Chapter 14, Clinical Judgment
Test Bank, Chapter Assignments, Discussions Plus Case Studies and Answers
Fundamentals of Nursing: The Art and Science of Person-Centered Care (10th Edition Taylor)
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
Answer: 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."
,Answer: 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
Answer: 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
Answer: 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
Answer: 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
Test Bank, Chapter Assignments, Discussions Plus Case Studies and Answers
Fundamentals of Nursing: The Art and Science of Person-Centered Care (10th Edition Taylor)
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
Answer: 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."
,Answer: 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
Answer: 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
Answer: 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
Answer: 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
