CLINCAL
JUDGEMENT/COMMUNICATION RNSG
1125 EXAM QUESTIONS AND ANSWERS
Read the following patient scenario and identify the step of the nursing process
represented by each numbered and boldfaced nursing activity.
Annie seeks the help of the nurse in the student health clinic because she suspects that
her roommate, Angela, suffered date rape. She is concerned because Angela chose not
to report the rape and does not seem to be coping well. (1) After talking with Annie, the
nurse learns that although Angela blurted out that she had been raped when she first
came home, since then she has refused verbalization about the rape ("I don't want to
think or talk about it"), has stopped attending all college social activities (a marked
change in behavior), and seems to be having nightmares. After analyzing the data, the
nurse believes that Angela might be experiencing (2) rape-trauma syndrome: silent
reaction. Fortunately, Angela trusts Annie and is willing to come to the student health
center for - ANSWER-(1) is an illustration of assessing: the collection of patient data. (2)
is an illustration of the identification of a nursing diagnosis: a health problem that
independent nursing intervention can resolve. (3) is an illustration of planning: outcome
identification and related nursing interventions. (4) is an illustration of implementing:
carrying out the care plan. (5) is an illustration of evaluating: measuring the extent to
which Angela has achieved targeted outcomes.
A female patient who is receiving chemotherapy for breast cancer tells the nurse, "The
treatment for this cancer is worse than the disease itself. I'm not going to come for my
therapy anymore." The nurse responds by using critical thinking skills to address this
patient problem. Which action is the first step the nurse would take in this process?
A. The nurse judges whether the patient database is adequate to address the problem.
B. The nurse considers whether or not to suggest a counseling session for the patient.
C. The nurse reassesses the patient and decides how best to intervene in her care.
D. The nurse identifies several options for intervening in the patient's care and critiques
the merit of each option. - ANSWER-c. The first step when thinking critically about a
situation is to identify the purpose or goal of your thinking. Reassessing the patient
helps to discipline thinking by directing all thoughts toward the goal. Once the problem
is addressed, it is important for the nurse to judge the adequacy of the knowledge,
identify potential problems, use helpful resources, and critique the decision.
The nursing process ensures that nurses are person centered rather than task
centered. Rather than simply approaching a patient to take vital signs, the nurse thinks,
"How is Mrs. Barclay today? Are our nursing actions helping her to achieve her goals?
How can we better help her?" This demonstrates which characteristic of the nursing
process?
A. Systematic
,B. Interpersonal
C. Dynamic
D. Universally applicable in nursing situations - ANSWER-b. Interpersonal. All of the
other options are characteristics of the nursing process, but the conversation and
thinking quoted best illustrates the interpersonal dimension of the nursing process.
A nurse is caring for a patient who has complications related to type 2 diabetes mellitus.
The nurse researches new procedures to care for foot ulcers when developing a care
plan for this patient. Which QSEN competency does this action represent?
A. Patient-centered care
B. Evidence-based practice
C. Quality improvement
D. Informatics - ANSWER-c. Quality improvement involves routinely updating nursing
policies and procedures. Providing patient-centered care involves listening to the patient
and demonstrating respect and compassion. Evidence-based practice is used when
adhering to internal policies and standardized skills. The nurse is employing informatics
by using information and technology to communicate, manage knowledge, and support
decision making.
A nurse is assessing a patient who is diagnosed with anorexia. Following the
assessment, the nurse recommends that the patient meet with a nutritionist. This action
best exemplifies the use of:
A. Clinical judgment
B. Clinical reasoning
C. Critical thinking
D. Blended competencies - ANSWER-a. Although all the options refer to the skills used
by nurses in practice, the best choice is clinical judgment as it refers to the result or
outcome of critical thinking or clinical reasoning—in this case, the recommendation to
meet with a nutritionist. Clinical reasoning usually refers to ways of thinking about
patient care issues (determining, preventing, and managing patient problems). Critical
thinking is a broad term that includes reasoning both outside and inside of the clinical
setting. Blended competencies are the cognitive, technical, interpersonal, and ethical
and legal skills combined with the willingness to use them creatively and critically when
working with patients.
An experienced nurse tells a beginning nurse not to bother studying too hard, since
most clinical reasoning becomes "second nature" and "intuitive" once you start
practicing. What thinking below should underlie the beginning nurse's response?
A. Intuitive problem solving comes with years of practice and observation, and novice
nurses should base their care on scientific problem solving.
B. For nursing to remain a science, nurses must continue to be vigilant about stamping
out intuitive reasoning.
C. The emphasis on logical, scientific, evidence-based reasoning has held nursing back
for years; it is time to champion intuitive, creative thinking!
