RN exams clinical judgment practice questions, set 135
RN exams · clinical judgment
RN exams clinical judgment practice questionsset 135
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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 nurse is planning preoperative teaching for a patient with hearing loss due to otosclerosis. The patient is scheduled for a stapedectomy with insertion of a prosthesis. What information is most crucial to include in the patients preoperative teaching?
A. The procedure is an effective, time-tested treatment for sensory hearing loss.
B. The patient is likely to experience resolution of conductive hearing loss after the procedure.
C. Several months of post-procedure rehabilitation will be needed to maximize benefits.
D. The procedure is experimental, but early indications suggest great therapeutic benefits.
Show answer and rationale
Correct answer: B — The patient is likely to experience resolution of conductive hearing loss after the procedure.
The correct answer is B: The patient is likely to experience resolution of conductive hearing loss after the procedure. This information is crucial to include in the preoperative teaching because it directly addresses the patient's expected outcome, providing reassurance and setting appropriate expectations. Stapedectomy with prosthesis insertion is a well-established treatment for otosclerosis-related conductive hearing loss. Choices A, C, and D are incorrect because they either provide misleading information (A, D) or are not directly relevant to the procedure or the patient's immediate postoperative experience (C). It is important to focus on accurate and relevant information to prepare the patient effectively for the upcoming surgery and its expected outcomes.
Question 2
What is the priority intervention for a patient with a suspected pulmonary embolism?
A. Administer supplemental oxygen.
B. Notify the healthcare provider immediately.
C. Prepare the patient for a CT scan.
D. Start anticoagulant therapy as prescribed.
Show answer and rationale
Correct answer: A — Administer supplemental oxygen.
The correct answer is A: Administer supplemental oxygen. This is the priority intervention for a patient with a suspected pulmonary embolism because it helps improve oxygenation and prevents further hypoxia. Oxygen therapy is crucial in stabilizing the patient's condition and should be initiated promptly.
Summary of other choices:
B: Notifying the healthcare provider is important, but administering oxygen takes precedence due to the immediate need for oxygenation.
C: While a CT scan is important for confirming the diagnosis, providing oxygen is more urgent to address the patient's hypoxia.
D: Starting anticoagulant therapy is a critical treatment for pulmonary embolism, but ensuring oxygenation is the immediate priority to stabilize the patient's condition.
Question 3
After a pericardiocentesis, what interventions should the nurse implement?
A. Monitor vital signs every 15 minutes for the first hour
B. Evaluate the client's cardiac rhythm
C. Record the amount of fluid removed as output
D. All of the above
Show answer and rationale
Correct answer: D — All of the above
After a pericardiocentesis, the nurse should implement multiple interventions to monitor the client's condition closely. Monitoring vital signs every 15 minutes for the first hour is crucial to detect any immediate changes that may indicate complications. Evaluating the client's cardiac rhythm is important to identify any arrhythmias that may occur due to the procedure. Recording the amount of fluid removed is essential to calculate fluid balance and ensure accurate monitoring of the client's status. Therefore, all the interventions mentioned are necessary to detect and manage any potential issues post-pericardiocentesis. Choices A, B, and C are all essential components of post-procedural care and should be implemented to ensure the client's safety and well-being.
Question 4
Which of the following outcome criteria is appropriate for the client with dementia?
A. The client will return to an adequate level of self-functioning.
B. The client will learn new coping mechanisms to handle anxiety.
C. The client will seek out resources in the community for support.
D. The client will follow an established schedule for activities of daily living.
Show answer and rationale
Correct answer: D — The client will follow an established schedule for activities of daily living.
The correct answer is D because clients with dementia often struggle with memory and cognitive functioning, making it essential to establish a routine for activities of daily living to promote independence and reduce confusion. This outcome criterion focuses on maintaining a structured schedule to support the client's ability to perform tasks consistently.
A is incorrect because expecting the client to return to an adequate level of self-functioning is unrealistic given the progressive nature of dementia. B is incorrect as learning new coping mechanisms may be challenging for someone with dementia due to cognitive impairment. C is incorrect because relying on the client to seek out resources in the community may not be feasible given their cognitive limitations.
Question 5
A client with diabetes mellitus is admitted with an infected foot ulcer. What intervention is most important for the nurse to implement?
A. Obtain a wound culture for testing.
B. Administer prescribed IV antibiotics.
C. Elevate the affected foot to reduce swelling.
D. Consult the wound care nurse for assessment.
Show answer and rationale
Correct answer: B — Administer prescribed IV antibiotics.
Administering prescribed IV antibiotics is the most crucial intervention in managing an infected foot ulcer in a client with diabetes mellitus. Antibiotics help combat the infection and prevent its spread systemically, which is vital in diabetic clients to prevent serious complications like sepsis. While obtaining a wound culture (Choice A) may provide valuable information for targeted antibiotic therapy, administering antibiotics promptly takes precedence to prevent the infection from worsening. Elevating the affected foot (Choice C) can help reduce swelling but is not as urgent as administering antibiotics. Consulting the wound care nurse (Choice D) may be beneficial for long-term wound management but does not address the immediate need to control the infection.
