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Chapter 05: Critical Thinking: A Lifelong Journey
Knecht: Success in Practical/Vocational Nursing
MULTIPLE CHOICE
1. A first-postoperative-day patient received pain medication
6 hours ago. He states he is not experiencing pain but
refuses to deep breathe and ambulate as ordered. The
nursing student caring for him consults her instructor,
asking whether it might be advisable to administer pain
medication. The student is using
a. the right brain hemisphere.
b. the intrapersonal learning style.
c. linguistic memory.
d. critical thinking.
ANS: D
The student has questioned the reason for the patient’s
refusal to deep breathe and ambulate and has suggested that
a possible cause may be the presence of discomfort that
could be relieved by medication. This qualifies as critical
thinking. The action described is not a good example of
right brain hemisphere use or use of the intrapersonal
learning style, and it is not related to linguistics.
DIF: Cognitive Level: Application
REF: p. 67 | p. 68
OBJ: 2 | 3
TOP: Critical thinking
Integrity
KEY: Nursing Process Step: PlanningMSC: NCLEX: Physiological
2. The nursing student tells a peer, “Once I begin studying, I don’t dare take a break. If I stop
for even 5 minutes, I know I’ll never go back to studying.” The peer identifies this statement
as
a. negative thinking.
b. random thinking.
c. ruminative thinking.
d. all-or-nothing thinking.
ANS: D
All-or-nothing thinking is characterized by making up one’s mind and not considering any
additional facts. The thinking is black and white, without grays. Negative thinking occurs
when the mind is stuck on negative thoughts and cannot move to other thinking. Random
thinking is characterized by intermittent thoughts without purpose or goal. Ruminative
thinking occurs when the individual focuses on a situation or scene and repeatedly replays it
in the mind.
DIF: Cognitive Level: Application
TOP: Critical thinking
MSC: NCLEX: N/A
REF: p. 66
OBJ: 1
KEY: Nursing Process Step: N/A
3. A patient tells the nursing student, “I keep thinking of the mistake I made that led to the
accident. I can’t get it out of my mind. Now my son has a broken leg.” The nursing
student correctly identifies this as
a. random thinking.
b. habitual thinking.
c. ruminative thinking.
d. directed thinking.
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ANS: C
Ruminative thinking replays the same situation repeatedly without reaching an outcome.
Random thinking involves many thoughts or scenes running aimlessly through the mind.
Habitual thinking involves routines performed as if on automatic pilot. Directed thinking is
purposeful and outcome oriented.
DIF: Cognitive Level: Analysis
REF: p. 66
TOP: Critical thinking
KEY: Nursing Process Step: Assessment (Data Collection)
MSC: NCLEX: Safe, Effective Care Environment
OBJ: 1
4. Which question should be asked by a nursing student who is developing a plan to increase
his critical thinking ability so as to achieve higher grades?
a. “Do I comprehend information from textbooks and classes?”
b. “I wonder how to improve my overall efficiency.”
c. “I’ll have to learn from my mistakes.”
d. “Someone needs to check my conclusions.”
ANS: A
This question deals with an important aspect of using critical thinking in nursing. One must
comprehend the information and then be able to recall and apply it. “I wonder how to improve my
overall efficiency” is a diffuse question and does not lend itself to planning without first being
narrowed and better focused. The other two options are not questions.
DIF: Cognitive Level: Comprehension
TOP: Critical thinking
MSC: NCLEX: N/A
REF: p. 68
OBJ: 7
KEY: Nursing Process Step: N/A
5. The student reads a definition of a nursing term and is asked to state whether the sentence
is true or false. The cognitive level of this exercise is
a. knowledge.
b. comprehension.
c. application.
d. analysis.
ANS: A
Knowledge refers to the ability to recall and repeat memorized information. The other options
are higher cognitive levels—comprehension: the ability to basically understand information,
recall it, and identify examples; application: the ability to use learned material in new
situations; analysis: to break down complex information into its basic parts and relate those
parts to the whole picture.
DIF: Cognitive Level: Application
TOP: Cognitive levels
MSC: NCLEX: N/A
REF: p. 70
OBJ: 4
KEY: Nursing Process Step: N/A
6. When an instructor asks a nursing student to answer a question in her or his own words and
give an example, the cognitive level used is
a. knowledge.
b. comprehension.
c. application.
d. analysis.
ANS: B
Comprehension refers to the ability to understand information, recall it, and identify examples.
Knowledge is the ability to recall and repeat memorized information. Application refers to
being able to use learned information in new situations. Analysis refers to being able to break
down complex information into its basic parts and relate the parts to the whole.
