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Writing Critical Thinking Questions For Nurses

Critical thinking can seem like such an abstract term that you don’t practically use. However, this could not be farther from the truth. Critical thinking is frequently used in nursing. Let me give you a few examples from my career in which critical thinking helped me take better care of my patient.

 

The truth is, that as nurses we can’t escape critical thinking . . . I know you hate the word . . . but let me show you how it actually works!

via GIPHY

 

RELATED ARTICLE:Ep211: Critical Thinking and Nursing Care Plans Go Together Like Chicken and Waffles

 

Critical Thinking in Nursing: Example 1

I had a patient that was scheduled to go to get a pacemaker placed at 0900. The physician wanted the patient to get 2 units of blood before going downstairs to the procedure. I administered it per protocol. About 30 minutes after that second unit got started, I noticed his oxygen went from 95% down to 92% down to 90%. I put 2L of O2 on him and it came up to 91%. But it just sort of hung around the low 90’s on oxygen.

 

I stopped. And thought. What the heck is going on?

 

I looked at his history. Congestive heart failure.

 

I looked at his intake and output. He was positive 1.5 liters.

 

I thought about how he’s got extra fluid in general, and because of his CHF he can’t really pump out the fluid he already has, let alone this additional fluid. Maybe I should listen to his lungs..

 

His lungs were clear earlier. I heard crackles throughout both lungs.

 

OK, so he’s got extra fluid that he can’t get out of his body.. What do I know that will get rid of extra fluid and make him pee? Maybe some lasix?

 

I ran over my thought process with a coworker before calling the doc. They agreed. I called the doc and before I could suggest anything, he said.. “Give him 20 mg IV lasix one time.. I’ll put the order in.” CLICK.

 

I gave the lasix. He peed like a racehorse (and was NOT happy with me for making that happen!). And he was off of oxygen before he went down to get his pacemaker.

 

Baddabing.. Badaboom.

 

RELATED ARTICLE:How to Use the Nursing Process to ACE Nursing School Exams

 

Critical Thinking in Nursing: Example 2

My patient just had her right leg amputated above her knee. She was on a dilaudid PCA and still complaining of awful pain. She maxed it out every time, still saying she was in horrible pain. The told the doctor when he rounded that morning that the meds weren’t doing anything. He added some oral opioids as well and wrote an order that it was okay for me to give both the oral and PCA dosings, with a goal of weaning off PCA.

 

“How am I going to do that?” I thought. She kept requiring more and more meds and I’m supposed to someone wean her off?

 

I asked her to describe her pain. She said it felt like nerve pain. Deep burning and tingling. She said the pain meds would just knock her out and she’d sleep for a little while but wake up in even worse pain. She was at the end of her rope.

 

I thought about nerve pain. I thought about other patients that report similar pain.. Diabetics with neuropathy would talk about similar pain… “What did they do for it?” I thought. Then I remembered that many of my patients with diabetic neuropathy were taking gabapentin daily for pain.

 

“So if this works for their nerve pain, could it work for a patient who has had an amputation?” I thought.

 

I called the PA for the surgeon and asked them what they thought about trying something like gabapentin for her pain, after I described my patient’s type of pain and thought process.

 

“That’s a really good idea, Kati. I’ll write for it and we’ll see if we can get her off the opioids sooner.”

 

She wrote for it. I gave it. It takes a few days to really kick in and once it did, the patient’s pain and discomfort was significantly reduced. She said to get rid of those other pain meds because they “didn’t do a damn thing,” and to “just give her that nerve pain pill because it’s the only thing that works”.

 

And that we did!

 

She was able to work with therapy more because her pain was tolerable and was finally able to get rest.

 

Conclusion

Critical thinking is something you’ll do every day as a nurse and honestly you probably do it in your regular non-nurse life as well. It’s basically stopping, looking at a situation, identifying a solution and trying it out. Critical thinking in nursing is just that, but in a clinical setting.

 

We’ve written a MASSIVE post on careplans and critical thinking:

Read More on Critical ThinkingHow to develop critical thinking as a nurse.

 

Trouble with Nursing Care Plans? You're not alone. Download our FREE template.
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Date Published - Sep 30, 2016
Date Modified - Jun 12, 2017

Written by Jon Haws RN

Jon Haws RN began his nursing career at a Level I Trauma ICU in DFW working as a code team nurse, charge nurse, and preceptor. Frustrated with the nursing education process, Jon started NRSNG in 2014 with a desire to provide tools and confidence to nursing students around the globe. When he's not busting out content for NRSNG, Jon enjoys spending time with his two kids and wife.

  • 1. 

    What is the "Nursing Process"? Select all that apply

    • A. 

      Organizational framework for the practice of Nursing

    • B. 

      Systematic method by which nurses plan and provide care for patients

    • C. 

      The application of the nursing process only applies to RN's and not LPN's

    • D. 

