Test Bank: Winningham's Critical Thinking Cases in Nursing,
6th Edition
Comprehensive Examination – 210 Questions with Answers and
Rationales
PART I: FOUNDATIONS OF CRITICAL THINKING AND CLINICAL REASONING
Decision Making, Problem Solving, Critical Thinking, and Clinical Reasoning
1. A nurse is applying a decision-making process to a clinical challenge. When applying this
process, the nurse must:
A. Analyze the root causes of a situation
B. Choose a solution to a problem
C. Focus and filter information to determine what is most important
D. Form an opinion by comparing solutions through reasoning
Answer: B. Choose a solution to a problem
Rationale: Decision making requires choosing a solution to a problem. Reasoning is the
process by which a nurse is able to focus and filter information and determine what is
most important to consider. Judgment is the process of forming an opinion by comparing
solutions through reasoning.
2. The patient is complaining of severe incisional pain 2 days after surgery. The patient has
morphine ordered intravenously or by mouth. When the nurse chooses to give the
medication orally, this is an example of which thought process?
A. Decision making
B. Reasoning
C. Problem solving
D. Judgment
Answer: D. Judgment
Rationale: Judgment is the process of forming an opinion by comparing solutions
through reasoning. The nurse observes that the patient's pain level is not decreasing and
further assesses the pain level through discussions with the patient. The nurse concludes
that the oral route is appropriate in this situation.
3. Which action should the nurse take when using critical thinking to make clinical
decisions?
A. Make decisions based on intuition
, B. Accept one established way to provide care
C. Consider what is important in a given situation
D. Rely solely on textbook knowledge
Answer: C. Consider what is important in a given situation
Rationale: Critical thinking involves considering what is important in a given situation,
analyzing information, and making informed decisions. Intuition alone is insufficient, and
relying on a single established way or textbook knowledge does not account for the
unique aspects of each clinical situation.
4. A nurse is caring for a patient with newly diagnosed diabetes. The nurse uses critical
thinking to develop a teaching plan. Which component of critical thinking is the nurse
demonstrating?
A. Discipline
B. Creativity
C. Perseverance
D. Intellectual humility
Answer: A. Discipline
Rationale: Discipline in critical thinking involves being thorough in whatever you do.
Using known criteria for assessment and evaluation, as in the case of developing a
teaching plan for a patient with diabetes, is an example of discipline.
5. A nursing student is learning about the components of critical thinking. Which statement
by the student indicates a need for further teaching?
A. "Critical thinking requires the nurse to be open-minded"
B. "Critical thinking involves analyzing information before making decisions"
C. "Critical thinking means following the physician's orders without question"
D. "Critical thinking requires the nurse to reflect on their own thinking"
Answer: C. "Critical thinking means following the physician's orders without question"
Rationale: Critical thinking involves independent analysis, questioning, and reflection.
Following orders without question does not demonstrate critical thinking. The nurse
must evaluate all information and make informed decisions.
6. A nurse is prioritizing care for four patients. Which patient should the nurse assess first?
A. A patient with a newly elevated temperature of 100.2°F (37.9°C) and new-onset
agitation and confusion
B. A patient requesting pain medication for a 6/10 pain level
C. A patient who needs assistance with ambulation
D. A patient requesting water
Answer: A. A patient with a newly elevated temperature of 100.2°F (37.9°C) and new-
, onset agitation and confusion
Rationale: The patient with new-onset fever and confusion may be experiencing a
serious complication such as sepsis or infection. This patient should be assessed first as
they present with the most urgent and potentially life-threatening condition.
7. Which of the following is the most important remediable risk factor for cardiovascular
disease in older adults?
A. Smoking
B. Hypertension
C. Hyperlipidemia
D. Obesity
Answer: A. Smoking
Rationale: Smoking is considered the most important remediable risk factor for
cardiovascular disease in older adults. Smoking cessation significantly reduces
cardiovascular risk and is a modifiable behavior that can be addressed through nursing
interventions.
8. A nurse is using the nursing process to care for a patient. In which phase does the nurse
analyze data to identify patient problems?
A. Assessment
B. Diagnosis
C. Planning
D. Evaluation
Answer: B. Diagnosis
Rationale: In the diagnosis phase of the nursing process, the nurse analyzes assessment
data to identify patient problems (nursing diagnoses). Assessment involves collecting
data, planning involves developing interventions, and evaluation involves determining if
goals were met.
