined differently by various individuals. In fact, some leaders
recognize critical thinking as a concept that does not have one universally accepted definition. Leaders
describe critical thinking as a skill that can be developed, often requiring intentional focus and work, and
involving problem-solving that is creative, intuitive, logical, and analytic.
Question format: Multiple Choice
Chapter 14: Clinical Judgment
Cognitive Level: Understand
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Nursing Process
Reference: p. 382
,3. A nurse accesses the electronic health record of a client and reviews the client's history for results of
previous laboratory studies completed. Then the nurse accesses the record for current laboratory study
results, comparing them to better understand a client's status before deciding if there is a need to
contact the health care provider. The nurse's actions demonstrate which concept?
A. clinical reasoning
B. clinical judgment
C. backward reasoning
D. critical thinking - ANS ✔✔A
Rationale: The nurse is using clinical reasoning. Clinical reasoning refers to the "thought processes that
allow health care providers to arrive at a conclusion" and "as the process of thinking that results in a
clinical judgment." Critical thinking may be used to access the electronic health record and to learn to
navigate through the screens, but clinical reasoning is used to decide what the nurse should review,
when to review it, and how each piece of data relates to the others to create a clinical picture. In this
case, the nurse is comparing the data prior to determining if the health care provider should be notified.
Clinical judgment is the result or observed outcome of critical thinking and decision-making. Backward
reasoning is deductive reasoning that relies on applying widely accepted knowledge and principles to a
model or a combination of models to solve problems.
Question format: Multiple Choice
Chapter 14: Clinical Judgment
Cognitive Level: Apply
Client Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Nursing Process
Reference: p. 384
4. A nurse has completed an initial assessment of a client with a history of respiratory distress. Upon
entering the client's room later in the day, the nurse finds the client is short of breath and leaning
forward to breathe. The nurse gathers additional information and notes rapid shallow breaths, a
decrease in oxygen saturation levels, and diminished breath sounds. The nurse determines that these
are significant changes in the client's condition and calls the client's health care provider to report the
situation. The nurse is demonstrating which behavior?
A. clinical judgment
B. critical thinking
C. clinical reasoning
D. knowledge integration - ANS ✔✔A
Rationale: The nurse is demonstrating clinical judgment by calling the health care provider and
subsequently clinical decision-making, the foundation of which is based on critical thinking, knowledge
from nursing and other disciplines, and clinical reasoning. The actions the nurse took to arrive at the
decision to call the provider reflect the processes of critical thinking, integration of knowledge, and
clinical reasoning. The nurse used critical thinking by identifying the change in the client's condition,
recognizing a problem, and then gathering additional data. The nurse integrated knowledge by using
what was previously known about the client and considered the current findings. Using clinical
reasoning, the nurse took the information that was gathered and arrived at a conclusion: the decision to
call the provider.
Question format: Multiple Choice
Chapter 14: Clinical Judgment
, Cognitive Level: Apply
Client Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process
Reference: p. 384
5. A nurse manager is observing a newly hired nurse's behavior while providing care to a client and notes
the following:
• Recognizes the majority of deviations in clients' status
• Occasionally misses the most subtle signs
• Continually assesses clients based on findings
• Actively seeks out the family for information to support plans
Using Lasater's clinical judgment rubric, the manager identifies the nurse as functioning at which level?
A. accomplished
B. beginning
C. developing
D. exemplary - ANS ✔✔A
Rationale: According to Lasater's rubric, the nurse's behaviors demonstrate the level of "accomplished,"
as exhibited by the ability to regularly observe and monitor a variety of data, noticing the most useful
information, but possibly missing the most subtle signs, recognizing the most obvious patterns and
deviations in data, using them to continually assess, and actively seek subjective information about the
client's situation from the client and family to support planning intervention, but occasionally not
pursuing important leads. A nurse with beginning competency would be confused by the clinical
information and amount and type of data, focusing on one thing at a time and missing most patterns and
deviations. A nurse with developing competency attempts to monitor a variety of data but is
overwhelmed by the array of data, focusing on the most obvious data and missing some important data.
