RN exams clinical judgment practice questions, set 141
RN exams · clinical judgment
RN exams clinical judgment practice questionsset 141
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
A 25-year-old patient was delivered to an infectious diseases unit on the 3rd day of illness with complaints of headache, pain in lumbar spine and gastrocnemius muscles, high fever, chill. Objectively: condition of moderate severity. Scleras are icteric. Pharynx is hyperemic. Tongue is dry with dry brown coating. Abdomen is distended. Liver is enlarged by 2 cm. Spleen is not enlarged. Palpation of muscles, especially gastrocnemius muscles, is painful. Urine is dark in color. Stool is normal in color. The most likely diagnosis is:
A. Leptospirosis
B. Infectious mononucleosis
C. Malaria
D. Viral hepatitis A
Show answer and rationale
Correct answer: A — Leptospirosis
The correct diagnosis is Leptospirosis. Leptospirosis presents with headache, fever, muscle pain, jaundice, and kidney involvement. The patient's symptoms of headache, lumbar and muscle pain, high fever, icteric scleras, and dark urine are classic for Leptospirosis. The enlarged liver could be due to liver involvement in the disease. The absence of splenic enlargement and normal stool color rule out malaria. Infectious mononucleosis typically presents with sore throat and lymphadenopathy, which are absent in this case. Viral hepatitis A may present with similar symptoms, but the presence of muscle pain and dark urine is more indicative of Leptospirosis. Therefore, based on the patient's symptoms and clinical findings, Leptospirosis is the most likely diagnosis.
Question 2
A highly suspicious patient who has delusions of persecution about being poisoned has refused all hospital meals for 3 days. Which of the following interventions would be most appropriate under these circumstances?
A. Feed the patient via tube, involuntarily via court order if needed.
B. Offer to taste each food item on the tray yourself while he watches.
C. Allow the patient to contact a local restaurant to deliver his meals.
D. Allow him supervised access to use food vending machines in the hospital lobby.
Show answer and rationale
Correct answer: D — Allow him supervised access to use food vending machines in the hospital lobby.
Step 1: In this scenario, the patient is refusing hospital meals due to delusions of being poisoned, indicating a lack of trust.
Step 2: By allowing supervised access to food vending machines in the hospital lobby, the patient can choose his own food, promoting autonomy and trust-building.
Step 3: This intervention respects the patient's autonomy while ensuring access to food.
Step 4: In contrast, feeding via tube involuntarily (Option A) violates autonomy, tasting food yourself (Option B) doesn't address the issue of trust, and ordering from a restaurant (Option C) may not be feasible or safe in a hospital setting.
Summary: Option D is the most appropriate as it balances patient autonomy and safety, addressing the refusal of hospital meals effectively.
Question 3
You are called to assist an adult diabetic who was found unconscious in bed. On arrival, your patient is unresponsive with snoring respirations and cool, clammy skin. Your glucometer will not power up, so blood glucose analysis is impossible at the present time. Which of the following would be most appropriate after controlling the patient's airway and delivering high-flow oxygen therapy?
A. Administer glucagon to the patient intramuscularly in a large muscle group like the gluteal muscles
B. Start an intravenous line, draw blood samples, and administer one amp of dextrose 50 percent (D50)
C. Start an intravenous line, and draw blood samples before administering a glucose-containing IV fluid bolus
D. Quickly establish an intravenous line, and transport the patient to the nearest hospital for blood glucose analysis prior to medication administration
Show answer and rationale
Correct answer: B — Start an intravenous line, draw blood samples, and administer one amp of dextrose 50 percent (D50)
The correct answer is B because administering dextrose 50% via IV is the most appropriate and rapid way to treat hypoglycemia in an unresponsive diabetic patient. Dextrose will quickly raise the blood glucose levels and help reverse the hypoglycemic state. Starting an IV line is crucial for immediate access to administer the dextrose. Drawing blood samples is unnecessary in this emergency situation as immediate treatment is required to prevent further deterioration. Administering glucagon intramuscularly may delay the treatment process as it takes longer to raise blood glucose levels compared to IV dextrose. Transporting the patient to the hospital for blood glucose analysis before treatment can be dangerous as delays in treatment can lead to irreversible harm.
Question 4
Mucous membrane partially or completely covering the vaginal orifice is called as:
A. Clitoris
B. Labia
C. Hymen
D. Vulva
Show answer and rationale
Correct answer: C — Hymen
The correct answer is C: Hymen. The hymen is a mucous membrane that partially or completely covers the vaginal orifice. It is a thin tissue located at the opening of the vagina. The hymen can vary in appearance and may partially cover the vaginal opening, making it an essential anatomical structure to consider. The other choices are incorrect because:
A: Clitoris - The clitoris is a highly sensitive sexual organ located above the vaginal opening, not covering it.
B: Labia - The labia are the folds of skin surrounding the vaginal opening, not covering it entirely.
D: Vulva - The vulva refers to the external female genitalia, including the labia, clitoris, and vaginal opening, but it does not specifically refer to the mucous membrane covering the vaginal orifice.
