RN exams clinical judgment practice questions, set 112
RN exams · clinical judgment
RN exams clinical judgment practice questionsset 112
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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
A patient reports fears of having cervical cancer and says to the nurse, I've had Pap smears by six different doctors. The results are normal, but I'm sure that's because of errors in the laboratory. Which disorder would the nurse suspect?
A. Functional neurologic (conversion) disorder
B. Illness anxiety disorder (hypochondriasis)
C. Body dysmorphic disorder
D. Dissociative amnesia with fugue
Show answer and rationale
Correct answer: B — Illness anxiety disorder (hypochondriasis)
The correct answer is B: Illness anxiety disorder (hypochondriasis). This disorder involves excessive worry about having a serious illness despite medical reassurance. In this case, the patient's persistent fear of cervical cancer despite normal Pap smear results and attributing them to laboratory errors aligns with the characteristic of illness anxiety disorder.
Other choices:
A: Functional neurologic (conversion) disorder - This disorder involves physical symptoms without a medical explanation. The patient in the question does not exhibit physical symptoms.
C: Body dysmorphic disorder - This disorder involves preoccupation with perceived defects in physical appearance. The patient's concern is not related to body image.
D: Dissociative amnesia with fugue - This disorder involves memory loss with sudden travel or wandering. The patient does not display memory loss or wandering behavior in the scenario.
Question 2
Which type of fiber could be considered the longest?
A. preganglionic parasympathetic
B. preganglionic sympathetic
C. postganglionic parasympathetic
D. postganglionic sympathetic
Show answer and rationale
Correct answer: A — preganglionic parasympathetic
The correct answer is A: preganglionic parasympathetic. Preganglionic fibers are the longest in the autonomic nervous system, with parasympathetic fibers generally having longer preganglionic fibers compared to sympathetic fibers. Parasympathetic preganglionic fibers originate from the cranial nerves and sacral spinal cord, allowing them to travel longer distances to reach their ganglia. In contrast, sympathetic preganglionic fibers originate from the thoracic and lumbar spinal cord, resulting in shorter lengths compared to parasympathetic fibers. Therefore, preganglionic parasympathetic fibers are considered the longest among the given choices. Postganglionic fibers, whether parasympathetic or sympathetic, are shorter as they only need to travel to their target organs from the ganglia.
Summary:
- A: Correct, as preganglionic parasympathetic fibers are the longest in the autonomic nervous system
Question 3
Which type of fiber could be considered the longest?
A. preganglionic parasympathetic
B. preganglionic sympathetic
C. postganglionic parasympathetic
D. postganglionic sympathetic
Show answer and rationale
Correct answer: A — preganglionic parasympathetic
The correct answer is A: preganglionic parasympathetic. Preganglionic fibers are the longest in the autonomic nervous system, with parasympathetic fibers generally having longer preganglionic fibers compared to sympathetic fibers. Parasympathetic preganglionic fibers originate from the cranial nerves and sacral spinal cord, allowing them to travel longer distances to reach their ganglia. In contrast, sympathetic preganglionic fibers originate from the thoracic and lumbar spinal cord, resulting in shorter lengths compared to parasympathetic fibers. Therefore, preganglionic parasympathetic fibers are considered the longest among the given choices. Postganglionic fibers, whether parasympathetic or sympathetic, are shorter as they only need to travel to their target organs from the ganglia.
Summary:
- A: Correct, as preganglionic parasympathetic fibers are the longest in the autonomic nervous system
Question 4
A patient says, I feel detached and weird all the time, like I'm looking at life through a cloudy window. Everything seems unreal. These feelings really interfere with my work and study. Which term should the nurse use to document this complaint?
A. Depersonalization
B. Hypochondriasis
C. Dissociation
D. Malingering
Show answer and rationale
Correct answer: A — Depersonalization
Correct Answer: A. Depersonalization
Rationale:
1. Depersonalization involves feeling detached from oneself or reality, as described by the patient.
2. The patient's description of feeling like they are looking through a cloudy window aligns with depersonalization symptoms.
