Ch10 - Critical Thinking and Clinical Reasoning

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Kozier & Erb’s Fundamentals of Nursing, 9/E

Chapter 10
Question 1
Type: MCSA
Nurses must use critical thinking in their day-to-day practice,

especially in circumstances surrounding client care and wise use of
resources. In which of the following situations would critical
thinking be most beneficial?
1. Administering IV push meds to critically ill clients

2. Educating a home health client about treatment options
3. Teaching new parents car seat safety
4. Assisting an orthopedic client with the proper use of crutches
Correct Answer: 2
Rationale 1: Administering IV meds (even to critically ill clients)

does not require much reasoning. There are standard procedures to
follow and, most of the time, clear answers about the rationale.
Rationale 2: Nurses who utilize good critical-thinking skills are able

to think and act in areas where there are neither clear answers nor
standard procedures. Treatment options, especially for the home health
client, can be extensive. There are many points to consider (good and
bad), and choosing between treatment options can cause conflict among
family members. The nurse in this case must use creativity, analysis
based on science, and problem-solving skills–all of which contribute
to critical-thinking skills.
Rationale 3: Teaching new parents about car seat safety does not
require much reasoning. There are standard procedures to follow and,
most of the time, clear answers about the rationale.
Rationale 4: Teaching correct use of crutches does not require much

reasoning. There are standard procedures to follow and, most of the
time, clear answers about the rationale.
Global Rationale: Page Reference: 164
Cognitive Level: Applying
Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 01 Describe the significance of developing critical-

thinking abilities in order to practice safe, effective, and
professional nursing care.
Question 2
Type: MCSA
A rehab client has orders for active range of motion exercises to her
shoulder following a stroke. The client doesn’t like to do these
because they are uncomfortable and she can’t understand “what good
they will do anyway.” Which of the following statements by the nurse
demonstrates the critical-thinking component of creativity?
1. “You’ll only get worse if you don’t do these exercises.”

2. “As soon as you get these into your routine, you’ll feel better.”
3. “Your physician wouldn’t have ordered these if they weren’t
important.”
4. “Here’s a marker. See how many circles you can make on this board
in 10 minutes.”
Correct Answer: 4
Rationale 1: Explaining the rationale for doing or not doing the

exercises is not using creativity. It is merely explaining the reason.
Rationale 2: This shows no creativity but merely dismissing the

client’s concerns and feelings.
Rationale 3: This doesn’t show any creativity but merely dismisses the
client’s feelings.
Rationale 4: Making the exercise routine into something more–like a

game, or drawing a picture, or even “decorating the walls,” for
example–would raise a challenge to the client, take the focus off the
why, and still achieve the end result.
Client Need Sub:
Learning Outcome: 02 Explore ways of demonstrating critical thinking

in clinical practice.
Question 3
Type: MCSA
A student nurse who claims to be very uncreative doesn’t understand

why it is necessary to learn and develop new ideas in the clinical
area. The best response by the nurse educator is:
1. “Creativity allows unique solutions to unique problems.”

2. “Not all your answers are going to be from your textbook.”
3. “Creativity makes nursing more fun.”
4. “You’ll get bored if you don’t learn to be creative.”
Correct Answer: 1
Rationale 1: Creativity is thinking that results in the development of

new ideas and products and is the ability to develop and implement new
and better solutions. When nurses incorporate creativity into their
thinking, they are able to find unique solutions to unique problems.
Creativity does make the nurse look beyond the answers found in the
text, but it also brings originality and individuality to nursing.
Rationale 2: This option does not address the reason creativity is a

major component to critical thinking but appears to dismiss the
student’s statement.
Rationale 3: This option doesn’t address the reason for creativity in

nursing but merely trivializes its importance.
Rationale 4: This option doesn’t address the reason for creativity in

nursing but merely provides a personal motive for creativity.
Client Need Sub:

