RN exams clinical judgment practice questions, set 111
RN exams · clinical judgment
RN exams clinical judgment practice questionsset 111
You notice cues, form a hypothesis, act, and evaluate — the same loop Next Generation items reward. Five of the 15 questions include the correct answer and rationale. The other ten keep answers in the study hub. Continue with the RN exams exam guide or more RN exams practice questions.
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
Nursing intervention during the lumbar puncture procedure includes:
A. Monitoring Mrs. GC's color, pulse and respiration
B. Labeling all laboratory specimens in numerical order
C. Positioning Mrs. GC on her side with knees drawn up to her chest
D. All of the above
Show answer and rationale
Correct answer: C — Positioning Mrs. GC on her side with knees drawn up to her chest
During a lumbar puncture procedure, it is important to position the patient correctly to facilitate the procedure and minimize the risk of complications. Placing the patient on their side with their knees drawn up to their chest helps open up the spaces in the lower spine, making it easier for the healthcare provider to access the appropriate area for the procedure. This position also helps to minimize the risk of post-procedure complications such as spinal headaches. Monitoring the patient's vital signs is important but does not specifically relate to the nursing intervention during the lumbar puncture procedure. Labeling laboratory specimens in numerical order is also a routine task but not directly related to the procedure itself. Thus, the correct intervention during the lumbar puncture procedure is positioning the patient on their side with knees drawn up to the chest.
Question 2
Jose is a 4-year-old child scheduled for a cardiac catheterization. What should be included in preoperative teaching?
A. Directed at his parents because he is too young to understand
B. Detailed in regard to the actual procedures so he will know what to expect
C. Done several days before the procedure so that he will be prepared
D. Adapted to his level of development so that he can understand
Show answer and rationale
Correct answer: D — Adapted to his level of development so that he can understand
Preoperative teaching for Jose, a 4-year-old child, scheduled for a cardiac catheterization should be adapted to his level of development so that he can understand. Children at this age have limited cognitive and emotional understanding, so using simple language, visuals, and play-based strategies is essential. It is important to provide age-appropriate information to reduce anxiety and improve cooperation during the procedure. Preoperative teaching should focus on preparing Jose for what he will see, hear, and experience in a way that is tailored to his developmental stage. Involving play tools such as medical play dolls or child-friendly illustrations can help Jose grasp the concept of the procedure and alleviate fears. It is important to involve both Jose and his parents in the teaching process to ensure they understand how to support and prepare him for the procedure.
Question 3
Which symptoms should the nurse expect to observe during the physical assessment of an adolescent girl with severe weight loss and disrupted metabolism associated with anorexia nervosa?
A. Dysmenorrhea and oliguria
B. Tachycardia and tachypnea
C. Heat intolerance and increased blood pressure
D. Lowered body temperature and brittle nails
Show answer and rationale
Correct answer: B — Tachycardia and tachypnea
An adolescent girl with severe weight loss and disrupted metabolism associated with anorexia nervosa is likely to exhibit tachycardia (rapid heart rate) and tachypnea (rapid breathing). These symptoms are common manifestations of the body's response to malnutrition and starvation. Tachycardia occurs as a compensatory mechanism to maintain an adequate supply of oxygen to vital organs, while tachypnea helps to eliminate excess carbon dioxide due to metabolic imbalances. It is essential for the nurse to recognize these signs during the physical assessment as they indicate the severity of the condition and the need for immediate intervention to prevent further complications. Dysmenorrhea and oliguria, heat intolerance and increased blood pressure, and lowered body temperature and brittle nails are not typically associated with the physical manifestations of anorexia nervosa.
Question 4
Cystic fibrosis most often affects multiple systems of the body. The primary factor responsible for possible multiple clinical manifestations is which of the following?
A. Hyperactivity of sweat glands
B. Hypoactivity of parasympathetic nervous system
C. Sweat chloride test >60 mEq/L
D. Increased viscosity resulting in mucous gland secretions
Show answer and rationale
Correct answer: D — Increased viscosity resulting in mucous gland secretions
Cystic fibrosis (CF) is an inherited genetic disorder caused by mutations in the CFTR gene, leading to the production of thick, sticky mucus. This increased viscosity affects various organs and systems in the body, causing multiple clinical manifestations. The abnormal secretions block the airways in the lungs, leading to recurrent lung infections, breathing difficulties, and ultimately respiratory failure. In the digestive system, the thick mucus blocks the pancreatic ducts, impairing the release of digestive enzymes, which can result in malabsorption and malnutrition. Additionally, the thick secretions can affect the liver, leading to complications like liver disease. Therefore, the primary factor responsible for the multiple clinical manifestations in cystic fibrosis is the increased viscosity of the mucous gland secretions, which impacts various systems in the body.