3. Interference with work and study suggests significant distress, a common feature of depersonalization disorder.
Summary of other choices:
B. Hypochondriasis: Involves excessive worry about having a serious illness, which is not indicated in the patient's complaint.
C. Dissociation: While depersonalization is a type of dissociative symptom, it specifically refers to feeling detached and unreal, not necessarily a broader dissociative disorder.
D. Malingering: Involves feigning or exaggerating symptoms for secondary gain, which is not evident in the patient's genuine distress and impairment.
Question 5
The external male genital structures include the:
A. Testis.
B. Scrotum.
C. Epididymis.
D. Vas deferens.
Show answer and rationale
Correct answer: B — Scrotum.
The correct answer is B: Scrotum. The scrotum is a pouch of skin and muscle that houses and protects the testes, which are the actual male reproductive glands responsible for producing sperm. The scrotum also helps regulate the temperature of the testes to ensure optimal sperm production.
A: Testis - While the testis is an external male genital structure, it is not the correct answer in this context as the question specifically asks for external structures.
C: Epididymis - The epididymis is a coiled tube located on the back of each testicle where sperm mature and are stored. It is an internal structure and not considered part of the external genital structures.
D: Vas deferens - The vas deferens is a tube that carries sperm from the epididymis to the urethra during ejaculation. It is also an internal structure and not part of the external genital structures.
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Question 6
A patient says, I know I have a brain tumor despite the results of the magnetic resonance image (MRI). The radiologist is wrong. People who have brain tumors vomit, and yesterday I vomited all day. Which response by the nurse fosters cognitive restructuring?
A. You do not have a brain tumor. The more you talk about it, the more it reinforces your illogical thinking.
B. Let's see whether any other explanations for your vomiting are possible.
C. You seem so worried. Let's talk about how you're feeling.
D. We should talk about something else.
Correct answer:
The correct answer is B because it encourages the patient to consider alternative explanations for their symptoms, which is key in cognitive restructuring. By exploring other possible reasons for the vomiting, the patient is guided to challenge their automatic assumption of having a brain tumor. This approach helps the patient to reevaluate their thoughts and beliefs in a more rational manner.
Choices A, C, and D are incorrect:
A: This response dismisses the patient's concerns without addressing the underlying irrational belief. It does not promote cognitive restructuring.
C: While acknowledging the patient's emotions is important, this response does not actively challenge the patient's irrational belief or encourage critical thinking.
D: Changing the subject does not address the patient's cognitive distortions and does not facilitate cognitive restructuring.
A. Zidovudine in combination with other antiretrovirals is an alternative initial treatment for HIV infection
B. Zidovudine is also used to prevent transmission of HIV from the mother to her fetus and to treat AIDS-related dementia
C. Peripheral neuropathy is a specific adverse reaction to Zidovudine
D. Zidovudine is converted by cellular enzymes to an active form
Correct answer:
The correct answer is D: Zidovudine is converted by cellular enzymes to an active form (zidovudine diphosphate). Zidovudine itself is a prodrug that needs to be metabolized by cellular enzymes to its active form, zidovudine diphosphate, which inhibits HIV replication by acting as a nucleoside reverse transcriptase inhibitor. This active form is essential for its antiretroviral activity.
Incorrect Choices:
A: Zidovudine in combination with other antiretrovirals is an alternative initial treatment for HIV infection - This is incorrect because zidovudine is commonly used in combination with other antiretrovirals as a first-line treatment for HIV infection, not as an alternative treatment.
B: Zidovudine is also used to prevent transmission of HIV from the mother to her fetus and to treat AIDS-related dementia - This is incorrect because zidovudine is primarily used in
Your adult patient is experiencing symptomatic bradycardia with a heart rate of 40 bpm. Once on the monitor, it reveals the patient has a complete third-degree atrioventricular block and is found to be hypotensive as well. Which of the following medications should be avoided, if possible?