      The Nursing Scope and Standards of Practice of the ANA outlines the steps of the nursing process

  • 2. 

    Match the Nursing Process on the left with its description on the right 

    • C. Plan and Identify Outcome
  • 3. 

    ANA defines it as a"systematic dynamic process by which the nurse, through interaction with the client, significant others  and health care providers collect and analyzes data about the client

    • A. 

    • B. 

    • C. 

    • D. 

  • 4. 

    Which of the following is not true about Focused ASSESSMENT

    • A. 

      When patient is critically ill or disoriented

    • B. 

      When patient is unable to respond

    • C. 

      Preferably early in the morning before breakfast.

    • D. 

      When drastic changes are happening to a patient.

  • 5. 

    A synonym for significant data that usually demonstrate an unhealthy response. 

    • A. 

    • B. 

    • C. 

    • D. 

  • 6. 

    Headache, itchiness, warmth

    • A. 

    • B. 

    • C. 

    • D. 

  • 7. 

    Secondary Source of Data. (Select all that apply) 

    • A. 

    • B. 

    • C. 

    • D. 

  • 8. 

    Which of the following is not a method of data collection?

    • A. 

    • B. 

    • C. 

    • D. 

  • 9. 

    If the first method of data collection is to conduct an interview, what is the second method?

    • A. 

    • B. 

    • C. 

    • D. 

      Performance of a physical examination

  • 10. 

    After establishing a database and before the identification of nursing diagnosis, what does a nurse do? 

    • A. 

      Documentation of database

    • B. 

    • C. 

    • D. 

      Acquiring a database of information

  • 11. 

    Data Clustering

    • A. 

      Analyzing signs and symptoms

    • B. 

      Identifying patient statements

    • C. 

      Grouping related cues together

    • D. 

      Entering patient data in the computer

  • 12. 

    Deficient Fluid Volume (Select all that apply)

    • A. 

    • B. 

      Dry skin and dry oral mucous

    • C. 

    • D. 

  • 13. 

    Which of the following refers to the definition of a Nursing Problem?

    • A. 

      Nurse overload and nurse burnout

    • B. 

      When the nurse calls in sick

    • C. 

      Any health care condition that requires diagnostic, therapeutic, or educational actions.

    • D. 

  • 14. 

     Clinical judgment

    • A. 

    • B. 

      Job description of a clinical nurse

    • C. 

    • D. 

  • 15. 

    Components of a Nursing Diagnosis. Select all that apply  

    • A. 

      Nursing diagnosis title or label

    • B. 

      Definition of the title or label

    • C. 

    • D. 

      Contributing, etiologic or related factors

    • E. 

  • 16. 

    Which of the following are true regarding nursing diagnosis? 

    • A. 

      A nursing diagnosis is any problem related to the health of a patient

    • B. 

      When writing a nursing diagnosis, place the adjective before the noun modified

    • C. 

      A nursing diagnosis is usually the etiology of the disease

    • D. 

      Both medical and nursing diagnosis can be converted into a nursing intervention.

  • 17. 

    Clear, precise description of a problem 

    • A. 

    • B. 

    • C. 

    • D. 

  • 18. 

    Risk factors

    • A. 

    • B. 

      Analysis of a health issue

    • C. 

    • D. 

      Circumstances that increase the susceptibility of a patient to a problem

  • 19. 

    Clinical cues, signs, symptoms that furnish evidence that the problem exists. 

    • A. 

    • B. 

    • C. 

    • D. 

  • 20. 

    How cues, signs and symptoms identified in patient's assessment are written

    • A. 

    • B. 

    • C. 

    • D. 

  • 21. 

    "Constipation related to insufficient fluid intake manifested by increased abdominal pressure". What is the defining characteristic? 

    • A. 

    • B. 

    • C. 

      Increased abdominal pressure

    • D. 

  • 22. 

    What is RISK NURSING DIAGNOSIS as described by NANDA-I?  Select all that apply

    • A. 

      Human responses to health conditions/life processes that may develop in a vulnerable individual/family

    • B. 

      Describes the symptoms of the disease

    • C. 

      Supported by risk factors that contribute to increased vulnerability

    • D. 

      Proof that the person is suffering from an illness

  • 23. 

    How many parts does a RISK NURSING DIAGNOSIS have?

    • A. 

    • B. 

    • C. 

    • D. 

  • 24. 

    Which of the following is a Risk Nursing Diagnosis statement? 

    • A. 

      Risk for falls related to unstable balance

    • B. 

      Constipated because of fecal impaction

    • C. 

    • D. 

      Constipation related to dehydration

  • 25. 

    Syndrome Nursing Diagnosis

    • A. 

      An isolated disease with numerous symptoms

    • B. 

      Numerous symptoms describing a single disease

    • C. 

      Used when a cluster of actual or risk nursing diagnosis are predicted to be present

    • D. 

