Test Bank for Critical Thinking, Clinical Reasoning, and Clinical Judgment: A Practical Approach, 7th Edition (Chapters 1-7)

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TEST BANKCritical Thinking ClinicalReasoning and Clinical Judgment:A Practical Approach7th Editionby Rosalinda Alfaro-LeFevreTEST BANK

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Critical Thinking Clinical Reasoning and Clinical Judgment 7th Edition: A PracticalApproach Test Bank by Rosalinda Alfaro-LeFevreTable ofContents:1. What are Critical Thinking, Clinical Reasoning, and Clinical Judgment?32. Becoming a Critical Thinker103. Critical Thinking and Learning Cultures: Teaching, Learning, and Taking Tests184. Interprofessional Clinical Reasoning, Decision Making, and Judgment305. Ethical Reasoning, Professionalism, Evidence-Based Practice, and Quality Improvement426. Practicing Clinical Reasoning, Clinical Judgment, and Decision-making Skills667. Interprofessional Practice Skills: Communication, Teamwork, and Self-Management88

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Chapter 1. What are Critical Thinking, Clinical Reasoning, and Clinical Judgment?Alfaro-LeFevre: Critical Thinking Clinical Reasoning and Clinical Judgment 7th Edition APractical Approach Test BankMultiple ChoiceIdentify the choice that best completes the statement or answers the question.1. Which of the following characteristics do the various definitions of critical thinking haveincommon? Critical thinking1) Requires reasoned thought2) Asks the questions why? or how?3) Is a hierarchical process4) Demands specialized thinking skillsANS: 1The definitions listed in the text as well as definitions in Box 2-1 state that critical thinkingrequires reasoning or reasoned thinking. Critical thinking is neither linear nor hierarchical. Thatmeans that the steps involved in critical thinking are not necessarily sequential, where mastery ofone step is necessary to proceed to the next. Critical thinking is a purposeful, dynamic, analyticprocess that contributes to reasoned decisions and sound contextual judgments.PTS:1DIF:Moderate high-level question, answer not stated verbatimKEY: Nursing process: N/A | Client need: SECE | Cognitive level: Analysis2. A few nurses on a unit have proposed to the nurse manager that the process for documentingcare on the unit be changed. They have described a completely new system. Why isit importantfor the nurse manager to have a critical attitude? It will help the manager to1) Consider all the possible advantages and disadvantages2) Maintain an open mind about the proposed change3) Apply the nursing process to the situation4) Make a decision based on past experience with documentationANS: 2A critical attitude enables the person to think fairly and keep an open mind.PTS:1DIF:ModerateKEY: Nursing process: N/A | Client need: SECE | Cognitive level:Comprehension3. The nurse has just been assigned to the clinical care of a newly admitted patient. To knowhow to best care for the patient, the nurse uses the nursing process. Which step would thenurseprobably do first?1) Assessment2) Diagnosis3) Plan outcomes4) Plan interventions

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ANS: 1Assessment is the first step of the nursing process. The nursing diagnosis is derived from the datagathered during assessment, outcomes from the diagnosis, and interventions from the outcomes.PTS:1DIF:EasyKEY: Nursing process: Assessment | Client need: SECE | Cognitive level: Application4. Which of the following is an example of theoretical knowledge?1) A nurse uses sterile technique to catheterize a patient.2) Room air has an oxygen concentration of 21%.3) Glucose monitoring machines should be calibrated daily.4) An irregular apical heart rate should be compared with the radialpulse.ANS: 2Theoretical knowledge consists of research findings, facts, principles, and theories. The oxygenconcentration of room air is a scientific fact. The others are examples of practicalknowledgewhat to do and how to do it.PTS:1DIF:Moderate; high-level question, answer not stated verbatimKEY: Nursing process: N/A | Client need: SECE | Cognitive level: Application5. Which of the following is an example of practical knowledge? (Assume all are true.)1) The tricuspid valve is between the right atrium and ventricle of the heart.2) The pancreas does not produce enough insulin in type 1 diabetes.3) When assessing the abdomen, you should auscultate before palpating.4) Research shows pain medication given intravenously acts faster than by other routes.ANS: 3Practical knowledge is knowing what to do and how to do it, such as how to do an assessment.The others are examples of theoretical knowledge, anatomy (tricuspid valve), fact (type 1diabetes), and research (IV pain medication).PTS:1DIF:Moderate high-level question, answer not stated verbatimKEY: Nursing process: N/A | Client need: SECE | Cognitive level: Application6. Which of the following is an example of self-knowledge? The nurse thinks, I know that I1) Should take the clients apical pulse for 1 minute before giving digoxin2) Should follow the clients wishes even though it is not what I would want3) Have religious beliefs that may make it difficult to take care of some clients4) Need to honor the clients request not to discuss his health concern with the familyANS: 3

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Self-knowledge is being aware of your religious and cultural beliefs and values. Taking the pulseis an example of practical knowledge. Following client wishes and honoring client requests areexamples of ethical knowledge.PTS:1DIFifficult; high-level question, answer not stated verbatim | V1, high-level question,answer not stated verbatimKEY: Nursing process: N/A | Client need: SECE | Cognitive level: Application7. Which of the following is the most important reason for nurses to be critical thinkers?1) Nurses need to follow policies and procedures.2) Nurses work with other healthcare team members.3) Nurses care for clients who have multiple health problems.4) Nurses have to be flexible and work variable schedules.ANS: 3Critical thinking is essential for client care, particularly when the care is complex, involvingnumerous health issues. Following policies and procedures does not necessarily require criticalthinking, and working with others or being flexible and working different schedules do notnecessarily require critical thinking.PTS:1DIF:Moderate; high-level question, answer not stated verbatimKEY: Nursing process: N/A | Client need: SECE | Cognitive level: Application8. The nurse administering pain medication every 4 hours is an example of which aspect ofpatient care?1) Assessment data2) Nursing diagnosis3) Patient outcome4) Nursing interventionANS: 4Interventions are activities that will help the patient achieve a goal, such as administering pain-relieving medication. An example of assessment data might be, Patient reports pain is a 5 on a 1to 10 scale. The nursing diagnosis would be Pain. The nurse might define the patient outcome inthis scenario as, The patient will state the level of pain is less than 4.PTS:1DIF:Moderate; high-level question, answer not stated verbatimKEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application9. How does nursing diagnosis differ from a medical diagnosis? A nursing diagnosis is1) Terminology for the clients disease or injury2) A part of the clients medical diagnosis3) The clients presenting signs and symptoms4) A clients response to a health problemANS: 4

