NUR 6130 Exam 1 | Questions and Answers | Newest 2026 |
100% Correct - William Paterson University. - 149 Questions
Section 1: Nursing Process and Critical Thinking (Questions 1-15)
1 A nurse is caring for a patient with sepsis who develops acute kidney injury. The nurse notes a sudden drop in
urine output and an increase in serum creatinine. Which type of clinical reasoning is the nurse primarily using
when integrating these findings with the patient's history of hypertension and recent nephrotoxic antibiotic use?
A) Inductive reasoning, because the nurse is generating a hypothesis from specific observations.
B) Deductive reasoning, because the nurse is applying a general principle (sepsis can cause kidney injury) to a
specific case.
C) Intuitive reasoning, because the nurse relies on pattern recognition from past experiences.
D) Analogical reasoning, because the nurse compares the current case to a similar prior case.
Answer: B
Rationale: Deductive reasoning moves from general principles to specific instances. The nurse knows the general
principle that sepsis and nephrotoxic drugs can cause acute kidney injury; applying this to the patient's specific data
is deductive. Inductive reasoning would involve forming a general conclusion from many specific observations,
which is not the primary process here. Intuitive and analogical reasoning are less systematic and not the main
cognitive strategy in this scenario.
2 During a post-shift debriefing, a novice nurse states, 'I noticed the patient's heart rate increased after the blood
transfusion, so I stopped the transfusion immediately.' The preceptor asks the nurse to explain the reasoning.
Which critical thinking component is the preceptor fostering?
A) Reflection-on-action, because the nurse is analyzing the event after it occurred.
B) Reflection-in-action, because the nurse thought during the event.
C) Clinical inquiry, because the nurse is questioning the cause of the tachycardia.
D) Metacognition, because the nurse is thinking about their own thought process.
Answer: A
Rationale: Reflection-on-action occurs after an event, where the nurse reviews and analyzes what happened, what
was done, and why. The preceptor's request for explanation encourages this retrospective analysis.
Reflection-in-action happens during the event (the nurse did think to stop the transfusion, but the debriefing is
after). Clinical inquiry is about questioning evidence, and metacognition is awareness of one's own thinking, but
the specific action here is post-event analysis.
3 A nursing student is assessing a patient with chest pain. The student collects data on vital signs, ECG changes,
and pain characteristics, then formulates a hypothesis of acute myocardial infarction. Which phase of Tanner's
Clinical Judgment Model does this represent?
A) Noticing, because the student is gathering initial cues.
B) Interpreting, because the student is making sense of the data.
C) Responding, because the student decides to treat the pain.
D) Reflecting, because the student evaluates the outcome.
Answer: B
Rationale: In Tanner's model, 'Interpreting' involves analyzing the data to form a hypothesis or explanation. The
student gathers data (Noticing) and then interprets it to hypothesize MI. 'Responding' is the action taken, and
'Reflecting' is the evaluation afterward. The question specifically asks about the phase of forming the hypothesis,
,which is Interpreting.
4 A nurse is using the nursing process to care for a patient with heart failure. The nurse identifies the nursing
diagnosis 'Excess Fluid Volume related to decreased cardiac output.' Which step of the nursing process involves
validating this diagnosis with the patient's subjective report of shortness of breath and objective findings of
edema and crackles?
A) Assessment, because data collection is ongoing.
B) Diagnosis, because the nurse is analyzing data to form a diagnosis.
C) Planning, because the nurse is setting goals.
D) Implementation, because the nurse is carrying out interventions.
Answer: B
Rationale: The nursing diagnosis phase includes analysis and validation of data to formulate a nursing diagnosis.
Validating the diagnosis by comparing subjective and objective data is a key part of this phase. Assessment is the
collection of data, but validation occurs during diagnosis. Planning and implementation come after the diagnosis is
established.
5 A nurse is evaluating the effectiveness of a pain management plan for a postoperative patient. The patient rates
pain as 3/10, but the nurse observes grimacing and splinting. Which critical thinking action should the nurse
take?
