Chapter 15: 🧠 Critical Thinking & Clinical Judgment

1. The main purpose of critical thinking in nursing is to:
A. Perform routine tasks more quickly
B. Make accurate clinical decisions that improve patient outcomes
C. Eliminate the need for patient input
D. Depend solely on physician judgment

B. Make accurate clinical decisions that improve patient outcomes

Rationale: Critical thinking in nursing is about analyzing, reflecting, and deciding actions that ensure safe and effective patient care.

2. Why is critical thinking in nursing more complex than everyday problem-solving?
A. Nurses only follow routine orders
B. Patients are unique, complex, and can change quickly
C. Nursing is always predictable
D. Everyday problems are more challenging

B. Patients are unique, complex, and can change quickly

Rationale: Unlike simple daily decisions, nursing care requires flexibility, reflection, and adaptation due to patient complexity and rapid changes.

3. Clinical judgment in nursing is best defined as:
A. Performing delegated tasks
B. Following physician instructions
C. The outcome of critical thinking and decision-making that guides nursing actions
D. Relying only on textbook knowledge

C. The outcome of critical thinking and decision-making that guides nursing actions.

Rationale: Clinical judgment results from critical thinking, leading nurses to decisions about priorities and interventions.

4. What differentiates the role of RNs from assistive personnel (APs)?
A. RNs have fewer responsibilities
B. APs analyze data while RNs document it
C. Both perform tasks independently
D. RNs analyze patient data, anticipate problems, and act quickly

D. RNs analyze patient data, anticipate problems, and act quickly

Rationale: RNs use critical thinking and judgment, while APs mainly perform delegated tasks.

5. According to Tanner’s model, which factor MOST influences accurate clinical judgment?
A. Random textbook memorization
B. Experience and knowledge of the patient’s usual responses
C. Relying solely on checklists
D. Ignoring patient context

B. Experience and knowledge of the patient’s usual responses

Rationale: Experience and knowing the patient’s normal patterns help nurses recognize changes quickly.

6. Which is the correct sequence of the NCSBN Clinical Judgment Model?
A. Prioritize → Recognize cues → Analyze cues → Evaluate outcomes
B. Recognize cues → Analyze cues → Prioritize problems → Generate solutions → Take action → Evaluate outcomes
C. Diagnose → Plan → Implement → Evaluate
D. Collect data → Plan → Reflect → React

B. Recognize cues → Analyze cues → Prioritize problems → Generate solutions → Take action → Evaluate outcomes

Rationale: The NCSBN model follows a systematic process to guide safe and effective nursing judgments.

7. In Mr. Lawson’s case (post-op pain, immobility), Nurse Tonya’s priority problems were:
A. Nutrition and infection risk
B. Anxiety and sleep
C. Pain and immobility
D. Fluid imbalance and depression

C. Pain and immobility

Rationale: Mr. Lawson’s pain and immobility required immediate intervention to improve mobility and prevent complications.

8. Which critical thinking skill involves finding significance and relationships in data?
A. Interpretation
B. Analysis
C. Inference
D. Evaluation

C. Inference

Rationale: Inference is the process of drawing meaning from data and identifying relationships between findings.

9. Which step of the nursing process involves identifying patient problems and formulating nursing diagnoses?
A. Assessment
B. Diagnosis
C. Planning
D. Evaluation

B. Diagnosis

Rationale: Diagnosis is the step where nurses analyze assessment data to determine patient problems and form nursing diagnoses.

10. Which of the following is a critical thinking competency unique to nursing?
A. Problem solving
B. Decision making
C. Diagnostic reasoning
D. Scientific method

C. Diagnostic reasoning

Rationale: Diagnostic reasoning is specific to nursing, involving interpretation of patient signs/symptoms to form nursing diagnoses.

11. What is the purpose of using the scientific method in nursing practice?
A. To document tradition-based practices
B. To avoid testing hypotheses
C. To systematically solve problems through observation, testing, and evaluation
D. To reduce reliance on patient data

C. To systematically solve problems through observation, testing, and evaluation

Rationale: The scientific method provides a structured way to investigate clinical questions and improve care.

