Critical thinking exams like HESI, TEASI & ATI

[LTCovenant]

Hello fellow Pre-Nursing Hopefuls.

Like you, I have been testing for pre entrance exams and, like you, I was having problems with "The Critical Thinking" aspect of preparation. Here is what I found out... we are all screwed. lmao... no... we are not... but for some reason it is a concept that "nursing educators" think people are born with and either have no clue on how to teach it or have no clue that it needs to be taught.

So, I have been digging and am willing to share what I have found.

First off, you are most likely already doing it... thinking critically. The definition of Critical thinking is basically stated as: the application of critical thinking in the field of practiced nursing and is a discipline made up of a specific and reflective reasoning process that will help guide the nurse in generating, implementing, and evaluating approaches for dealing with patient care and professional concerns. I found this explanation in Kozier & Erb's Fundamentals of Nursing (8th edition, chapter 10: critical thinking and the nursing process, pages 162 - 173).

Second, you must be aware of the "primary goal as a nurse" when thinking critically for these tests. The primary goal as a nurse is "to keep the patient safe at all times."

So, the best example I have found for "What Critical Thinking is" and "how to think critically" was given as follows. "It is about gathering data and filtering the data about what is important NOW and then determining (with your skill set and nursing knowledge) what should happen next to keep the patient safe at all times. And if something were to happen, what could I do about it".

Two example types of questions I came across for the pre level or entrance level exams would possibly sound something like:

1) Your a floor nurse and you enter a patients room where the patient has defecated himself and needs to be changed. You find that there are no clean sheets available in your unit. What would be the best answer of the four choices given?

a) Clean the patient, pulling all dirty sheets and leave the patient on the bed until some clean sheets can be obtained?

b) Clean the patient, pulling all dirty sheets and use clean towels as sheets

c) Ask the floor aid to find you some clean sheets from another unit

d) Inform you unit supervisor

I will tell you, I do not know what the answer is. I read it somewhere and it was never given to me. My very first thought would be "C" because asking the floor aid to find and bring some would actually stop all future incidents if other patients needed to have linens changed as well. But, after researching I have decided I would answer "B", to clean the patient, pulling all dirty sheets and use clean towels as sheets. Why would I pick this choice? This selection addresses the "primary goal as a nurse" which is to keep the patient safe. You NEVER want to leave a person on just the mattress. You actually want a barrier there between your patient and the bed. It also addresses the issue which is that the patient needs to be cleaned as promptly as possible. It is neither morally right nor physically safe for the patient to be left there like that. Also if a doctor or a family member were to walk in the reaction would most likely be a question as to why you were neglecting the patient.

2) You walk into a patient's room that is post-op for a repair of a distal radius fracture. The doctor has left instructions for Norco or IV Morphine to be given for the pain if needed. The patient is complaining about the pain. You look at his fingers and they appear to be pink. You question the level of pain on a 1 to 10 scale and the patient expresses a level 2 for pain. What would be the best answer of the four choices given?

a) Give the patient Norco for the pain.

b) Adjust the patient for comfort

c) Give the patient IV Morphine

d) Call the doctor

This one was explained as "B", adjust the patient for comfort. Why? Although the doctor left orders for Norco or IV Morphine to be given for the pain, the level of pain is only at 2. Norco could be administered, but at that level it should not be necessary and the doctor had already anticipated some level of pain because he left an order for pain medication to be given. Also, IV Morphine is fast and very strong so it is over kill. This also does not warrant to call the doctor because he already left instructions to give the medication for pain and most doctors do not want to be bothered after the patient is on the floor unless it is a sever reason. They will follow up on the patient during rounds the next morning. If the information were to have been different like the patient had already been adjusted for comfort and his pain level was at an 8, then "A", give the patient Norco would have been a better answer. If the patient would have expressed that his pain was sharp and high and his finger tips were looking pail, then answer "D", call the doctor would have been the best choice.

So, as I understand Critical Thinking and its application to the entrance exam, the format to follow on all exams would be

1) What takes care of the problem NOW

2) What keeps my patient safe NOW

3) And what is the best answer that addresses the issue NOW without overkill.

I hope that helps. As I said, like you I am taking my exams for my BSRN. I am currently a First Surgical Assistant for an Upper Extremity Surgeon and a supportive First Surgical Assistant for the additional 8 Doctors in the practice. I am moving forward to obtain my BSRN with the support and encouragement of the Practice Physicians. I have been in the medical field for about four years now. I truly hope this helps and if you find that my information was flawed, please let me know. Like you, I only want to do my best in this chosen career field and can use all the help I can get.

My Very Best in Your Endeavors,

LT Covenant