A) Accept the patient's self-report as the gold standard and document pain as 3/10.
B) Reassess pain using a different pain scale and consider behavioral indicators.
C) Increase the analgesic dose based solely on the behavioral observations.
D) Document the discrepancy and refer the patient to a pain specialist.
Answer: B
Rationale: Critical thinking requires reconciling conflicting data. Self-report is primary, but behavioral cues may
indicate underreported pain. Reassessing with a different tool (e.g., behavioral scale) helps clarify. Accepting only
self-report ignores important cues; increasing dose without reassessment is unsafe; referral may be premature
without further assessment.
6 A nurse is prioritizing care for four patients: one with unstable angina, one with a new colostomy, one with
pneumonia and hypoxia, and one with a fractured hip awaiting surgery. Using the ABCDE framework, which
patient should the nurse see first?
A) The patient with unstable angina, because chest pain indicates cardiac compromise.
B) The patient with pneumonia and hypoxia, because oxygenation is the priority.
C) The patient with a new colostomy, because of risk for infection and education needs.
D) The patient with a fractured hip, because surgery may be delayed.
Answer: B
Rationale: ABCDE prioritization (Airway, Breathing, Circulation, Disability, Exposure) places breathing and
oxygenation as top priorities after airway. Hypoxia indicates a breathing problem that can rapidly deteriorate.
Unstable angina is a circulation issue but is secondary to hypoxia. Colostomy and hip fracture are important but not
immediately life-threatening compared to hypoxia.
7 A nurse is developing a plan of care for a patient with chronic obstructive pulmonary disease (COPD). The
nurse writes the goal: 'Patient will ambulate 50 feet without dyspnea by day 3.' Which critical thinking error is
most evident in this goal?
A) The goal is not measurable, because 'without dyspnea' is subjective.
B) The goal is not realistic, given the patient's baseline oxygen saturation.
,C) The goal is not time-bound, because 'day 3' is too vague.
D) The goal is not patient-centered, because it does not involve the patient's input.
Answer: B
Rationale: For a patient with COPD, ambulating 50 feet without dyspnea is likely unrealistic, especially if the
patient has baseline hypoxemia or severe disease. Goals must be realistic based on patient status. While 'without
dyspnea' is somewhat subjective, it can be measured via patient report. The goal is time-bound (day 3) and could be
patient-centered if discussed, but the main flaw is lack of realism.
8 A nurse is using the Clinical Decision Support System (CDSS) integrated into the electronic health record. The
CDSS alerts the nurse that a patient's potassium level is 6.2 mEq/L and suggests administering calcium
gluconate. Which critical thinking step must the nurse perform before implementing the suggestion?
A) Verify the potassium level by redrawing blood and checking for hemolysis.
B) Administer the calcium gluconate immediately because the alert is evidence-based.
C) Document the alert and proceed with the suggested intervention.
D) Consult the prescriber only if the patient shows ECG changes.
Answer: A
Rationale: Critical thinking requires verification of abnormal results before acting, as lab errors (e.g., hemolysis) can
cause false elevations. CDSS alerts are aids, not substitutes for clinical judgment. Immediate administration
without verification could harm the patient if the potassium is actually normal. Consulting the prescriber is
appropriate after verification, but not before.
9 A nurse is teaching a patient about self-management of diabetes. The nurse uses the 'teach-back' method to
confirm understanding. Which critical thinking strategy does this exemplify?
A) Using evidence-based practice, because teach-back is supported by research.
B) Evaluating the outcome of the teaching intervention.
C) Assessing the patient's learning needs before teaching.
D) Planning the teaching based on the patient's health literacy.
Answer: B
Rationale: Teach-back is a method to evaluate whether the patient understood the information. It is part of the
evaluation phase of the nursing process, not assessment or planning. While it is evidence-based, the question asks
what strategy it exemplifies in critical thinking-evaluation of the teaching outcome.