A. Epinephrine
B. Dopamine
C. Dobutamine
D. Atropine
Correct answer:
The correct answer is D: Atropine. In a patient with symptomatic bradycardia due to complete third-degree AV block, atropine should be avoided if possible because it works by blocking the parasympathetic nervous system, potentially worsening the AV block. The first-line treatment for symptomatic bradycardia with hypotension in this scenario is transcutaneous pacing or external temporary pacing. If atropine is ineffective or contraindicated, other options like dopamine, dobutamine, or epinephrine may be considered to support blood pressure until more definitive treatment can be initiated. Dopamine and dobutamine can help increase heart rate and improve cardiac output, while epinephrine can provide inotropic and chronotropic support. However, these medications should be used cautiously and in consultation with a specialist due to the risk of exacerbating the AV block.
Your adult patient is experiencing symptomatic bradycardia with a heart rate of 40 bpm. Once on the monitor, it reveals the patient has a complete third-degree atrioventricular block and is found to be hypotensive as well. Which of the following medications should be avoided, if possible?
A. Epinephrine
B. Dopamine
C. Dobutamine
D. Atropine
Correct answer:
The correct answer is D: Atropine. In a patient with symptomatic bradycardia due to complete third-degree AV block, atropine should be avoided if possible because it works by blocking the parasympathetic nervous system, potentially worsening the AV block. The first-line treatment for symptomatic bradycardia with hypotension in this scenario is transcutaneous pacing or external temporary pacing. If atropine is ineffective or contraindicated, other options like dopamine, dobutamine, or epinephrine may be considered to support blood pressure until more definitive treatment can be initiated. Dopamine and dobutamine can help increase heart rate and improve cardiac output, while epinephrine can provide inotropic and chronotropic support. However, these medications should be used cautiously and in consultation with a specialist due to the risk of exacerbating the AV block.
Which of the following anthelmintic acts as a cholinergic agonist in the nematodes and causes spastic paralysis of the worms?
A. Piperazine
B. Pyrantel pamoate
C. Mebendazole
D. Albendazole
Correct answer:
Step-by-step rationale for why Pyrantel pamoate (choice B) is the correct answer:
1. Pyrantel pamoate is a cholinergic agonist that acts on nematodes by stimulating nicotinic receptors, leading to spastic paralysis of the worms.
2. Its mechanism of action involves depolarizing the neuromuscular junction, causing sustained muscle contraction in the parasites.
3. This spastic paralysis makes the worms lose their ability to maintain attachment to the host's intestine, facilitating their expulsion from the body.
4. Piperazine (choice A) works by blocking the response of the worm's muscle cells to acetylcholine, causing flaccid paralysis.
5. Mebendazole (choice C) and Albendazole (choice D) are benzimidazole anthelmintics that inhibit microtubule formation, leading to impaired glucose uptake and energy depletion in the parasites, not acting as cholinergic agonists.
Which of the following anthelmintic acts as a cholinergic agonist in the nematodes and causes spastic paralysis of the worms?
A. Piperazine
B. Pyrantel pamoate
C. Mebendazole
D. Albendazole
Correct answer:
Step-by-step rationale for why Pyrantel pamoate (choice B) is the correct answer:
1. Pyrantel pamoate is a cholinergic agonist that acts on nematodes by stimulating nicotinic receptors, leading to spastic paralysis of the worms.
2. Its mechanism of action involves depolarizing the neuromuscular junction, causing sustained muscle contraction in the parasites.
3. This spastic paralysis makes the worms lose their ability to maintain attachment to the host's intestine, facilitating their expulsion from the body.
4. Piperazine (choice A) works by blocking the response of the worm's muscle cells to acetylcholine, causing flaccid paralysis.
5. Mebendazole (choice C) and Albendazole (choice D) are benzimidazole anthelmintics that inhibit microtubule formation, leading to impaired glucose uptake and energy depletion in the parasites, not acting as cholinergic agonists.
A 16 y.o. girl is diagnosed with genital herpes. She is tearful and as she asks what she can do to prevent complications of the disease. Based on the data provided, which nursing diagnosis is appropriate for her plan of care?