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A nursing diagnosis is the clients response to actual or potential health problems.PTS:1DIF:ModerateKEY: Nursing process: Diagnosis | Client need: SECE | Cognitive level:Recall10. Which statement about the nursing process is correct?1) It was developed from the ANA Standards of Care.2) It is a problem-solving method to guide nursing activities.3) It is a linear process with separate, distinct steps.4) It involves care that only the nurse will give.ANS: 2The nursing process is a problem-solving process that guides nursing actions. The ANAorganizes its Standards of Care around the nursing process, but the process was not developedfrom the standards. The nursing process is cyclical and involves care the nurses give or delegateto other members of the healthcare team.PTS:1DIF:EasyKEY:Nursing process: N/A | Client need: SECE | Cognitive level: Recall11. What do critical thinking and the nursing process have in common?1) They are both linear processes used to guide ones thinking.2) They are both thinking methods used to solve a problem.3) They both use specific steps to solve a problem.4) They both use similar steps to solve a problem.ANS: 2Critical thinking and the nursing process are ways of thinking that can be used in problemsolving (although critical thinking can be used beyond problem-solving applications). Neithermethod of thinking is linear. The nursing process has specific steps; critical thinking does not.PTS:1DIFifficultKEY: Nursing process: N/A | Client need: SECE | Cognitive level: Analysis12. A nurse admits a patient to the unit after completing a comprehensive interview andphysical examination. To develop a nursing diagnosis, the nurse must now1) Analyze the assessment data2) Consult standards of care3) Decide which interventions are appropriate4) Ask the clients perceptions of her health problemANS: 1The basis of the nursing diagnosis is the assessment data. Standards of care are referred to whenestablishing nursing interventions. Customizing interventions personalizes nursing care. Askingthe patient about her perceptions is a method to validate whether the nurse has chosen the correctnursing diagnosis and would probably have been done during the comprehensive assessment.PTS: 1 DIF: Moderate KEY: Nursing process: Diagnosis | Client need: SECE | Cognitive level:Application

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13. The nurse developed a care plan for a patient to help prevent Impaired Skin Integrity. Shehas made sure that nursing assistive personnel change the patients position every 2 hours. Intheevaluation phase of the nursing process, which of the following would the nurse do first?1) Determine whether she has gathered enough assessment data.2) Judge whether the interventions achieved the stated outcomes.3) Follow up to verify that care for the nursing diagnosis was given.4) Decide whether the nursing diagnosis was accurate for the patients condition.ANS: 2The evaluation phase judges whether the interventions were effective in achieving the desiredoutcomes and helped to alleviate the nursing diagnosis. This must be done before examining thenursing process steps and revising the care plan.PTS:1DIF:Moderate14. In caring for a patient with comorbidities, the nurse draws upon her knowledge of diabetesand skin integrity. In a spirit of inquiry, she looks up the latest guidelines for providingskincare and includes them in the plan of care. The nurse provides skin care according to theprocedural guidelines and begins regular monitoring to evaluate the effectiveness of theinterventions. These activities are best described as1) Full-spectrum nursing2) Critical thinking3) Nursing process4) Nursing knowledgeANS: 1Full-spectrum nursing (1) involves the use of critical thinking, nursing knowledge, nursingprocess, and patient situation. Although the other answers are important for planning anddelivering nursing care, they do not reflect all the nurse has demonstrated.PTS:1DIFifficultKEY: Nursing process: N/A | Client need: PHSI | Cognitive level: Analysis15. The nurse is preparing to admit a patient from the emergency department. The transferringnurse reports that the patient is obese. The nurse has been overweight at one time and worksvery hard now to maintain a healthy weight. She immediately thinks, I know I tend tofeelnegatively about obese people; I figure if I can stop eating, they should be able to. I mustremember how very difficult that is and be very careful not to be judgmental of this patient. Thisbest illustrates1) Theoretical knowledge2) Self-knowledge3) Using reliable resources4) Use of the nursing processANS: 2Self-knowledge is self-understandingawareness of ones beliefs, values, biases, and so on. Thatbest describes the nurses awareness that her bias can affect her patient care. Theoretical