10 A nurse is caring for a patient with diabetic ketoacidosis (DKA). The nurse notes that the patient's serum
glucose is 450 mg/dL, potassium is 5.5 mEq/L, and arterial pH is 7.1. The provider prescribes intravenous
fluids and insulin. Which nursing action demonstrates critical thinking in the implementation phase?
A) Starting insulin infusion immediately without checking potassium again.
B) Administering potassium replacement along with insulin to prevent hypokalemia.
C) Waiting for the blood glucose to drop below 250 mg/dL before starting insulin.
D) Giving sodium bicarbonate to correct the acidosis before insulin.
Answer: B
Rationale: In DKA, insulin drives potassium into cells, causing hypokalemia. The initial potassium is elevated (5.5)
due to acidosis, but as insulin works, potassium drops. Critical thinking anticipates this and ensures potassium
replacement is available or administered to prevent dangerous hypokalemia. Starting insulin without potassium
monitoring is risky; waiting for glucose to drop is incorrect (insulin is needed to stop ketogenesis); sodium
bicarbonate is not routinely recommended and may worsen intracellular acidosis.
, 11 A nurse is evaluating a patient's response to a complex care regimen. The patient has achieved some goals but
not others, and new clinical data suggest a shift in priorities. According to the nursing process, which action
best demonstrates critical thinking in this situation?
A) Document the unmet goals and continue the existing plan unchanged until the next evaluation cycle.
B) Reassess the patient, identify new patterns, and modify the care plan to reflect current priorities.
C) Consult with the healthcare provider to request additional diagnostic tests before altering any interventions.
D) Discontinue all interventions that have not yet achieved their goals to avoid unnecessary care.
Answer: B
Rationale: Critical thinking in the nursing process requires continuous reassessment and adaptation. Option B
reflects the iterative nature of the process-using new data to revise the plan. Option A fails to respond to new
evidence; C delays action unnecessarily; D is premature and may eliminate beneficial interventions.
12 During a patient handoff, a nurse reports that a patient's pain level has increased from 3 to 7 on a 0-10 scale
over the past hour, despite receiving prescribed analgesics. Using critical thinking, what should the receiving
nurse prioritize first?
A) Administer an additional dose of the prescribed PRN analgesic immediately.
B) Reassess the patient's pain characteristics, vital signs, and potential causes before intervening.
C) Notify the healthcare provider of the change and await new orders.
D) Review the patient's medication administration record to ensure the previous dose was given correctly.
Answer: B
Rationale: Critical thinking requires a systematic assessment before action. Option B ensures the nurse gathers data
to understand the pain's etiology, which may indicate a complication. Option A is premature without reassessment;
C delays while the patient is in distress; D is a component but not the priority.
13 A nurse is developing a plan of care for a patient with multiple chronic conditions. The patient expresses
conflicting goals: wanting to maintain independence but also needing assistance with daily activities. Which
critical thinking approach best addresses this situation?
A) Prioritize the patient's safety above all other goals and implement full assistance.
B) Collaborate with the patient to identify mutually acceptable outcomes that balance autonomy and support.
C) Refer the patient to social work for decision-making, as the conflict is beyond nursing scope.
D) Document the conflict and proceed with the plan that maximizes clinical efficiency.
Answer: B
Rationale: Critical thinking involves patient-centered care and shared decision-making. Option B respects patient
autonomy while addressing safety through negotiation. Option A disregards patient preferences; C abdicates
nursing responsibility; D ignores the patient's values.
14 A nurse is reviewing a patient's laboratory results and notes a serum potassium level of 5.8 mEq/L. The
patient's vital signs are stable, and the ECG shows no acute changes. Using critical thinking, what is the nurse's
most appropriate initial action?
A) Administer sodium polystyrene sulfonate as prescribed for hyperkalemia.
B) Recheck the potassium level with a new blood sample to rule out hemolysis.
C) Immediately notify the healthcare provider and prepare for dialysis.
D) Document the result as an expected finding and continue monitoring.
Answer: B
Rationale: Critical thinking includes verifying unexpected results before acting. Hemolysis can cause spurious
hyperkalemia. Option B is a prudent first step. Option A may be unnecessary; C is premature; D ignores a
potentially critical value.