A nurse with exemplary competency focuses observation appropriately and is able to regularly observe
and monitor a wide variety of data, recognizing subtle patterns and deviations, using these to guide
assessment.
Question format: Multiple Choice
Chapter 14: Clinical Judgment
Cognitive Level: Analyze
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Nursing Process
Reference: p. 386
6. A nurse enters a client's room and observes the client sitting in a chair looking out the window. The
nurse obtains the client's vital signs and gathers information about the client's current level of pain.
Based on this information, the nurse identifies a potential problem with pain control and decides to call
the provider to obtain a prescription for an analgesic. The nurse is engaged in which action?
A. using the nursing process
B. care planning
C. concept mapping
D. evaluating - ANS ✔✔A
Rationale: The nursing process outlines the way nurses think, it represents the unique, shared language
of nurses. The care plan is used as a teaching tool to explicate the steps the nurse mentally goes through
when developing, delivering, and evaluating a client's individualized plan of care. Nurses organize their
INTRODUCTION TO NURSING CONCEPTS 1 STUDY GUIDE
1. A nurse is providing care to several clients. Which situation(s) reflects the nurse using clinical
judgment? Select all that apply.
A. deciding on appropriate actions based on the facility's approved algorithm
B. providing evidence to revise a current protocol for intravenous insertion
C. gathering additional assessment findings to support changes in a client's status
D. referring to any female client using the "she" pronoun
E. holding off on notifying a health care provider about the deterioration in a client's status until family
members arrive - ANS ✔✔A, B, C
Rationale: Critical thinking, clinical reasoning, and clinical judgment occur in the quiet moments. Framing
the approach to a client using their identified pronouns rather than making a generalization (e.g.,
referring to any female client as "she") requires a measure of clinical judgment. Identifying and then
using an algorithm or protocol based on clinical findings requires clinical judgment. Reviewing the
evidence and contributing to the development or revision of that algorithm or protocol requires clinical
judgment. Nurses also use clinical judgment to determine whether to immediately call the health care
provider or to determine if there are additional assessments that are needed to formulate a
recommendation. However, waiting to notify the provider about a deterioration in the client's condition
until family members arrive would be inappropriate.
Question format: Multiple Select
Chapter 14: Clinical Judgment
Cognitive Level: Understand
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Nursing Process
Reference: p. 382
2. A nurse educator is conducting an in-service program for a group of newly hired nurses at the facility.
The topic addresses the use of critical thinking in the clinical area. The nurse educator determines that
additional instruction is needed based on which statement made by the group?
A. "There is one universal definition of critical thinking."
B. "Critical thinking requires intentional focus."
C. "The ability to think critically can be learned."
D. "Creativity, intuition, and logic are needed for critical thinking." - ANS ✔✔A
Rationale: Critical thinking has been defined differently by various individuals. In fact, some leaders
recognize critical thinking as a concept that does not have one universally accepted definition. Leaders
describe critical thinking as a skill that can be developed, often requiring intentional focus and work, and
involving problem-solving that is creative, intuitive, logical, and analytic.
Question format: Multiple Choice
Chapter 14: Clinical Judgment
Cognitive Level: Understand
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Nursing Process
Reference: p. 382
,3. A nurse accesses the electronic health record of a client and reviews the client's history for results of
previous laboratory studies completed. Then the nurse accesses the record for current laboratory study
results, comparing them to better understand a client's status before deciding if there is a need to
contact the health care provider. The nurse's actions demonstrate which concept?
A. clinical reasoning
B. clinical judgment
C. backward reasoning
D. critical thinking - ANS ✔✔A
Rationale: The nurse is using clinical reasoning. Clinical reasoning refers to the "thought processes that
allow health care providers to arrive at a conclusion" and "as the process of thinking that results in a
clinical judgment." Critical thinking may be used to access the electronic health record and to learn to
navigate through the screens, but clinical reasoning is used to decide what the nurse should review,
when to review it, and how each piece of data relates to the others to create a clinical picture. In this
case, the nurse is comparing the data prior to determining if the health care provider should be notified.