12. In the example where a patient could not read medication labels, the nurse’s problem-solving involved:
A. Asking the physician to take over
B. Ignoring the issue
C. Identifying the root cause and suggesting large labels and a pill organizer
D. Reporting the patient for noncompliance

C. Identifying the root cause and suggesting large labels and a pill organizer

Rationale: Effective problem-solving identifies the root cause and develops practical, patient-centered solutions.

13. Why should new nurses avoid relying solely on intuition?
A. Intuition is never useful in nursing
B. It always leads to incorrect conclusions
C. Intuition requires experience and knowledge to be accurate
D. Patients do not like intuitive nurses

C. Intuition requires experience and knowledge to be accurate

Rationale: Intuition can be valuable but must be supported by clinical knowledge and experience.

14. Which statement BEST summarizes the difference between critical thinking and clinical judgment?
A. Critical thinking = outcome, clinical judgment = process
B. Critical thinking = process, clinical judgment = outcome
C. Both are processes only
D. Both are outcomes only

B. Critical thinking = process, clinical judgment = outcome

Rationale: Critical thinking is the thought process, while clinical judgment is the decision or action resulting from that process.

15. Decision making in nursing is best defined as:
A. Choosing only one routine intervention for every patient
B. Following physician orders without questioning
C. Selecting a course of action from several options when faced with a problem
D. Collecting data without acting on it

C. Selecting a course of action from several options when faced with a problem

Rationale: Decision making involves weighing options and criteria to choose the best intervention or action.

16. Which of the following BEST illustrates diagnostic reasoning?
A. Administering medication because it is ordered
B. Gathering patient data, analyzing cues, interpreting evidence, and identifying a diagnosis
C. Creating new hospital policies
D. Asking only yes/no questions

B. Gathering patient data, analyzing cues, interpreting evidence, and identifying a diagnosis

Rationale: Diagnostic reasoning requires analyzing and interpreting signs and symptoms to form nursing diagnoses.

17. A patient develops redness over the hip due to immobility. The nurse decides to turn the patient every 2 hours and use a special mattress. This is an example of:
A. Diagnostic reasoning
B. Decision avoidance
C. Clinical decision making
D. Intuition

C. Clinical decision making

Rationale: Clinical decision making is selecting nursing interventions to resolve patient problems.

18. Inductive reasoning in nursing means:
A. General principle → applied to case
B. Specific observations → general conclusion
C. Ignoring evidence and following tradition
D. Asking only patient preference

B. Specific observations → general conclusion

Rationale: Inductive reasoning builds general conclusions from specific data points.

19. Why is “knowing the patient” essential for clinical decision making?
A. It replaces critical thinking
B. It ensures nurses only follow routines
C. It helps nurses recognize subtle changes and act quickly
D. It prevents collaboration

C. It helps nurses recognize subtle changes and act quickly

Rationale: Familiarity with patient patterns and responses allows timely recognition of deterioration.

20. When prioritizing care for multiple patients, the nurse should:
A. Care for the most stable patient first
B. Always delegate urgent tasks to APs
C. Address unstable patients before stable ones
D. Choose tasks based on convenience

C. Address unstable patients before stable ones

Rationale: Unstable or deteriorating patients require priority attention.

21. Which level of critical thinking is typical of new nurses?
A. Commitment
B. Complex
C. Basic
D. Intuitive

C. Basic

Rationale: Basic thinkers rely on experts and rules, viewing decisions as right or wrong.

22. At the “commitment” level of critical thinking, nurses:
A. Depend entirely on experts
B. Make independent decisions and accept accountability
C. Avoid taking responsibility
D. Only follow step-by-step rules

B. Make independent decisions and accept accountability

Rationale: Commitment reflects independence, accountability, and mature judgment.