Question 4
Type: MCSA
A nurse educator assigned students an activity to implement Socratic

questioning in their daily lives. Which of the following is a question
about reason using this technique?
1. “What makes you think cramming for a test is an ineffective way

to study?”
2. “What other ways of studying could you implement?”
3. “If you didn’t study for your test, what is the probability you
will fail?”
4. “If you study all the unit outcomes, what effect will that have?”
Correct Answer: 1
Rationale 1: Socratic questioning is a technique one can use to look

beneath the surface, recognize and examine assumptions, search for
inconsistencies, examine multiple points of view, and differentiate
what one knows from what one merely believes. Questions about evidence
and reason focus on just that (e.g., what evidence is there, how do
you know, what would change your mind).
Rationale 2: Asking about ways to study would be a question about the

problem (studying) which is not an example of Socratic questioning..
Rationale 3: Asking about the effects of studying is questioning about

implications and consequences. which is not an example of Socratic
questioning.
Rationale 4: Asking about the effects of studying is questioning about

implications and consequences which is not an example of Socratic
questioning.
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 03 Discuss the skills and attitudes of critical

thinking
Question 5
Type: MCSA
A client comes into the emergency department (ED) with a productive

cough, audible coarse crackles, elevated temperature of 102.3°F,
chills, and body aches. The nurse identifies the problem as

respiratory compromise. The nurse is using which of the following?
1. Deductive reasoning
2. Inductive reasoning
3. Socratic questioning
4. Critical analysis
Correct Answer: 1
Rationale 1: Deductive reasoning is reasoning from the general to the

specific. The nurse starts with a framework and makes descriptive
interpretations of the client’s condition in relation to the
framework. Productive cough, crackles, fever, and chills all point to
problems with respiratory status.
Rationale 2: Inductive reasoning would be making a generalization from

a set of facts or observation. In this case, the nurse using inductive
reasoning could presume that the client has bronchitis or a bacterial
respiratory infection.
Rationale 3: Socratic questioning looks beneath the surface and asking

questions to come to a conclusion about the situation that is not what
is described in the stem.
Rationale 4: Critical analysis looks beneath the surface and asking

questions to come to a conclusion about the situation.
Global Rationale: Page Reference: 165-166
Cognitive Level: Understanding
Client Need: Physiological Integrity
Client Need Sub:

Question 6
Type: MCSA
A nurse is taking a health history from a client who states that he

has been to numerous physicians and has had numerous laboratory tests
(all of which were abnormal) and exploratory surgery, but no one is
able to explain the etiology of his problem. The client also states
that he has a PhD in epidemiology and he has a rare form of a
neurological disorder. The nurse who utilizes critical thinking will

make this statement:
1. “Why don’t you just tell your physician what you think you have?”
2. “Did you bring your prior tests and results with you, so we don’t
repeat anything?”
3. “If you know what you have, what do you want from us?”
4. “Describe what tests you’ve had and explain the symptoms of this
disorder.”
Correct Answer: 4
Rationale 1: “Why” questions make clients very defensive and doing so

does not utilize critical thinking skills.
Rationale 2: Asking a “yes/no” question offers little other

information and doing so does not utilize critical thinking skills.
Rationale 3: Asking the client what he wants does not help to find out
more information about the client’s situation or prior history and
doing so does not utilize critical thinking skills.
Rationale 4: In critical thinking, the nurse also differentiates

statements of fact, inference, judgment, and opinion. The nurse will
have to ascertain the accuracy of information and evaluate the
credibility of the information sources.
Client Need Sub:

03 Discuss the skills and attitudes of critical thinking
Question 7
Type: MCSA
A nurse educator has always believed that lectures with focused

outlines are the best way to present theory content in class. A
colleague who teaches the same group of students, but a different
subject, utilizes group work and in-class activities to teach
difficult content and finds that students perform as well, or better,

on their tests. The first educator in this situation is starting to
rethink her position. This is an example of which of the following?
1. Integrity
2. Perseverance
3. Fair-mindedness
4. Humility
Correct Answer: 1
Rationale 1: Intellectual integrity requires that individuals apply

the same rigorous standards of proof to their own knowledge and
beliefs as they apply to the knowledge and beliefs of others. Trying
new teaching techniques in the hope that students might respond
positively shows that the first educator is willing to question her
own practices, just as she would question those of another.
Rationale 2: Perseverance is determination that enables critical

thinkers to clarify concepts and sort out related issues, in spite of
difficulties and frustrations.
Rationale 3: Fair-mindedness is assessing all viewpoints with the same

standards and not basing judgments on personal or group bias or
prejudice.
Rationale 4: Intellectual humility means having an awareness of the

limits of one’s own knowledge. Critical thinkers are willing to admit
what they do not know, seek new information, and rethink their
conclusions in light of new knowledge.
Client Need: Safe Effective Care Environment
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Planning