Clinical judgment is the result or observed outcome of critical thinking and decision-making. Backward
reasoning is deductive reasoning that relies on applying widely accepted knowledge and principles to a
model or a combination of models to solve problems.
Question format: Multiple Choice
Chapter 14: Clinical Judgment
Cognitive Level: Apply
Client Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Nursing Process
Reference: p. 384
4. A nurse has completed an initial assessment of a client with a history of respiratory distress. Upon
entering the client's room later in the day, the nurse finds the client is short of breath and leaning
forward to breathe. The nurse gathers additional information and notes rapid shallow breaths, a
decrease in oxygen saturation levels, and diminished breath sounds. The nurse determines that these
are significant changes in the client's condition and calls the client's health care provider to report the
situation. The nurse is demonstrating which behavior?
A. clinical judgment
B. critical thinking
C. clinical reasoning
D. knowledge integration - ANS ✔✔A
Rationale: The nurse is demonstrating clinical judgment by calling the health care provider and
subsequently clinical decision-making, the foundation of which is based on critical thinking, knowledge
from nursing and other disciplines, and clinical reasoning. The actions the nurse took to arrive at the
decision to call the provider reflect the processes of critical thinking, integration of knowledge, and
clinical reasoning. The nurse used critical thinking by identifying the change in the client's condition,
recognizing a problem, and then gathering additional data. The nurse integrated knowledge by using
what was previously known about the client and considered the current findings. Using clinical
reasoning, the nurse took the information that was gathered and arrived at a conclusion: the decision to
call the provider.
Question format: Multiple Choice
Chapter 14: Clinical Judgment
, Cognitive Level: Apply
Client Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process
Reference: p. 384
5. A nurse manager is observing a newly hired nurse's behavior while providing care to a client and notes
the following:
• Recognizes the majority of deviations in clients' status
• Occasionally misses the most subtle signs
• Continually assesses clients based on findings
• Actively seeks out the family for information to support plans
Using Lasater's clinical judgment rubric, the manager identifies the nurse as functioning at which level?
A. accomplished
B. beginning
C. developing
D. exemplary - ANS ✔✔A
Rationale: According to Lasater's rubric, the nurse's behaviors demonstrate the level of "accomplished,"
as exhibited by the ability to regularly observe and monitor a variety of data, noticing the most useful
information, but possibly missing the most subtle signs, recognizing the most obvious patterns and
deviations in data, using them to continually assess, and actively seek subjective information about the
client's situation from the client and family to support planning intervention, but occasionally not
pursuing important leads. A nurse with beginning competency would be confused by the clinical
information and amount and type of data, focusing on one thing at a time and missing most patterns and
deviations. A nurse with developing competency attempts to monitor a variety of data but is
overwhelmed by the array of data, focusing on the most obvious data and missing some important data.
A nurse with exemplary competency focuses observation appropriately and is able to regularly observe
and monitor a wide variety of data, recognizing subtle patterns and deviations, using these to guide
assessment.
Question format: Multiple Choice
Chapter 14: Clinical Judgment
Cognitive Level: Analyze
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Nursing Process
Reference: p. 386
6. A nurse enters a client's room and observes the client sitting in a chair looking out the window. The
nurse obtains the client's vital signs and gathers information about the client's current level of pain.
Based on this information, the nurse identifies a potential problem with pain control and decides to call
the provider to obtain a prescription for an analgesic. The nurse is engaged in which action?
A. using the nursing process
B. care planning
C. concept mapping
D. evaluating - ANS ✔✔A
Rationale: The nursing process outlines the way nurses think, it represents the unique, shared language
of nurses. The care plan is used as a teaching tool to explicate the steps the nurse mentally goes through
when developing, delivering, and evaluating a client's individualized plan of care. Nurses organize their
