Chapter 4: Clinical Judgment in Nursing
Answer Key for Critical Thinking Exercises
1. Answer:
a. F. L.’s family/power of attorney: To provide a source for F. L.’s personal and medical
history as well as any support system that may be in place.
b. F. L.’s group home case worker: To provide information on F. L.’s daily routine and the
best methods for providing her with comfort and support in a new environment. The case
worker will also be able to identify people who will be with F. L. on the day of surgery and
who is best able to provide emotional support to F. L. and understand her communication
needs.
c. F. L.’s cardiologist: To clear her for surgery and provide the oncology surgeon with
insight into the severity or risk associated with the anticipated breast cancer surgery.
d. F. L.’s neurologist: To clear her for surgery and provide the oncology surgeon with
information to help prevent seizure activity preoperatively or postoperatively when the
patient may be NPO.
e. A list of medications that F. L. takes regularly is crucial to avoid drug interactions with
anesthesia or analgesia. It is also important to maintain programmed medication when a
patient is admitted into an acute-care setting.
f. Review F.L.’s most recent laboratory results to identify potential concerns that can be
addressed in the preoperative plan of care.
2. Answer:
Sean should seek out more experienced practitioners who frequently work with intellectually
disabled individuals who have multiple body system concerns. Novice nurses need to seek
support from experienced health care professionals to gain confidence in their clinical judgment
skills. Not doing so may result in delayed life-preserving interventions and poor patient
outcomes. This collaboration will assist Sean in his development of sound clinical judgment and
help him gain insight in F. L.’s special needs. It will also help him identify specific interventions
to include in her patient-centered plan of care.
A second critical-thinking strategy that will enhance Sean’s clinical judgment is to enhance his
knowledge base by reviewing evidence-based practice literature on (1) patients with special
needs, (2) nursing strategies to address multiple body system concerns, and (3) best preoperative
care planning. These actions will help support his professional development from the level of
advanced beginner to competent within the Benner stages of clinical competence.
The best plan for F. L. would include preoperative placement in a quiet, relaxed
atmosphere surrounded by her familiar family members or care providers from the group home.
This will help to allay her fears and comfort her in an unfamiliar environment. This intervention
has the potential to provide for the best patient outcome.
Copyright © 2023 by Elsevier, Inc. All rights reserved.
3. Answer:
After collecting and evaluating all of F. L.’s data, Sean should incorporate reflection to gauge
whether his assumptions are correct or what will work best for F. L. Reflection can be in-action
(reading a patient response as it occurs) as well as on-action, which takes place retrospectively.
Reflecting following an experience helps nurses gain knowledge from situations in which patient
outcomes are desirable and positive, and when outcomes are unexpected and negative.
Copyright © 2023 by Elsevier, Inc. All rights reserved.