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knowledge consists of information, facts, principles, and theories in nursing and relateddisciplines; it consists of research findings and rationally constructed explanations ofphenomena. Using reliable resources is a critical thinking skill. The nursing process is aproblem-solving process consisting of the steps of assessing, diagnosing, planning outcomes,planning interventions, implementing, and evaluating. The nurse has not yet met this patient, soshe could not have begun the nursing process.PTS:1DIFifficult KEY: Nursing process: N/A | Client need: PHSI | Cognitive level:ComprehensionMultiple ResponseIdentify one or more choices that best complete the statement or answer the question.1. Which aspects of healthcare are affected by a clients culture? Select all that apply.1) How the clients views healthcare2) How the client views illness3) How the client will pay for healthcare services4) The types of treatments the client will accept5) When the client will seek healthcare services6) The environment where the healthcare services are provided7) The ease of accessibility of healthcare servicesANS: 1, 2, 4, 5Culture affects clients view of health and healthcare. It influences how they will define illness,when they will seek healthcare, and what treatments are acceptable in their culture. How servicesare paid for is related to economic status. Regardless of culture, anyone can be affected byprevious healthcare experiences, the environment in which healthcare is provided, andaccessibility of services.PTS:1DIF:ModerateKEY:Nursing process: N/A | Client need: SECE | Cognitive level: RecallMatchingMatch the critical thinking attitude on the left with the appropriate example on the right.1)Reading the instruction manual of a new glucose monitoring machine2)Asking for help with a procedure because you have not done it before3)Obtaining the latest research about a new diagnostic procedure even though the articles aredifficult to find4)Questioning the reason for a new staffing policy5)Realizing your feelings about alternative medicine may interfere with the care you give apatient6)Asking a patients feelings about his cancer diagnosis7)Questioning your feelings when a patients family requests withholding nutrition for a

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terminally ill client1. Independent thinking2. Intellectual curiosity3. Intellectual humility4. Intellectual empathy5. Intellectual courage6. Intellectual perseverance1.ANS: 4 PTS: 1 DIF: DifficultKEY: Nursing process: N/A | Client need: SECE | Cognitive level: Application2.ANS: 1 PTS: 1 DIF: DifficultKEY: Nursing process: N/A | Client need: SECE | Cognitive level: Application3.ANS: 2 PTS: 1 DIF: DifficultKEY: Nursing process: N/A | Client need: SECE | Cognitive level: Application4.ANS: 6 PTS: 1 DIF: DifficultKEY: Nursing process: N/A | Client need: SECE | Cognitive level: Application5.ANS: 7 PTS: 1 DIF: DifficultKEY: Nursing process: N/A | Client need: SECE | Cognitive level: Application6.ANS: 3 PTS: 1 DIF: DifficultKEY: Nursing process: N/A | Client need: SECE | Cognitive level: ApplicationMatch the terms from the critical thinking model in your text with the correct example.1)I wonder if my values about quality of life have affected my thinking.2)What should I have done differently?3)I need to talk with the client to make sure the family gave me the correct information.4)I have been through a situation like this before.5)There are several interventions that would work in this situation.6)I need to follow the steps in the procedure manual.7. Contextual awareness8. Inquiry9. Considering alternatives10. Analyzing assumptions11. Reflecting skeptically7.ANS:4PTS:1DIFifficult8.ANS:3PTS:1DIFifficult9.ANS:5PTS:1DIFifficult10.ANS:1PTS:1DIFifficult11.ANS:2PTS:1DIFifficult

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Chapter 2. Becoming a CriticalThinkerMULTIPLE CHOICE1.The nurse who uses the nursing process will:a.helpreducethe obvioussignsofdiscomfort.b.help the patient adhere to the physicians treatment protocol.c.approachthepatientsdisorderinastep-by-stepmethod.d.make all significant nursing care decisions involving patientcare.ANS: CThe nursing process is a collaborative process used throughout the patients stay. It is anorganized method for identifying and meeting patient needs in a step-by-step manner.2.A nurse will arrive at a nursing diagnosis through the nursing process step of:a.planning.b.evaluation.c.research.d.assessment.ANS: DAs a result of the nursing assessment, a nursing diagnosis is established.3.In the collaborative process of delivering care based on the nursing process, the responsibilityof the LPN/LVN is to:a.collectdataofhealthstatus.b.selectanursingdiagnosis.c.organizedatato helptheRN evaluatepatientprogress.d.prioritizenursingdiagnosesformoreeffective care.ANS: AThe LPN/LVN collects data of the patients health status to assist the RN in selecting a nursingdiagnosis.4.The participants of the planning stage of the nursing process during which the health goals aredefined include the:a.RN.

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b.health team led by the RN.c.healthteam,thepatient,andthepatientsfamily.d.health team as directed by the physician.ANS: CThe planning stage during which the health goals are defined are best shared by the entire healthteam, the patient, and the patients family for the optimum outcome.5.When a resident in the nursing home complains of constipation, the nurse performs a digitalrectal examination and finds a hard fecal mass. This is an example of:a.implementation.b.nursing diagnosis.c.assessment.d.evaluation.ANS: CThe examination to confirm and affirm the complaint of constipation is an assessment.6.The nurse completing morning assessments on a patient who is sitting up in bed is told by thepatient, Im having trouble breathingI cant seem to get enough air. The best nursing response isto:a.notify the doctor as soon as he or she comes in later in themorning.b.finish the vital signs for the assigned patients, and then notifythecharge nurse.c.reassure the patient, if his blood pressure and pulse are normal.d.notifythechargenurseimmediatelyofthepatientsstatement.ANS: BThe nurse should finish the assessment in order to confirm the complaint and inform the chargenurse.7.The order in which the nursing process is approached is:a.planning, assessment, implementation, nursing diagnosis,evaluation.

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b.nursing diagnosis, evaluation, assessment, implementation,planning.c.assessment, nursing diagnosis, planning, implementation,evaluation.d.evaluation, nursing diagnosis, planning, implementation,assessment.ANS: CThe order of assessment, nursing diagnosis, planning, implementation, and evaluation sets up abasis for an organized approach to nursing care.8.Once the nursing plan has been initiated, the nursing care plan will:a.stayin place untilall nursing goalshave been met.b.change as the patients condition changes.c.remainon thepatient record toshowprogress.d.be given to the patient for final approval.ANS: BThe nursing care plan is always a work in progress and will change as the patient conditionchanges.9.When a patient states, I cant walk very well, the first problem-solving step would be to:a.consideralternativessuchasawheelchairorwalker.b.find out what the problem is, such as weakness or poorbalance.c.choosethealternativewiththebestchanceofsuccess.d.consider the outcomes of thechoices, such as danger of fallingwitha walker.ANS: BDefining the problem clearly assists in the interventions to reduce the problem.10.A student nurse can begin to develop critical thinking skills by means of:a.workingwithamoreexperiencednurse.