Question 5
An aspect of computer use in patient care in which the LPN may need to be proficient includes:
A. input of data such as requests for radiographs or laboratory services.
B. programming the computer to record data from primary care provider and other health care workers.
C. educating patients how to use hospital computers to access information such as discharge instructions or information relative to specific medications.
D. scheduling admissions, discharges, and nurse staffing to keep the unit at the best occupancy and utilization.
Show answer and rationale
Correct answer: A — input of data such as requests for radiographs or laboratory services.
The correct answer is A because LPNs are often responsible for inputting patient data such as requests for radiographs or lab services into the computer system. This task requires proficiency in navigating electronic health records to accurately document patient information. Option B is incorrect as LPNs typically do not program computers but rather use pre-existing systems. Option C is incorrect because educating patients on computer use is usually the responsibility of other healthcare professionals. Option D is also incorrect as scheduling admissions and nurse staffing is typically managed by unit coordinators or nurse managers, not LPNs. In summary, the LPN's role in computer use for patient care primarily involves inputting data accurately and efficiently.
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Question 6
The nurse had developed a close relationship with the family of a client who is dying. Which nursing intervention(s) are most appropriate in dealing with the family?
A. Encouraging family discussion of feelings
B. Accepting the family's experience of anger
C. Facilitating the use of spiritual practices identified by the family
D. All of the above
Correct answer:
When a nurse has developed a close relationship with a dying client's family, it is crucial to provide comprehensive support. Encouraging family discussion of feelings helps them express their emotions and concerns, fostering a sense of relief. Accepting the family's experience of anger without judgment validates their emotions and promotes trust. Facilitating the use of spiritual practices identified by the family acknowledges their beliefs and values, offering comfort and solace. Therefore, all of the above interventions are essential in providing holistic care and support during such a challenging time. Choices A, B, and C each play a vital role in addressing different aspects of the family's emotional and spiritual needs, making option D the correct answer.
An anxious 12-year-old child receives an injection from the nurse and sighs with relief when it is done. After a moment of reflection, the girl asks the nurse, 'Is it hard to give someone an injection?' This child's question is evidence that the child has developed which cognitive skill?
A. Conservation
B. Accommodation
C. Decentering
D. Class inclusion
Correct answer:
The correct answer is C: Decentering. Decentering is the ability to consider multiple aspects of a situation, which the child's question demonstrates. In this scenario, the child's question shows that she is thinking beyond her own experience and considering the difficulty or complexity of giving an injection from the nurse's perspective. Choices A, B, and D are incorrect. Conservation refers to understanding that certain properties of an object remain the same despite changes in its appearance. Accommodation is the process of adjusting existing knowledge or creating new mental categories to incorporate new information. Class inclusion involves understanding the relationship between a whole set and its subsets, which is not demonstrated in the child's question.
You readmitted a client who was in another department a month ago. Since you will need the previous chart, from whom do you request the old chart?
A. Central supply section
B. Previous doctor's clinic
C. Department where the patient was previously admitted
D. Medical records section
Correct answer:
The correct answer is D, Medical records section. This is because the medical records section is responsible for maintaining and storing all patient records, including previous charts. Requesting the old chart from the medical records section ensures accuracy and completeness of the client's medical history.
A: Central supply section - Incorrect, as this department is responsible for providing medical supplies and equipment, not maintaining patient records.
B: Previous doctor's clinic - Incorrect, as the clinic may not have the complete medical history if the patient has been seen in multiple departments.
C: Department where the patient was previously admitted - Incorrect, as they may not have access to the complete medical records from other departments.
Which description of disease activity in a single area corresponds to endemic levels of disease?
A. There are usually 20–30 cases each week, and this past week there were 29 cases.
B. There are usually fewer than 20 cases per year, and this past week there were 2 cases.
C. There are usually up to 10 cases per week, and this past week there were 40 cases.
D. There are usually 100,000 cases worldwide each month, and this past month there were 10 million
Correct answer:
Rationale for Correct Answer A:
- Endemic levels refer to consistent, expected rates of disease in a specific area.
- Choice A states there are usually 20-30 cases each week, consistent with endemic levels.
- The fact that there were 29 cases this past week aligns with the usual range, indicating endemicity.
- This means the disease is consistently present in that area without significant spikes or drops.
Summary of Incorrect Choices:
- Choice B: The usual rate in this choice is much lower than endemic levels, making it unlikely to be endemic.
- Choice C: The usual rate is exceeded significantly in the past week, indicating an outbreak rather than endemicity.
- Choice D: The global scale mentioned is not relevant to determining endemic levels in a single area.
The purpose of a tracheostomy is to remove obstruction and ease:
A. breathing.
B. comfort.
C. swallowing.
D. talking.
Correct answer:
The purpose of a tracheostomy is primarily to remove an obstruction in the upper airway, typically the larynx or pharynx, in order to maintain a patient's airway and facilitate breathing. By creating a direct airway through the neck into the trachea, a tracheostomy helps improve the flow of air into the lungs, especially in situations where the upper airway is compromised due to an injury, infection, or other medical conditions. This procedure is crucial for patients who are unable to breathe effectively through their nose and mouth, providing a more stable and secure air passage for oxygen delivery. While a tracheostomy may also influence other aspects like comfort and swallowing in some cases, the primary and immediate purpose is to ensure adequate breathing.