Question 5
Which equation is used to calculate the power P of the machine?
A. P = ÃŽâ€E × t
B. P = W × t
C. P = ÃŽâ€E / t
D. P = W / ÃŽâ€E
Show answer and rationale
Correct answer: C — P = ÃŽâ€E / t
The correct equation for calculating power is P = ΔE / t. Power is defined as the rate at which work is done or energy is transferred. In this equation, ΔE represents the change in energy and t represents the time taken for that change. Dividing the change in energy by the time gives us the power. This equation aligns with the fundamental definition of power.
Choice A (P = ΔE × t) is incorrect because it implies that power is directly proportional to both the change in energy and time, which is not always the case.
Choice B (P = W × t) is incorrect because it incorrectly uses work (W) in the equation for power, while power is specifically related to the rate at which work is done, not the work itself.
Choice D (P = W / ΔE) is incorrect because it suggests power is inversely proportional to the change in energy, which is not a characteristic of power.
Keep going past these 15 questions
Missed-question review, longer banks, and the rest of 20,000+ nursing practice questions open when you start studying.
Stems and choices stay public so you can still reason. Correct answers and full rationales unlock with the rest of the bank.
Question 6
A 12-year-old male is brought to the clinic after falling during a skateboarding trick. The child's vital signs are heart rate 135 beats/minute, respirations 20 breaths/minute, and blood pressure 90/60. Which finding should the practical nurse report to the healthcare provider immediately?
A. The client complains of his back being sore.
B. Capillary refill is less than 2 seconds.
C. Blood pressure is 94/68.
D. Peripheral pulses are weak and rapid.
Correct answer:
In this scenario, the 12-year-old male with a heart rate of 135 beats/minute, respirations of 20 breaths/minute, and blood pressure of 90/60 after falling during a skateboarding trick exhibits signs of shock. Weak and rapid peripheral pulses are concerning as they may indicate decreased cardiac output and tissue perfusion, which are signs of shock. This finding should be reported to the healthcare provider immediately for further evaluation and intervention to prevent potential complications. The other choices are less urgent. Complaints of back soreness (choice A) could be related to musculoskeletal injury. Capillary refill less than 2 seconds (choice B) is within the normal range, indicating adequate peripheral perfusion. A blood pressure of 94/68 (choice C) is slightly higher than the initial reading and may be compensatory in response to the fall and shock state.
A 45-year old female diabetic is displaying signs of irritability and irrational behavior during an office visit. The nurse observes visible tremors in the client's hands. based on the client's history and the nurse's understanding of diabetes mellitus, the nurse interprets these findings to be signs of:
A. hyperglycemia
B. hyperglycemic hyperosmolar
C. diabetic ketoacidosis (DKA) nonketosis (HHNK)
D. hypoglycemia
Correct answer:
The signs of irritability, irrational behavior, and visible tremors in the hands observed in the 45-year old female diabetic suggest hypoglycemia. Hypoglycemia occurs when blood sugar levels drop below normal levels, causing the body and brain to receive inadequate fuel. This leads to symptoms like irritability, irrational behavior, and tremors, which are signs of the brain not receiving enough glucose for proper functioning. In diabetic patients, particularly those on medications like insulin or certain oral hypoglycemic agents, hypoglycemia can occur if they take too much medication, skip meals, or engage in excessive physical activity without adjusting their treatment regimen. Immediate treatment for hypoglycemia usually involves consuming a rapid source of sugar, such as glucose tablets, juice, or candy, to quickly raise blood sugar levels back to normal range.
