RN exams clinical judgment practice questions, set 106
RN exams · clinical judgment
RN exams clinical judgment practice questionsset 106
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Five clinical judgment questions with answers
Cover the key. Write the first action. Then open the rationale and name why the other choices fail.
Question 1
Which intervention by the community health nurse improves care for clients during the transition from behavioral health hospitalization to outpatient care?
A. Ensuring effective communication among health care providers
B. Reducing the number of providers involved in the client's care
C. Requiring medications to be taken under direct observation by a nurse
D. Attending follow-up appointments with the client
Show answer and rationale
Correct answer: A — Ensuring effective communication among health care providers
The correct answer is A: Ensuring effective communication among health care providers. This intervention is crucial for coordinating care, sharing important information, and preventing gaps in care during the transition. Effective communication ensures that all providers are on the same page regarding the client's treatment plan, medications, and follow-up care. This promotes continuity of care and reduces the risk of misunderstandings or errors.
Choice B, reducing the number of providers, may limit access to necessary resources and expertise. Choice C, requiring medications to be taken under direct observation, may not be feasible or necessary for all clients and could impede autonomy. Choice D, attending follow-up appointments with the client, is important but does not address the broader issue of communication among all providers involved in the client's care.
Question 2
Which of the following statements is least likely to be made by a humanist?
A. Humans are unique.
B. The behavior of humans tends to be influenced by environmental circumstances.
C. Humans have a basic need to fulfill their potentials.
D. Research on animals has little relevance to understanding human behavior.
Show answer and rationale
Correct answer: B — The behavior of humans tends to be influenced by environmental circumstances.
The corrected question assesses the least likely statement made by a humanist. Choice B, 'The behavior of humans tends to be influenced by environmental circumstances,' is least likely to be made by a humanist. Humanists believe that human behavior is not simply dictated by environmental circumstances but is influenced by a combination of factors, including personal experiences, emotions, and conscious decisions. Choices A, C, and D are more aligned with humanist perspectives. Choice A acknowledges the uniqueness of humans, which is a common theme in humanistic psychology. Choice C reflects the humanistic belief that individuals strive to reach their full potential and self-actualization. Choice D contrasts with humanist views as humanists often consider research on animals to be relevant in understanding human behavior due to shared basic psychological processes.
Question 3
A welder who recently lost his leg in a work-related accident is being admitted to an inpatient psychiatric unit. The client states,"I'm worried because I can't support my family anymore!" Which nursing diagnosis is most reflective of this client's presenting problem?
A. Ineffective coping R/T poor self-esteem.
B. Ineffective role performance R/T loss of job.
C. Impaired social interaction R/T altered body image.
D. Knowledge deficit R/T wound and skin care.
Show answer and rationale
Correct answer: B — Ineffective role performance R/T loss of job.
The correct answer is B: Ineffective role performance R/T loss of job. This nursing diagnosis is the most reflective of the client's presenting problem because the client is expressing worry about not being able to support his family anymore due to losing his job as a welder. This directly relates to a disruption in his ability to fulfill his role as the provider for his family.
A: Ineffective coping R/T poor self-esteem is incorrect because the client's primary concern is related to financial support, not self-esteem.
C: Impaired social interaction R/T altered body image is incorrect as the client's worry is about providing for his family, not about altered body image affecting social interactions.
D: Knowledge deficit R/T wound and skin care is incorrect as the client's main concern is about financial support, not a lack of knowledge about wound and skin care.
Question 4
A patient was arrested for breaking windows in the home of a former domestic partner. The patient's history also reveals childhood abuse by a punitive parent, torturing family pets, and an arrest for disorderly conduct. Which nursing diagnosis has priority?
A. Risk for injury
B. Ineffective coping
C. Impaired social interaction
D. Risk for other-directed violence
Show answer and rationale
Correct answer: D — Risk for other-directed violence
The correct answer is D: Risk for other-directed violence. This is the priority nursing diagnosis because the patient's history of breaking windows, childhood abuse, and torturing pets suggests a potential for violent behavior towards others. The patient's actions indicate a risk of harm to others, making it essential to address this safety concern first.
A: Risk for injury is not the priority as the focus should be on the potential harm the patient may cause to others rather than self-injury.