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b.questioning every statement made by instructors to be sure ofits correctness.c.memorizing class notes for tests and studying all night for bigtests.d.listening attentively and focusing on the speakers words andmeaning.ANS: DCritical thinking involves foundation skills such as effective reading and writing and attentivelistening.11.When a nurse prioritizes the patient care, consideration is given to:a.completing assessments before mid-shift.b.consideringsituationsthatmayresultinanalteration ofhealth.c.assuming all health care activities for a group of patients.d.identifyingwhocan assistwiththeaspect ofcare.ANS: BPriority setting includes addressing health-endangering situations and physiological needs first.12.When the nurse checks to see whether a patient has had relief 45 minutes after administeringpain medication, the nurse is performing a(n):a.nursing diagnosis.b.implementation.c.assessment.d.evaluation.ANS: DEvaluation is the step in which the nurse determines whether the plan and interventions areeffective or need to be modified.MSC: NCLEX: Physiological Integrity: basic care and comfort13.The activity that is implementation in nursing care is:a.checking the assigned patients blood pressure, pulse, andrespiration.

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b.changingthepatientssurgicaldressing.c.asking the patient to demonstrate how to give himselfmedication after teaching him.d.discussing the patient with other team members to establish acare plan.ANS: BChanging a dressing that is soiled is a nursing intervention performed to meet a patients need.Checking vital signs is assessment. Demonstrating medication administration is evaluation.Discussing the patient with other team members is planning.14.Constant nursing assessments and evaluations of the patient will most likely result in:a.the nursing care plan changing to reflect appropriate priorities.b.smallchanges inthe patientcondition beingoverlooked.c.cluttered and confusing documentation.d.impededproblemsolving.ANS: AContinued assessment and evaluation are necessary; reprioritizing and reorganizing activitiesoccur in response to the patients changing condition.15.The effect of using a scientific problem-solving approach in nursing care will cause decisionmaking to be:a.sloweddownconsiderablybythemultiplesteps.b.rigid and non-patient oriented.c.improved nursing care outcomes.d.unrelated to the nursing process.ANS: CA scientific problem-solving approach is most likely to result in positive patient outcomes.16.An emergency room nurse will give first priority to the patient with the most critical need,which is the patient who:a.is bleeding from a chin laceration.b.complains of a productive cough.

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c.hasafeverof102F.d.complainsofseverechestpain.ANS: DBecause the chance of a bad outcome is highest for the patient with chest pain, it is mostappropriate to assess this patient first.COMPLETION17.When the nurse constructs a nursing approach after careful judgment and sound reasoning,the nurse has used a system of.ANS:critical thinkingCritical thinking is a concept in which decisions are made using solidly based judgments andreasoning.18.Critical thinking is considered to be the keystone and foundation of the development of.ANS:clinical judgmentClinical judgment is built on the ability to think critically.19.The tasks of synthesizing data and linking nursing interventions with patient health problemsare enhanced by the process of.ANS:concept mappingConcept mapping is a method to promote critical thinking by visualizing relationships betweenpatient health problems and effective intervention.MULTIPLE RESPONSE20.Activities considered to be aspects of the implementation step of the nursing process are:(Select all that apply.)a.documentation of care given.b.assemblyofsupplies.c.analysis of data gathered.d.modification of aspects of the plan.

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e.evaluation of the patient response.ANS: A, BDocumentation of care and assembly of supplies are nursing interventions performed during theimplementation step of the nursing process.21.Descriptions of the activities involved in the nursing diagnosis step of the nursing processare: (Select all that apply.)a.determination of potential health problems.b.clustering of related assessments.c.sharingofinformationwiththepatientandphysician.d.determination of desired outcomes.e.evaluation of probable outcomes.ANS: A, BDuring the nursing diagnosis step, assessment data are analyzed and clustered to determinehealth problems, and appropriate nursing diagnoses are selected.22.Which of the following items could be the responsibility of the LPN/LVN for a patients planof care? (Select all that apply.)a.Collect data.b.Performnursinginterventions.c.Initiate the plan of care.d.Assist the RN with evaluation of the patients response tonursing interventions.e.Documentnursingcare.ANS: A, B, DRegistered nurses are officially responsible for the initiation of nursing care plans for eachpatient, but the LPN/LVN assists with each part of the care plan. The LPN/LVN is oftenresponsible for data collection to assist the RN with the assessment phase.OTHER23.A nurse begins rounds on a medicalsurgical nursing unit. Review the following patients onher assignment. Prioritize the order in which the patients should be assessed, based on theirdescriptions.(Separate letters with a comma and space as follows: A, B, C, D.)A.A 22-year-old patient who is awakening from neck surgery.

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B.An 82-year-old patient who is blind and needs discharge instructions.C.A 44-year-old patient with dehydration from vomiting and diarrhea, who was admitted 3 daysago and who has an IV infusion of fluids.D.A 35-year-old patient admitted for an injury to his left femoral artery, which required surgicalrepair 8 hours ago following an ice-skating accident.ANS:A, D, C, BNursing priorities need to address patients with life-threatening concerns first. A patient justawakening from neck surgery needs to be assessed first because of the concerns of trachealswelling. A patient with a compromised limb is the next priority. The patient on IV fluids fordehydration is next. The patient for discharge is the last priority.24.Place the steps of the problem-solving approach in the appropriate order.(Separate letterswith a comma and space as follows: A, B, C, D, E.)A.Predict the likelihood of each outcome occurring.B.Choose the alternative with the best chance of success.C.Consider all possible alternatives as the solution to the problem.D.Identify the problem.E.Examine possible outcomes of each alternative.ANS:D, C, E, A, BThe problem-solving approach requires that a problem be clearly identified, all possiblealternative solutions be examined, outcomes of solutions be considered, probability of outcomeoccurring be predicted, and the best alternative be chosen.

