NR 226
NR 226 EXAM 1 - REVIEW QUESTIONS AND ANSWERS
While assessing a patient, the nurse observes that the patient's
intravenous (IV) line is not infusing at the ordered rate. The
nurse assesses the patient for pain at the IV site, checks the
flow regulator on the tubing, looks to see if the patient is lying
on the tubing, checks the point of connection between the
tubing and the IV catheter, and then checks the condition of the
site where the intravenous catheter enters the patient's skin.
After the nurse readjusts the flow rate, the infusion begins at
the correct rate. This is an example of:
A. Inference.
B. Diagnostic reasoning.
C. Competency.
D. Problem solving. - correct answer D. Problem solving
-This is an example of problem solving. The nurse collects
information and tries options until she is able to find a solution
to the slowed infusion rate. The focus is on solving the problem
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with the patient's IV and not on solving the patient's health
problem; thus this is not the diagnostic reasoning process.
The nurse sits down to talk with a patient who lost her sister 2
weeks ago. The patient reports she is unable to sleep, feels very
fatigued during the day, and is having trouble at work. The
nurse asks her to clarify the type of trouble. The patient
explains she can't concentrate or even solve simple problems.
The nurse records the results of the assessment, describing the
patient as having ineffective coping. This is an example of:
A. Diagnostic reasoning.
B. Competency.
C. Inference.
D. Problem solving. - correct answer A. Diagnostic reasoning
-In this example the nurse collects information about the
patient, sees patterns in the data collected, and makes a nursing
diagnosis. This is an example of the diagnostic process.
A nurse has worked on an oncology unit for 3 years. One patient
has become visibly weaker and states, "I feel funny." The nurse
knows how patients often have behavior changes before
developing sepsis when they have cancer. The nurse asks the
patient questions to assess thinking skills and notices the
patient shivering. The nurse goes to the phone, calls the
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physician, and begins the conversation by saying, "I believe that
your patient is developing sepsis. I want to report symptoms I'm
seeing." What examples of critical thinking concepts does the
nurse show? (Select all that apply.)
A. Experience
B. Ethical
C. Analyticity
D. Self-confidence
E. Risk taking - correct answer C & D.
-Among critical thinking concepts, the nurse shows analyticity
(analyzing information, gathering additional findings, and
sensing a problem), and self-confidence (calling the physician,
which shows trust in his own reasoning). The nurse's experience
would have influenced the familiarity of patient symptoms, but
in this text experience is considered a component of the critical
thinking model and not a concept. Acting ethically is a critical
thinking standard.
.A nurse who is working on a surgical unit is caring for four
different patients. Patient A will be discharged home and is in
need of instruction about wound care. Patients B and C have
returned from the operating room within an hour of each other,
and both require vital signs and monitoring of their intravenous
(IV) lines. Patient D is resting following a visit by physical
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therapy. Which of the following activities by the nurse
represent(s) use of clinical decision making for groups of
patients? (Select all that apply.)
A. Consider how to involve patient A in deciding whether to
involve the family caregiver in wound care instruction.
B. Think about past experience with patients who develop
postoperative complications.
C. Decide which activities can be combined for patients B and C.
D. Carefully gather any assessment information and identify
patient problems. - correct answer A & C
-Considering how to involve patients in decisions and how to
combine nursing activities to be more organized and allow for
resolving more than one problem at a time are examples of
clinical decision making for groups of patients. Thinking about
past experience with patients is an example of reflection, an
approach to strengthen critical thinking skills. Gathering
assessment information is part of the process of diagnostic
reasoning, which should be applied to each patient.
The surgical unit has initiated the use of a pain-rating scale to
assess patients' pain severity during their postoperative
recovery. The registered nurse (RN) looks at the pain flow sheet
to see the pain scores recorded for a patient over the last 24
hours. Use of the pain scale is an example of which intellectual
standard?
NR 226 EXAM 1 - REVIEW QUESTIONS AND ANSWERS
While assessing a patient, the nurse observes that the patient's
intravenous (IV) line is not infusing at the ordered rate. The
nurse assesses the patient for pain at the IV site, checks the
flow regulator on the tubing, looks to see if the patient is lying
on the tubing, checks the point of connection between the
tubing and the IV catheter, and then checks the condition of the
site where the intravenous catheter enters the patient's skin.
After the nurse readjusts the flow rate, the infusion begins at
the correct rate. This is an example of:
A. Inference.
B. Diagnostic reasoning.
C. Competency.
D. Problem solving. - correct answer D. Problem solving
-This is an example of problem solving. The nurse collects
information and tries options until she is able to find a solution
to the slowed infusion rate. The focus is on solving the problem
,NR 226
with the patient's IV and not on solving the patient's health
problem; thus this is not the diagnostic reasoning process.
The nurse sits down to talk with a patient who lost her sister 2
weeks ago. The patient reports she is unable to sleep, feels very
fatigued during the day, and is having trouble at work. The
nurse asks her to clarify the type of trouble. The patient
explains she can't concentrate or even solve simple problems.
The nurse records the results of the assessment, describing the
patient as having ineffective coping. This is an example of:
A. Diagnostic reasoning.
B. Competency.
C. Inference.
D. Problem solving. - correct answer A. Diagnostic reasoning
-In this example the nurse collects information about the
patient, sees patterns in the data collected, and makes a nursing
diagnosis. This is an example of the diagnostic process.
A nurse has worked on an oncology unit for 3 years. One patient
has become visibly weaker and states, "I feel funny." The nurse
knows how patients often have behavior changes before
developing sepsis when they have cancer. The nurse asks the
patient questions to assess thinking skills and notices the
patient shivering. The nurse goes to the phone, calls the
,NR 226
physician, and begins the conversation by saying, "I believe that
your patient is developing sepsis. I want to report symptoms I'm
seeing." What examples of critical thinking concepts does the
nurse show? (Select all that apply.)
A. Experience
B. Ethical
C. Analyticity
D. Self-confidence
E. Risk taking - correct answer C & D.
-Among critical thinking concepts, the nurse shows analyticity
(analyzing information, gathering additional findings, and
sensing a problem), and self-confidence (calling the physician,
which shows trust in his own reasoning). The nurse's experience
would have influenced the familiarity of patient symptoms, but
in this text experience is considered a component of the critical
thinking model and not a concept. Acting ethically is a critical
thinking standard.
.A nurse who is working on a surgical unit is caring for four
different patients. Patient A will be discharged home and is in
need of instruction about wound care. Patients B and C have
returned from the operating room within an hour of each other,
and both require vital signs and monitoring of their intravenous
(IV) lines. Patient D is resting following a visit by physical
, NR 226
therapy. Which of the following activities by the nurse
represent(s) use of clinical decision making for groups of
patients? (Select all that apply.)
A. Consider how to involve patient A in deciding whether to
involve the family caregiver in wound care instruction.
B. Think about past experience with patients who develop
postoperative complications.
C. Decide which activities can be combined for patients B and C.
D. Carefully gather any assessment information and identify
patient problems. - correct answer A & C
-Considering how to involve patients in decisions and how to
combine nursing activities to be more organized and allow for
resolving more than one problem at a time are examples of
clinical decision making for groups of patients. Thinking about
past experience with patients is an example of reflection, an
approach to strengthen critical thinking skills. Gathering
assessment information is part of the process of diagnostic
reasoning, which should be applied to each patient.
The surgical unit has initiated the use of a pain-rating scale to
assess patients' pain severity during their postoperative
recovery. The registered nurse (RN) looks at the pain flow sheet
to see the pain scores recorded for a patient over the last 24
hours. Use of the pain scale is an example of which intellectual
standard?
