Critical Thinking Skills Test In Nursing

Critical thinking . . . schmritical thinking

The term gets tossed around so much in nursing education now that it has really lost all value.  In fact, I think that rather than teaching students HOW to critically think . . . many schools are just using the word because they HAVE to.

This episode discusses what critical thinking is, what the cognitive levels of NCLEX questions are, and how to combine that knowledge to answer the questions AND be an amazing nurse.

Cognitive Levels of NCLEX Questions

We’ve talked about this a few times on the blog HERE and HERE but I think that understanding what you are up against is essential.

The NCSBN who write the NCLEX exam uses Blooms Taxonomy  to develop questions.  Essentially Blooms Taxonomy is:

A continuum of increasing cognitive complexity—from remember to create.

As you can see from the image, it is made up of 6 cognitive levels that increase in complexity as you move “up” the pyramid.

In other words, it is much easier to remember a fact than it is too create a concept . . . from a cognitive standpoint.

If you learn that the normal lab value range for sodium is 135-145 . . . all you have to do is remember that fact to get a remember question right.

Pretty simple . . . however, if you are given a question about a patient with a deteriorating neuro status and are ask what the best action would be for this patient . . . would you be able to analyze the situation and determine that a sodium level needs to be checked?

The second question takes you to a much deeper level of understanding and requires you to actually APPLY the knowledge and ANALYZE previous knowledge to best care for the patient.

This is where you need to be hanging out. . . forget simply remembering facts . . . you need to be critically thinking about patient care in order to best care for patients.

In reality, I don’t give a damn if you can tell me a sodium level is low AFTER THE FACT . . . its a bit late by then.  Can you recognize the signs of SIADH and prompt the physician to run a Na level before the patient starts declining neurologically due to hyponatremia . . . see where I went there . . . ?  Can you see the difference in the two situations?

 

What is Critical Thinking?

So let’s talk about critical thinking and how it applies to everything we are talking about here.

The NCSBN website states the following:

Since the practice of nursing requires you to apply knowledge, skills and abilities, the majority of questions on the NCLEX are written at the cognitive level of apply or higher. And these questions, by nature, require critical thinking.

Answering these correctly will require you to do something with what you have learned, to manipulate previously learned material in new ways or find connections between many facts.

Again, since the majority of NCLEX questions fall into this category, this is exactly the type of questions you need to practice answering!

There it is again . . . the BUZZ word (critical thinking) . . . but once again no tips or information on what that means or how to develop it is given.

4 Steps to Critical Thinking in Nursing

Essentially there are 4 steps to critical thinking . . . in nursing and in life . . . and developing the ability to critically think will work wonders in your life.

  • Suspend ALL Judgement
  • Collect ALL Information
  • Balance ALL Information
  • Make a Complete and Holistic Decision

You have to start by suspending all judgement.  In other words, if you walk into a patients room and see them tachycardic and armature decision would be to run and grab the metoprolol to try to drop the heart rate.

An advanced clinician will WAIT until they have more information . . . not leaving the patient untreated . . . but not jumping freakishly into the WRONG treatment because they learned that tachycardia is bad . . .

Now you must collect ALL information.  This is clutch! Don’t make a decision until you have collected every piece of data that you need to collect . . . on a tachycardic patient you can check BP, temp, run an EKG, check urine output.

Now, balance all information.  This means take all the data that you have and start weighing it to find out what is pertenant and what you can ignore.  If the temp is 98.9 . . . it’s probably not the cause.  If the BP is 74/56 are we looking at a volume issue?

Finally, make your decision . . . with all the data in and after looking over it all very closely you can begin to make your decision.

Critical Thinking in Nursing and on the NCLEX®

Lastly, I just want to talk briefly about how this applies to NCLEX questions . . .

Here is an actual practice NCLEX question from our Nursing Practice Questions Program (or NPQ, as we like to call it)!