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Chapter 3. Critical Thinking and Learning Cultures: Teaching, Learning, andTaking TestsMULTIPLE CHOICE1.A nurse working in an immigrant community is aware that different racial, religious, andsocial groups have their own integrated patterns of human behavior that include language,thoughts, communication, action, values, and institutions. This is known as the groups:a.values.c.culture.b.morals.d.tradition.ANS: CCulture is comprised of a series of integrated patterns of human behaviors that include language,thought, communication, actions, customs, beliefs, and values as well as institutions of racial,ethnic, religious, or social groups. While humans share many of the same characteristics, they arealso uniquely different according to these specific patterns of identity. Traditions, values, andmorals can be a part of ones culture.PTS: 1 DIF: Comprehension REF: CULTURE2.During a class on cultural beliefs, the instructor would most likely explain that these beliefsare:

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a.conscious and unconscious.c.reality.b.hereditary.d.genetic.ANS: ACultural beliefs can be conscious or unconscious and serve as points of reference to guide theoutlook and decisions of individuals. They are neither hereditary nor genetic, but theycan belearnedthrough association with family and relatives.PTS: 1 DIF: Comprehension REF: CULTURE3.A nursing instructor tests students on their understanding of the concept of values. Whichresponse by a student indicates that further teaching is needed?a.Valuesprovideasetofrulesbywhichtolive.b.Valuesguideactionsanddecisions.c.Valueshinderproblemsolvingandgivedirectiontolife.d.Valuesinfluencehowpeoplereacttoothers.ANS: CValues perform important functions in our lives and the way in which we view and interact withthe world around us. Some important functions of values are that they provide a set of rules tolive by; guide actions and decisions; give direction to peoples lives and help them to solveproblems (not hinder problem solving); influence how individuals perceive and react to others;help determine basic attitudes concerning personal, social, and philosophical issues; reflect anindividuals identity; and provide a basis for self-evaluation.PTS: 1 DIF: Application REF: CULTURE4.A group of nurses have recently been hired at your hospital. Because the nurses are from adifferent country, they would most likely experience which of the following?a.Ambivalencec.Hoarding of tradition in ethnicgroupsb.Improved lifestyled.CultureshockANS: DCulture shock can occur when an individual immigrates to a different country with a differentculture. This can occur when the values and beliefs upheld by the new culture are radicallydifferent from the individuals native culture.PTS: 1 DIF: Application REF: CULTURE5.Registered nurses can be identified as which of the following within health care professionals?

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a.Culturec.Groupb.Subcultured.OrganizationANS: BSmaller groups within a culture are called subcultures. Subcultures may consist of professionaland occupational affiliations (nurses), nationality or race, age groups, gender, socioeconomicfactors, political viewpoints, and/or sexual orientation.PTS: 1 DIF: Comprehension REF: CULTURE6.You are completing a survey which poses questions regarding your genetic traits and physicalcharacteristics. The information that is being asked is related to which of the following?a.Culturec.Raceb.Acculturationd.Cultural ethnicityANS: CRace describes a geographical or global population that is distinguished by its physicalcharacteristics such as skin color or facial features or other genetic traits. Cultural ethnicityidentifies a person based upon racial, tribal, linguistic, religious, national, or cultural groups.Acculturation concerns the loss of cultural identity into the new or more dominant culturalgroup.PTS: 1 DIF: Comprehension REF: RACE AND ETHNICITY7.A nurse is working in an environment where a large portion of the clients appear to be of thesame race; however, the nurse is aware that within each broad category of race are numerouscultural groups. Why is this important for the nurse to recognize?a.Fordemographic datacollectionb.Different cultural groups have different views of health-related illnesspractices for carec.Topreventracismfromoccurringontheunitamongthepatientsd.ToprovidethebestcarepossibleaccordingtotheirheritageandtraditionsANS: BWhile the clients may appear to be of the same race, their culture and views of health-relatedillness practices may be quite different. For example, there are subcultures such as the differentNative America tribes broadly categorized as Native American, or the subcultures that comprisethe term Hispanic (i.e., Caribbean, Cuban, Guatemalan, Puerto Rican, Mexican, and Central andSouth American peoples).

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PTS: 1 DIF: Application REF: POPULATION GROUPS8.You attend a conference on health disparities. You learn different techniques for assistingvictims of health disparities using problem-solving activities. Which problem-solving activityidentified by one of the conference participants would indicate that further clarification isnecessary?a.Increasing health care knowledge of the communityb.Seekinghealthcareaccessc.Breakingdownbarriersand traditionstowesternmedicined.Servingasarole modelfornewnursesANS: CVictims of health disparities include those subcultures or people who have been separated fromthe mainstream, resulting in decreased access to health care and higher rates of mortality andmorbidity. Some ways in which nurses can help these groups are by increasing the health careknowledge of the community, seeking health care access, breaking down barriers and ensuringaccess to education and care (not breaking down barriers and traditions to western medicine),and serving as role models for new nurses.PTS: 1 DIF: Analysis REF: HEALTH CARE DISPARITY9.You are working in a clinic with a culturally diverse client base and wish to provide culturallycompetent care. Which isnotnecessarily a component in the process of culturally competentcare?a.Cultural awarenessc.Culturalorganizationsb.Cultural knowledged.Cultural desireANS: CCulturally competent care is an integration of knowledge, attitudes, and skills that enhancescross-cultural communication and effective interactions. This type of care is a process thatcombines the elements of cultural awareness, cultural knowledge, cultural skills, culturalencounters (not cultural organizations), and cultural desire.PTS: 1 DIF: ComprehensionREF: CULTURAL COMPETENCE10.A nursing instructor asks a group of students if they can identify some nursing theories andmodels that have been developed to assist nurses in the delivery of culturally competent care.Which response by a student would indicate that further teaching is needed?a.LeiningersTransculturalNursingb.PurnellsModelforCulturalCompetence

