RN exams clinical judgment practice questions, set 130
RN exams · clinical judgment
RN exams clinical judgment practice questionsset 130
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
All of the following are ways the kidney are used for urine formation and drug clearance except:
A. Filtration
B. Tubular secretion
C. Tubular filtration
D. Tubular reabsorption
Show answer and rationale
Correct answer: C — Tubular filtration
The correct answer is C: Tubular filtration. The kidney does not perform tubular filtration as a method for urine formation and drug clearance. The process of urine formation involves filtration, secretion, and reabsorption. Filtration occurs at the glomerulus, where blood is filtered to form the initial filtrate. Tubular secretion involves the active transport of substances from the blood into the renal tubules to be eliminated in urine. Tubular reabsorption is the process of reclaiming useful substances from the filtrate back into the blood. Therefore, tubular filtration is not a valid process in urine formation and drug clearance, making it the correct answer. Choices A, B, and D are incorrect as they are essential processes in urine formation and drug clearance.
Question 2
A client at 36 weeks' gestation reports severe itching without a rash. What condition should the nurse suspect?
A. Cholestasis of pregnancy.
B. Preeclampsia.
C. Gestational diabetes.
D. Intrauterine growth restriction.
Show answer and rationale
Correct answer: A — Cholestasis of pregnancy.
The correct answer is A: Cholestasis of pregnancy. Severe itching without a rash in a pregnant client at 36 weeks' gestation is often indicative of cholestasis of pregnancy, a liver condition that can occur during pregnancy. This condition is characterized by reduced bile flow, leading to the accumulation of bile acids in the blood, resulting in itching, especially on the palms and soles of the feet. Other choices (B) Preeclampsia, (C) Gestational diabetes, and (D) Intrauterine growth restriction are not typically associated with severe itching without a rash in the absence of other specific symptoms. Preeclampsia presents with hypertension and proteinuria, gestational diabetes with high blood sugar levels, and intrauterine growth restriction with poor fetal growth.
Question 3
A client who is reading a newspaper asks, "This article about health care states that many providers of health care lack effectiveness. What is the difference between effectiveness and efficiency?" The nurse explains that:
A. effective means performing the correct test or intervention whereas efficiency refers to the wise use of supplies and resources for the desired outcome.
B. effective refers to competence in clinical practice and efficiency describes quick completion of the task.
C. efficiency means wasting and meeting a minimum standard and effectiveness refers to taking all the time needed to exceed expectations.
D. efficiency refers to speed and effectiveness refers to the usefulness of the implementation.
Show answer and rationale
Correct answer: A — effective means performing the correct test or intervention whereas efficiency refers to the wise use of supplies and resources for the desired outcome.
Step 1: Define effectiveness and efficiency - Effectiveness is achieving the intended outcome, while efficiency is achieving the outcome with minimal waste.
Step 2: Analyze option A - It correctly defines effectiveness as performing the correct test or intervention and efficiency as the wise use of supplies and resources for the desired outcome.
Step 3: Justification - The nurse explains that many healthcare providers lack effectiveness, indicating they are not achieving the desired outcomes, which aligns with the definition of effectiveness in option A.
Step 4: Summary of incorrect choices - B incorrectly defines efficiency as quick completion of tasks, C confuses efficiency with wastage, and D incorrectly associates efficiency with speed rather than minimal waste.
Question 4
When demanding the needs of a community which of the following are the most important indicators? SATA
A. Demand for services in the community
B. Expert's determination of what is needed in the community
C. Obvious health disparities between the advantage and disadvantage populations
D. Verbalize expression of need from community informants
Show answer and rationale
Correct answer: A — Demand for services in the community
Rationale for choice A being correct:
1. Demand for services in the community is a direct reflection of the actual needs and priorities of the community members.
2. It indicates what services are lacking or insufficient, helping prioritize resources effectively.
3. Demand-driven approach ensures community participation and ownership in decision-making processes.
4. Meeting the demands helps improve community well-being and satisfaction.
Summary for why other choices are incorrect:
B: Expert's determination may overlook actual needs and preferences of the community.
C: Health disparities are important but do not necessarily capture the full spectrum of community needs.
D: Verbal expressions may not always align with the actual demands or priorities of the community.
Question 5
Low-level radiation, resulting from industrial leakage or medical X-rays, __________.
A. is harmful only when combined with other teratogens
B. can increase the risk of childhood cancer
C. rarely causes lasting damage
D. is safe during the last trimester
Show answer and rationale
Correct answer: B — can increase the risk of childhood cancer
Low-level radiation, whether from industrial leakage or medical X-rays, can increase the risk of childhood cancer by potentially damaging the developing fetus's cells. Even though the risk is relatively low, it is still a significant concern that should be acknowledged and monitored closely, especially during prenatal development. Choice A is incorrect as low-level radiation can still be harmful on its own without the need to be combined with other teratogens. Choice C is incorrect because low-level radiation exposure can indeed cause lasting damage, especially in the context of childhood cancer risk. Choice D is incorrect because low-level radiation exposure, even during the last trimester, can pose risks to the developing fetus and is not considered entirely safe.