B: Ineffective coping may be a contributing factor, but the immediate concern is the risk of violence towards others.
C: Impaired social interaction does not address the urgent safety issue of potential violence towards others.
In summary, the priority nursing diagnosis is D as it addresses the immediate risk of harm to others based on the patient's history and behavior.
Question 5
The parent of a 4-year-old rewards and praises the child for helping a sibling, being polite, and using good manners. These qualities are likely to be internalized and become part of which system of the personality?
A. Id
B. Ego
C. Superego
D. Preconscious
Show answer and rationale
Correct answer: C — Superego
The correct answer is C: Superego. The superego is responsible for internalizing societal norms, values, and moral standards. By rewarding and praising the child for positive behaviors such as helping a sibling and using good manners, the parent is reinforcing these moral values, which are then internalized by the child through the development of the superego. The superego acts as the conscience and strives for perfection based on societal expectations.
Option A (Id) is incorrect because the Id is the instinctual and impulsive part of the personality driven by the pleasure principle. Option B (Ego) is incorrect as the Ego mediates between the Id and the external world, dealing with reality. Option D (Preconscious) is incorrect as it refers to the part of the mind that contains thoughts and memories that are not currently in awareness but can be easily accessed.
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Question 6
Johnny is twelve-year-old boy who has had an increase in aggressive behaviors, picking fights with other students at his school. Johnny's mother calls his doctor's office to ask if there is medication to help decrease these behaviors. After gathering more information about the recent increase in Johnny's outbursts, what is the best response from the nurse?
A. Allow more freedom at home as that may be adding to his outbursts.'
B. Medication may not be indicated right away; there are other options.'
C. Tell Johnny that his behavior is unacceptable.'
D. Allow Johnny to skip school if he is having a difficult time being there.'
Correct answer:
The correct answer is B: Medication may not be indicated right away; there are other options.
Rationale:
1. Medication should not be the first line of intervention for behavior issues in children.
2. It is important to explore other options such as therapy, counseling, behavior modification techniques.
3. Understanding the root cause of Johnny's behavior is crucial before considering medication.
4. Rushing into medication without exploring other avenues may not address the underlying issues.
Summary:
A: Allowing more freedom at home could potentially worsen Johnny's behavior by reinforcing the negative actions.
C: Telling Johnny his behavior is unacceptable without addressing the underlying cause may not effectively reduce his aggression.
D: Allowing Johnny to skip school is not a solution; addressing the behavior and providing appropriate support is essential.
A patient begins a new program to assist with building social skills. In which part of the plan of care should a nurse record the item, "Encourage patient to attend one psychoeducational group daily"?
A. Assessment
B. Implementation
C. Analysis
D. Evaluation
Correct answer:
The correct answer is B: Implementation. In the nursing process, implementation involves carrying out the plan of care. Encouraging the patient to attend a psychoeducational group daily is an action that is part of implementing the care plan to improve social skills. This step focuses on putting the plan into action and actively supporting the patient in achieving the desired outcomes.
A: Assessment is incorrect because assessment involves collecting data and information about the patient's condition, not actively implementing interventions.
C: Analysis is incorrect as it involves interpreting and making sense of the assessment data to identify problems and strengths, not implementing interventions.
D: Evaluation is incorrect because it involves assessing the effectiveness of the interventions implemented, not actively carrying out the interventions themselves.
A patient asks, What are neurotransmitters? My doctor said mine are imbalanced. Select the nurse™s best response.
A. How do you feel about having imbalanced neurotransmitters?Â
B. Neurotransmitters protect us from harmful effects of free radicals.Â
C. Neurotransmitters are substances we consume that influence memory and mood.Â
D. Neurotransmitters are natural chemicals that pass messages between brain cells.Â
Correct answer:
The correct answer is D because neurotransmitters are indeed natural chemicals that pass messages between brain cells. This response directly addresses the patient's question by providing a clear and accurate definition of neurotransmitters.
Choice A is incorrect because it does not provide any information about neurotransmitters and focuses on the patient's feelings instead. Choice B is incorrect as it confuses neurotransmitters with antioxidants that protect against free radicals. Choice C is incorrect because it inaccurately suggests that neurotransmitters are substances consumed, which is not the primary function of neurotransmitters.