100% Correct - William Paterson University. - 149 Questions
Section 1: Nursing Process and Critical Thinking (Questions 1-15)
1 A nurse is caring for a patient with sepsis who develops acute kidney injury. The nurse notes a sudden drop in
urine output and an increase in serum creatinine. Which type of clinical reasoning is the nurse primarily using
when integrating these findings with the patient's history of hypertension and recent nephrotoxic antibiotic use?
A) Inductive reasoning, because the nurse is generating a hypothesis from specific observations.
B) Deductive reasoning, because the nurse is applying a general principle (sepsis can cause kidney injury) to a
specific case.
C) Intuitive reasoning, because the nurse relies on pattern recognition from past experiences.
D) Analogical reasoning, because the nurse compares the current case to a similar prior case.
Answer: B
Rationale: Deductive reasoning moves from general principles to specific instances. The nurse knows the general
principle that sepsis and nephrotoxic drugs can cause acute kidney injury; applying this to the patient's specific data
is deductive. Inductive reasoning would involve forming a general conclusion from many specific observations,
which is not the primary process here. Intuitive and analogical reasoning are less systematic and not the main
cognitive strategy in this scenario.
2 During a post-shift debriefing, a novice nurse states, 'I noticed the patient's heart rate increased after the blood
transfusion, so I stopped the transfusion immediately.' The preceptor asks the nurse to explain the reasoning.
Which critical thinking component is the preceptor fostering?
A) Reflection-on-action, because the nurse is analyzing the event after it occurred.
B) Reflection-in-action, because the nurse thought during the event.
C) Clinical inquiry, because the nurse is questioning the cause of the tachycardia.
D) Metacognition, because the nurse is thinking about their own thought process.
Answer: A
Rationale: Reflection-on-action occurs after an event, where the nurse reviews and analyzes what happened, what
was done, and why. The preceptor's request for explanation encourages this retrospective analysis.
Reflection-in-action happens during the event (the nurse did think to stop the transfusion, but the debriefing is
after). Clinical inquiry is about questioning evidence, and metacognition is awareness of one's own thinking, but
the specific action here is post-event analysis.
3 A nursing student is assessing a patient with chest pain. The student collects data on vital signs, ECG changes,
and pain characteristics, then formulates a hypothesis of acute myocardial infarction. Which phase of Tanner's
Clinical Judgment Model does this represent?
A) Noticing, because the student is gathering initial cues.
B) Interpreting, because the student is making sense of the data.
C) Responding, because the student decides to treat the pain.
D) Reflecting, because the student evaluates the outcome.
Answer: B
Rationale: In Tanner's model, 'Interpreting' involves analyzing the data to form a hypothesis or explanation. The
student gathers data (Noticing) and then interprets it to hypothesize MI. 'Responding' is the action taken, and
'Reflecting' is the evaluation afterward. The question specifically asks about the phase of forming the hypothesis,
,which is Interpreting.
4 A nurse is using the nursing process to care for a patient with heart failure. The nurse identifies the nursing
diagnosis 'Excess Fluid Volume related to decreased cardiac output.' Which step of the nursing process involves
validating this diagnosis with the patient's subjective report of shortness of breath and objective findings of
edema and crackles?
A) Assessment, because data collection is ongoing.
B) Diagnosis, because the nurse is analyzing data to form a diagnosis.
C) Planning, because the nurse is setting goals.
D) Implementation, because the nurse is carrying out interventions.
Answer: B
Rationale: The nursing diagnosis phase includes analysis and validation of data to formulate a nursing diagnosis.
Validating the diagnosis by comparing subjective and objective data is a key part of this phase. Assessment is the
collection of data, but validation occurs during diagnosis. Planning and implementation come after the diagnosis is
established.
5 A nurse is evaluating the effectiveness of a pain management plan for a postoperative patient. The patient rates
pain as 3/10, but the nurse observes grimacing and splinting. Which critical thinking action should the nurse
take?
A) Accept the patient's self-report as the gold standard and document pain as 3/10.