All of the following tracts originate from cerebral cortex EXCEPT:
A. Corticospinal tract
B. Corticonuclear tract
C. Rubrospinal tract
D. Corticoreticular tract
Correct answer:
Rubrospinal tract . The corticospinal tract originatfrom the primary motor cortex (precentral gyrus), descending through the brainstem and spinal cord for voluntary movement control, such as hand dexterity. The corticonuclear tract also arisfrom the cortex, targeting cranial nerve nuclei (e.g., 5, 7, 10) for facial or tongue movements, with partial decussation. The corticoreticular tract begins in the cortex, projecting to the reticular formation in the brainstem to modulate posture and locomotion. In contrast, the rubrospinal tract originatfrom the red nucleus in the midbrain, not the cortex, and decussatto influence flexor tone, especially in the upper limbs. This midbrain origin distinguishit from the cortical tracts, as seen in its role in cerebellar-motor coordination rather than direct cortical control. Thus, C is the exception, making it the correct answer.
The nurse is conducting an assessment on a school-age child with urosepsis. Which assessment finding should the nurse expect?
A. Fever with a positive blood culture
B. Proteinuria and edema
C. Oliguria and hypertension
D. Anemia and thrombocytopenia
Correct answer:
In a school-age child with urosepsis, the nurse should expect the assessment finding of fever with a positive blood culture. Urosepsis is a severe infection in the urinary tract that has spread to the bloodstream, causing systemic symptoms such as fever. Positive blood cultures indicate the presence of bacteria in the bloodstream, confirming the diagnosis of sepsis. Other common symptoms of urosepsis may include chills, rapid heart rate, increased respiratory rate, and altered mental status. Proteinuria and edema (choice B) are more indicative of kidney disorders such as nephrotic syndrome rather than urosepsis. Oliguria and hypertension (choice C) may be seen in conditions like acute kidney injury but are not specific to urosepsis. Anemia and thrombocytopenia (choice D) are more characteristic of conditions such as hemolytic uremic syndrome rather than urosepsis.
Which of the Following Hormones Are Expected to Increase in the Body After Consuming a Banana Split?
A. Prolactin
B. Glucagon
C. Insulin
D. Thyroid hormone
Correct answer:
Step-by-step rationale for why choice C (Insulin) is correct:
1. A banana split is high in carbohydrates and sugar.
2. Consuming carbohydrates and sugar triggers an increase in blood glucose levels.
3. Insulin is released by the pancreas in response to high blood glucose levels to facilitate the uptake of glucose into cells for energy.
4. Therefore, after consuming a banana split, insulin levels in the body are expected to increase to regulate blood glucose levels.
Summary of why other choices are incorrect:
- A: Prolactin is a hormone involved in lactation and is not directly related to consuming a banana split.
- B: Glucagon is released in response to low blood glucose levels to increase blood sugar, opposite of what is expected after consuming a banana split.
- D: Thyroid hormone regulates metabolism and is not directly influenced by consuming a banana split.
Which of the following statements regarding pituitary hormones is false?
A. The hypothalamus makes oxytocin and antidiuretic hormone, which are transported to the posterior pituitary for storage.
B. Antidiuretic hormone, released by the posterior pituitary, causes urine volume to increase and blood volume to decrease.
C. Luteinizing hormone, an anterior pituitary hormone, triggers ovulation of an egg from the ovary and causes the ruptured follicle to produce progesterone and some estrogens.
D. Hyposecretion of follicle-stimulating hormone or luteinizing hormone leads to sterility in both males and females.
Correct answer:
Step 1: Antidiuretic hormone (ADH) is released by the posterior pituitary, and its main function is to increase water reabsorption in the kidneys, leading to decreased urine volume and increased blood volume.
Step 2: If ADH causes urine volume to increase and blood volume to decrease, it would be counterproductive to its known physiological role.
Step 3: Therefore, Choice B is false as it contradicts the established function of ADH.
Summary:
- Choice A is true because oxytocin and antidiuretic hormone are indeed produced in the hypothalamus and stored in the posterior pituitary.
- Choice C is true as luteinizing hormone does trigger ovulation and stimulates the production of progesterone and some estrogens.
- Choice D is true because hyposecretion of follicle-stimulating hormone or luteinizing hormone can lead to infertility in both males and females.
A 40-year-old G2, P1 woman is admitted to the labor and delivery unit with contractions 6 minutes apart. She is 36 weeks pregnant, has a history of placenta previa, and is currently experiencing moderate vaginal bleeding. What should the nurse be prepared to do?