A. Risk for transmission of infection
B. Pain
C. Health-seeking behaviours
D. Ineffective sexuality pattern
Correct answer:
Given that the 16-year-old girl has been diagnosed with genital herpes and is concerned about preventing complications of the disease, the most appropriate nursing diagnosis would be "Risk for transmission of infection." Genital herpes is a highly contagious sexually transmitted infection, and individuals with the infection can transmit it to their partners through sexual contact. Therefore, it is crucial to educate the girl on ways to prevent the transmission of the infection to others. By addressing this nursing diagnosis, the healthcare team can provide guidance on safer sexual practices, including the use of condoms, abstinence during outbreaks, and communication with partners to prevent the spread of the infection. This nursing diagnosis focuses on promoting the girl's health and preventing further complications related to the transmission of genital herpes.
A patient says, I feel detached and weird all the time, like I'm looking at life through a cloudy window. Everything seems unreal. These feelings really interfere with my work and study. Which term should the nurse use to document this complaint?
A. Depersonalization
B. Hypochondriasis
C. Dissociation
D. Malingering
Correct answer:
Correct Answer: A. Depersonalization
Rationale:
1. Depersonalization involves feeling detached from oneself or reality, as described by the patient.
2. The patient's description of feeling like they are looking through a cloudy window aligns with depersonalization symptoms.
3. Interference with work and study suggests significant distress, a common feature of depersonalization disorder.
Summary of other choices:
B. Hypochondriasis: Involves excessive worry about having a serious illness, which is not indicated in the patient's complaint.
C. Dissociation: While depersonalization is a type of dissociative symptom, it specifically refers to feeling detached and unreal, not necessarily a broader dissociative disorder.
D. Malingering: Involves feigning or exaggerating symptoms for secondary gain, which is not evident in the patient's genuine distress and impairment.
In the operating room, personnel should be responsible for ensuring cleanliness, proper temperature, humidity, and lighting. Who carries those responsibilities?
A. circulating nurse
B. scrub nurse
C. surgeon
D. anesthesiologist
Correct answer:
The circulating nurse is responsible for ensuring the cleanliness, proper temperature, humidity, and lighting in the operating room. The circulating nurse plays a crucial role in maintaining the overall environment and ensuring that it meets the necessary standards for the safety and well-being of the patient and the surgical team. They are in charge of coordinating and overseeing all aspects of the operating room environment, including maintaining a sterile field, assisting with instrument setup, and ensuring that all equipment is functioning properly. Additionally, the circulating nurse manages communication within the operating room and ensures that all necessary supplies are available during the surgical procedure. It is within the circulating nurse's scope of practice to take charge of these responsibilities to create an optimal operating room environment.
A patient says, I know I have a brain tumor despite the results of the magnetic resonance image (MRI). The radiologist is wrong. People who have brain tumors vomit, and yesterday I vomited all day. Which response by the nurse fosters cognitive restructuring?
A. You do not have a brain tumor. The more you talk about it, the more it reinforces your illogical thinking.
B. Let's see whether any other explanations for your vomiting are possible.
C. You seem so worried. Let's talk about how you're feeling.
D. We should talk about something else.
Correct answer:
The correct answer is B because it encourages the patient to consider alternative explanations for their symptoms, which is key in cognitive restructuring. By exploring other possible reasons for the vomiting, the patient is guided to challenge their automatic assumption of having a brain tumor. This approach helps the patient to reevaluate their thoughts and beliefs in a more rational manner.
Choices A, C, and D are incorrect:
A: This response dismisses the patient's concerns without addressing the underlying irrational belief. It does not promote cognitive restructuring.
C: While acknowledging the patient's emotions is important, this response does not actively challenge the patient's irrational belief or encourage critical thinking.
D: Changing the subject does not address the patient's cognitive distortions and does not facilitate cognitive restructuring.
RN exams clinical judgment practice questions, set 112 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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