Question 1

A nurse with 6 year's labor and delivery experience is floated to the intensive care unit. In this situation, the nurse would most likely function at the level of&#10;A) advanced beginner.&#10;B) competent.&#10;C) novice.&#10;D) proficient.

Accepted Answer

According to Benner's Five Levels of Competency in Nurses, a novice is one who has no experience in situations in which they are expected to perform. This nurse would need specific rules to guide action. An advanced beginner has seen enough real situations to note recurring and meaningful components of the situation. A competent nurse has been on the job or in similar situations for 2-3 years. A proficient nurse has a great deal of situational perception as the result of 3-5 years of experience.

Question 2

The process by which a nurse uses purposeful thinking, informed reasoning, reflections, and thinking about thinking in clinical situations is called&#10;A) clinical judgment.&#10;B) critical thinking.&#10;C) decision making.&#10;D) problem solving.

Accepted Answer

Critical thinking is a process of thinking that ensures conclusions are self-correctable, reasonable, informed, and precise. This is done through informed reasoning, purposeful thinking, reflecting on situations, and thinking about one's thinking. Clinical judgment uses experience to guide assessments and decision making. Decision making involves using the scientific process to identify a specific problem, assess and weigh all options, test possibilities, and consider the consequences of the choice of action. Problem solving is more focused with the selection of only pertinent information about the problem and evaluating the solution over time. All are part of critical thinking but none are as broad.

Question 3

A nurse brings a client a medication that is scheduled once daily with food. The medication administration record lists it as being due at 9:00 AM. The client refuses the medication, asking to take it later. The nurse replies "That's OK. I can give it to you with your lunch if you like." Which statement about the nurse is correct? The nurse

A) is being flexible and logical.
B) just made a medication error.
C) needs to call the doctor.
D) should tell the patient to take the medication now.

is being flexible and logical.

Accepted Answer

Flexible and logical are two attitudes and characteristics of a critical thinker. Hospital pharmacies often schedule once-a-day medications at 9:00 AM. The important aspect of this medication is that it is indeed given once a day and with food. The time of day does not matter as long as it is consistent. The nurse could call the pharmacy and ask them to change the time on the medication administration record. The other three options all demonstrate inflexibility and rule-bound behavior.

Question 4

A nurse is confused about the best way to confirm placement of a small flexible feeding tube before giving a bolus feeding. Colleagues on the unit suggest several different methods. The best process by which to determine a policy outlining the appropriate course of action is

A) critical reasoning.
B) evidence-based practice.
C) problem solving.
D) professional judgment.

Accepted Answer

Evidence-based practice (EBP) is a process by which nurses make clinical decisions using the best available research evidence, clinical expertise, and client preferences to guide actions. There are several steps necessary to solve problems using this method. None of the other options provides as broad a foundation for a practice change as EBP, which utilizes research in the literature to inform practice changes, which are then evaluated for institutional fit and feasibility.

Question 5

A nurse is working in the intensive care unit. When assessing the clients, the nurse notes one of them, who was scheduled to transfer to a step-down unit as soon as a bed becomes available, has a respiratory rate change from 18 to 20 breaths/min and an oxygen saturation (O₂ sat) of 92%, when earlier it was 93%. The client denies complaints. The nurse calls the physician and requests a chest x-ray and arterial blood gases (ABGs). This nurse is working at which Benner Level of Competency in Nurses?

A) Advanced beginner
B) Competent
C) Expert
D) Proficient

Accepted Answer

The expert nurse is able to grasp the important components of a situation intuitively, noticing subtle changes, and zeroing in on the problem immediately. This nurse is also flexible. The advanced beginner is not flexible, is slow to act, and still needs rules to guide practice. The competent nurse is beginning to be able to master many situations in nursing but is still somewhat slow. The proficient nurse is perceptive and sees subtle changes rapidly, but would not be able to zero in on the problem as rapidly as the expert nurse.

Question 6

It is crucial for the nurse to be able to make sound decisions using critical thinking because&#10;A) it is the most efficient use of the nurse's time and resources.&#10;B) it uses previously learned knowledge in predictable situations.&#10;C) most clients have problems for which there are no textbook answers.&#10;D) nurses can recognize problems rapidly and provide speedy responses to situations.

Accepted Answer

Most client care situations are unique-not predictable-and nurses must adapt previously learned knowledge to new circumstances, drawing from multiple sources of information. It may well be more efficient and rapid, but that is not the primary reason critical thinking is valuable.

Question 7

At the beginning of the shift a student nurse is meeting with the registered nurse (RN) assigned to the student's client. The student nurse should provide the RN with which information? (Select all that apply.)

A) Assessments the student will make
B) Documentation the student will complete
C) Medications the student will administer
D) Treatments the student can perform
E) What time the student is going to lunch

Accepted Answer

These are all important components of the student's report to the RN. The time the student will take lunch is not crucial to discuss at this time and may well change depending on client status and needs at lunchtime.

Question 8

A nurse who is alert to changes, confident, open-minded, proactive, and questioning is displaying which characteristics?&#10;A) Alfaro's Attitudes and Characteristics of a Critical Thinker&#10;B) Benner's Five Levels of Competency in Nurses&#10;C) Hawk's Model of Critical Thinking in Registered Nurses&#10;D) Universal Intellectual Standards

Accepted Answer

There are 29 attitudes and characteristics of a critical thinker listed in Box 3-1, 5 of which are listed here. Benner's model has 5 levels of nursing competency: novice, advanced beginner, competent, proficient, and expert. The Universal Intellectual Standards encourage thoughtful examination of clinical problems. There is no Hawk's Model of Critical Thinking in Registered Nurses.

Deck 3: Critical Thinking