A. Perform a vaginal examination to determine cervical dilation
B. Assist the health care provider to perform artificial rupture of the membranes
C. Initiate external fetal monitoring
D. Encourage patient to ambulate to intensify labor
Correct answer:
The correct answer is C: Initiate external fetal monitoring. In this scenario, the patient is at 36 weeks of gestation with a history of placenta previa and moderate vaginal bleeding, indicating a high-risk situation. External fetal monitoring allows for continuous assessment of the fetal heart rate and uterine contractions, which is crucial for identifying signs of fetal distress or complications related to placenta previa. This monitoring can help guide timely interventions and decision-making to ensure the safety of the mother and baby. Performing a vaginal examination (A) may increase the risk of bleeding in cases of placenta previa. Artificial rupture of membranes (B) can also lead to increased bleeding and should be avoided in this situation. Encouraging ambulation (D) is not recommended due to the risk of exacerbating bleeding and potential complications.
A floor nurse pages you about a patient who is having chest pain. You order an electrocardiogram and rush to see the patient. He describes the pain as tight pressure and is demonstrably sweating and gasping for air. The ECG comes back with acute ST-segment elevations in inferior leads, and you diagnose a myocardial infarction. You start giving the patient oxygen and give him sublingual nitroglycerin and morphine for pain. You also give him another medication, which you have read may prolong his survival in this situation. What class of medication is it?
A. β-Blocker
B. α-Agonist
C. Muscarinic agonist
D. Neuromuscular blocker
Correct answer:
The correct answer is A: β-Blocker. β-Blockers are indicated in the management of myocardial infarction as they help reduce myocardial oxygen demand by decreasing heart rate, blood pressure, and contractility. This results in less strain on the heart muscle and can improve survival outcomes. Additionally, β-blockers can prevent arrhythmias and reduce the risk of recurrent infarction. In this scenario, where the patient is experiencing an acute myocardial infarction with ST-segment elevations, the use of a β-blocker is crucial in managing the condition and improving the patient's prognosis.
Summary of other choices:
B: α-Agonist - Not indicated in the management of myocardial infarction.
C: Muscarinic agonist - Not indicated in the management of myocardial infarction.
D: Neuromuscular blocker - Not indicated in the management of myocardial infarction.
The nurse is educating a new postpartum woman about peri-care. Which action by the client indicates understanding?
A. The woman applied her peri-pad from back to front.
B. The woman performed peri-care three times a day.
C. The woman washed her hands before and after performing peri-care.
D. The woman mixed tap water and hydrogen peroxide in her peri-bottle.
Correct answer:
The correct answer is C because washing hands before and after performing peri-care is crucial to prevent infection. Beforehand, it reduces the risk of introducing harmful bacteria into the perineal area. Afterward, it prevents potential contamination of hands. This action demonstrates understanding of maintaining proper hygiene during peri-care.
Explanation of other choices:
A: Applying the peri-pad from back to front is incorrect as it can introduce bacteria from the rectal area to the vaginal area, increasing the risk of infection.
B: Performing peri-care three times a day is not necessarily an indication of understanding proper technique and hygiene. Frequency alone does not ensure correct practice.
D: Mixing tap water and hydrogen peroxide in the peri-bottle is not recommended as it can disrupt the natural flora in the perineal area and cause irritation.
One of the two hormones made by the pituitary that help regulate reproductive cells is luteinizing hormone. The other hormone is .
A. follicle-stimulating hormone
B. epinephrine
C. norepinephrine
D. androgens
Correct answer:
The correct answer is A: follicle-stimulating hormone (FSH). FSH is the other hormone made by the pituitary gland that helps regulate reproductive cells, along with luteinizing hormone (LH). FSH is responsible for stimulating the growth and maturation of ovarian follicles in females and spermatogenesis in males.
Explanation:
1. FSH is directly involved in the reproductive process by stimulating follicle development and sperm production.
2. Epinephrine and norepinephrine are not hormones produced by the pituitary gland and are involved in the stress response.
3. Androgens are male sex hormones produced primarily by the testes, not the pituitary gland.
In summary, FSH is the correct answer as it plays a crucial role in regulating reproductive cells, while the other choices are not involved in the reproductive system or are not produced by the pituitary gland.
RN exams clinical judgment practice questions, set 111 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
No. Nursier is independent practice. Register through the official path named on the RN exams exam guide.
The first five questions already include the rationale. Start full practice to unlock the remaining keys, missed-question review, and the rest of the bank.
Keep going past these 15 questions
Missed-question review, longer banks, and the rest of 20,000+ nursing practice questions open when you start studying.