23. Which factor is the MOST important source of nursing knowledge for decision making?
A. Physician experience
B. Patient data
C. Policies and procedures
D. Standardized care plans

B. Patient data

Rationale: While all are useful, patient data is the foundation of accurate nursing decisions.

24. Which environmental factor MOST threatens accurate decision making?
A. Patient engagement
B. Frequent interruptions and time pressure
C. Support from colleagues
D. Unit collaboration

B. Frequent interruptions and time pressure

Rationale: Stressors like interruptions and urgency can decrease decision quality.

25. Which attitude involves asking “Why this intervention instead of another?”
A. Confidence
B. Thinking independently
C. Fairness
D. Humility

B. Thinking independently

Rationale: Thinking independently means questioning and seeking evidence rather than blindly following instructions.

26. A nurse who admits mistakes and seeks guidance when unsure demonstrates which critical thinking attitude?
A. Confidence
B. Risk taking
C. Integrity
D. Humility

D. Humility

Rationale: Humility involves self-awareness, admitting limitations, and asking for help.

27. Which is an example of applying an intellectual standard?
A. Giving medication without checking the order
B. Asking if an anticoagulant will worsen wound healing (relevance and logic)
C. Delegating tasks without considering patient needs
D. Prioritizing based only on convenience

B. Asking if an anticoagulant will worsen wound healing (relevance and logic)

Rationale: Intellectual standards ensure reasoning is clear, logical, and relevant.

28. Reflection in nursing practice is BEST described as:
A. Ignoring outcomes to save time
B. Writing down events without analysis
C. Reviewing decisions to learn, improve, and plan for future practice
D. Only documenting mistakes

C. Reviewing decisions to learn, improve, and plan for future practice

Rationale: Reflection is a structured process to analyze decisions and enhance future practice.

29. Reflective journaling helps nurses by:
A. Replacing patient records
B. Developing self-evaluation, observation, and linking theory to practice
C. Eliminating the need for peer discussion
D. Providing answers to test questions

B. Developing self-evaluation, observation, and linking theory to practice

Rationale: Journaling promotes reflection, evaluation, and deeper understanding of clinical experiences.

30. Concept mapping is MOST useful for:
A. Listing tasks in order
B. Replacing care plans
C. Showing relationships between patient problems, diagnoses, and interventions
D. Avoiding teamwork

C. Showing relationships between patient problems, diagnoses, and interventions

Rationale: Concept mapping creates a visual link of complex patient data to improve critical thinking.

31. Which statement best summarizes the relationship between critical thinking and the nursing process?
A. They are unrelated
B. Critical thinking replaces the nursing process
C. The nursing process provides a framework for applying critical thinking
D. Only the nursing process ensures accurate care

C. The nursing process provides a framework for applying critical thinking

Rationale: The nursing process offers structure, while critical thinking ensures thoughtful, evidence-based decisions.

32. Which is the correct order of the REFLECT model?
A. Recall → Explore → Create → Time → Learn → Examine → Feelings
B. Examine → Learn → Recall → Create → Time → Feelings → Explore
C. Recall → Examine → Feelings → Learn → Explore → Create → Time
D. Recall → Create → Feelings → Time → Learn → Examine → Explore

C. Recall → Examine → Feelings → Learn → Explore → Create → Time

Rationale: The REFLECT model follows: Recall, Examine, Feelings, Learn, Explore, Create, Time.

33. Which critical thinking trait involves anticipating patient responses and being proactive?
A. Open-mindedness
B. Truth-seeking
C. Analyticity
D. Responsibility

C. Analyticity

Rationale: Analyticity means anticipating outcomes and responses to ensure safety and preparedness.

34. When handling a questionable medication order, the safe nursing action includes:
A. Administering it immediately
B. Asking another nurse to confirm without reviewing
C. Holding the medication and clarifying with the provider
D. Ignoring the concern and documenting later

C. Holding the medication and clarifying with the provider

Rationale: Patient safety requires clarification before administering potentially harmful medications.