A 56-year-old male patient has been admitted to the cardiac unit with exacerbation of heart failure symptoms. The nurse has given him a nursing diagnosis of decreased cardiac output related to heart failure, as evidenced by a poor ejection fraction, weakness, edema, and decreased urinary output. Which of the following nursing interventions are most appropriate in this situation?

42% of the students that have taken this question have selected this answer:

Administer IV fluid boluses to increase urinary output

The problem with that answer is that it is thinking at a REMEMBERING level when this question requires ANALYSIS level comprehension.

Test takers see urine output as low . . . and want to correct that quickly with fluids.

However, this is a CHFer . . . you can’t (shouldn’t) bolus your CHF patient especially during an exacerbation . . . you could send the patient into pulmonary edema and drastically impact their respiratory status.

So the lesson here. . . . in school, on the NCLEX, and on the clinical floor . . . slow down, stay calm and start thinking at an analysis level.

And I promise you this helps in “REAL” life too . . . not just in nursing.

How to Develop Critical Thinking Skills

Here are two articles and websites that talk about the development of critical thinking that will help you get to the analysis level and feel more confident with NCLEX style questions and remain calm on the nursing floor.

And as always . . . check out our NursingPracticeQuestions.com site to take a few practice NCLEX questions.

 

Your Thoughts

Ok . . . enough from me.  I want to hear your thoughts.  What are you doing to improve your critical thinking skills?

Date Published - Jan 15, 2016
Date Modified - Sep 18, 2016

Written by Jon Haws RN

Jon Haws RN began his nursing career at a Level I Trauma ICU in DFW working as a code team nurse, charge nurse, and preceptor. Frustrated with the nursing education process, Jon started NRSNG in 2014 with a desire to provide tools and confidence to nursing students around the globe. When he's not busting out content for NRSNG, Jon enjoys spending time with his two kids and wife.

  • 1. 

    What is the "Nursing Process"? Select all that apply

    • A. 

      Organizational framework for the practice of Nursing

    • B. 

      Systematic method by which nurses plan and provide care for patients

    • C. 

      The application of the nursing process only applies to RN's and not LPN's

    • D. 

      The Nursing Scope and Standards of Practice of the ANA outlines the steps of the nursing process

  • 2. 

    Match the Nursing Process on the left with its description on the right 

    • C. Plan and Identify Outcome
  • 3. 

    ANA defines it as a"systematic dynamic process by which the nurse, through interaction with the client, significant others  and health care providers collect and analyzes data about the client

    • A. 

    • B. 

    • C. 

    • D. 

  • 4. 

    Which of the following is not true about Focused ASSESSMENT

    • A. 

      When patient is critically ill or disoriented

    • B. 

      When patient is unable to respond

    • C. 

      Preferably early in the morning before breakfast.

    • D. 

      When drastic changes are happening to a patient.

  • 5. 

    A synonym for significant data that usually demonstrate an unhealthy response. 

    • A. 

    • B. 

    • C. 

    • D. 

  • 6. 

    Headache, itchiness, warmth

    • A. 

    • B. 

    • C. 

    • D. 

  • 7. 

    Secondary Source of Data. (Select all that apply) 

    • A. 

    • B. 

    • C. 

    • D. 

  • 8. 

    Which of the following is not a method of data collection?

    • A. 

    • B. 

    • C. 

    • D. 

  • 9. 

    If the first method of data collection is to conduct an interview, what is the second method?

    • A. 

    • B. 

    • C. 

    • D. 

      Performance of a physical examination

  • 10. 

    After establishing a database and before the identification of nursing diagnosis, what does a nurse do? 

    • A. 

      Documentation of database

    • B. 

    • C. 

    • D. 

      Acquiring a database of information

  • 11. 

    Data Clustering

    • A. 

      Analyzing signs and symptoms

    • B. 

      Identifying patient statements

    • C. 

      Grouping related cues together

    • D. 

      Entering patient data in the computer

  • 12. 

    Deficient Fluid Volume (Select all that apply)

    • A. 

    • B. 

