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A nurse uses critical-thinking skills to develop the care plan for an older adult with dementia awaiting placement in a long-term care facility. Which statements describe characteristics of the critical thinking used by nurses engaged in clinical reasoning? Select all that apply.
- A. Functions independently of nursing standards, ethics, and state practice acts
- B. Based on the principles of the nursing process, problem solving, and the scientific method
- C. Driven by patient, family, and community needs as well as nurses' needs to give competent, efficient care
- D. Avoids designs to compensate for problems created by human nature, such as medication errors
- E. Constantly reevaluating, self-correcting, and striving for improvement
- F. Focuses on the big picture rather than identifying the key problems, issues, and risks involved with patient care
Correct Answer: B,C,E
Rationale: Critical thinking applied to clinical reasoning and clinical judgment is guided by standards, policies and procedures, and ethics. When applying principles of nursing process, problem solving, and the scientific method, clinical reasoning identifies the key problems, issues, and risks. This 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 reevaluating, self-correcting, and striving to improve the quality and safety of health care systems.
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The nursing assessment of a patient with a diagnosis of anorexia nervosa reveals the patient consumes a vegan diet of 700 calories daily and has lost 30 lb in 4 months. The nurse's recommendation to meet with a nutritionist is the outcome of which process?
- A. Clinical judgment
- B. Nursing process
- C. Clinical reasoning
- D. Critical thinking
Correct Answer: A
Rationale: Clinical judgment is the outcome of critical thinking and clinical reasoning, using the nursing process as a framework. Clinical reasoning refers to ways of thinking about patient care issues including weighing and validating options (determining, preventing, and managing patient problems). Critical thinking includes reasoning both outside and inside of the clinical setting.
When implementing a thoughtful, patient-centered care plan, which action does the nurse prioritize?
- A. The patient's loved ones are considered part of the team.
- B. A caring relationship with mutual trust is established.
- C. Measures for safety are visibly incorporated.
- D. Transparent communication is observed.
Correct Answer: C
Rationale: Although developing a thoughtful, patient-centered approach is focused on caring and mutual trust, the nurse uses the nursing process and Maslow's hierarchy of needs to prioritize care. Safety is a higher-level need than love and belonging, and therefore the priority.
A nursing student is committed to providing thoughtful, person-centered care. Which nursing actions demonstrate this type of care? Select all that apply.
- A. Assisting patients to select meals based on their cultural observances
- B. Providing nursing care based on patients' needs and preferences
- C. Documenting nursing interventions in the electronic health record
- D. Reviewing fingerstick blood glucose levels with the primary nurse
- E. Listening to a patient's concern for their ill significant other
Correct Answer: A,B,E
Rationale: The nursing process ensures that nurses are person centered rather than task centered. Attending to cultural preferences and needs and listening to a patient's concerns are patient-centered actions. Documentation and communication with other members of the health care team are not specifically patient centered.
The nursing philosophy in an acute care hospital includes a commitment to deliver thoughtful, person-centered care. Which description of the nursing process best supports this commitment?
- A. Systematic
- B. Interpersonal
- C. Dynamic
- D. Universally applicable in nursing situations
Correct Answer: B
Rationale: Interpersonal. All other options are characteristics of the nursing process but focus on the patient best illustrates the interpersonal dimension of the nursing process.
A new graduate nurse phones the surgeon to report their patient is having severe incisional pain. The surgeon asks about vital signs and appearance of the wound, causing the nurse to return to the bedside for additional assessments. Upon reflection with the preceptor, which characteristic of the nursing process should the nurse have remembered?
- A. Centric
- B. Dynamic
- C. Interpersonal
- D. Systematic
Correct Answer: D
Rationale: The nursing process is systematic, iterative, and overlapping. By reporting an isolated symptom, the nurse has overlooked the benefit of systematic and inclusive assessment. While the nursing process is presented as an orderly progression of phases, there is a dynamic interaction and flow of phases into one another.