, D. It is simply a matter of preference; some nurses are logical, scientific thinkers, and
some are intuitive, creative thinkers. - ANSWER-a. Beginning nurses must use nursing
knowledge and scientific problem solving as the basis of care they give; intuitive
problem solving comes with years of practice and observation. If the beginning nurse
has an intuition about a patient, that information should be discussed with the faculty
member, preceptor, or supervisor. Answer b is incorrect because there is a place for
intuitive reasoning in nursing, but it will never replace logical, scientific reasoning.
Critical thinking is contextual and changes depending on the circumstances, not on
personal preference.
The nurse uses blended competencies when caring for patients in a rehabilitation
facility. Which examples of interventions involve cognitive skills? Select all that apply.
A. The nurse uses critical thinking skills to plan care for a patient.
B. The nurse correctly administers IV saline to a patient who is dehydrated.
C. The nurse assists a patient to fill out an informed consent form.
D. The nurse learns the correct dosages for patient pain medications.
E. The nurse comforts a mother whose baby was born with Down syndrome.
F. The nurse uses the proper procedure to catheterize a female patient. - ANSWER-a,
d. Using critical thinking and learning medication dosages are cognitive competencies.
Performing procedures correctly is a technical skill, helping a patient with an informed
consent form is a legal/ethical issue, and comforting a patient is an interpersonal skill.
A nurse uses critical thinking skills to focus on the care plan of an older adult who has
dementia and needs placement in a long-term care facility. Which statements describe
characteristics of this type of critical thinking applied to clinical reasoning? Select all that
apply.
A. It functions independently of nursing standards, ethics, and state practice acts.
B. It is based on the principles of the nursing process, problem solving, and the
scientific method.
C. It is driven by patient, family, and community needs as well as nurses' needs to give
competent, efficient care.
D. It is not designed to compensate for problems created by human nature, such as
medication errors.
E. It is constantly re-evaluating, self-correcting, and striving for improvement.
It focuses on the big picture rather than identifying the key problems, issues, and risks
involved with patient care. - ANSWER-b, c, e. Critical thinking applied to clinical
reasoning and judgment in nursing practice is guided by standards, policies and
procedures, and ethics codes. It is based on principles of nursing process, problem
solving, and the scientific method. It carefully identifies the key problems, issues, and
risks involved, and is driven by patient, family, and community needs, as well as nurses'
needs to give competent, efficient care. It also calls for strategies that make the most of
human potential and compensate for problems created by human nature. It is constantly
re-evaluating, self-correcting, and striving to improve
JUDGEMENT/COMMUNICATION RNSG
1125 EXAM QUESTIONS AND ANSWERS
Read the following patient scenario and identify the step of the nursing process
represented by each numbered and boldfaced nursing activity.
Annie seeks the help of the nurse in the student health clinic because she suspects that
her roommate, Angela, suffered date rape. She is concerned because Angela chose not
to report the rape and does not seem to be coping well. (1) After talking with Annie, the
nurse learns that although Angela blurted out that she had been raped when she first
came home, since then she has refused verbalization about the rape ("I don't want to
think or talk about it"), has stopped attending all college social activities (a marked
change in behavior), and seems to be having nightmares. After analyzing the data, the
nurse believes that Angela might be experiencing (2) rape-trauma syndrome: silent
reaction. Fortunately, Angela trusts Annie and is willing to come to the student health
center for - ANSWER-(1) is an illustration of assessing: the collection of patient data. (2)
is an illustration of the identification of a nursing diagnosis: a health problem that
independent nursing intervention can resolve. (3) is an illustration of planning: outcome
identification and related nursing interventions. (4) is an illustration of implementing:
carrying out the care plan. (5) is an illustration of evaluating: measuring the extent to
which Angela has achieved targeted outcomes.
A female patient who is receiving chemotherapy for breast cancer tells the nurse, "The
treatment for this cancer is worse than the disease itself. I'm not going to come for my
therapy anymore." The nurse responds by using critical thinking skills to address this
patient problem. Which action is the first step the nurse would take in this process?
A. The nurse judges whether the patient database is adequate to address the problem.
B. The nurse considers whether or not to suggest a counseling session for the patient.
C. The nurse reassesses the patient and decides how best to intervene in her care.
D. The nurse identifies several options for intervening in the patient's care and critiques
the merit of each option. - ANSWER-c. The first step when thinking critically about a
situation is to identify the purpose or goal of your thinking. Reassessing the patient
helps to discipline thinking by directing all thoughts toward the goal. Once the problem
is addressed, it is important for the nurse to judge the adequacy of the knowledge,
identify potential problems, use helpful resources, and critique the decision.
The nursing process ensures that nurses are person centered rather than task
centered. Rather than simply approaching a patient to take vital signs, the nurse thinks,
"How is Mrs. Barclay today? Are our nursing actions helping her to achieve her goals?
How can we better help her?" This demonstrates which characteristic of the nursing
process?