The following structures are felt during bimanual pelvic examination
A. Ovary
B. Uterus
C. Fallopian Tube
D. Cervix
Correct answer:
The correct answer is B: Uterus. During a bimanual pelvic examination, the examiner can palpate the uterus between their fingers. The uterus is a key structure that can be felt for its size, shape, and position. The ovaries, fallopian tubes, and cervix are not typically felt during a bimanual exam as they are located deeper within the pelvis and are not easily palpable. Palpating the ovaries directly is not typically part of a routine pelvic examination due to their small size and position behind the uterus. The fallopian tubes are also not typically palpable during a bimanual exam as they are located laterally to the uterus. The cervix may be felt during the exam, but it is not the main structure that is typically palpated during a bimanual pelvic examination.
The nurse is educating a client about postpartum warning signs. Which symptom requires immediate medical attention?
A. Increased lochia after breastfeeding.
B. Perineal discomfort on day 3 postpartum.
C. Fever of 101°F and foul-smelling lochia.
D. Mild fatigue and trouble sleeping.
Correct answer:
The correct answer is C: Fever of 101°F and foul-smelling lochia. This combination indicates a possible infection like endometritis, which can be life-threatening if not promptly treated. Fever is a sign of systemic infection, and foul-smelling lochia suggests an infected uterus. Immediate medical attention is crucial to prevent complications.
A: Increased lochia after breastfeeding is common and not necessarily alarming unless it is excessive or accompanied by other symptoms.
B: Perineal discomfort on day 3 postpartum is expected due to the healing process and does not typically require immediate medical attention.
D: Mild fatigue and trouble sleeping are common postpartum symptoms but do not indicate a medical emergency unless they are severe or persistent.
You are called to assist an adult diabetic who was found unconscious in bed. On arrival, your patient is unresponsive with snoring respirations and cool, clammy skin. Your glucometer will not power up, so blood glucose analysis is impossible at the present time. Which of the following would be most appropriate after controlling the patient's airway and delivering high-flow oxygen therapy?
A. Administer glucagon to the patient intramuscularly in a large muscle group like the gluteal muscles
B. Start an intravenous line, draw blood samples, and administer one amp of dextrose 50 percent (D50)
C. Start an intravenous line, and draw blood samples before administering a glucose-containing IV fluid bolus
D. Quickly establish an intravenous line, and transport the patient to the nearest hospital for blood glucose analysis prior to medication administration
Correct answer:
The correct answer is B because administering dextrose 50% via IV is the most appropriate and rapid way to treat hypoglycemia in an unresponsive diabetic patient. Dextrose will quickly raise the blood glucose levels and help reverse the hypoglycemic state. Starting an IV line is crucial for immediate access to administer the dextrose. Drawing blood samples is unnecessary in this emergency situation as immediate treatment is required to prevent further deterioration. Administering glucagon intramuscularly may delay the treatment process as it takes longer to raise blood glucose levels compared to IV dextrose. Transporting the patient to the hospital for blood glucose analysis before treatment can be dangerous as delays in treatment can lead to irreversible harm.
The purpose of a tracheostomy is to remove obstruction and ease:
A. breathing.
B. comfort.
C. swallowing.
D. talking.
Correct answer:
The purpose of a tracheostomy is primarily to remove an obstruction in the upper airway, typically the larynx or pharynx, in order to maintain a patient's airway and facilitate breathing. By creating a direct airway through the neck into the trachea, a tracheostomy helps improve the flow of air into the lungs, especially in situations where the upper airway is compromised due to an injury, infection, or other medical conditions. This procedure is crucial for patients who are unable to breathe effectively through their nose and mouth, providing a more stable and secure air passage for oxygen delivery. While a tracheostomy may also influence other aspects like comfort and swallowing in some cases, the primary and immediate purpose is to ensure adequate breathing.
Nurse Mandy is preparing a client for magnetic resonance imaging (MRI) to confirm or rule out a spinal cord lesion. During the MRI scan, which of the following would pose a threat to the client?
A. The client lies still.
B. The client asks questions.
C. The client hears thumping sounds.
D. The client wears a watch and wedding band.
Correct answer:
Correct Answer: D (The client wears a watch and wedding band)
Rationale:
1. MRI machines use strong magnetic fields, which can interact with metal objects like a watch and wedding band, causing them to move or heat up.
2. Movement of metal objects can lead to injury to the client or interfere with the imaging process.
3. It is essential for the client to remove all metal objects before entering the MRI room to ensure safety and accurate imaging.
Summary:
A: The client lying still is important for a successful MRI scan and does not pose a threat.
B: Client asking questions does not pose a threat, as communication is normal during the procedure.
C: Hearing thumping sounds is a common experience during an MRI scan and does not pose a direct threat to the client.
RN exams clinical judgment practice questions, set 141 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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