Question 8
Type: MCSA
A nurse who just moved from an urban area to a sparsely populated

rural area understands that certain customs and practices the nurse is
familiar with may be quite foreign to the people in the new area. This
nurse is practicing which of the attitudes of critical thinking?
1. Fair-mindedness
2. Insight into egocentricity
3. Intellectual humility
4. Intellectual courage to challenge the status quo and rituals
Correct Answer: 2
Rationale 1: Fair-mindedness means assessing all viewpoints with the

same standards and not basing judgments on personal or group bias or
prejudice. the status quo and rituals is taking a fair examination of
one’s own ideas or views, especially those to which one may have a
strongly negative reaction.
Rationale 2: Critical thinkers are open to the possibility that their

personal biases or social pressures and customs could unduly affect
their thinking. They actively try to examine their own biases and
bring them to awareness each time they make a decision. Understanding
that how things were done and what practices were common may be
completely different in the new surroundings is an example of the
nurse implementing this attitude.
Rationale 3: Intellectual humility means having an awareness of the

limits of one’s own knowledge.
Rationale 4: Intellectual courage to challenge the status quo and

rituals is taking a fair examination of one’s own ideas or views,
especially those to which one may have a strongly negative reaction.
Client Need Sub: Management of Care

thinking
Question 9
Type: MCSA
When implementing a quicker way to set up and initiate an IV while

still following safe practice, a nurse is practicing which of the
attitudes of critical thinking?
1. Independence
2. Intellectual courage to challenge the status quo or rituals
3. Integrity
4. Confidence
Correct Answer: 1
Rationale 1: Nurses who can think for themselves and consider

different methods of performing technical skills–not just the way they
may have been taught in school–develop an attitude of independence.
Rationale 2: Courage to challenge the status quo comes from

recognizing that sometimes beliefs are false or misleading. Integrity
requires that individuals apply the same rigorous standards of proof
to their own knowledge and beliefs; that is not what is described in
the stem.
Rationale 3: Integrity requires that individuals apply the same

rigorous standards of proof to their own knowledge and beliefs; that
is not what is described in the stem.
Rationale 4: Confidence is the self assurance to act on one’s own

beliefs; that is not what is described in the stem.

02 Explore ways of demonstrating critical thinking in clinical

practice.
Question 10
Type: MCSA
A nurse continues to question the practice of administering rectal

suppositories to residents in a long-term care facility at bedtime,
rather than earlier in the day. When told that this is the best time
for staff and that’s the routine that has been practiced for a long
time, the nurse continues to research whether there would be a better
time, especially in the best interest of the residents. This nurse is
practicing which of the critical-thinking attitudes?
1. Confidence
2. Perseverance
3. Curiosity
4. Integrity
Correct Answer: 3
Rationale 1: Confidence comes from cultivating reasoning and examining

arguments. In this case, the nurse did not reason anything out, but is
still asking questions.
Rationale 2: Perseverance happens from determination in clarifying

concepts and sorting out related issues, in spite of difficulties and
frustrations. This nurse is still asking questions, not making any
changes in spite of difficulties or frustrations.
Rationale 3: The internal conversation going on within the mind of a

critical thinker is filled with questions. The curious nurse may value
tradition but is not afraid to examine traditions to be sure they are
still valid, as in this case. This nurse is asking valid questions.
Rationale 4: Integrity requires that individuals apply the same

rigorous standards of proof to their own knowledge and beliefs as they
apply to the knowledge and beliefs of others.

Question 11
Type: MCSA
A seasoned nurse works in a busy ICU unit. When a particularly complex

client is admitted, the nurse uses past experiences and knowledge
gained from those situations to help care for this client. This nurse
is practicing which of the attributes of critical thinking?
1. Reflection
2. Context
3. Dialogue
4. Time
Correct Answer: 4
Rationale 1: Reflection involves being able to determine what data are

relevant and to make connections between that data and the decisions
reached but that is not what is described in the stem..
Rationale 2: Context is an essential consideration in nursing since

care must always be individualized, taking knowledge and applying it
to real people but that is not what is described in the stem.
Rationale 3: Dialoque is a purposed exchange of information but that

is not what is described in the stem
Rationale 4: The attribute of time emphasizes the value of using past

learning in current situations that then guide future actions.
Global Rationale:

