Funda Ch.10 - Critical Thinking & Clinical Reasoning

 A client with diarrhea also has a primary care provider’s order for a bulk laxative daily. The nurse, not realizing that bulk laxatives can help solidify certain types of diarrhea, concludes, “The primary care provider does not know the client has diarrhea.” What type of statement is this?

• A fact

• An inference

• A judgement

• An opinion

Answer explanation

Rationale: The nurse has inferred and concluded something that is beyond the available information (and in this case may not be accurate). The prescription and the diarrhea are facts (option 1). It would be judgment and opinion if the nurse stated that the laxative would make the diarrhea worse and should not be given (options 3 and 4). (Note: Critical thinking will cause this nurse to examine the assumptions made and gather more data before acting.)

A client reports feeling hungry, but does not eat when food is served. Using clinical reasoning skills, the nurse should perform which of the following?

• Assess why the client is not ingesting the food provided

• Continue to leave the food at the bedside until the client is hungry enough to eat

• Notify the primary care provider that tube feeding may be indicated soon

• Believe the client is not really hungry

Answer explanation

Rationale: The nurse recognizes that many assumptions (beliefs) could interfere with the client eating—such as that the food presented is not culturally appropriate. These assumptions must be clarified with the process of clinical reasoning.

A client complains of shortness of breath. During assessment the nurse observes that the client has edema of the left leg only. The nurse reviews evidence-based practice literature and reflects on a previous client with the same clinical manifestations. What do these actions represent?

• Clinical judgement

• Clinical Reasoning

• Reflection

• Intuition

Answer explanation

Rationale: Reviewing evidence-based literature and identifying similarities in the clinical manifestations of symptoms is an act of clinical reasoning. Past experiences in care enhance the nurse’s ability to recognize and respond in the delivery of client-centered care. 

The client who is short of breath benefits from the head of the bed being elevated. Because this position can result in skin breakdown in the sacral area, the nurse decides to study the amount of sacral pressure occurring in other positions. What decision making is the nurse engaging in?

• The research method

• Intuition

• The nursing process

• The trial-and-error method

Answer explanation

Rationale: The research method uses a research study based approach to problem solving.

In the clinical reasoning process, the nurse sets and weighs the criteria, examines alternatives, and performs which of the following before implementing a plan?

• Reexamines the purpose for making the decision

• Consults the client and family members to determine their view of the criteria

• Identifies and considers various means for reaching the outcomes

• Determines the logical course of action should intervening problems arise

Answer explanation

Rationale: : It is important to project what problems might interfere with the plan and have appropriate responses prepared to prevent the interferences. The purpose for the decision should have been clear enough at the outset as to not require reexamination at this point.

The nurse is concerned about a client who begins to breathe very rapidly. Which action by the nurse reflects clinical reasoning?

• Notify the primary care provider

• Obtain vital signs and oxygen saturation

• Request a chest x-ray

• Call the rapid response team

Answer explanation

 The nurse’s intuition is like a sixth sense that allows the nurse to recognize cues and patterns to reach correct conclusions. The nurse appropriately obtains vital signs and an oxygen saturation to assess the client’s clinical picture more fully. Option 1 supports appropriate nursing actions, but the client’s respiratory status should be assessed first.

The nurse is teaching a client about wound care during a followup visit in the client’s home. Which critical thinking attitude causes the nurse to reconsider the plan and supports evidence based practice when the client states, “I just don’t know how I can afford these dressings”?

• Integrity

• Intellectual humility

• Confidence

• Independence

Answer explanation

Rationale: By reconsidering the type of dressing used based on research, the nurse is using integrity.

When the nurse considers that a client is from a developing country and may have a positive tuberculosis test due to a prior vaccination, which critical thinking attitude and skill is the nurse practicing?

•  Creating environments that support critical thinking

•  Tolerating dissonance and ambiguity

•  Self-assessment

•  Seeking situations where good thinking is practiced

Answer explanation

Rationale:  Nurses must embrace exploration of the perspectives of individuals from different ages, cultures, religions, socioeconomic levels, and family structures to create environments that support critical thinking.

A client in a cardiac rehabilitation program says to the nurse, “I have to eat a low-sodium diet for the rest of my life, and I hate it!” Which is the most appropriate response by the nurse?

•  “I will get a dietary consult to talk to you before next week.”

•  “What do you think is so difficult about following a low-sodium diet?”

•  “At least you survived a heart attack and are able to return to work.”

•  “You may not need to follow a low-sodium diet for as long as you think.”

Answer explanation

Rationale: The nurse recognizes the need to obtain further information from the client in order to respond directly to the client’s statement.

Which reasoning process describes the nurse’s actions when the nurse evaluates possible solutions for care of an infected wound for optimal client outcomes?

• Intuition

• Research process

• Trial and error

• Problem solving

Answer explanation

Rationale: A nurse thinks critically, evaluates possible solutions, and uses problem solving.