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c.Campinha-BacotesProcessofCulturalCompetenced.GigerandMorrisonsModelforTransculturalAwarenessANS: DSeveral nursing theories and models have been developed to help nurse leaders preventworkplace difficulties when working with people who are different due to age, ethnicity, race,culture, or religion. Some of these theories and models are Leiningers Transcultural Nursing,Purnells Model for Cultural Competence, Campinha-Bacotes Process of Cultural Competence inthe Delivery of Health Care Service, and Giger and Davidhizars Transcultural Assessment Model(not Giger and Morrisons Model for Transcultural Awareness)..PTS: 1 DIF: Application REF: CULTURAL COMPETENCE11.A nursing instructor teaches students that according to DeRosa and Kochuras (2006) articleentitled Implement Culturally Competent Health Care in your Workplace, cultures have differentpatterns of verbal and nonverbal communication. Which response by a student, when tested onthis material, will indicate to the instructor that further teaching is necessary?a.Conversationalstylec.Eye contactb.Personalbehaviord.SubjectmatterANS: BDeRosa and Kochura (2006, October) noted four potential differences in communication amongdifferent cultures. They identifiedpersonal space(not personal behavior),conversational style(i.e., silence may be taken as a sign of respect or acknowledgment),eye contact(in somecultures, direct eye contact can be viewed as a sign of disrespect), andsubject matter(somesubjects are taboo in certain cultures).PTS: 1 DIF: Analysis REF: EVIDENCE FROM THE LITERATURE12.You are conducting an in-service on organizational culture. Which response regarding theimportant components of organizational culture would indicate that further clarification isneeded?a.Visionstatementc.Resource allocation and rewardb.Relative diversityd.DegreeofchangeANS: AOrganizational culture is a system of shared beliefs and values that actively influences thebehavior of an organization. Five primary components arevalues(the foundation for theorganization, they guide behavior and express the organizations philosophy),relative diversity(by having an organizational culture, some degree of similarity is assumed, but the amount ofdeviation tolerated from this similarity differs),resource allocation and reward(distribution of

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monies and resources tells people what and who is valued in the organization),degree of change(fast-paced organizations differ from slower-paced ones and how they react to change), andstrength of the culture(how much influence the culture exerts). Vision statement isnotacomponent of organizational culture.PTS: 1 DIF: Analysis REF: ORGANIZATIONAL SOCIALIZATION13.Perceptions of the nurses role in health care can vary according to culture. For example, Insome Asian cultures, when a nurse assists with bathing or feeding, the family may perceive thenurses actions as which of the following?a.Rude behaviorb.Dedicationtothepatientc.Respect and an attempt to help the patientd.DemonstrationofattentivenesstothepatientsphysicalcomfortneedsANS: AAccording to Mattson (2009), in Asian countries, where families are very involved in patientcare, it would be considered rude for the nurse to assist in bathing or feeding a patient. However,in American health care facilities, if the nurse does not ensure that these services are done, staffmembers could view this nurse as a slacker who is not completing his job duties.PTS: 1 DIF: AnalysisREF: DIFFERENT PERCEPTIONS OF THE NURSES ROLE14.You are working with staff from different cultures and are aware of the importance ofrealizing that there may be different perceptions of a variety of aspects inherent in the health careregime. Which of the following is not one of these potential areas of differing perception?a.Staffresponsibilitiesc.Locus of controlb.Role of the health carepractitionerd.TimeorientationANS: BWorking with staff from a variety of cultures brings with it differing perceptions of the healthcare regime and its inherent elements. Some potential areas of difference are differingperceptions of staff responsibilities, the role of the nurse, (not the health care practitioner), locusof control, time orientation, educational differences, and language differences.PTS: 1 DIF: ComprehensionREF: WORKING WITH STAFF FROM DIFFERENT CULTURES

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15.A nurse manager conducts an in-service on techniques to facilitate multiculturalcommunication. Which technique suggested by one of the nurses would indicate to the nursemanager that further clarification is needed?a.Avoidingtheuseofslangtermsb.Recognizingthat educationalbackgrounds innursing maybe vastlydifferentc.Providing your coworker with resources that may help to reinforce verbalcommunicationd.AvoidingusingIstatementswhenofferingconstructivecriticismANS: DSome techniques that may help to facilitate communication among multicultural workers includeavoiding the use of slang terms; recognizing that your coworker probably has an educationalbackground in nursing that is different from yours; providing your coworker with resources suchas written protocols and procedures to reinforce your verbal communication. When providingconstructive criticism you should try to use I statements instead of you statements. It is alsoimportant to remember to praise your coworkers competency in technical skills to inspire self-confidence.PTS: 1 DIF: AnalysisREF: IMPROVING COMMUNICATION ON THE TEAM16.A nursing instructor has just completed a lecture on how Jamieson and OMara (1991)established a program to help nurse managers manage a diverse staff. The instructor then askedthe group to identify the steps put forth by Jamieson and OMara. Which comment by anindividual would indicate that further teaching is needed?a.Determinewhichculturalgroupsarerepresentedonstaff.b.Understandtheorganizationsvaluesandgoals.c.Decidehowtomanageconflict.d.AnalyzepresentconditionswithintheorganizationANS: CJamieson and OMaras (1991) six-step plan for nurse managers who work with a culturallydiverse staff are to determine which cultural groups are represented on staff, understand theorganizations values and goals, decide on what is best for the future of the organization (not onlydecide how to manage conflict), analyze present conditions within the organization, plan ways toreach the desired future state and decide how to manage transitions, and evaluate the results.PTS: 1 DIF: Analysis REF: MANAGERIAL RESPONSIBILITIES