04 Discuss the relationships among critical thinking, the problem-

solving process, and the decision-making process.
Question 12
Type: MCSA
A nurse is taking an admission history from a client who is easily

distracted and offers irrelevant information about his health and
social history. Although careful to document what the client relates,
the nurse sorts out the relevant data to determine the best nursing
care for this client. This nurse is practicing which attribute of

critical thinking?
1. Reflection
2. Context
3. Dialogue
4. Time
Correct Answer: 1
Rationale 1: Reflection involves being able to determine what data are

relevant and to make connections between that data and the decisions
reached.
Rationale 2: Context is an essential consideration in nursing since

care must always be individualized, taking knowledge and applying it
to real people but that is not what is described in the stem.
Rationale 3: Dialogue, which need not involve other persons, refers to

the process of serving as both teacher and student in learning from
situations.
Rationale 4: Time emphasizes the value of using past learning in

current situations that then guide future actions.

Question 13
Type: MCSA
A client is complaining of shortness of breath, has no pallor, no

cyanosis, and no accessory muscle use with respirations. The client’s
respiratory rate is 16 breaths per minute. The nurse is concerned that
the client’s report and the physical findings conflict. This nurse is
using which universal standard of critical thinking?
1. Clarity
2. Accuracy
3. Logicalness
4. Significance
Correct Answer: 3
Rationale 1: Clarity provides examplesand that is not the process

described in the stem.
Rationale 2: Accuracy is asking if something is true and that is not

the process described in the stem.
Rationale 3: Logicalness would ask if the report follows from the

evidence. In this case, it does not. However, the nurse is still
questioning which shows she is engaged in critically thinking through
the situation.
Rationale 4: Significance is prioritizing the facts and that is not

the process described in the stem.
Nursing/Integrated Concepts: Nursing Process: Assessment

Question 14
Type: MCSA
A nurse enters the room of a critically ill child and has a sense that
“something” isn’t right. After performing an initial physical
assessment and finding that the child is stable, the nurse continues
to perform a check of all the lines and equipment in the room and
finds that the last IV solution hung by the previous nurse was not the
correct solution. This nurse was utilizing which method of problem
solving?
1. Trial and error

2. Intuition
3. Judgment
4. Scientific method
Correct Answer: 2
Rationale 1: Trial and error is solving problems through a number of

approaches until a solution is found.
Rationale 2: Intuition is the understanding or learning of things

without the conscious use of reasoning. It is also known as sixth
sense, hunch, instinct, feeling, or suspicion. Clinical experience
allows the nurse to recognize cues and patterns and begin to reach
correct conclusions using intuition. Finding no cause for concern in
the physical assessment of the client, the nurse is not satisfied and
continues to assess the client’s surroundings, finding the error.
Rationale 3: Judgment is not part of problem solving.
Rationale 4: The scientific method requires that the nurse evaluate

potential solutions to a given problem in an organized, formal, and
systematic approach.
Client Need Sub: Safety and Infection Control
Learning Outcome: 04 Discuss the relationships among critical

thinking, the problem-solving process, and the decision-making
process.
Question 15
Type: MCSA
A client has had a nonhealing wound for a period of time. The home
health nurse decides to implement a variety of wound care products to
see if any of them work. Each day, the nurse switches to a different
brand or product. In this situation, the nurse is utilizing which
method of problem solving?
1. Intuition
2. Scientific method
3. Research process
4. Trial and error
Correct Answer: 4
Rationale 1: Trial and error is solving problems by utilizing a number

of approaches. Trial-and-error methods can be dangerous in nursing
because the client might suffer harm if an approach is inappropriate.
In this case, the client may not suffer harm, but there will be no way
to know if one product used is effective since the nurse is changing
them on a daily basis. Intuition is the learning of things without
conscious use of reasoning—also known as the sixth sense, hunch, or
instinct. Scientific method and research process are both formalized,
systematic, and logical approaches to solving problems.



Cognitive Level: Analyzing
Client Need Sub:


Question 16
Type: MCSA
A nurse is caring for a client who has unstable cardiac dysrhythmias.