DIF: Cognitive Level: Application
TOP: Cognitive levels
MSC: NCLEX: N/A
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REF: p. 70
OBJ: 4
KEY: Nursing Process Step: N/A
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7. The nursing student has learned the principles of determining and recording intake and
output. When the student cares for a patient who has had a liquid breakfast and has voided
twice and vomited once, the student documents intake and output in the patient’s chart using
the cognitive level known as
a. knowledge.
b. comprehension.
c. application.
d. analysis.
ANS: C
Knowledge refers to recalling memorized information. Comprehension refers to repeating
information in one’s own words or identifying an example. Analysis refers to breaking down
complex information and relating the parts to the whole picture. Application calls for being
able to use learned material in new situations. Because the student documents the intake and
output, he is using information learned.
DIF: Cognitive Level: Application
TOP: Cognitive levels
MSC: NCLEX: Physiological Integrity
REF: p. 70
OBJ: 4
KEY: Nursing Process Step: Implementation
8. During morning report, the nursing student receives a description of the assigned
patient’s current problems. When the student determines the priority nursing intervention,
she is processing information at the cognitive level known as
a. knowledge.
b. comprehension.
c. application.
d. analysis.
ANS: D
Analysis is used when the individual organizes and prioritizes. This scenario suggests a higher
level of functioning than cited in the other options.
DIF: Cognitive Level: Application
REF: p. 70
OBJ: 4
TOP: Cognitive levels
KEY: Nursing Process Step: Planning
MSC: NCLEX: Safe, Effective Care Environment
9. Which factor that influences critical thinking provides the best rationale for using a
team meeting to plan care for a patient?
a. Collaboration
b. Moral development
c. Self-confidence
d. Maturity
ANS: A
Collaborative effort promotes critical thinking skills; thus, care planning by a
knowledgeable group is likely to result in creative solutions to problems. The other options
do not provide a rationale for using team planning sessions.
DIF: Cognitive Level: Analysis
REF: p. 67 | p. 70 OBJ: 7
TOP: Critical thinking
KEY: Nursing Process Step: Planning
MSC: NCLEX: Safe, Effective Care Environment
10. Which remark by a nurse demonstrates the use of critical thinking?
a. “I just let my thoughts flow.”
b. “My mind is made up. Why listen further?”
c. “I play and replay a situation, like using instant replay.”
d. “I think about what other information I need before proceeding.”
ANS: D
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Critical thinking requires the individual to have access to all necessary information. This is
accomplished by collecting and verifying data in an organized way, arranging data in an
organized way, looking for gaps in information, and then proceeding with data analysis.
DIF: Cognitive Level: Application
REF: pp. 68-70
TOP: Critical thinking
KEY: Nursing Process Step: Assessment (Data Collection)
OBJ: 2
MSC: NCLEX: N/A
11. A nurse is caring for a postpartum patient. The nurse assesses the patient’s fundus, notes that
it is deviated to the side, and instructs the patient to void. The nurse understands that this
intervention should allow the fundus to effectively contract. The nurse’s thinking is
purposeful and outcome oriented. This is an example of
a. directed thinking.
b. habitual thinking.
c. nonfocused thinking.
d. ruminative thinking.
ANS: A
Directed thinking is purposeful and outcome oriented. Habitual thinking involves any routine
that is important but does not require one to think hard about how to do it. Nonfocused
thinking occurs when the brain is engaged out of habit without much conscious thought.
Ruminative thinking occurs when the same situation or scene is replayed in the mind over and
over, without reaching an outcome.
DIF: Cognitive Level: Application
TOP: Critical thinking
MSC: NCLEX: N/A
REF: p. 66
OBJ: 1
KEY: Nursing Process Step: N/A
12. A nurse is performing routine vital signs on patients. The nurse has obtained vital signs
many times before and is able to do so without much conscious thought. This is an example
of
a. directed thinking.
b. negative thinking.
c. ruminative thinking.
d. nonfocused thinking.
ANS: D
Directed thinking is purposeful and outcome oriented. Negative thinking occurs when the
mind is stuck on negative thoughts and blocks worthwhile thinking. Ruminative thinking
occurs when the same situation or scene is replayed in the mind over and over, without
reaching an outcome. Nonfocused thinking occurs when the brain is engaged out of habit,
without much conscious thought.
DIF: Cognitive Level: Application
TOP: Critical thinking
MSC: NCLEX: N/A
REF: p. 66
OBJ: 1
KEY: Nursing Process Step: N/A
13. A nursing instructor encourages student nurses to use critical thinking in the clinical setting.
The instructor understands that critical thinking
a. uses both logic and intuition. b.
is driven by the nurse’s needs. c.
entails nonpurposeful thinking.
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d. is based on nonscientific methods.
ANS: A
Critical thinking entails purposeful, informed, outcome-focused thinking that uses both logic
and intuition; is driven by the patient’s, family’s, and community’s needs; and is based on the
principles of the nursing process and scientific methods.