In summary, choice D is the best response as it accurately defines neurotransmitters, while the other choices are incorrect due to their lack of clarity or accuracy regarding the nature and function of neurotransmitters.
A 52-year-old man with a history of hypertension presents for a follow-up visit. He denies any complaints. His only medication is hydrochlorothiazide. He has some laboratory tests done that reveal mild elevations of his ALT and AST levels. His total bilirubin and alkaline phosphatase levels are normal. He is brought back to have his tests repeated and to have further testing. His AST and ALT are still elevated. His iron studies are normal. His hepatitis C antibody is negative. His hepatitis A IgM is negative. His hepatitis B surface antigen and antibody are negative. His IgM antibody to hepatitis B core antigen (IgM anti-HBc) is positive. Which of the following statements is correct?
A. He is a chronic carrier of the hepatitis B virus
B. There is a $90 \%$ chance that he is positive for hepatitis D
C. Hepatitis B infection has been ruled out
D. If his hepatitis B surface antibody turns positive in three months, then he had an acute hepatitis B infection
Correct answer:
The most specific marker for the diagnosis of acute hepatitis B is IgM antibody to hepatitis B core antigen (IgM anti-HBc). However, false positives can occur. Chronic carriers of hepatitis B will typically have a positive hepatitis B surface antigen (HbsAg) and a positive IgG antibody to hepatitis B core antigen (IgG anti-HBc). Patients may sometimes be low-level carriers with a negative HbsAg and only a positive IgG anti-HBc. Hepatitis D requires the presence of HbsAg to cause infection. It is associated with acute HBV infection (predominantly in intravenous drug users) but the overall incidence is low. When a patient presents with this pattern, repeating the tests in two to three months may assist in the diagnosis. If the IgM anti-HBc disappears and either a hepatitis B surface antibody or IgG anti-HBc appears, then it is likely that he had an acute infection.
A nurse was the case manager for a client with serious mental illness for 6 years. The client died by suicide 1 week ago. Today, the client’s spouse asks, “I always wondered if my spouse was a victim of sexual abuse in childhood. What can you tell me about that?”Can the nurse disclose information to the surviving spouse?
A. Yes
B. No
C. It depends on state law
D. It depends on how damaging the physician feels this would be to all concerned.
Correct answer:
The correct answer is B: No. The nurse cannot disclose information to the surviving spouse. As a healthcare professional, the nurse is bound by patient confidentiality even after the patient's death. The information regarding sexual abuse is considered confidential and cannot be shared without the patient's consent. Revealing such sensitive information without the patient's permission would violate the client's privacy rights and ethical principles of confidentiality. It is crucial to uphold confidentiality to maintain trust and protect the client's dignity, even after their passing. Choices A and C are incorrect because they suggest disclosing information without considering the legal and ethical implications. Choice D is incorrect as the decision should not be based on subjective feelings but on established principles of confidentiality and ethical guidelines.
Which important points should the nurse teach a patient about using herbal preparations? (Select all that apply.)
A. Buying from online sources is preferable and cheaper.
B. Check active and inactive ingredients.
C. Discontinue use if side or adverse effects occur.
D. Avoid herbals during pregnancy and breast-feeding.
Correct answer:
The correct answer is B: Check active and inactive ingredients. This is important because some herbal preparations may contain ingredients that can interact with medications or cause adverse effects. By checking both active and inactive ingredients, the patient can ensure they are not allergic to any components.
Incorrect choices:
A: Buying from online sources is preferable and cheaper - Online sources may not provide reliable information on the quality and safety of herbal preparations.
C: Discontinue use if side or adverse effects occur - While this may be necessary in some cases, it is not a proactive approach to ensuring safe use of herbal preparations.
D: Avoid herbals during pregnancy and breast-feeding - While this is generally good advice, it is not applicable to all herbal preparations and may limit the patient's options without proper guidance.
A nurse was the case manager for a client with serious mental illness for 6 years. The client died by suicide 1 week ago. Today, the client’s spouse asks, “I always wondered if my spouse was a victim of sexual abuse in childhood. What can you tell me about that?â€Can the nurse disclose information to the surviving spouse?
