NR 226 Exam 1 Questions With Complete
Solutions
While7assessing7a7patient,7the7nurse7observes7that7the7patient's7intravenous7(IV)7line7is
not7infusing7at7the7ordered7rate.7The7nurse7assesses7the7patient7for7pain7at7the7IV7site,
7
checks7the7flow7regulator7on7the7tubing,7looks7to7see7if7the7patient7is7lying7on7the7tubin
7
g,7checks7the7point7of7connection7between7the7tubing7and7the7IV7catheter,7and7then7ch
ecks7the7condition7of7the7site7where7the7intravenous7catheter7enters7the7patient's7skin.7
After7the7nurse7readjusts7the7flow7rate,7the7infusion7begins7at7the7correct7rate.7This7is7a
n7example7of:
A.7Inference.
B.7Diagnostic7reasoning.
C.7Competency.
D.7Problem7solving.7-7correct7answer✔ ✔ D.7Problem7solving
-
This7is7an7example7of7problem7solving.7The7nurse7collects7information7and7tries7options
until7she7is7able7to7find7a7solution7to7the7slowed7infusion7rate.7The7focus7is7on7solving7t
7
he7problem7with7the7patient's7IV7and7not7on7solving7the7patient's7health7problem;7thus7t
his7is7not7the7diagnostic7reasoning7process.
The7nurse7sits7down7to7talk7with7a7patient7who7lost7her7sister727weeks7ago.7The7patient7
reports7she7is7unable7to7sleep,7feels7very7fatigued7during7the7day,7and7is7having7trouble
at7work.7The7nurse7asks7her7to7clarify7the7type7of7trouble.7The7patient7explains7she7can
7
't7concentrate7or7even7solve7simple7problems.7The7nurse7records7the7results7of7the7ass
essment,7describing7the7patient7as7having7ineffective7coping.7This7is7an7example7of:
A.7Diagnostic7reasoning.
B.7Competency.
C.7Inference.
,D.7Problem7solving.7-7correct7answer✔ ✔ A.7Diagnostic7reasoning
-
In7this7example7the7nurse7collects7information7about7the7patient,7sees7patterns7in7the7d
ata7collected,7and7makes7a7nursing7diagnosis.7This7is7an7example7of7the7diagnostic7pro
cess.
A7nurse7has7worked7on7an7oncology7unit7for737years.7One7patient7has7become7visibly7w
eaker7and7states,7"I7feel7funny."7The7nurse7knows7how7patients7often7have7behavior7ch
anges7before7developing7sepsis7when7they7have7cancer.7The7nurse7asks7the7patient7qu
estions7to7assess7thinking7skills7and7notices7the7patient7shivering.7The7nurse7goes7to7th
e7phone,7calls7the7physician,7and7begins7the7conversation7by7saying,7"I7believe7that7you
r7patient7is7developing7sepsis.7I7want7to7report7symptoms7I'm7seeing."7What7examples7o
f7critical7thinking7concepts7does7the7nurse7show?7(Select7all7that7apply.)
A.7Experience
B.7Ethical
C.7Analyticity
D.7Self-confidence
E.7Risk7taking7-7correct7answer✔ ✔ C7&7D.
-
Among7critical7thinking7concepts,7the7nurse7shows7analyticity7(analyzing7information,7ga
thering7additional7findings,7and7sensing7a7problem),7and7self-
confidence7(calling7the7physician,7which7shows7trust7in7his7own7reasoning).7The7nurse's
experience7would7have7influenced7the7familiarity7of7patient7symptoms,7but7in7this7text7e
7
xperience7is7considered7a7component7of7the7critical7thinking7model7and7not7a7concept.7
Acting7ethically7is7a7critical7thinking7standard.
.A7nurse7who7is7working7on7a7surgical7unit7is7caring7for7four7different7patients.7Patient7A
7 will7be7discharged7home7and7is7in7need7of7instruction7about7wound7care.7Patients7B7an
d7C7have7returned7from7the7operating7room7within7an7hour7of7each7other,7and7both7req
uire7vital7signs7and7monitoring7of7their7intravenous7(IV)7lines.7Patient7D7is7resting7followi
,ng7a7visit7by7physical7therapy.7Which7of7the7following7activities7by7the7nurse7represent(s
)7use7of7clinical7decision7making7for7groups7of7patients?7(Select7all7that7apply.)
