Test 4 Review CHP 10-14

Chapter 10 Critical Thinking Checkpoint page 173
Mr. W. is a 53-year-old, recently retired engineer with a history of irritable bowel

syndrome that causes frequent diarrhea and
rectal bleeding. His wife is a schoolteacher. It is mid-December when he comes to
your clinic complaining about not feeling
good. You conclude he is having a reoccurrence of his intestinal problem.
1. What questions would you ask yourself to check this assumption?
2. How would you demonstrate that you are using the critical thinking attitude of
confidence in reasoning?
3. Socrates might ask you about the consequences of your conclusion by posing
the question What are the
implications of your thinking? How would you answer? Consider the
implications if you are correct and if you are incorrect in your assumption.
4. Critical thinkers look for subtle cues. Which cues in this situation require
follow-up?
Chapter 10
Critical Thinking Possibilities
1.Examples include the following: What evidence supports the assumption? What
other explanations for his condition are possible? What might another nurse who
sees this situation think? What evidence would suggest a different assumption?
2.This attitude says that critical thinking will lead to appropriate conclusions. It
requires that you trust yourself, examine the influence of emotions on your
thinking, and use logic to reach conclusions. Suggest how you can show that you
have considered these things.
3.If your conclusion is correct and acted on, you have helped keep the clients
problems at a minimum through early intervention. He can receive proper treatment
and the nurse can develop a plan of care to assist the client and family with the impact
of the condition. If you are incorrect in your assumption and do not consider what the
correct conclusion was, time may be wasted and the real condition could worsen.
Increased cost, emotional frustration, and other negative
outcomes may result.
4.How does the client feel about his recent retirement? What is the impact of his
retirement while his wife continues to work? Do the coming holidays play a role in his
illness?
Chapter 11 Critical Thinking Page 196

Eighty-two-year-old Ms. T. is in the hospital for hip replacement surgery.
1. What are the key areas of information to obtain regarding her past history?
2. Which physiological systems are the most important for data collection before
her surgery?
3. What exactly would you say to her to determine if someone will be at home to
assist her after discharge?
4. Which other sources of data might be appropriate to access in her case?
Chapter 11
1.Extremely important areas to include are allergies, comorbidities (other health
problems or diseases), and previous experience with surgery.
2.Because the musculoskeletal system is the reason she is in the hospital, it would be
given priority. Due to her age and the immobility that will follow surgery, other priority
systems would be cardiopulmonary and integumentary.
3.Many answers may be correct. The ques tion should be open ended and designed to
prompt the client for the desired information (for example, it would not be helpful to ask
her where she lives). One
example would be It may not be possible for you to be alone when you go home from
the hospital. Tell me about who might be available to assist you.
4.Consider family, friends, clergy, and her old charts.
A client has recently been diagnosed with lung cancer. Someone has written the
nursing diagnosis of Anxiety on the
care plan.
1. What data/defining characteristics would support this nursing diagnosis?
2. Which related factors might exist in his situation?
3. Which other nursing diagnoses might you expect to find in this case?
4. Another nursing diagnosis on the care plan reads Lung cancer related to
smoking. Is this diagnosis written in an acceptable format? If not, why not?
Chapter 12
1.Examples would include insomnia; fidgeting; dry mouth; increased pulse, blood
pressure, and respirations; and poor attention span.
2.Examples include the uncertainty of the prognosis, lack of knowledge about the
condition and its treatment, and fear of pain.
3.Ineffective Airway Clearance or Breathing Pattern, Ineffective Coping, Spiritual
Distress, Hopelessness, (Readiness for Enhanced Comfort), Grieving.
4.Although this may be a true statement, lung cancer is a medical diagnosisnot a
nursing diagnosis, which is a response to health status or a health problem. In addition,
the stressor (related to) should be something the nurse can treat independently.
1. What assumptions does the nurse make when deciding that using a
standardized care plan for Deficient Fluid
Volume is appropriate for this client?
2. Identify an outcome in the care plan and its nursing intervention that contribute
to discharge care planning.
What evidence supports your choice?
3. Consider how the nurse shares the development of the care plan and outcomes
with the client.
4. Not every intervention has a time frame or interval specified. It may be implied.
Under what circumstances is this acceptable practice?
5. In Table 131, Ineffective Airway Clearance is Amandas highest priority nursing
diagnosis. Under whatconditions might this diagnosis be of only moderate
priority in Amandas case?
Chapter 13
1.The nurse assumes that the standardized care plan is comprehensive enough for this
client with the individualization that is applied to it.
2.The last outcome for Anxiety, Freely expressing concerns and possible solutions
about work and parenting roles, and the associated interventions are examples
because the roles described occur between the client and her family in the home rather
than in the hospital setting.
3.Several possibilities exist. The nurse needs to set aside time to discuss the plan with
the client, alone or with other family and health care team members. The plan can be
presented verbally or in writing. It can be initiated by the nurse who seeks validation
from the client. Or the problem list, nursing diagnoses, goals, outcomes, and
interventions can be decided on by the client and nurse together after the nurse
presents assessment data.
4.If agency guidelines delineate the frequency of nursing interventions and the care plan
does not require these more often than specified, no time frame is required. Also, if the
intervention is performed during every interaction (e.g., the nurse remains calm and
appears confident), no frequency need be written.
5.Nursing diagnoses related to airway are often the highest priority because they
represent life-threatening conditions. In reassessing priorities, the nurse considers new
problems as well as progress toward meeting existing goals. If the airway problem is in
the process of improving, other diagnoses may become higher priority

1. From reviewing Amanda Aquilinis nursing care plan, what general conclusions
can you make about the desired
outcomes for Ineffective Airway Clearance and Anxiety?
2. Despite some of the outcomes being only partially met or not met, no new
interventions were written for several
outcomes. What reasons might there be for this?
3. For the nursing diagnosis of Anxiety, most of the outcomes are fully met.
Would you delete this diagnosis from the care plan at this time? Why or why not?
4. Since the Evaluation Statements column is generally not used on written care
plans, where would auditors or
persons conducting quality assessments find these data?
Chapter 14
1.For Ineffective Airway Clearance, the overall outcome has not been met.
Although the client is able to cough productively, the care plan requires
modification and continuation in order to achieve all of the goals. For Anxiety,
the overall outcome has been met for the most part. Ongoing assessment and data
collection are indicated.
2.Some possibilities are that the interventions have not been adequately
implemented (and still are needed) or more time is needed for their effects to be
apparent.
3.It might be good to keep the diagnosis so it can be followed in case it reoccurs.
On the other hand, the outcomes remaining may be accomplished through plans
for other nursing diagnoses (such as respiratory rate) or are ongoing (teaching).
4.Data collected are recorded in the chart on graphic records and nurses notes (see
chapter 15).

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Chapter 10 Critical Thinking Checkpoint page 173

Mr. W. is a 53-year-old, recently retired engineer with a history of irritable bowel

Chapter 11 Critical Thinking Page 196

Chapter 14 Critical Thinking Page 247

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