The client has orders for medications, one of which is by oral route,
the other by IV delivery. The nurse realizes that the IV route would
be fastest, but is also concerned about the side effects that this
drug may produce and the fact that the client has never taken the
drug, so any adverse effect is unknown. The nurse is implementing
which step of the decision-making process?
1. Identify the purpose

2. Seek alternatives
3. Project
4. Implement
Correct Answer: 2
Rationale 1: In this step, the decision maker (nurse) identifies

possible ways to meet the criteria. Alternatives considered are which
route to give a certain medication: IV versus oral. The nurse is
utilizing his experience, taking what he knows about cardiac problems
and pharmacology, and will make a selection based on that information.
Identifying the purpose, in this case, would be determining that the
client needs intervention to control the dysrhythmia. Projecting is
when the nurse applies creative thinking and skepticism to determine
what might go wrong as a result of a decision and develops plans to
prevent, minimize, or overcome any problems. Implementation is taking
the plan into action.




Client Need Sub:

Question 17
Type: MCSA
A nurse is checking over the past charting of the previous shift,

paying special attention to how a particular client responded to
nursing interventions throughout the day. The nurse is caring for this
client and wants to see what has been effective, as well as what
didn’t work. This nurse is utilizing which of the steps of the
decision-making process?
1. Set the criteria

2. Examine alternatives
3. Implement
4. Evaluate the outcome
Correct Answer: 4
Rationale 1: In evaluating, the nurse determines the effectiveness of

the plan and whether the initial purpose was achieved. In this
situation, the nurse wants to determine what worked on the previous
shift and what didn’t. This will help with deciding on interventions
for the client during the shift. Setting criteria is based on three
questions: What is the desired outcome? What needs to be preserved?
What needs to be avoided? Examining alternatives ensures that there is
an objective rationale in relation to the established criteria for
choosing one strategy over another. In this case, the nurse is
evaluating the previous nurse’s alternatives, not choosing new ones.
Implementation is putting a plan into action.




Client Need Sub:

Question 18
Type: MCSA
A nurse is being questioned by the parents of a client whose physician

ordered a battery of invasive tests. They are wondering why their
child should have to go through all the pain and discomfort of these
studies. The nurse is not familiar with the situation and has just
come on duty for the evening shift. A limited report was given by the
previous shift. The nurse understands that the child is stable at this
time and has no pain, but the nurse has not been able to review the
chart or do an initial assessment at this point. The best response by
the nurse is:
1. “I’m not sure I can answer your question just now.”

2. “It’s a good idea to listen to what your physician wants.”
3. “Your child’s doctor is the best there is. I don’t see why you
wouldn’t follow his advice.”
4. “Maybe you should get another opinion if you’re not comfortable
with your doctor.”
Correct Answer: 1
Rationale 1: Suspending judgment means tolerating ambiguity for a

time. If an issue is complex it may not be resolved quickly and
judgment should be postponed. In this case, the nurse just doesn’t
have enough information to give a good answer to the parents. For a
while, the nurse will need to say, “I don’t know” and be comfortable
with that answer. Telling the parents to agree with the physician
before the nurse knows all the facts might be premature, even if he is
the best physician in the area. It would also be premature to tell the
parents to get another opinion. Nurses should not give advice or
counsel, merely information.




Client Need Sub:

thinking
Question 19
Type: MCSA
A client comes into the clinic with complaints of “extreme” low back
pain after helping to move a heavy object. The client is pale and
diaphoretic and walks bent at the waist. Before taking vital signs,
the nurse projects that the blood pressure as well as heart rate will
be elevated. This is an example of which of the following?
1. Fact
2. Inference
3. Judgment
4. Opinion
Correct Answer: 2
Rationale 1: Inferences are conclusions drawn from facts, going beyond

facts to make a statement about something that is not currently known.
In this case, acute, severe pain will most likely cause the blood
pressure as well as pulse rate to be elevated as the body’s response
to the painful experience. Fact can be verified through investigation.
In this case, fact would be the elevated pulse and blood pressure
readings. Judgment is evaluating facts and information that reflect
values or other criteria; it is a type of opinion. Because the nurse
understands the pathophysiology of pain, thinking about changes in
vital signs is more than a judgment—it is an inference. Opinions are
beliefs formed over time and include judgments that may fit facts or
be in error.

be in error.

be in error.

be in error.
Client Need Sub:

Question 20
Type: MCSA
A nurse is completing a plan of care for a client. The statement

“client will be able to walk 10 feet, twice a day without shortness of
breath” is which part of the nursing process (in comparison to the
decision-making process)?
1. Assess
2. Diagnose
3. Plan
4. Evaluate
Correct Answer: 3
Rationale 1: The planning portion of the nursing process involves

setting criteria (walking 10 feet twice a day), weighting the
criteria, and seeking/examining alternatives when compared to the
decision-making process. Assessment is the same as identifying the
purpose. Diagnosing is putting a label on the problem. Evaluating is
reviewing the outcome.