DIF: Cognitive Level: Application
TOP: Critical thinking
MSC: NCLEX: N/A
REF: p. 66
OBJ: 3
KEY: Nursing Process Step: N/A
14. A nursing student demonstrates the ability to break down complex information into its basic
parts and relate those parts to the whole picture. This is an example of what cognitive level?
a. Analysis
b. Knowledge
c. Application
d. Comprehension
ANS: A
Analysis means being able to break down complex information into its basic parts and relate
those parts to the whole picture. Knowledge refers to the ability to recall and repeat
information one has memorized. Application means being able to use learned material in new
situations. Comprehension refers to the ability to very basically understand information,
recall it, and identify examples of that information.
DIF: Cognitive Level: Application
TOP: Cognitive levels
MSC: NCLEX: N/A
REF: p. 70
OBJ: 4
KEY: Nursing Process Step: N/A
15. A student nurse recalls that sleeping medications are administered at 2100. When the
student is questioned about why sleeping medications are given at this time, the student
states, “I memorized that sleeping pills are given at 2100. I have no idea why.” The student
is using what cognitive level?
a. Analysis
b. Knowledge
c. Application
d. Comprehension
ANS: B
Analysis means to be able to break down complex information into its basic parts and relate
those parts to the whole picture. Knowledge refers to the ability to recall and repeat
information one has memorized. Application means being able to use learned material in new
situations. Comprehension refers to the ability to very basically understand information,
recall it, and identify examples of that information.
DIF: Cognitive Level: Application
TOP: Cognitive levels
MSC: NCLEX: N/A
REF: p. 70
OBJ: 4
KEY: Nursing Process Step: N/A
16. A student nurse recently learned about Maslow’s Hierarchy of Needs during a lecture. During
the clinical rotation, the student is able to prioritize patient care based on Maslow’s Hierarchy
of Needs. The student is using what cognitive level?
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a.
b.
c.
d.
Analysis
Knowledge
Application
Comprehension
ANS: C
Analysis means to be able to break down complex information into its basic parts and relate
those parts to the whole picture. Knowledge refers to the ability to recall and repeat
information one has memorized. Application means being able to use learned material in new
situations. Comprehension refers to the ability to very basically understand information,
recall it, and identify examples of that information.
DIF: Cognitive Level: Application
TOP: Cognitive levels
MSC: NCLEX: N/A
REF: p. 70
OBJ: 4
KEY: Nursing Process Step: N/A
17. A nurse is caring for a postpartum patient who is hemorrhaging. The nurse considers
several possibilities for postpartum hemorrhaging, including retained placental fragments, a
full bladder, and uterine atony. The nurse is using what cognitive level?
a. Analysis
b. Knowledge
c. Application
d. Comprehension
ANS: A
Knowledge refers to the ability to recall and repeat information one has memorized.
Comprehension refers to the ability to very basically understand information, recall it, and
identify examples of that information. Application means being able to use learned material
in new situations. Analysis means to be able to break down complex information into its basic
parts and relate those parts to the whole picture.
DIF: Cognitive Level: Application
TOP: Cognitive levels
MSC: NCLEX: N/A
REF: p. 70
OBJ: 4
KEY: Nursing Process Step: N/A
18. A nursing student demonstrates the ability to recall and repeat memorized information but
does not understand the information. This is an example of what cognitive level?
a. Analysis
b. Knowledge
c. Application
d. Comprehension
ANS: B
Knowledge refers to the ability to recall and repeat information one has memorized.
Comprehension refers to the ability to very basically understand information, recall it, and
identify examples of that information. Application means being able to use learned material
in new situations. Analysis means to be able to break down complex information into its basic
parts and relate those parts to the whole picture.
DIF: Cognitive Level: Application
TOP: Cognitive levels
MSC: NCLEX: N/A
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REF: p. 70
OBJ: 4
KEY: Nursing Process Step: N/A
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19. A nursing student demonstrates the ability to basically understand information, recall it,
and identify examples of that information. This is an example of what cognitive level?
a. Analysis
b. Knowledge
c. Application
d. Comprehension
ANS: D
Knowledge refers to the ability to recall and repeat information one has memorized.
Comprehension refers to the ability to very basically understand information, recall it, and
identify examples of that information. Application means being able to use learned material
in new situations. Analysis means to be able to break down complex information into its basic
parts and relate those parts to the whole picture.
DIF: Cognitive Level: Application
TOP: Cognitive levels
MSC: NCLEX: N/A
REF: p. 70
OBJ: 4
KEY: Nursing Process Step: N/A
20. A nursing student demonstrates the ability to use learned material in new situations. This is
an example of what cognitive level?
a. Analysis
b. Knowledge
c. Application
d. Comprehension
ANS: C
Analysis means to be able to break down complex information into its basic parts and relate
those parts to the whole picture. Knowledge refers to the ability to recall and repeat
information one has memorized. Application means being able to use learned material in new
situations. Comprehension refers to the ability to very basically understand information,
recall it, and identify examples of that information.