A.7Consider7how7to7involve7patient7A7in7deciding7whether7to7involve7the7family7caregive
r7in7wound7care7instruction.
B.7Think7about7past7experience7with7patients7who7develop7postoperative7complications.
C.7Decide7which7activities7can7be7combined7for7patients7B7and7C.
D.7Carefully7gather7any7assessment7information7and7identify7patient7problems.7-
7correct7answer✔ ✔ A7&7C
-
Considering7how7to7involve7patients7in7decisions7and7how7to7combine7nursing7activities
7to7be7more7organized7and7allow7for7resolving7more7than7one7problem7at7a7time7are7ex
amples7of7clinical7decision7making7for7groups7of7patients.7Thinking7about7past7experien
ce7with7patients7is7an7example7of7reflection,7an7approach7to7strengthen7critical7thinking7
skills.7Gathering7assessment7information7is7part7of7the7process7of7diagnostic7reasoning,
7 which7should7be7applied7to7each7patient.
The7surgical7unit7has7initiated7the7use7of7a7pain-
rating7scale7to7assess7patients'7pain7severity7during7their7postoperative7recovery.7The7r
egistered7nurse7(RN)7looks7at7the7pain7flow7sheet7to7see7the7pain7scores7recorded7for7a
7patient7over7the7last7247hours.7Use7of7the7pain7scale7is7an7example7of7which7intellectu
al7standard?
A.7Deep
B.7Relevant
C.7Consistent
D.7Significant7-7correct7answer✔ ✔ C.7Consistent
-
Use7of7the7same7pain7scale7for7assessing7pain7acuity7is7an7example7of7being7consisten
t.
During7a7home7health7visit7the7nurse7prepares7to7instruct7a7patient7in7how7to7perform7ra
nge-of-
, motion7(ROM)7exercises7for7an7injured7shoulder.7The7nurse7verifies7that7the7patient7too
k7an7analgesic7307minutes7before7arrival7at7the7patient's7home.7After7discussing7the7pur
pose7for7the7exercises7and7demonstrating7each7one,7the7nurse7has7the7patient7perform7
them.7After7two7attempts7with7only7the7second7of7three7exercises,7the7patient7stops7and
says,7"This7hurts7too7much.7I7don't7see7why7I7have7to7do7this7so7many7times."7The7nur
7
se7applies7the7critical7thinking7attitude7of7integrity7in7which7of7the7following7actions?
A.7"I7understand7your7reluctance,7but7the7exercises7are7necessary7for7you7to7regain7fun
ction7in7your7shoulder.7Let's7go7a7bit7more7slowly7and7try7to7relax."
B.7"I7see7that7you're7uncomfortable.7I'll7call7your7doctor7to7decide7the7next7step."
C.7"Show7me7exactly7where7your7pain7is7and7rate7it7for7me7on7a7scale7o7-
correct7answer✔ ✔
7
A.7"I7understand7your7reluctance,7but7the7exercises7are7necessary7for7you7to7regain7fu
nction7in7your7shoulder.7Let's7go7a7bit7more7slowly7and7try7to7relax."
-
The7nurse7reviews7the7position7of7requiring7exercises7to7restore7function7and7decides7t
o7try7a7different7approach7to7proceed,7which7is7an7example7of7integrity.7In7calling7the7do
ctor7for7the7next7step,7the7nurse7does7not7reinforce7the7importance7of7exercises,7which7i
s7likely7the7standard7of7care7for7this7type7of7patient.7In7asking7the7location7and7strength7
of7the7pain7the7nurse7is7interpreting7further7to7determine7if7any7other7physical7problems7
are7developing.7In7attempting7to7learn7if7any7other7underlying7problems7exist,7the7nurse
is7showing7curiosity.
7
The7nurse7cared7for7a714-year-
old7with7renal7failure7who7died7near7the7end7of7the7work7shift.7The7health7care7team7trie
d7for7457minutes7to7resuscitate7the7child7with7no7success.7The7family7was7devastated7b
y7the7loss,7and,7when7the7nurse7tried7to7talk7with7them,7the7mother7said,7"You7can't7ma
ke7me7feel7better;7you7don't7know7what7it's7like7to7lose7a7child."7Which7of7the7following7e
xamples7of7journal7entries7might7best7help7the7nurse7reflect7and7think7about7this7clinical
experience?7(Select7all7that7apply.)