Client Need Sub:
Learning Outcome: 04 Discuss the relationships among critical

thinking, the problem-solving process, and the decision-making
process.
Question 21
Type: MCSA
A nurse is caring for a client of a different culture. The nurse is

not familiar with the customs of this particular client and becomes
disturbed when the client’s spouse makes all the decisions about care
and treatments. The nurse’s reaction is an example of which of the
following?
1. Inference
2. Judgment
3. Opinion
4. Evaluation
Correct Answer: 3
Rationale 1: Opinions are beliefs formed over time and include

judgments that may fit facts or be in error. In this case, the nurse
may not understand that culturally, this may be very appropriate and
fitting for this client. If this is the case, the nurse should not
become disturbed by the spouse’s attention. Inferences are conclusions
drawn from the facts, going beyond facts to make a statement about
something not currently known. Judgment is an evaluation of facts or
information that reflects values or other criteria; it is a type of
opinion. Evaluation is considering the results or outcome.



Client Need Sub:


thinking
Question 22
Type: MCSA
Before beginning a particularly stressful shift in a critical care

nursery, a nurse is in the practice of reviewing his attitudes and
feelings about death and dying, dignity of people, and the parental
role in understanding and questioning cares and treatments. This nurse
is cultivating which of the following?
1. Critical-thinking attitudes
2. Dissonance
3. Ambiguity
4. Self-assessment
Correct Answer: 4
Rationale 1: Nurses are in and around situations that require

attitudes of curiosity, fair-mindedness, humility, courage, and
perseverance. They need attitudes that foster critical thinking. A
rigorous personal assessment may help determine what attitudes a nurse
already possesses and which need to be cultivated. Identifying weak or
vulnerable attitudes and reflecting on situations where decisions were
made and then later regretted helps to assess the nurse’s own biases
and perceptions.

and perceptions.

and perceptions.

and perceptions.
Client Need Sub:

thinking
Question 23
Type: MCSA
A nurse educator senses that a student has been struggling with

clinical skills learned in lab. In the clinical area, this student is
usually lagging behind and seems to be involved when the other
students have opportunities to perform some of the tasks. The educator
pairs the student with a particularly outgoing staff nurse who has a
number of unique clients with a variety of treatments and cares. The
educator is utilizing which type of problem solving?
1. Trial and error

2. Intuition
3. Research process
4. Experience
Correct Answer: 2

without the conscious use of reasoning. It is also known as the sixth
sense, hunch, instinct, feeling, or suspicion. In this case, the
educator has a sense that the student is struggling, though there are
no real facts to support it. Experience is part of intuition, but by
itself, not a particular way to problem solve. Trial and error uses a
number of approaches until a solution is found, which is not the case
here. Trial-and-error methods in nursing care can be dangerous because
the client might suffer harm if an approach is inappropriate. The
research process is a systematic, analytical, and logical way to

problem solve.

problem solve.

problem solve.

problem solve.
Client Need Sub:


Question 24
Type: MCMA
Critical-thinking nurses must develop which of the following specific

attitudes or traits?
Standard Text: Select all that apply.
1. Independence.
2. Egocentricity.
3. Intellectual humility.
4. Fair-mindedness.
5. Confidence.
6. Perseverance.
Correct Answer: 1,3,4,5,6
Rationale 1: Attributes that foster critical thinking include

independence.
Rationale 2: Attributes that foster critical thinking include insight

into egocentricity (which is open to the possibility that biases or
social pressures and customs can affect one’s thinking) but not
egocentricity itself.

intellectual humility.
Rationale 4: Attributes that foster critical thinking include fair-

mindedness.

confidence.

perseverance.
Client Need Sub:


thinking
Question 25
Type: MCMA
A nurse shows an understanding of the reasons critical thinking is so

vital to today’s nursing profession when stating:
1. “Patient acuity is so much greater than it was even 10 years

ago.”
2. “Care delivery systems are only as good as the nurses delivering
care.”
3. “Nurses have always relied on common sense thinking to provide
quality, appropriate nursing care.”
4. “With health care being so expensive, nursing has to take on
responsibility to keep the costs controlled.”
5. “My practice involves caring for clients who require care that
didn’t even exist when I went to school.”
Correct Answer: 1,2,4,5
Rationale 1: According to R. Alfaro LeFevre’s Top 10 Reasons to

Improve Thinking, patients are sicker, with multiple problems, and so
nursing care requires a more critical form of thinking in order to
meet their nursing needs.