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17.A nurse preceptor is working with a new graduate nurse and asks if the nurse knows thedifferent generations that comprise the current workforce that the new graduate nurse managersmay have to supervise. The preceptor would recognize that clarification is needed if the newgraduate identified which of the following as one of the generations?a.Baby Boomersc.GenXersb.Pre-millennialsd.Echo BoomersANS: BThe preceptor would need to clarify that none of the generations are known as pre-millennials.The four distinct generations that make up the current workforce include the traditionals (bornbefore 1940); the baby boomers (born between 1940 and 1960); generation X, or genXers (bornbetween 1960 and 1980); and generation Y, or echo boomers/millennials (born after 1980).PTS: 1 DIF: Analysis REF: GENERATIONAL PERCEPTIONS18.You notice that one of your nursing colleagues has an impaired ability to integrate meaningand purpose in life through her own connectedness with others, self, music, nature, or a higherpower. Your colleague is most likely experiencing which of the following?a.Spiritualdistressc.Depressionb.Philosophicaldistressd.SchizoidpersonalitydisorderANS: ASpiritual distress is a recognized nursing diagnosis that consists of an impaired ability tointegrate meaning and purpose in life through an individuals connectedness with self, others, art,music, literature, nature, or a higher power. In order to relieve this distress, it is expected thatindividuals will reconnect with those items/elements that they consider to be important (i.e.,meditation, prayer, religious services or rituals, communing with nature or animals, sharing ofself, or caring for others) in order to return to meaning and purpose in life. Depression consists ofa variety of symptoms that interfere with the ability to work, eat, sleep, and function in activitiesthat once brought pleasure. Schizoid personality disorder consists of a pattern of indifference tosocial relationships and a limited range of emotional expression and experience.PTS: 1 DIF: Comprehension REF: SPIRITUAL DISTRESS19.The nurse manager wants to motivate a 55-year-old staff nurse. Taking the nurses age intoconsideration, which type of motivation would be most effective for this nurse?a.Sendingthenursealetteronajob welldoneb.Givingpublicacknowledgement andreward forgoodperformancec.Tellingthenurseofopportunitiesforgrowthanddevelopmentd.Emphasizingtheimportanceandsignificanceofthenurseswork

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ANS: BStaff nurses who are 55 years old would be considered being from the Baby Boomer generation.The most effective means of motivating nurses in this age group would be to give publicacknowledgement and reward for good performance.PTS: 1 DIF: Analysis REF: GENERATIONAL PERCEPTIONS20.During a Community Health clinical, a students asks the instructor, What is meant by healthdisparities? The instructor would be correct in responding that health disparities refer to:a.differencesineachindividualsresponsetoillnessanddiseasestates,whichisreflective of cultural beliefs.b.differences in types of care an individual receives based on whether theindividual pays for health care with personal funds, private insurance, orfederal assistance.c.thedifferentbeliefsandvaluesthatindividualsexpressbasedonageandethnicity.d.differences in health risks and health status measures that reflect the poorerhealthstatusthatis founddisproportionately in certainpopulation groups.ANS: DThe termhealth disparitiesrefers to differences in health risks and health status measures thatreflect the poorer health status that is found disproportionately in certain population groups.These health disparities include differences in the occurrence of illness, disease, and deathamong minorities and other vulnerable populations in the United States.PTS: 1 DIF: Application REF: HEALTH DISPARITIES21.One of the nurses on your unit tells you that his grandmother, who speaks no English, wasrecently admitted to the hospital with a heart condition. The nurses caring for the grandmotherhave labeled her a difficult patient. The nurse further explains that the grandmother immigratedfrom China just 6 months ago and generally only interacts with family members and close familyfriends. You hypothesize that the grandmother is most likely experiencing which of thefollowing?a.Cultural intensityc.Culturalstereotypingb.Cultureshockd.Cultural incompetenceANS: BThe nurses grandmother is most likely experiencing culture shock. Many patients experienceculture shock because of the unfamiliar sounds and sights and strangers they come in contact

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with while in the hospital. This shock intensifies for patients who are recent immigrants or whodo not speak English.PTS: 1 DIF: Analysis REF: CULTURE22.Several nurses from outside the United States were recently hired at your hospital becausethey had passed the NCLEX-RN. According to Mattson (2009), many of these nurses would beastonished by which of the following?a.Numberofmedicationseachpatient receivesb.Amountofsuppliesnurseswasteoneachpatient.c.Amountofdocumentationandthefocusoncost-effectivecared.Numberoflanguagesspokenfluentlybythestaff.ANS: CAccording to Mattson (2009), the nurses from other countries would be most astonished by theamount of documentation and the focus on cost-effective care in the United States.PTS: 1 DIF: KnowledgeREF: DIFFERENT PERCEPTIONS OF THE NURSES ROLE23.You recently accepted a position on the Labor and Delivery unit at the local hospital. Yourecognize that infant mortality rates in 2005 were highest among babies born to:a.non-Hispanic Black mothers.b.Asianadolescent girlsbetween theages of14-18.c.unmarriedCaucasianwomen.d.Hispanicwomenbetweentheagesof19-24.ANS: AIn 2005, infant mortality rates were highest among babies born to non-Hispanic Black mothers.PTS: 1 DIF: Knowledge REF: HEALTH DISPARITIESMULTIPLE RESPONSE24.You are a nurse manager who is attempting to develop generational diversity amongst yournursing workforce. Which of the following would be your key approaches? Select all that apply.a.Utilizingeffectiveapproachesthatarespecifictotheapplicablestaffgenerationb.Continually exploring the workplace cultureand conditions and maintainingthe ability to be flexible in interventions and response mechanisms