A. Yes
B. No
C. It depends on state law
D. It depends on how damaging the physician feels this would be to all concerned.
Correct answer:
The correct answer is B: No. The nurse cannot disclose information to the surviving spouse. As a healthcare professional, the nurse is bound by patient confidentiality even after the patient's death. The information regarding sexual abuse is considered confidential and cannot be shared without the patient's consent. Revealing such sensitive information without the patient's permission would violate the client's privacy rights and ethical principles of confidentiality. It is crucial to uphold confidentiality to maintain trust and protect the client's dignity, even after their passing. Choices A and C are incorrect because they suggest disclosing information without considering the legal and ethical implications. Choice D is incorrect as the decision should not be based on subjective feelings but on established principles of confidentiality and ethical guidelines.
A patient reports good results from taking an herb to manage migraine headache pain. The nurse confirms there are no hazardous interactions between the herb and the patient’s current prescription drugs. Select the nurse’s best comment to the patient.
A. “Thanks for telling me. I’ll make a note in your medical record that you take it.”
B. "You are experiencing a placebo effect. When we believe something will help, it usually does.”
C. "Self-management of health problems can be dangerous. You should have notified me sooner.”
D. "Research studies show that herbals actually increase migraine pain by inflaming nerve cells in the brain.”
Correct answer:
The correct answer is B: "You are experiencing a placebo effect. When we believe something will help, it usually does.”
Rationale:
1. The nurse acknowledges the patient’s positive experience with the herb, validating the patient's perspective.
2. By mentioning the placebo effect, the nurse educates the patient about the potential psychological benefits of belief in a treatment.
3. The nurse's comment is non-judgmental and encourages open communication with the patient.
4. This response promotes patient empowerment in managing their health.
Summary:
A: Merely noting in the medical record does not address the patient’s experience or provide valuable information.
C: This response is accusatory and may discourage the patient from sharing important information in the future.
D: This statement is incorrect and may cause unnecessary fear or confusion for the patient.
During a long-distance run on a hot day, an athlete produces large quantities of sweat. As a result, the kidneys change the rate of urine production. Why is this change important?
A. Decreased urine production increases the amino acids in the blood.
B. Increased urine production removes amino acids produced as a result of running.
C. Decreased urine production allows the body to conserve water.
D. Increased urine production allows more water to remain in the bloodstream.
Correct answer:
The correct answer is C: Decreased urine production allows the body to conserve water. When an athlete sweats a lot during a long-distance run on a hot day, the body loses water through sweat. To prevent dehydration, the kidneys reduce urine production, allowing the body to retain more water. This helps maintain proper hydration levels and prevent water loss.
Rationale:
A: Decreased urine production does not directly impact amino acids in the blood. Amino acids are primarily regulated by protein metabolism and dietary intake.
B: Increased urine production does not specifically target the removal of amino acids produced during exercise. Amino acids are typically metabolized and used for energy or protein synthesis.
D: Increased urine production does not help more water remain in the bloodstream. Excess water is typically excreted to maintain fluid balance.
A man who has had gout for several years comes to the clinic with a problem with his toe. On examination, the nurse notices the presence of hard, painless nodules over the great toe; one has burst open with a chalky discharge. This finding is known as:
A. Callus.
B. Plantar wart.
C. Bunion.
D. Tophi.
Correct answer:
The correct answer is D: Tophi. Tophi are deposits of uric acid crystals that accumulate in the joints of individuals with chronic gout. The presence of hard, painless nodules over the great toe that burst open with a chalky discharge is a classic presentation of tophi in a patient with gout. Tophi are not painful but can cause joint deformities and damage if left untreated.
A: Callus is a thickened and hardened area of skin that forms in response to repeated pressure or friction. Calluses are not associated with gout or chalky discharge.
B: Plantar wart is a benign growth on the sole of the foot caused by a viral infection. Plantar warts do not typically present with chalky discharge or nodules.
C: Bunion is a bony bump that forms on the joint at the base of the big toe. Bunions are not associated with gout or chalky discharge.
In summary, the presence of
RN exams clinical judgment practice questions, set 106 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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