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Question 6
When a specimen is required from a resident in an isolation room the nursing assistant should
A. Place the specimen into a biohazard bag while inside the room
B. Place the specimen into a biohazard bag when outside the room
C. Collect the specimen outside the resident's room
D. Transfer the specimen outside of the room keeping her gloves on
Correct answer:
Correct Answer: A
Rationale:
1. Placing the specimen into a biohazard bag inside the room minimizes the risk of contamination outside.
2. Biohazard bags are specifically designed to contain hazardous materials safely.
3. Handling the specimen inside the room reduces the chances of spreading potential pathogens.
4. Following proper protocol ensures the safety of both the resident and healthcare workers.
Summary:
B: Placing the specimen into a biohazard bag when outside the room increases the risk of contamination during transport.
C: Collecting the specimen outside the resident's room may lead to exposure to infectious agents.
D: Transferring the specimen outside of the room while keeping gloves on can still lead to contamination of the surrounding area.
When a Tae Kwon Do (TKD) master applies downward pressure just above the elbow joint on an attacker who immediately collapses to the ground, which reflex is applicable to this example?
A. Golgi tendon reflex
B. Myotatic reflex
C. Withdrawal reflex
D. Crossed-extensor reflex
Correct answer:
The Golgi tendon reflex is the correct answer. This reflex protects the muscle and tendons from excessive force by causing the muscle to relax. In this scenario, the downward pressure applied just above the elbow joint triggers the Golgi tendon reflex, resulting in the attacker's collapse. The other options are incorrect:
- The myotatic reflex (also known as the stretch reflex) is responsible for contracting a muscle in response to its stretch, not relaxing it.
- The withdrawal reflex is a spinal reflex that moves a body part away from a painful stimulus, not directly related to the scenario described.
- The crossed-extensor reflex is a reflex that occurs on the opposite side of the body in response to a withdrawal reflex, which is not the case in this situation.
A nurse is assisting a laboring person who is in the first stage of labor. What is the most appropriate intervention to promote relaxation and comfort?
A. encourage ambulation
B. administer pain medication
C. provide distraction and breathing techniques
D. offer relaxation techniques
Correct answer:
The correct answer is A: encourage ambulation. Walking during the first stage of labor can help facilitate the descent of the fetus, promote optimal positioning, and enhance comfort by utilizing gravity to aid in the progression of labor. Ambulation also encourages blood circulation and may provide a distraction from discomfort. Administering pain medication (B) is not the initial intervention in promoting relaxation and comfort during early labor. Providing distraction and breathing techniques (C) may be beneficial, but ambulation is more effective in promoting relaxation. Offering relaxation techniques (D) is helpful, but encouraging movement through ambulation is a more active approach in easing discomfort and promoting relaxation during the first stage of labor.
A 30-year-old pregnant patient is at 36 weeks gestation and expresses concerns about swelling in her legs. Which of the following assessments is most important for the nurse to make?
A. Assess the patient's weight gain during the pregnancy.
B. Examine the legs for any signs of deep vein thrombosis (DVT).
C. Instruct the patient to elevate her legs and rest.
D. Evaluate the patient's dietary intake of sodium.
Correct answer:
The correct answer is B: Examine the legs for any signs of deep vein thrombosis (DVT). At 36 weeks gestation, pregnant women are at higher risk for DVT due to increased blood volume and pressure on the veins from the growing uterus. DVT can be life-threatening if not detected early. Assessing for any signs of DVT such as redness, warmth, swelling, or pain in the legs is crucial for prompt intervention.
Incorrect choices:
A: Assessing weight gain is important but not the priority in this situation where DVT is a concern.
C: Instructing the patient to elevate her legs and rest can help with swelling but does not address the potential serious complication of DVT.
D: Evaluating dietary intake of sodium is not the priority in this situation where DVT is a concern.
The nurse is providing breast cancer education at a community facility. The American Cancer Society recommends that women get with mammograms:
A. Yearly after age 40
B. After the birth of the first child and every 2 years thereafter
C. After the first menstrual period and annually thereafter
D. Every 3 years between ages 20 and 40 and annually thereafter
Correct answer:
The correct answer is A: Yearly after age 40. This recommendation aligns with the American Cancer Society guidelines that suggest women should start getting annual mammograms at age 40. This age is important as it is when the risk of breast cancer increases. Yearly screenings help in early detection and better treatment outcomes. The other choices (B, C, D) are incorrect because they do not follow the ACS guidelines. Option B is incorrect as it does not specify an age for starting mammograms. Option C is incorrect as it suggests starting after the first menstrual period, which might be too early. Option D is incorrect as it recommends screenings every 3 years between ages 20 and 40, which is not in line with the ACS recommendation for yearly screenings after age 40.
A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehicle crash. On arrival in the ED he is diaphoretic and complaining of chest pain. His BP is 60/40mmHg and his respiratory rate is 40 breaths per minute. Which of the following best differentiates cardiac tamponade from tension pneumothorax as the cause of his hypotension?