9. A patient is at risk for orthostatic hypotension. Which individual is likely at the highest
risk for this condition?
A. A 25-year-old athlete
B. A 45-year-old with hypertension
C. A 70-year-old taking multiple antihypertensive medications
D. A 30-year-old pregnant woman
Answer: C. A 70-year-old taking multiple antihypertensive medications
Rationale: Older adults taking multiple antihypertensive medications are at the highest
risk for orthostatic hypotension due to age-related changes in blood pressure regulation
and the cumulative effects of antihypertensive medications.
, 10. A nurse is evaluating a patient's understanding of their new medication regimen. Which
action demonstrates the nurse's use of critical thinking in evaluation?
A. Asking the patient to repeat the medication names
B. Observing the patient taking the medications correctly
C. Comparing the patient's current knowledge to expected outcomes
D. Documenting that teaching was provided
Answer: C. Comparing the patient's current knowledge to expected outcomes
Rationale: Evaluation in critical thinking involves comparing the patient's current status
or knowledge to expected outcomes. This allows the nurse to determine whether
interventions have been effective and whether adjustments are needed.
PART II: MEDICAL-SURGICAL NURSING CASE STUDIES
Cardiovascular Disorders
11. A patient with heart failure is experiencing shortness of breath and peripheral edema.
The nurse notes crackles in the lung bases. Which intervention should the nurse
implement first?
A. Administer oxygen
B. Elevate the head of the bed
C. Administer prescribed diuretics
D. Restrict fluid intake
Answer: B. Elevate the head of the bed
Rationale: Elevating the head of the bed helps reduce venous return to the heart and
decreases pulmonary congestion, which can relieve shortness of breath. This is a priority
intervention that can be implemented immediately while preparing for other
interventions.
12. A patient with myocardial infarction is receiving thrombolytic therapy. Which assessment
finding requires immediate intervention?
A. Chest pain rated 3/10
B. Heart rate of 88 beats/min
C. Blood pressure of 110/70 mmHg
D. Bleeding from the IV site
Answer: D. Bleeding from the IV site
Rationale: Bleeding is a major complication of thrombolytic therapy. Active bleeding
from the IV site requires immediate intervention, including applying pressure and
notifying the healthcare provider. Other findings are within acceptable ranges.
6th Edition
Comprehensive Examination – 210 Questions with Answers and
Rationales
PART I: FOUNDATIONS OF CRITICAL THINKING AND CLINICAL REASONING
Decision Making, Problem Solving, Critical Thinking, and Clinical Reasoning
1. A nurse is applying a decision-making process to a clinical challenge. When applying this
process, the nurse must:
A. Analyze the root causes of a situation
B. Choose a solution to a problem
C. Focus and filter information to determine what is most important
D. Form an opinion by comparing solutions through reasoning
Answer: B. Choose a solution to a problem
Rationale: Decision making requires choosing a solution to a problem. Reasoning is the
process by which a nurse is able to focus and filter information and determine what is
most important to consider. Judgment is the process of forming an opinion by comparing
solutions through reasoning.
2. The patient is complaining of severe incisional pain 2 days after surgery. The patient has
morphine ordered intravenously or by mouth. When the nurse chooses to give the
medication orally, this is an example of which thought process?
A. Decision making
B. Reasoning
C. Problem solving
D. Judgment
Answer: D. Judgment
Rationale: Judgment is the process of forming an opinion by comparing solutions
through reasoning. The nurse observes that the patient's pain level is not decreasing and
further assesses the pain level through discussions with the patient. The nurse concludes
that the oral route is appropriate in this situation.
3. Which action should the nurse take when using critical thinking to make clinical
decisions?
A. Make decisions based on intuition
, B. Accept one established way to provide care
C. Consider what is important in a given situation
D. Rely solely on textbook knowledge
Answer: C. Consider what is important in a given situation
Rationale: Critical thinking involves considering what is important in a given situation,
analyzing information, and making informed decisions. Intuition alone is insufficient, and
relying on a single established way or textbook knowledge does not account for the
unique aspects of each clinical situation.
4. A nurse is caring for a patient with newly diagnosed diabetes. The nurse uses critical
thinking to develop a teaching plan. Which component of critical thinking is the nurse
demonstrating?
A. Discipline
B. Creativity
C. Perseverance
D. Intellectual humility
Answer: A. Discipline
Rationale: Discipline in critical thinking involves being thorough in whatever you do.