B) Reassess pain using a different pain scale and consider behavioral indicators.
C) Increase the analgesic dose based solely on the behavioral observations.
D) Document the discrepancy and refer the patient to a pain specialist.
Answer: B
Rationale: Critical thinking requires reconciling conflicting data. Self-report is primary, but behavioral cues may
indicate underreported pain. Reassessing with a different tool (e.g., behavioral scale) helps clarify. Accepting only
self-report ignores important cues; increasing dose without reassessment is unsafe; referral may be premature
without further assessment.
6 A nurse is prioritizing care for four patients: one with unstable angina, one with a new colostomy, one with
pneumonia and hypoxia, and one with a fractured hip awaiting surgery. Using the ABCDE framework, which
patient should the nurse see first?
A) The patient with unstable angina, because chest pain indicates cardiac compromise.
B) The patient with pneumonia and hypoxia, because oxygenation is the priority.
C) The patient with a new colostomy, because of risk for infection and education needs.
D) The patient with a fractured hip, because surgery may be delayed.
Answer: B
Rationale: ABCDE prioritization (Airway, Breathing, Circulation, Disability, Exposure) places breathing and
oxygenation as top priorities after airway. Hypoxia indicates a breathing problem that can rapidly deteriorate.
Unstable angina is a circulation issue but is secondary to hypoxia. Colostomy and hip fracture are important but not
immediately life-threatening compared to hypoxia.
7 A nurse is developing a plan of care for a patient with chronic obstructive pulmonary disease (COPD). The
nurse writes the goal: 'Patient will ambulate 50 feet without dyspnea by day 3.' Which critical thinking error is
most evident in this goal?
A) The goal is not measurable, because 'without dyspnea' is subjective.
B) The goal is not realistic, given the patient's baseline oxygen saturation.
,C) The goal is not time-bound, because 'day 3' is too vague.
D) The goal is not patient-centered, because it does not involve the patient's input.
Answer: B
Rationale: For a patient with COPD, ambulating 50 feet without dyspnea is likely unrealistic, especially if the
patient has baseline hypoxemia or severe disease. Goals must be realistic based on patient status. While 'without
dyspnea' is somewhat subjective, it can be measured via patient report. The goal is time-bound (day 3) and could be
patient-centered if discussed, but the main flaw is lack of realism.
8 A nurse is using the Clinical Decision Support System (CDSS) integrated into the electronic health record. The
CDSS alerts the nurse that a patient's potassium level is 6.2 mEq/L and suggests administering calcium
gluconate. Which critical thinking step must the nurse perform before implementing the suggestion?
A) Verify the potassium level by redrawing blood and checking for hemolysis.
B) Administer the calcium gluconate immediately because the alert is evidence-based.
C) Document the alert and proceed with the suggested intervention.
D) Consult the prescriber only if the patient shows ECG changes.
Answer: A
Rationale: Critical thinking requires verification of abnormal results before acting, as lab errors (e.g., hemolysis) can
cause false elevations. CDSS alerts are aids, not substitutes for clinical judgment. Immediate administration
without verification could harm the patient if the potassium is actually normal. Consulting the prescriber is
appropriate after verification, but not before.
9 A nurse is teaching a patient about self-management of diabetes. The nurse uses the 'teach-back' method to
confirm understanding. Which critical thinking strategy does this exemplify?
A) Using evidence-based practice, because teach-back is supported by research.
B) Evaluating the outcome of the teaching intervention.
C) Assessing the patient's learning needs before teaching.
D) Planning the teaching based on the patient's health literacy.
Answer: B
Rationale: Teach-back is a method to evaluate whether the patient understood the information. It is part of the
evaluation phase of the nursing process, not assessment or planning. While it is evidence-based, the question asks
what strategy it exemplifies in critical thinking-evaluation of the teaching outcome.
10 A nurse is caring for a patient with diabetic ketoacidosis (DKA). The nurse notes that the patient's serum
glucose is 450 mg/dL, potassium is 5.5 mEq/L, and arterial pH is 7.1. The provider prescribes intravenous
fluids and insulin. Which nursing action demonstrates critical thinking in the implementation phase?
