Clinical Decision-Making Review Questions with Answers and Rationales

A nurse working in the emergency department uses a clinical decision tree to determine the best course of action for a client who presents with signs and symptoms of a myocardial infarction (MI). Which statements are true regarding this clinical decision tool? (Select all that apply.) Rationale Clinical decision trees and protocols can assist in decision making, especially for nurses who do not have enough nursing experience, or nursing knowledge, to make decisions. This tool can assist in standardizing care because the tool can be used for all clients who present with similar symptoms. Because the tool has steps of decisions presented, it does not require higher-level decision making. However, the tool still requires some decision making by the nurse to ensure interventions are appropriate for the client. Question is complete. It requires no decision making. It requires standardization of care. Your answer is correct. It can assist in decision making. Your answer is correct. It cannot be implemented by all nurses. It requires higher-level decision making. Which clinical situation best exemplifies a nurse who is choosing between alternatives when making a clinical decision? Rationale The nurse who administers an IV narcotic instead of an oral narcotic is choosing between alternatives. The nurse who helps the client change position numerous times is using trial and error. The nurse acting on a "gut reaction" is using intuition. The nurse determining the nursing diagnosis is utilizing the nursing process. Question is complete. The nurse determines the client's nursing diagnosis is acute pain. The nurse administers an IV narcotic instead of an oral narcotic. Your answer is correct. The nurse has a "gut reaction" to the client's pain and calls the client's physician. The nurse changes the client's position numerous times until the client appears in less pain. A nurse is caring for a toddler who appears frightened by the nurse. To make the child more at ease, the nurse gives the toddler a disposable tape measure to play with. Which critical thinking concept is the nurse using? Rationale The nurse is using creativity, or finding a solution by using a method that is unconventional. In this case, the nurse is "thinking outside the box" to let the toddler play and put the child at e