Improve Thinking, redesigning care delivery is useless if nurses don’t
have the thinking skills required to deal with today’s world.
Rationale 3: While this might be true, medicine and nursing have

evolved tremendously, and so has the need for nurses to be critical
thinkers.

Improve Thinking, consumers and payers demand to see evidence of
benefits, efficiency, and results.

Improve Thinking, today’s progress often creates new problems that
can’t be solved by old ways of thinking.


Question 26
Type: MCMA
A nurse displays characteristics of a critical thinker:
1. When listening with empathy to a client who recently has been

diagnosed.
2. When waiting for the medical team to determine the focus of the
client’s supportive care.
3. When questioning a medication order that does not appear to meet
the client’s needs for pain management.
4. When exhibiting a willingness to try alternate methods of
addressing a client’s care needs.
5. When practicing nursing in a culturally competent fashion.
Correct Answer: 1,3,4,5
Rationale 1: Empathetic listening shows the ability to imagine others’

feelings and difficulties, which is characteristic of critical
thinking.
Rationale 2: Proactive anticipation of consequences, planning ahead,

and acting as opportunities and events require are characteristic of
real thinking.
Rationale 3: Courageously advocating for others demonstrates

attributes characteristic of critical thinking.
Rationale 4: Flexible changing of approaches as needed to get the best

results is a characteristic of critical thinking.
Rationale 5: Sensitivity to diversity, expressing appreciation of

human differences related to values and culture, is a characteristic
of critical thinking.
Client Need Sub:

thinking
Kozier & Erb’s Fundamentals of Nursing, 9/E Test Bank
Copyright 2012 by Pearson Education, Inc.

Ch10 - Critical Thinking and Clinical Reasoning

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Kozier & Erb’s Fundamentals of Nursing, 9/E

Nurses must use critical thinking in their day-to-day practice,

1. Administering IV push meds to critically ill clients

Rationale 1: Administering IV meds (even to critically ill clients)

Rationale 2: Nurses who utilize good critical-thinking skills are able

Rationale 4: Teaching correct use of crutches does not require much

Global Rationale: Page Reference: 164

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 01 Describe the significance of developing critical-

1. “You’ll only get worse if you don’t do these exercises.”

Rationale 1: Explaining the rationale for doing or not doing the

Rationale 2: This shows no creativity but merely dismissing the

Rationale 4: Making the exercise routine into something more–like a

Global Rationale: Page Reference: 164

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 02 Explore ways of demonstrating critical thinking

A student nurse who claims to be very uncreative doesn’t understand

1. “Creativity allows unique solutions to unique problems.”

Rationale 1: Creativity is thinking that results in the development of

Rationale 2: This option does not address the reason creativity is a

Rationale 3: This option doesn’t address the reason for creativity in

Rationale 4: This option doesn’t address the reason for creativity in

Global Rationale: Page Reference: 164

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 01 Describe the significance of developing critical-

A nurse educator assigned students an activity to implement Socratic

1. “What makes you think cramming for a test is an ineffective way

Rationale 1: Socratic questioning is a technique one can use to look

Rationale 2: Asking about ways to study would be a question about the

Rationale 3: Asking about the effects of studying is questioning about

Rationale 4: Asking about the effects of studying is questioning about

Global Rationale: Page Reference: 165

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 03 Discuss the skills and attitudes of critical

A client comes into the emergency department (ED) with a productive

chills, and body aches. The nurse identifies the problem as

Rationale 1: Deductive reasoning is reasoning from the general to the

Rationale 2: Inductive reasoning would be making a generalization from

Rationale 3: Socratic questioning looks beneath the surface and asking

Rationale 4: Critical analysis looks beneath the surface and asking

Global Rationale: Page Reference: 165-166

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 02 Explore ways of demonstrating critical thinking