Davis Advantage for Understanding Medical-Surgical Nursing 7th Edition Linda S. Williams

1. The nurse is caring for a group of patients on a medical–
   surgical unit. The licensed practical nurse/licensed vocational
   nurse (LPN/LVN) assesses the patient experiencing a low
   blood glucosefirst. Which process was needed to make this
   decision?
2. Application of clinical judgment
3. Recommendation of the registered nurse (RN)
4. Understanding of what regulates blood glucose levels
5. Knowing the patient’s past medical history
   ANS: 1
   Chapter: Chapter 1. Critical Thinking, Clinical Judgment, and the Nursing Process
   Objective: 7. Explain the difference between critical thinking and clinical judgment.
   Page: 2
   Heading: Clinical Judgment
   Integrated Process: Clinical Problem-Solving Process (Nursing Process)
   Client Need: SECE: Coordinated Care
   Cognitive Level: Comprehension [Understanding]
   Concept: Clinical Judgment
   Difficulty: Difficult
   Feedback
   1 Clinical judgment is the observed outcome of critical thinking and decision
   making. The nurse identified the patient at high risk and decided to assess this
   person first.
   2 The LPN/LVN needs to make clinical decisions independently from the RN.
   3 Understanding the pathophysiology of the disease does not determine how
   decisions are made.
   4 Past medical history is important, but the current clinical cues will determine
   prioritized nursing actions.

2. The LPN/LVN enters the room of a patient who is angry and yells, “I asked 5 minutes ago for my
   pain medication. You’re so worthless!” Which action by the nurse demonstrates intellectual
   integrity?
3. Refusing to share details of the interaction with colleagues
4. Responding to the patient that the unlicensed assistive personnel (UAP) did not
   communicate the information
5. Refusing to provide care for the patient
6. Getting the medication without saying another word
   ANS: 1
   Chapter: Chapter 1. Critical Thinking, Clinical Judgment, and the Nursing Process
   Objective: 4. Describe attitudes of good critical thinkers.
   Page: 3
   Heading: Critical Thinking Attitudes
   Integrated Process: Communication and Documentation
   Client Need: Psychosocial Integrity
   Cognitive Level: Application [Applying]
   Concept: Communication
   Difficulty: Moderate
   Feedback
   1 This action demonstrates intellectual integrity, as the nurse refuses to speak
   poorly about a patient’s behavior.
   2 This action does not allow for accountability and places blame.
   3 This action does not demonstrate the attitudes of critical thinking.
   4 Nurses should not allow patients to demean them. The nurse should tell the
   patient that they now have the opportunity to obtain the medication and will do
   so.
   PTS: 1
   CON: Communication
7. The nurse is collecting data on a patient. Which data is considered cues?
8. Respiratory rate of 26 per minute
9. The doctor will be at the agency in 5 minutes
10. The patient has three daughters
11. The client prefers to use a bedpan rather than a commode chair
    ANS: 1
    Chapter: Chapter 1. Critical Thinking, Clinical Judgment, and the Nursing Process
    Objective: 2. Discuss why critical thinking and clinical judgment are essential in nursing.
    Page: 4
    Heading: Clinical Judgment Process
    Integrated Process: Clinical Problem-Solving Process (Nursing Process)

Client Need: SECE: Coordinated Care
Cognitive Level: Application [Applying]
Concept: Clinical Judgment
Difficulty: Moderate
Feedback
1 Respiratory rate of 26 per minute is an example of a cue that alerts the nurse to a
possible problem.
2 The doctor’s presence is not a cue, but just information.
3 The number of children that a patient has is informational, unless the nurse
needs the support of the children to provide care, then it becomes important.
4 This is patient preference and not a cue.
PTS: 1
CON: Patient-Centered Care

4. Which items are a part of “generate solutions” when using the clinical judgment process?
5. Reposition the patient.
6. Leg pain is rated at an 8/10.
7. Pain medication allowed the patient to sleep.
8. The leg pain is caused from immobility.
   ANS: 1
   Chapter: Chapter 1. Critical Thinking, Clinical Judgment, and the Nursing Process
   Objective: 2. Discuss why critical thinking and clinical judgment are essential in nursing.
   Page: 4
   Heading: Clinical Judgement Process
   Integrated Process: Clinical Problem-Solving Process (Nursing Process)
   Client Need: SECE: Coordinated Care
   Cognitive Level: Comprehension [Understanding]
   Concept: Patient-Centered Care
   Difficulty: Easy
   Feedback
   1 Repositioning is an action or solution the nurse can use to provide comfort.
   2 A pain scale rating is a cue.
   3 The nurse is evaluating the outcome of the pain medication by recognizing that
   the patient is not sleeping.
   4 Recognizing that the pain is from immobility is the step of prioritizing
   hypotheses

5. The nurse is prioritizing care based on Maslow’s hierarchy of needs. Which need does the nurse
   identify as having the highest priority?
6. Job-related stress
7. Feelings of loneliness
8. Poor sleep habits
9. Lack of confidence
   ANS: 3
   Chapter: Chapter 1. Critical Thinking, Clinical Judgment, and the Nursing Process
   Objective: 7. Prioritize patient care activities based on Maslow’s hierarchy of human needs.
   Page: 6
   Heading: Prioritize Care
   Integrated Process: Caring
   Client Need: SECE: Coordinated Care
   Cognitive Level: Comprehension [Understanding]
   Concept: Patient-Centered Care
   Difficulty: Easy
   Feedback
   1 Job-related stress falls under safety, according to Maslow, and is addressed after
   physiological needs.
   2 According to Maslow, loneliness is addressed under social needs, following
   physiological and safety needs.
   3 Sleep is a physiological need and is the highest priority.
   4 Lack of confidence falls under self-esteem, according to Maslow, and is
   addressed following physiological, safety, and social needs.
   PTS: 1
   CON: Patient-Centered Care
10. The nurse is using the clinical judgment process to provide care to a patient experiencing nausea.
    During the process of generating solutions, the patient begins to vomit. What should the nurse do
    next?
11. Take actions as prepared.
12. Evaluate outcomes of the solutions generated.
13. Identify and analyze the new cues presented.
14. Generate different solutions.
    ANS: 3
    Chapter: Chapter 1. Critical Thinking, Clinical Judgment, and the Nursing Process
    Objective: 2. Discuss why critical thinking and clinical judgment are essential.
    in nursing