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Question 6
A patient with a history of hypertension is giving birth. During delivery, the staff was not able to stabilize the patient's blood pressure. As a result, the patient died shortly after delivery. This is an example of what type of death?
A. Early maternal death
B. Late maternal death
C. Direct obstetric death
D. Indirect obstetric death
Correct answer:
The correct answer is D: Indirect obstetric death. In this scenario, the patient's death was not directly caused by the obstetric event of giving birth, but rather by a pre-existing condition (hypertension) that was exacerbated during delivery. Indirect obstetric deaths are those caused by pre-existing conditions or external factors that are aggravated by the physiological effects of pregnancy. In contrast, early maternal death (choice A) occurs within 42 days of termination of pregnancy but is directly related to the pregnancy process. Late maternal death (choice B) occurs between 43 days and 1 year after termination of pregnancy. Direct obstetric deaths (choice C) are deaths resulting from obstetric complications during pregnancy, delivery, or postpartum period.
A very concerned mother is at the clinic with her infant who has a large, soft lump on the side of his head. She tells the nurse that she noticed the lump about 8 hours after her baby's birth and that it seems to be getting bigger. One possible explanation for this is:
A. hydrocephalus.
B. craniosynostosis.
C. cephalhematoma.
D. caput succedaneum.
Correct answer:
The correct answer is C: cephalhematoma. A cephalhematoma is a collection of blood between a baby's skull and the periosteum, typically occurring due to trauma during birth. In this case, the lump appeared 8 hours after birth, which aligns with the timeline for cephalhematoma development. It is soft because it consists of blood, and it can increase in size as the blood accumulates.
Incorrect Choices:
A: Hydrocephalus is an abnormal accumulation of cerebrospinal fluid within the brain, not a collection of blood.
B: Craniosynostosis is the premature fusion of skull bones, leading to an abnormal head shape, not a collection of blood.
D: Caput succedaneum is swelling of the soft tissues of a newborn's scalp due to pressure during delivery, not a collection of blood.
.A nurse is assessing a client who has been diagnosed with conversion disorder. Which of the following findings should the nurse expect?
A. Paralysis of a limb
B. Auditory hallucinations
C. Dissociative amnesia
D. Compulsive behaviors
Correct answer:
The correct answer is A: "Paralysis of a limb." Conversion disorder is a condition where psychological stress manifests as physical symptoms, such as paralysis, blindness, or seizures, without a clear organic cause. These symptoms are not consciously produced by the individual but are a result of psychological distress. Auditory hallucinations (B) are more commonly associated with psychotic disorders like schizophrenia. Dissociative amnesia (C) involves memory loss due to trauma or severe stress, not typically seen in conversion disorder. Compulsive behaviors (D) are more characteristic of obsessive-compulsive disorder. Therefore, in conversion disorder, the nurse should expect to find symptoms like paralysis of a limb that are not explained by medical conditions.
Which of the following should be reported by the nursing assistant because it is a possible sign of a pressure injury?
A. Intact skin
B. Broken skin between the toenails
C. Clean skin
D. Adequate resident hydration
Correct answer:
Correct Answer: B - Broken skin between the toenails
Rationale: Broken skin between the toenails can indicate the presence of a pressure injury, also known as a pressure ulcer. Pressure injuries often start as damage to the skin, such as breaks or tears, and can progress to more severe stages if not addressed promptly.
Summary of Other Choices:
A: Intact skin - This is not a sign of a pressure injury as intact skin does not show any visible damage or breakdown.
C: Clean skin - Clean skin does not necessarily indicate the presence of a pressure injury, as cleanliness alone does not provide information on skin integrity.
D: Adequate resident hydration - While hydration is important for overall skin health, it is not a direct indicator of a pressure injury.
After receiving a dose of penicillin, a client develops dyspnea and hypotension. Nurse Celestina suspects the client is experiencing anaphylactic shock. What should the nurse do first?
A. Page an anesthesiologist immediately and prepare to intubate the client.
B. Administer epinephrine, as prescribed, and prepare to intubate the client if necessary.
C. Administer the antidote for penicillin, as prescribed, and continue to monitor the client's vital signs.
D. Insert an indwelling urinary catheter and begin to infuse I.V. fluids as ordered.
Correct answer:
The correct answer is B: Administer epinephrine, as prescribed, and prepare to intubate the client if necessary. In anaphylactic shock, immediate administration of epinephrine is crucial to reverse the severe allergic reaction. Intubation may be necessary to maintain airway patency in case of severe respiratory distress.
