Chapter 02: Clinical Judgment and Systems
Thinking
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. To demonstrate clinical reasoning skills, what action does the nurse take?
a. Collaborating with co-workers to buddy up for lunch breaks
b. Delegating frequent vital signs on a new postoperative patient
c. Documenting a complete history and physical on an admission
d. Requesting the provider order medication for a client with high potassium
ANS: D
The components of clinical reasoning include assessing, analyzing, planning,
implementing, and evaluating. This nurse shows the ability to analyze by interpreting
the meaning of the lab value, to plan by anticipating the consequences of the lab
value, and to implement by taking action.
DIF: Analyzing TOP: Integrated Process: Nursing Process:
Implementation KEY: Clinical judgment MSC: Client Needs
Category: Safe and Effective Care Environment: Management of Care
2. The new nurse asks the preceptor how context affects clinical judgment. What
response by the preceptor is best?
a. “Context considers the whole of the patient’s story and circumstances.”
b. “It shouldn’t, only nursing knowledge would affect clinical judgment.”
c. “Outside influences such as environment in which you provide care, influence
your decisions.”
, d. “The context of the situation provides an extra layer of complexity to
consider.”
ANS: C
The context of a situation considers and supports clinical judgment. The factors
within this layer—such as environment, time pressure, availability or content of
electronic health records, resources, and individual nursing knowledge—have a direct
impact on clinical judgment. The other two options are too vague to provide
appropriate information.
DIF: Understanding TOP: Integrated Process: Teaching/Learning
KEY: Clinical judgment MSC: Client Needs Category:
Safe and Effective Care Environment: Management of Care
3. Once the nurse has considered all possible collaborative and client problems, what
action does the nurse take next?
a. Act on the observed cues.
b. Determine desired outcomes.
c. Generate solutions.
d. Prioritize the hypotheses.
ANS: D
Analyzing cues lead to a list of potential hypotheses. The nurse prioritizes them,
determines the desired outcomes, generates solutions, and acts. This is part of the six-
step clinical judgment model.
DIF: Understanding TOP: Integrated Process: Nursing Process: Diagnosis
KEY: Clinical judgment MSC: Client Needs Category: Safe and
Effective Care Environment: Management of Care
4. A nurse working in a medical home would do which of the following as part of the
job?
Thinking
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. To demonstrate clinical reasoning skills, what action does the nurse take?
a. Collaborating with co-workers to buddy up for lunch breaks
b. Delegating frequent vital signs on a new postoperative patient
c. Documenting a complete history and physical on an admission
d. Requesting the provider order medication for a client with high potassium
ANS: D
The components of clinical reasoning include assessing, analyzing, planning,
implementing, and evaluating. This nurse shows the ability to analyze by interpreting
the meaning of the lab value, to plan by anticipating the consequences of the lab
value, and to implement by taking action.
DIF: Analyzing TOP: Integrated Process: Nursing Process:
Implementation KEY: Clinical judgment MSC: Client Needs
Category: Safe and Effective Care Environment: Management of Care
2. The new nurse asks the preceptor how context affects clinical judgment. What
response by the preceptor is best?
a. “Context considers the whole of the patient’s story and circumstances.”
b. “It shouldn’t, only nursing knowledge would affect clinical judgment.”
c. “Outside influences such as environment in which you provide care, influence
your decisions.”
, d. “The context of the situation provides an extra layer of complexity to
consider.”
ANS: C
The context of a situation considers and supports clinical judgment. The factors
within this layer—such as environment, time pressure, availability or content of
electronic health records, resources, and individual nursing knowledge—have a direct
impact on clinical judgment. The other two options are too vague to provide
appropriate information.
DIF: Understanding TOP: Integrated Process: Teaching/Learning
KEY: Clinical judgment MSC: Client Needs Category:
Safe and Effective Care Environment: Management of Care
3. Once the nurse has considered all possible collaborative and client problems, what
action does the nurse take next?
a. Act on the observed cues.
b. Determine desired outcomes.
c. Generate solutions.
d. Prioritize the hypotheses.
ANS: D
Analyzing cues lead to a list of potential hypotheses. The nurse prioritizes them,
determines the desired outcomes, generates solutions, and acts. This is part of the six-
step clinical judgment model.
DIF: Understanding TOP: Integrated Process: Nursing Process: Diagnosis
KEY: Clinical judgment MSC: Client Needs Category: Safe and
Effective Care Environment: Management of Care
4. A nurse working in a medical home would do which of the following as part of the
job?