A) Starting insulin infusion immediately without checking potassium again.
B) Administering potassium replacement along with insulin to prevent hypokalemia.
C) Waiting for the blood glucose to drop below 250 mg/dL before starting insulin.
D) Giving sodium bicarbonate to correct the acidosis before insulin.
Answer: B
Rationale: In DKA, insulin drives potassium into cells, causing hypokalemia. The initial potassium is elevated (5.5)
due to acidosis, but as insulin works, potassium drops. Critical thinking anticipates this and ensures potassium
replacement is available or administered to prevent dangerous hypokalemia. Starting insulin without potassium
monitoring is risky; waiting for glucose to drop is incorrect (insulin is needed to stop ketogenesis); sodium
bicarbonate is not routinely recommended and may worsen intracellular acidosis.
, 11 A nurse is evaluating a patient's response to a complex care regimen. The patient has achieved some goals but
not others, and new clinical data suggest a shift in priorities. According to the nursing process, which action
best demonstrates critical thinking in this situation?
A) Document the unmet goals and continue the existing plan unchanged until the next evaluation cycle.
B) Reassess the patient, identify new patterns, and modify the care plan to reflect current priorities.
C) Consult with the healthcare provider to request additional diagnostic tests before altering any interventions.
D) Discontinue all interventions that have not yet achieved their goals to avoid unnecessary care.
Answer: B
Rationale: Critical thinking in the nursing process requires continuous reassessment and adaptation. Option B
reflects the iterative nature of the process-using new data to revise the plan. Option A fails to respond to new
evidence; C delays action unnecessarily; D is premature and may eliminate beneficial interventions.
12 During a patient handoff, a nurse reports that a patient's pain level has increased from 3 to 7 on a 0-10 scale
over the past hour, despite receiving prescribed analgesics. Using critical thinking, what should the receiving
nurse prioritize first?
A) Administer an additional dose of the prescribed PRN analgesic immediately.
B) Reassess the patient's pain characteristics, vital signs, and potential causes before intervening.
C) Notify the healthcare provider of the change and await new orders.
D) Review the patient's medication administration record to ensure the previous dose was given correctly.
Answer: B
Rationale: Critical thinking requires a systematic assessment before action. Option B ensures the nurse gathers data
to understand the pain's etiology, which may indicate a complication. Option A is premature without reassessment;
C delays while the patient is in distress; D is a component but not the priority.
13 A nurse is developing a plan of care for a patient with multiple chronic conditions. The patient expresses
conflicting goals: wanting to maintain independence but also needing assistance with daily activities. Which
critical thinking approach best addresses this situation?
A) Prioritize the patient's safety above all other goals and implement full assistance.
B) Collaborate with the patient to identify mutually acceptable outcomes that balance autonomy and support.
C) Refer the patient to social work for decision-making, as the conflict is beyond nursing scope.
D) Document the conflict and proceed with the plan that maximizes clinical efficiency.
Answer: B
Rationale: Critical thinking involves patient-centered care and shared decision-making. Option B respects patient
autonomy while addressing safety through negotiation. Option A disregards patient preferences; C abdicates
nursing responsibility; D ignores the patient's values.
14 A nurse is reviewing a patient's laboratory results and notes a serum potassium level of 5.8 mEq/L. The
patient's vital signs are stable, and the ECG shows no acute changes. Using critical thinking, what is the nurse's
most appropriate initial action?
A) Administer sodium polystyrene sulfonate as prescribed for hyperkalemia.
B) Recheck the potassium level with a new blood sample to rule out hemolysis.
C) Immediately notify the healthcare provider and prepare for dialysis.
D) Document the result as an expected finding and continue monitoring.
Answer: B
Rationale: Critical thinking includes verifying unexpected results before acting. Hemolysis can cause spurious
hyperkalemia. Option B is a prudent first step. Option A may be unnecessary; C is premature; D ignores a
potentially critical value.