A. Tachycardia
B. Pulse volume
C. Breath sounds
D. Pulse pressure
Correct answer:
The correct answer is C: Breath sounds. In cardiac tamponade, there may be muffled or distant heart sounds due to the accumulation of fluid around the heart, impacting its ability to pump effectively. In tension pneumothorax, breath sounds may be absent or decreased on the affected side due to lung collapse. This differentiation is important as cardiac tamponade requires emergent pericardiocentesis, while tension pneumothorax necessitates needle decompression. Choices A, B, and D are not as useful in differentiating between the two conditions. Tachycardia may be present in both conditions, pulse volume may be decreased in both, and pulse pressure may be narrowed in both due to decreased cardiac output. Breath sounds are a key differentiating factor in this scenario.
A woman with severe visual and auditory deficits is able to identify individuals by running her fingers lightly over her face. Which source is most likely to provide the input that allows for the woman's unique ability?
A. Special somatic afferent fibers
B. General somatic afferents
C. Special visceral afferent cells
D. General visceral afferent neurons
Correct answer:
The correct answer is C, special visceral afferent cells. These cells are responsible for functions like taste and smell. In individuals with severe visual and auditory deficits, their other sensory abilities, such as touch, can be heightened. Special somatic afferent fibers (choice A) are involved in sensations like touch and vibration from the skin and muscles, but they are not specific to the face. General somatic afferents (choice B) transmit sensory information from the skin, muscles, and joints, but they are not specialized for the unique ability described. General visceral afferent neurons (choice D) are responsible for transmitting sensory information from internal organs, not relevant to the woman's ability to identify individuals through touch on her face.
Your 30 year old female patient is c/o bad-smelling vaginal discharge with mild itching for about 3 weeks. Douching did not help. Denies painful urination or intercourse. She noticed the smell increased after intercourse and during her period last week. There are no lesions on the perineum. No lymphadenopathy. On speculum examination, there is a thin gray-white discharge. The pH of the discharge is over 4.5 and there is a fishy odor when potassium hydroxide (KOH) is applied to the vaginal secretions on the slide. Wet prep shows epithelial cells with stippled border (clue cells). What type of vaginitis best describes the findings?
A. Trichomonas vaginitis
B. Candida vaginitis
C. Bacterial vaginosis
D. Atrophic vaginitis
Correct answer:
The correct answer is C: Bacterial vaginosis. The key findings in this scenario point towards bacterial vaginosis. The presence of thin gray-white discharge, fishy odor with KOH, pH over 4.5, and clue cells on wet prep are classic for bacterial vaginosis. Trichomonas vaginitis (choice A) typically presents with yellow-green frothy discharge and motile trichomonads on microscopy. Candida vaginitis (choice B) is characterized by thick, white, cottage cheese-like discharge and budding yeast or pseudohyphae on microscopy. Atrophic vaginitis (choice D) usually occurs in menopausal women due to estrogen deficiency and presents with thin, pale vaginal walls and vaginal dryness. In this case, the absence of these findings makes bacterial vaginosis the most likely diagnosis.
While assessing several clients in a long-term health care facility, which client is at the highest risk for developing decubitus ulcers?
A. A 79-year-old malnourished client on bed rest
B. An obese client who uses a wheelchair
C. A client who had 3 episodes of incontinent diarrhea
D. An 80-year-old ambulatory diabetic client
Correct answer:
The correct answer is A: A 79-year-old malnourished client on bed rest. This client is at the highest risk for developing decubitus ulcers due to being malnourished and on bed rest, leading to decreased mobility and poor nutrition. This combination puts the client at significant risk for skin breakdown and pressure ulcers. Choice B is incorrect because although obesity is a risk factor for developing pressure ulcers, immobility and poor nutrition are higher risk factors. Choice C is incorrect as incontinence can contribute to skin breakdown but is not as high a risk factor as immobility and poor nutrition. Choice D is incorrect as an ambulatory client, even if diabetic, has better mobility than a bedridden client and is at lower risk for developing decubitus ulcers.
The nurse informs the patient that the frequency of range-of-motion (ROM) exercises should be:
A. once a day
B. once in the morning and once in the afternoon
C. 3 to 4 times a day
D. 4 to 6 times a day
Correct answer:
Range-of-motion exercises need to be frequent enough to maintain joint mobility and prevent stiffness, especially in patients at risk of contractures. Performing them 3 to 4 times a day ensures joints are moved through their full range multiple times, counteracting the effects of immobility without overtaxing the patient. Once a day is insufficient, as stiffness can develop within hours of inactivity. Twice daily (morning and afternoon) improves on that but may still allow periods of prolonged immobility. Four to six times might be ideal for severe cases but could exhaust the patient or staff resources unnecessarily. The 3 to 4 times recommendation balances efficacy and practicality, promoting flexibility and circulation while fitting into a realistic care schedule.
RN exams clinical judgment practice questions, set 130 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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