7
A.7Data7entry7of7time7of7day,7who7was7present,7and7condition7of7the7child
Solutions
While7assessing7a7patient,7the7nurse7observes7that7the7patient's7intravenous7(IV)7line7is
not7infusing7at7the7ordered7rate.7The7nurse7assesses7the7patient7for7pain7at7the7IV7site,
7
checks7the7flow7regulator7on7the7tubing,7looks7to7see7if7the7patient7is7lying7on7the7tubin
7
g,7checks7the7point7of7connection7between7the7tubing7and7the7IV7catheter,7and7then7ch
ecks7the7condition7of7the7site7where7the7intravenous7catheter7enters7the7patient's7skin.7
After7the7nurse7readjusts7the7flow7rate,7the7infusion7begins7at7the7correct7rate.7This7is7a
n7example7of:
A.7Inference.
B.7Diagnostic7reasoning.
C.7Competency.
D.7Problem7solving.7-7correct7answer✔ ✔ D.7Problem7solving
-
This7is7an7example7of7problem7solving.7The7nurse7collects7information7and7tries7options
until7she7is7able7to7find7a7solution7to7the7slowed7infusion7rate.7The7focus7is7on7solving7t
7
he7problem7with7the7patient's7IV7and7not7on7solving7the7patient's7health7problem;7thus7t
his7is7not7the7diagnostic7reasoning7process.
The7nurse7sits7down7to7talk7with7a7patient7who7lost7her7sister727weeks7ago.7The7patient7
reports7she7is7unable7to7sleep,7feels7very7fatigued7during7the7day,7and7is7having7trouble
at7work.7The7nurse7asks7her7to7clarify7the7type7of7trouble.7The7patient7explains7she7can
7
't7concentrate7or7even7solve7simple7problems.7The7nurse7records7the7results7of7the7ass
essment,7describing7the7patient7as7having7ineffective7coping.7This7is7an7example7of:
A.7Diagnostic7reasoning.
B.7Competency.
C.7Inference.
,D.7Problem7solving.7-7correct7answer✔ ✔ A.7Diagnostic7reasoning
-
In7this7example7the7nurse7collects7information7about7the7patient,7sees7patterns7in7the7d
ata7collected,7and7makes7a7nursing7diagnosis.7This7is7an7example7of7the7diagnostic7pro
cess.
A7nurse7has7worked7on7an7oncology7unit7for737years.7One7patient7has7become7visibly7w
eaker7and7states,7"I7feel7funny."7The7nurse7knows7how7patients7often7have7behavior7ch
anges7before7developing7sepsis7when7they7have7cancer.7The7nurse7asks7the7patient7qu
estions7to7assess7thinking7skills7and7notices7the7patient7shivering.7The7nurse7goes7to7th
e7phone,7calls7the7physician,7and7begins7the7conversation7by7saying,7"I7believe7that7you
r7patient7is7developing7sepsis.7I7want7to7report7symptoms7I'm7seeing."7What7examples7o
f7critical7thinking7concepts7does7the7nurse7show?7(Select7all7that7apply.)
A.7Experience
B.7Ethical
C.7Analyticity
D.7Self-confidence
E.7Risk7taking7-7correct7answer✔ ✔ C7&7D.
-
Among7critical7thinking7concepts,7the7nurse7shows7analyticity7(analyzing7information,7ga
thering7additional7findings,7and7sensing7a7problem),7and7self-
confidence7(calling7the7physician,7which7shows7trust7in7his7own7reasoning).7The7nurse's
experience7would7have7influenced7the7familiarity7of7patient7symptoms,7but7in7this7text7e
7
xperience7is7considered7a7component7of7the7critical7thinking7model7and7not7a7concept.7
Acting7ethically7is7a7critical7thinking7standard.
.A7nurse7who7is7working7on7a7surgical7unit7is7caring7for7four7different7patients.7Patient7A
7 will7be7discharged7home7and7is7in7need7of7instruction7about7wound7care.7Patients7B7an
d7C7have7returned7from7the7operating7room7within7an7hour7of7each7other,7and7both7req
uire7vital7signs7and7monitoring7of7their7intravenous7(IV)7lines.7Patient7D7is7resting7followi
,ng7a7visit7by7physical7therapy.7Which7of7the7following7activities7by7the7nurse7represent(s
)7use7of7clinical7decision7making7for7groups7of7patients?7(Select7all7that7apply.)