Using known criteria for assessment and evaluation, as in the case of developing a
teaching plan for a patient with diabetes, is an example of discipline.
5. A nursing student is learning about the components of critical thinking. Which statement
by the student indicates a need for further teaching?
A. "Critical thinking requires the nurse to be open-minded"
B. "Critical thinking involves analyzing information before making decisions"
C. "Critical thinking means following the physician's orders without question"
D. "Critical thinking requires the nurse to reflect on their own thinking"
Answer: C. "Critical thinking means following the physician's orders without question"
Rationale: Critical thinking involves independent analysis, questioning, and reflection.
Following orders without question does not demonstrate critical thinking. The nurse
must evaluate all information and make informed decisions.
6. A nurse is prioritizing care for four patients. Which patient should the nurse assess first?
A. A patient with a newly elevated temperature of 100.2°F (37.9°C) and new-onset
agitation and confusion
B. A patient requesting pain medication for a 6/10 pain level
C. A patient who needs assistance with ambulation
D. A patient requesting water
Answer: A. A patient with a newly elevated temperature of 100.2°F (37.9°C) and new-
, onset agitation and confusion
Rationale: The patient with new-onset fever and confusion may be experiencing a
serious complication such as sepsis or infection. This patient should be assessed first as
they present with the most urgent and potentially life-threatening condition.
7. Which of the following is the most important remediable risk factor for cardiovascular
disease in older adults?
A. Smoking
B. Hypertension
C. Hyperlipidemia
D. Obesity
Answer: A. Smoking
Rationale: Smoking is considered the most important remediable risk factor for
cardiovascular disease in older adults. Smoking cessation significantly reduces
cardiovascular risk and is a modifiable behavior that can be addressed through nursing
interventions.
8. A nurse is using the nursing process to care for a patient. In which phase does the nurse
analyze data to identify patient problems?
A. Assessment
B. Diagnosis
C. Planning
D. Evaluation
Answer: B. Diagnosis
Rationale: In the diagnosis phase of the nursing process, the nurse analyzes assessment
data to identify patient problems (nursing diagnoses). Assessment involves collecting
data, planning involves developing interventions, and evaluation involves determining if
goals were met.
9. A patient is at risk for orthostatic hypotension. Which individual is likely at the highest
risk for this condition?
A. A 25-year-old athlete
B. A 45-year-old with hypertension
C. A 70-year-old taking multiple antihypertensive medications
D. A 30-year-old pregnant woman
Answer: C. A 70-year-old taking multiple antihypertensive medications
Rationale: Older adults taking multiple antihypertensive medications are at the highest
risk for orthostatic hypotension due to age-related changes in blood pressure regulation
and the cumulative effects of antihypertensive medications.
, 10. A nurse is evaluating a patient's understanding of their new medication regimen. Which
action demonstrates the nurse's use of critical thinking in evaluation?
A. Asking the patient to repeat the medication names
B. Observing the patient taking the medications correctly
C. Comparing the patient's current knowledge to expected outcomes
D. Documenting that teaching was provided
Answer: C. Comparing the patient's current knowledge to expected outcomes
Rationale: Evaluation in critical thinking involves comparing the patient's current status
or knowledge to expected outcomes. This allows the nurse to determine whether
interventions have been effective and whether adjustments are needed.
PART II: MEDICAL-SURGICAL NURSING CASE STUDIES
Cardiovascular Disorders
11. A patient with heart failure is experiencing shortness of breath and peripheral edema.
The nurse notes crackles in the lung bases. Which intervention should the nurse
implement first?
A. Administer oxygen
B. Elevate the head of the bed
C. Administer prescribed diuretics
D. Restrict fluid intake
Answer: B. Elevate the head of the bed
Rationale: Elevating the head of the bed helps reduce venous return to the heart and
decreases pulmonary congestion, which can relieve shortness of breath. This is a priority
intervention that can be implemented immediately while preparing for other
interventions.
12. A patient with myocardial infarction is receiving thrombolytic therapy. Which assessment
finding requires immediate intervention?
A. Chest pain rated 3/10
B. Heart rate of 88 beats/min
C. Blood pressure of 110/70 mmHg
D. Bleeding from the IV site
Answer: D. Bleeding from the IV site
Rationale: Bleeding is a major complication of thrombolytic therapy. Active bleeding
from the IV site requires immediate intervention, including applying pressure and
notifying the healthcare provider. Other findings are within acceptable ranges.