A. Systematic
,B. Interpersonal
C. Dynamic
D. Universally applicable in nursing situations - ANSWER-b. Interpersonal. All of the
other options are characteristics of the nursing process, but the conversation and
thinking quoted best illustrates the interpersonal dimension of the nursing process.
A nurse is caring for a patient who has complications related to type 2 diabetes mellitus.
The nurse researches new procedures to care for foot ulcers when developing a care
plan for this patient. Which QSEN competency does this action represent?
A. Patient-centered care
B. Evidence-based practice
C. Quality improvement
D. Informatics - ANSWER-c. Quality improvement involves routinely updating nursing
policies and procedures. Providing patient-centered care involves listening to the patient
and demonstrating respect and compassion. Evidence-based practice is used when
adhering to internal policies and standardized skills. The nurse is employing informatics
by using information and technology to communicate, manage knowledge, and support
decision making.
A nurse is assessing a patient who is diagnosed with anorexia. Following the
assessment, the nurse recommends that the patient meet with a nutritionist. This action
best exemplifies the use of:
A. Clinical judgment
B. Clinical reasoning
C. Critical thinking
D. Blended competencies - ANSWER-a. Although all the options refer to the skills used
by nurses in practice, the best choice is clinical judgment as it refers to the result or
outcome of critical thinking or clinical reasoning—in this case, the recommendation to
meet with a nutritionist. Clinical reasoning usually refers to ways of thinking about
patient care issues (determining, preventing, and managing patient problems). Critical
thinking is a broad term that includes reasoning both outside and inside of the clinical
setting. Blended competencies are the cognitive, technical, interpersonal, and ethical
and legal skills combined with the willingness to use them creatively and critically when
working with patients.
An experienced nurse tells a beginning nurse not to bother studying too hard, since
most clinical reasoning becomes "second nature" and "intuitive" once you start
practicing. What thinking below should underlie the beginning nurse's response?
A. Intuitive problem solving comes with years of practice and observation, and novice
nurses should base their care on scientific problem solving.
B. For nursing to remain a science, nurses must continue to be vigilant about stamping
out intuitive reasoning.
C. The emphasis on logical, scientific, evidence-based reasoning has held nursing back
for years; it is time to champion intuitive, creative thinking!
, D. It is simply a matter of preference; some nurses are logical, scientific thinkers, and
some are intuitive, creative thinkers. - ANSWER-a. Beginning nurses must use nursing
knowledge and scientific problem solving as the basis of care they give; intuitive
problem solving comes with years of practice and observation. If the beginning nurse
has an intuition about a patient, that information should be discussed with the faculty
member, preceptor, or supervisor. Answer b is incorrect because there is a place for
intuitive reasoning in nursing, but it will never replace logical, scientific reasoning.
Critical thinking is contextual and changes depending on the circumstances, not on
personal preference.
The nurse uses blended competencies when caring for patients in a rehabilitation
facility. Which examples of interventions involve cognitive skills? Select all that apply.
A. The nurse uses critical thinking skills to plan care for a patient.
B. The nurse correctly administers IV saline to a patient who is dehydrated.
C. The nurse assists a patient to fill out an informed consent form.
D. The nurse learns the correct dosages for patient pain medications.
E. The nurse comforts a mother whose baby was born with Down syndrome.
F. The nurse uses the proper procedure to catheterize a female patient. - ANSWER-a,
d. Using critical thinking and learning medication dosages are cognitive competencies.
Performing procedures correctly is a technical skill, helping a patient with an informed
consent form is a legal/ethical issue, and comforting a patient is an interpersonal skill.
A nurse uses critical thinking skills to focus on the care plan of an older adult who has
dementia and needs placement in a long-term care facility. Which statements describe
characteristics of this type of critical thinking applied to clinical reasoning? Select all that
apply.
A. It functions independently of nursing standards, ethics, and state practice acts.
B. It is based on the principles of the nursing process, problem solving, and the
scientific method.
C. It is driven by patient, family, and community needs as well as nurses' needs to give
competent, efficient care.
D. It is not designed to compensate for problems created by human nature, such as
medication errors.
E. It is constantly re-evaluating, self-correcting, and striving for improvement.
It focuses on the big picture rather than identifying the key problems, issues, and risks
involved with patient care. - ANSWER-b, c, e. Critical thinking applied to clinical
reasoning and judgment in nursing practice is guided by standards, policies and
procedures, and ethics codes. It is based on principles of nursing process, problem
solving, and the scientific method. It carefully identifies the key problems, issues, and
risks involved, and is driven by patient, family, and community needs, as well as nurses'
needs to give competent, efficient care. It also calls for strategies that make the most of
human potential and compensate for problems created by human nature. It is constantly
re-evaluating, self-correcting, and striving to improve