      Numerous symptoms leading to an idiopathic disorder

  • 26. 

    Wellness Nursing Diagnosis

    • A. 

    • B. 

    • C. 

      Human responses to levels of good health in an individual, family or community

    • D. 

  • 27. 

    Certain Physiologic complications that nurses monitor to detect their onset or changes in the patient's status.    

    • A. 

    • B. 

    • C. 

    • D. 

  • 28. 

    Potential complications: hypoglycemia.  This is a sample of what?

    • A. 

    • B. 

    • C. 

    • D. 

  • 29. 

    Identification of a disease or condition by a scientific evaluation of physical signs, symptoms, history, laboratory test and procedures. 

    • A. 

    • B. 

    • C. 

    • D. 

  • 30. 

    Difference between Medical and Nursing Diagnoses

    • A. 

      Medical is etiology; Nursing is human response

    • B. 

      Medical is disease; Nursing is the cause of disease

    • C. 

      Medical is illness; Nursing is illness too

    • D. 

      Medical is to heal the disease: Nursing is to discover the disease

  • 31. 

    Difference between a goal statement and an outcome statement

    • A. 

      A good outcome statement is specific to the patient

    • B. 

      Goals are general deadlines that are to be met

    • C. 

      An outcome statement refers to what the nurse will do

    • D. 

      Goals and Statements are practically the same

  • 32. 

    The purpose to which an effort is directed 

    • A. 

    • B. 

    • C. 

    • D. 

  • 33. 

    Which of the following statements describe a well-written patient outcome statement? Select all that apply.  

    • A. 

    • B. 

      Focuses on the completion of nursing interventions

    • C. 

      Does not interfere with the medical care plan

    • D. 

      Includes a time frame for patient reevaluation

  • 34. 

    A common framework that helps guide the prioritization of nursing tasks during the process of planning

    • A. 

      Ericsson's psychosocial development

    • B. 

    • C. 

    • D. 

  • 35. 

    Nursing interventions

    • A. 

      Depend on the tasks delegated by the nursing supervisor

    • B. 

      A sequence of prioritized tasks that describe a nurse's job

    • C. 

      Activities that promote the achievement of the desired patient outcome

    • D. 

      An act of taking care of the sick

  • 36. 

    Which of the following is not a Physician Prescribed intervention?

    • A. 

      Ordering diagnostic tests

    • B. 

    • C. 

    • D. 

      Elevating an edematous leg

  • 37. 

    Which of the following is not a nurse-prescribed intervention?

    • A. 

      Turning the patient every two hours

    • B. 

    • C. 

      Offering a vitamin supplement

    • D. 

      Monitoring a patient for complications

  • 38. 

    Which of the following statements about the nursing process is true. 

    • A. 

      A nursing process is written together with a nursing care plan

    • B. 

      A nursing care plan is a product of the nursing process

    • C. 

      Both the nursing process and the nursing care plan are purely critical thinking strategies

    • D. 

      The nursing process is not an accurate clinical theory

  • 39. 

    IN which of the following scenarios would a standardized nursing care plan be appropriate? 

    • A. 

    • B. 

      Center for infection control

    • C. 

    • D. 

      Maternity floor without a single Cesarean delivery

  • 40. 

    Prioritization of tasks belongs to which phase of the Nursing Process? 

    • A. 

    • B. 

    • C. 

    • D. 

    • E. 

  • 41. 

    Documentation is a vital component of which phase of the nursing process?

    • A. 

    • B. 

    • C. 

    • D. 

    • E. 

  • 42. 

    Validation of patient outcome and goals

    • A. 

    • B. 

    • C. 

    • D. 

  • 43. 

    Evidence based practice

    • A. 

      Past educational knowledge

    • B. 

    • C. 

    • D. 

      Integration of research and clinical experience

  • 44. 

    Which of the following is not considered a standardized language in nursing?

    • A. 

    • B. 

    • C. 

    • D. 

  • 45. 

    Variance

    • A. 

    • B. 

      Patient does not achieve expected outcome

    • C. 

    • D. 

  • 46. 

    Which of the following is not the role of the LPN/LVN in the nursing process?

    • A. 

    • B. 

      Gather further data to confirm problems

    • C. 

      Discuss details of the disease as part of patient education

    • D. 

      Observe and report signficant cues

  • 47. 

    Which of the following are functions of managed care? Select all that apply. 

    • A. 

      Provides control over health care services

    • B. 

      Standardized diagnosis and treatment

    • C. 

    • D. 

      Primary resource for patient advocacy

  • 48. 

    Clinical pathway

    • A. 

      Nursing career development plan

    • B. 

    • C. 

      A concept map for care plans

    • D. 

      Specific location in a healthcare facility

  • 49. 

    A reflective reasoning process that guides a nurse in generating, implementing and evaluating approaches for dealing with client care and professional concerns

    • A. 

    • B. 

    • C. 

    • D.