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c.Addressing the needs of the older generations first since they have been withthe agency the longestd.Workingsuccessfullywithproblemsthatariseduetogenerationaldifferencese.Creatinganorganizationalenvironmentthatconnectswithallstaff,therebyincreasing retention ratesf.Addressing the needs of the younger generations because they have moreyearsto contribute to the workforceANS: A, B, D, EThe International Council of Nurses and the International Center for Human Resources inNursing identified four approaches to developing generational diversity in the nursing workforce.They included utilizing effective approaches that are specific to the applicable staff generation;continually exploring the workplace culture and conditions and maintaining the ability to beflexible in interventions and response mechanisms; working successfully with problems thatarise due to generational differences; and creating an organizational environment that connectswith all staff, thereby increasing retention rates.PTS: 1 DIF: ComprehensionREF: GENERATIONAL PERCEPTIONS25.You have a client who is experiencing a spiritual need. You refer to Carson and Koenigsspiritual assessment because it involves five broad questions that you can use. Which of thefollowing would be included among the questions? Select all that apply.a.Doesthemedicalcareconflictwithanyofthepatientsspiritualbeliefs?b.Isthepatientexperiencingcomfortorstressrelatedtospiritualbeliefs?c.Willthehealthcareprovidersspiritualbeliefsnegativelyimpactthepatient?d.Isthereinvolvement orsupportfrom anyreligiouscommunity?e.Do the patients spiritual beliefs impact health care decision-makingpractices?f.Is there a need for additional referrals?ANS: A, B, D, E, FCarson and Koenigs spiritual assessment involves five broad questions focusing around whetherthe medical care conflicts with any of the patients spiritual beliefs, whether the patient isexperiencing comfort or stress related to spiritual beliefs, whether there is involvement orsupport from any religious community, how the patients spiritual beliefs impact health caredecision-making practices, and if there is a need for additional referrals. The nurses spiritualbeliefs are not an aspect of the patient assessment.

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PTS: 1 DIF: Comprehension REF: SPIRITUAL ASSESSMENT26.As the nurse manager, you recognize that the elimination of disparities is a multifacetedchallenge that includes interventions aimed at access to care as well as factors associated withprejudice and bias. Strategies to reduce health disparities would include which of the following?Select all that apply.a.Improving access and infrastructures at the public health and health caresystemslevelsb.Encouragingallnursingstaffmemberstoreturntoschoolinordertobeeligible for promotionsc.Increasingthediversityofthenursingstafftoenhancepatientandproviderrelations and reduce problems in cross-cultural communicationd.Examining the organizations culture, condition, and training needs and thenadvocating for changes that reduce disparitiese.Only assigning nurses to patients who are members of the nurses own ethnicgroup and age groupf.Utilizing culturally and linguistically appropriate approaches to nursing carethat can be flexible to patient needs while still identifying and addressingpotentialbarriers that are specifictothe individual patientANS: A, C, D, FAs the nurse manager, you recognize that strategies to reduce health disparities includeimproving access and infrastructures at the public health and health care systems levels;increasing the diversity of the nursing staff to enhance patient and provider relations and reduceproblems in cross-cultural communication; examining the organizations culture, condition, andtraining needs and then advocating for changes that reduce disparities; and utilizing culturallyand linguistically appropriate approaches to nursing care that can be flexible to patient needswhile still identifying and addressing potential barriers that are specific to the individual patient.

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Chapter 4. Interprofessional Clinical Reasoning, Decision Making, andJudgmentMULTIPLE CHOICE1.Which of the following is Pauls definition of critical thinking?a.Thinking about your thinking while youre thinking in order to make yourthinking betterb.Purposeful, outcome-directed thinking based upon a body of non-scientificknowledge derived from research and other courses of evidencec.Making sense of our world by carefully examining our thinking and thethinking of others in order to clarify and improve our understandingd.Understanding of the argument, recognizing fallacies, and distinguishingpremises from conclusionsANS: APaul (1992) provided a rather interesting and somewhat amusing view of critical thinking asthinking about your thinking while youre thinking in order to make your thinking better. Otherdefinitions include the making sense of our world through examination of our thinking and thethinking of others (questioning) and understanding of the argument, recognition of fallacies, andthe recognition of premises from conclusions.PTS: 1 DIF: Knowledge REF: CRITICAL THINKING2.An instructor has just completed teaching a class on critical thinking to a group of sophomorenursing students. On the test the instructor asked, Which of the following are the basiccomponents required for the development of sound critical thinking skills? Which of thefollowing responses would indicate that further teaching is needed?a.Critical readingc.Critical listeningb.Criticalwritingd.Critical evaluationANS: DThe four basic aptitudesreading, writing, listening, and speaking (not evaluation)are essential forthe development of effective critical thinking skills. While being able to critically evaluate agiven situation or decision is a valuable tool, it uses all of these critical aptitudes in order for theprocess of evaluation to take place.PTS: 1 DIF: Application REF: CRITICAL THINKING3.In class, students tell the teacher that they often watch or observe themselves as they performtasks or make decisions about particular situations. The teacher would most likely inform thestudents that what they are doing is called:a.critical thinking.c.intuitive thinking.

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