DIF: Cognitive Level: Application
TOP: Cognitive levels
MSC: NCLEX: N/A
REF: p. 70
OBJ: 4
KEY: Nursing Process Step: N/A
21. Clinical judgments about patients that result from critical thinking have what as their basis?
a. Evidence
b. Assumptions
c. Ethical principles
d. Personal preference of the nurse
ANS: A
Judgments should be made on the basis of facts or evidence, rather than assumptions or the
nurse’s preference. Ethical principles influence decisions, with the nurse choosing to do the
right thing for the patient.
DIF: Cognitive Level: Comprehension REF: p. 67 | p. 68 OBJ: 2
TOP: Critical thinking
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment
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MULTIPLE RESPONSE
1. To describe critical thinking in nursing to a peer, which characteristics would the
nurse mention? (Select all that apply.)
a. Random use
b. Patient focused
c. Uses logic and intuition
d. Bases judgments on assumptions
e. Does not require ongoing evaluation
ANS: B, C
Critical thinking in nursing attempts to find a solution for a patient problem or need. It is
purposeful and uses both logic and intuition. Critical thinking is purposeful rather than
random. Judgments are based on evidence rather than assumptions. Critical thinking is
constantly re-evaluating and self-correcting.
DIF: Cognitive Level: Application
REF: p. 66 | pp. 68-70
OBJ: 2 | 3
TOP: Critical thinking
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care
Environment
2. During a performance evaluation, the evaluator describes several behaviors of the nurse.
Select the observations that indicate the nurse uses critical thinking. (Select all that
apply.)
a. “I have noted that you base care on patient needs.”
b. “Your caregiving is guided by identified outcomes.”
c. “You use professional standards as guidelines.”
d. “You tailor interventions to the circumstances.”
ANS: A, B, C, D
Each behavior is consistent with the advanced way of thinking known as critical thinking and
with use of clinical judgment.
DIF: Cognitive Level: Analysis
REF: p. 66
OBJ: 2 | 3
TOP: Critical thinking
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment
3. An instructor tells a nursing student, “I have noticed that you sometimes engage in
nonfocused thinking.” Which behaviors are consistent with the instructor’s
observation? (Select all that apply.)
a. The student consistently looks for solutions to problems.
b. The student makes up his mind quickly and ignores additional facts.
c. The student focuses on the negative aspects of nearly every situation.
d. The student looks for creative ways to improve situations.
ANS: B, C
The student who makes up his mind quickly and ignores additional facts is an example of allor-none thinking, a type of nonfocused thinking. The student who focuses on the negative
aspects of nearly every situation is an example of negative thinking, another type of
nonfocused thinking. The remaining options are goal oriented and purposeful; therefore, they
are not examples of nonfocused thinking.
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DIF: Cognitive Level: Analysis
REF: p. 66
OBJ: 1
TOP: Critical thinking
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment
4. To think critically, it is necessary to do which of the following? (Select all that apply.)
a. Access information
b. Comprehend information
c. Recall the comprehended information when needed
d. Store comprehended information in short-term memory only
e. Know what to do when information is not in long-term memory
ANS: A, B, C, E
To think critically, it is necessary to access information, comprehend information, store
comprehended information in long-term memory, recall the comprehended information when
needed, and know what to do when information is not in long-term memory.
DIF: Cognitive Level: Comprehension
TOP: Critical thinking
MSC: NCLEX: N/A
REF: p. 68
OBJ: 2 | 3
KEY: Nursing Process Step: N/A
5. A nursing student determines that she needs to increase her reading effectiveness. Identify
two effective strategies for accomplishing this goal that can be implemented immediately.
a. Read one word at a time.
b. Move her lips while reading.
c. Read recreational literature more slowly than technical material.
d. Underline unfamiliar words.
ANS: B, D
Moving the lips while reading increases understanding for readers who are auditory learners.
Underlining unfamiliar words signals the need to determine the definition of the word and
thus enhance one’s medical vocabulary.
DIF: Cognitive Level: Comprehension
TOP: Reading effectively
MSC: NCLEX: N/A
REF: p. 68
OBJ: 6
KEY: Nursing Process Step: N/A
6. Characteristics and attitudes of critical thinkers include which of the following? (Select
all that apply.)
a. Self-confident
b. Honest and upright
c. Logical and intuitive
d. Sensitive to diversity
e. Analytical and insightful
f. Closed- and unfair-minded
ANS: A, B, C, D, E
Characteristics and attitudes of critical thinkers include self-confidence, inquisitiveness,
honesty and uprightness, alertness to context, openness and fair-mindedness, analytical and
insightful thinking, logical and intuitive perception, reflection and self-correction, and
sensitivity to diversity.
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