      Dry skin and dry oral mucous

    • C. 

    • D. 

  • 13. 

    Which of the following refers to the definition of a Nursing Problem?

    • A. 

      Nurse overload and nurse burnout

    • B. 

      When the nurse calls in sick

    • C. 

      Any health care condition that requires diagnostic, therapeutic, or educational actions.

    • D. 

  • 14. 

     Clinical judgment

    • A. 

    • B. 

      Job description of a clinical nurse

    • C. 

    • D. 

  • 15. 

    Components of a Nursing Diagnosis. Select all that apply  

    • A. 

      Nursing diagnosis title or label

    • B. 

      Definition of the title or label

    • C. 

    • D. 

      Contributing, etiologic or related factors

    • E. 

  • 16. 

    Which of the following are true regarding nursing diagnosis? 

    • A. 

      A nursing diagnosis is any problem related to the health of a patient

    • B. 

      When writing a nursing diagnosis, place the adjective before the noun modified

    • C. 

      A nursing diagnosis is usually the etiology of the disease

    • D. 

      Both medical and nursing diagnosis can be converted into a nursing intervention.

  • 17. 

    Clear, precise description of a problem 

    • A. 

    • B. 

    • C. 

    • D. 

  • 18. 

    Risk factors

    • A. 

    • B. 

      Analysis of a health issue

    • C. 

    • D. 

      Circumstances that increase the susceptibility of a patient to a problem

  • 19. 

    Clinical cues, signs, symptoms that furnish evidence that the problem exists. 

    • A. 

    • B. 

    • C. 

    • D. 

  • 20. 

    How cues, signs and symptoms identified in patient's assessment are written

    • A. 

    • B. 

    • C. 

    • D. 

  • 21. 

    "Constipation related to insufficient fluid intake manifested by increased abdominal pressure". What is the defining characteristic? 

    • A. 

    • B. 

    • C. 

      Increased abdominal pressure

    • D. 

  • 22. 

    What is RISK NURSING DIAGNOSIS as described by NANDA-I?  Select all that apply

    • A. 

      Human responses to health conditions/life processes that may develop in a vulnerable individual/family

    • B. 

      Describes the symptoms of the disease

    • C. 

      Supported by risk factors that contribute to increased vulnerability

    • D. 

      Proof that the person is suffering from an illness

  • 23. 

    How many parts does a RISK NURSING DIAGNOSIS have?

    • A. 

    • B. 

    • C. 

    • D. 

  • 24. 

    Which of the following is a Risk Nursing Diagnosis statement? 

    • A. 

      Risk for falls related to unstable balance

    • B. 

      Constipated because of fecal impaction

    • C. 

    • D. 

      Constipation related to dehydration

  • 25. 

    Syndrome Nursing Diagnosis

    • A. 

      An isolated disease with numerous symptoms

    • B. 

      Numerous symptoms describing a single disease

    • C. 

      Used when a cluster of actual or risk nursing diagnosis are predicted to be present

    • D. 

      Numerous symptoms leading to an idiopathic disorder

  • 26. 

    Wellness Nursing Diagnosis

    • A. 

    • B. 

    • C. 

      Human responses to levels of good health in an individual, family or community

    • D. 

  • 27. 

    Certain Physiologic complications that nurses monitor to detect their onset or changes in the patient's status.    

    • A. 

    • B. 

    • C. 

    • D. 

  • 28. 

    Potential complications: hypoglycemia.  This is a sample of what?

    • A. 

    • B. 

    • C. 

    • D. 

  • 29. 

    Identification of a disease or condition by a scientific evaluation of physical signs, symptoms, history, laboratory test and procedures. 

    • A. 

    • B. 

    • C. 

    • D. 

  • 30. 

    Difference between Medical and Nursing Diagnoses

    • A. 

      Medical is etiology; Nursing is human response

    • B. 

      Medical is disease; Nursing is the cause of disease

    • C. 

      Medical is illness; Nursing is illness too

    • D. 