A.7Consider7how7to7involve7patient7A7in7deciding7whether7to7involve7the7family7caregive
r7in7wound7care7instruction.
B.7Think7about7past7experience7with7patients7who7develop7postoperative7complications.
C.7Decide7which7activities7can7be7combined7for7patients7B7and7C.
D.7Carefully7gather7any7assessment7information7and7identify7patient7problems.7-
7correct7answer✔ ✔ A7&7C
-
Considering7how7to7involve7patients7in7decisions7and7how7to7combine7nursing7activities
7to7be7more7organized7and7allow7for7resolving7more7than7one7problem7at7a7time7are7ex
amples7of7clinical7decision7making7for7groups7of7patients.7Thinking7about7past7experien
ce7with7patients7is7an7example7of7reflection,7an7approach7to7strengthen7critical7thinking7
skills.7Gathering7assessment7information7is7part7of7the7process7of7diagnostic7reasoning,
7 which7should7be7applied7to7each7patient.
The7surgical7unit7has7initiated7the7use7of7a7pain-
rating7scale7to7assess7patients'7pain7severity7during7their7postoperative7recovery.7The7r
egistered7nurse7(RN)7looks7at7the7pain7flow7sheet7to7see7the7pain7scores7recorded7for7a
7patient7over7the7last7247hours.7Use7of7the7pain7scale7is7an7example7of7which7intellectu
al7standard?
A.7Deep
B.7Relevant
C.7Consistent
D.7Significant7-7correct7answer✔ ✔ C.7Consistent
-
Use7of7the7same7pain7scale7for7assessing7pain7acuity7is7an7example7of7being7consisten
t.
During7a7home7health7visit7the7nurse7prepares7to7instruct7a7patient7in7how7to7perform7ra
nge-of-
, motion7(ROM)7exercises7for7an7injured7shoulder.7The7nurse7verifies7that7the7patient7too
k7an7analgesic7307minutes7before7arrival7at7the7patient's7home.7After7discussing7the7pur
pose7for7the7exercises7and7demonstrating7each7one,7the7nurse7has7the7patient7perform7
them.7After7two7attempts7with7only7the7second7of7three7exercises,7the7patient7stops7and
says,7"This7hurts7too7much.7I7don't7see7why7I7have7to7do7this7so7many7times."7The7nur
7
se7applies7the7critical7thinking7attitude7of7integrity7in7which7of7the7following7actions?
A.7"I7understand7your7reluctance,7but7the7exercises7are7necessary7for7you7to7regain7fun
ction7in7your7shoulder.7Let's7go7a7bit7more7slowly7and7try7to7relax."
B.7"I7see7that7you're7uncomfortable.7I'll7call7your7doctor7to7decide7the7next7step."
C.7"Show7me7exactly7where7your7pain7is7and7rate7it7for7me7on7a7scale7o7-
correct7answer✔ ✔
7
A.7"I7understand7your7reluctance,7but7the7exercises7are7necessary7for7you7to7regain7fu
nction7in7your7shoulder.7Let's7go7a7bit7more7slowly7and7try7to7relax."
-
The7nurse7reviews7the7position7of7requiring7exercises7to7restore7function7and7decides7t
o7try7a7different7approach7to7proceed,7which7is7an7example7of7integrity.7In7calling7the7do
ctor7for7the7next7step,7the7nurse7does7not7reinforce7the7importance7of7exercises,7which7i
s7likely7the7standard7of7care7for7this7type7of7patient.7In7asking7the7location7and7strength7
of7the7pain7the7nurse7is7interpreting7further7to7determine7if7any7other7physical7problems7
are7developing.7In7attempting7to7learn7if7any7other7underlying7problems7exist,7the7nurse
is7showing7curiosity.
7
The7nurse7cared7for7a714-year-
old7with7renal7failure7who7died7near7the7end7of7the7work7shift.7The7health7care7team7trie
d7for7457minutes7to7resuscitate7the7child7with7no7success.7The7family7was7devastated7b
y7the7loss,7and,7when7the7nurse7tried7to7talk7with7them,7the7mother7said,7"You7can't7ma
ke7me7feel7better;7you7don't7know7what7it's7like7to7lose7a7child."7Which7of7the7following7e
xamples7of7journal7entries7might7best7help7the7nurse7reflect7and7think7about7this7clinical
experience?7(Select7all7that7apply.)
7
A.7Data7entry7of7time7of7day,7who7was7present,7and7condition7of7the7child