Choice A is incorrect because paging an anesthesiologist and preparing for intubation should not be the first action; administering epinephrine takes precedence. Choice C is incorrect as administering an antidote for penicillin would not address the immediate life-threatening symptoms of anaphylactic shock. Choice D is incorrect as inserting a urinary catheter and infusing IV fluids are not the priority actions in managing anaphylactic shock.
The degree or extent of disease-evoking power that a microorganism has is referred to as:
A. virulence
B. strength
C. resistance
D. competence
Correct answer:
The correct answer is A: virulence. Virulence refers to the degree or extent of disease-evoking power that a microorganism possesses. This term specifically describes the ability of a microorganism to cause disease in a host. It is a crucial factor in understanding the pathogenicity of different microorganisms.
Choice B: strength is incorrect because it does not specifically relate to the disease-causing potential of a microorganism. Choice C: resistance refers to the ability of an organism to withstand the effects of a particular agent, such as a drug or environmental factor. Choice D: competence is not directly related to the disease-causing ability of a microorganism, but rather refers to the ability of an organism to perform a specific function effectively.
What is one way a nursing assistant can help a family respond to the death of a loved one?
A. Influencing the family with the NA's religion
B. Promptly reporting a request for a clergy visit
C. Isolating the family and friends
D. Judging past behavior to make the family feel better
Correct answer:
The correct answer is B: Promptly reporting a request for a clergy visit. This is the best choice because it shows empathy and support for the family's spiritual and emotional needs during a difficult time. It respects the family's beliefs and values, providing them with the necessary support from a clergy member. It helps the family cope with their grief and find comfort in their faith.
Choice A is incorrect as imposing personal religious beliefs on the family may not align with their own beliefs, causing discomfort. Choice C is incorrect as isolating the family and friends can lead to further emotional distress and hinder the grieving process. Choice D is incorrect as judging past behavior is not helpful and may cause additional emotional pain for the family.
Select the drug which tends to reverse insulin resistance by increasing cellular glucose transporters:
A. Glibenclamide
B. Rosiglitazone
C. Acarbose
D. Prednisolone
Correct answer:
The correct answer is B: Rosiglitazone. Rosiglitazone is a thiazolidinedione that works by activating peroxisome proliferator-activated receptor gamma (PPAR-gamma), which then increases the expression of glucose transporters on the cell membrane. This leads to improved cellular glucose uptake and utilization, thus reversing insulin resistance.
Rationale:
A. Glibenclamide is a sulfonylurea that stimulates insulin secretion from the pancreas but does not directly affect cellular glucose transporters.
C. Acarbose is an alpha-glucosidase inhibitor that delays carbohydrate digestion but does not increase cellular glucose transporters.
D. Prednisolone is a corticosteroid that can worsen insulin resistance by increasing blood glucose levels through various mechanisms.
A male client with diabetes mellitus type 2, who is taking pioglitazone PO daily, reports to the nurse the recent onset of nausea, accompanied by dark-colored urine, and a yellowish cast to his skin. What instructions should the nurse provide?
A. Seek immediate medical assistance to evaluate the cause of these symptoms.
B. Discontinue the medication and follow up with a healthcare provider.
C. Increase fluid intake and monitor urine color.
D. Continue taking the medication and report any changes.
Correct answer:
The correct answer is A: 'Seek immediate medical assistance to evaluate the cause of these symptoms.' The symptoms described by the client, including nausea, dark-colored urine, and yellowish skin, are indicative of possible liver toxicity, a serious side effect of pioglitazone. Therefore, immediate medical evaluation is necessary to assess the severity of the condition and prevent further complications. Choices B, C, and D are incorrect: B advises discontinuing the medication without seeking immediate medical assistance, which could delay necessary treatment; C focuses solely on increasing fluid intake and monitoring urine color, overlooking the urgency of the situation; and D suggests continuing the medication when prompt evaluation is crucial in this scenario.
The causative agent of botulism causes severe food poisoning. Specify the most characteristic morphological feature of botulism causative agent:
A. Gram-positive bacillus with subterminal spore
B. Thick gram-positive non-spore-forming bacillus
C. Gram-positive bacillus with terminal spore
D. Thin mobile bacillus with central spore
Correct answer:
The correct answer is D: Thin mobile bacillus with central spore. This is because the causative agent of botulism, Clostridium botulinum, is a gram-positive bacillus that typically appears as a thin rod-shaped bacterium with a central endospore. This characteristic morphology is essential in the identification of Clostridium botulinum.
A: Gram-positive bacillus with subterminal spore - This is incorrect as Clostridium botulinum typically has a central endospore, not a subterminal one.
B: Thick gram-positive non-spore-forming bacillus - This is incorrect as Clostridium botulinum forms endospores, although they are not thick.
C: Gram-positive bacillus with terminal spore - This is incorrect as the spore of Clostridium botulinum is typically central, not terminal.
RN exams clinical judgment practice questions, set 135 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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