      Medical is to heal the disease: Nursing is to discover the disease

  • 31. 

    Difference between a goal statement and an outcome statement

    • A. 

      A good outcome statement is specific to the patient

    • B. 

      Goals are general deadlines that are to be met

    • C. 

      An outcome statement refers to what the nurse will do

    • D. 

      Goals and Statements are practically the same

  • 32. 

    The purpose to which an effort is directed 

    • A. 

    • B. 

    • C. 

    • D. 

  • 33. 

    Which of the following statements describe a well-written patient outcome statement? Select all that apply.  

    • A. 

    • B. 

      Focuses on the completion of nursing interventions

    • C. 

      Does not interfere with the medical care plan

    • D. 

      Includes a time frame for patient reevaluation

  • 34. 

    A common framework that helps guide the prioritization of nursing tasks during the process of planning

    • A. 

      Ericsson's psychosocial development

    • B. 

    • C. 

    • D. 

  • 35. 

    Nursing interventions

    • A. 

      Depend on the tasks delegated by the nursing supervisor

    • B. 

      A sequence of prioritized tasks that describe a nurse's job

    • C. 

      Activities that promote the achievement of the desired patient outcome

    • D. 

      An act of taking care of the sick

  • 36. 

    Which of the following is not a Physician Prescribed intervention?

    • A. 

      Ordering diagnostic tests

    • B. 

    • C. 

    • D. 

      Elevating an edematous leg

  • 37. 

    Which of the following is not a nurse-prescribed intervention?

    • A. 

      Turning the patient every two hours

    • B. 

    • C. 

      Offering a vitamin supplement

    • D. 

      Monitoring a patient for complications

  • 38. 

    Which of the following statements about the nursing process is true. 

    • A. 

      A nursing process is written together with a nursing care plan

    • B. 

      A nursing care plan is a product of the nursing process

    • C. 

      Both the nursing process and the nursing care plan are purely critical thinking strategies

    • D. 

      The nursing process is not an accurate clinical theory

  • 39. 

    IN which of the following scenarios would a standardized nursing care plan be appropriate? 

    • A. 

    • B. 

      Center for infection control

    • C. 

    • D. 

      Maternity floor without a single Cesarean delivery

  • 40. 

    Prioritization of tasks belongs to which phase of the Nursing Process? 

    • A. 

    • B. 

    • C. 

    • D. 

    • E. 

  • 41. 

    Documentation is a vital component of which phase of the nursing process?

    • A. 

    • B. 

    • C. 

    • D. 

    • E. 

  • 42. 

    Validation of patient outcome and goals

    • A. 

    • B. 

    • C. 

    • D. 

  • 43. 

    Evidence based practice

    • A. 

      Past educational knowledge

    • B. 

    • C. 

    • D. 

      Integration of research and clinical experience

  • 44. 

    Which of the following is not considered a standardized language in nursing?

    • A. 

    • B. 

    • C. 

    • D. 

  • 45. 

    Variance

    • A. 

    • B. 

      Patient does not achieve expected outcome

    • C. 

    • D. 

  • 46. 

    Which of the following is not the role of the LPN/LVN in the nursing process?

    • A. 

    • B. 

      Gather further data to confirm problems

    • C. 

      Discuss details of the disease as part of patient education

    • D. 

      Observe and report signficant cues

  • 47. 

    Which of the following are functions of managed care? Select all that apply. 

    • A. 

      Provides control over health care services

    • B. 

      Standardized diagnosis and treatment

    • C. 

    • D. 

      Primary resource for patient advocacy

  • 48. 

    Clinical pathway

    • A. 

      Nursing career development plan

    • B. 

    • C. 

      A concept map for care plans

    • D. 

      Specific location in a healthcare facility

  • 49. 

    A reflective reasoning process that guides a nurse in generating, implementing and evaluating approaches for dealing with client care and professional concerns

    • A. 

    • B. 

    • C. 

    • D. 

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