RN exams clinical judgment practice questions, set 149
RN exams · clinical judgment
RN exams clinical judgment practice questionsset 149
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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
Expectant parents ask a prenaNtal RnursIe eGducaBto.rC, “WMhich setting for childbirth limits the U S N T O amount of parent–infant interaction?” Which answer should the nurse provide for these parents in order to assist them in choosing an appropriate birth setting?
A. Birth center
B. Home birth
C. Traditional hospital birth
D. Labor, birth, and recovery room
Show answer and rationale
Correct answer: C — Traditional hospital birth
The correct answer is C: Traditional hospital birth. In a traditional hospital setting, there may be limited parent-infant interaction due to medical interventions, procedures, and protocols that can restrict immediate bonding opportunities. The presence of medical staff, equipment, and potential complications may create a more clinical environment, impacting the initial bonding experience.
Summary:
A: Birth center - Typically encourages parent-infant interaction and supports a more natural birth experience.
B: Home birth - Allows for maximum parent-infant interaction in a familiar and comfortable environment.
D: Labor, birth, and recovery room - Provides a dedicated space for labor and recovery, but still allows for parent-infant interaction after birth.
Question 2
A nurse from the maternity unit is floated to the critical care unit because of staff shortage on the evening shift. Which client would be appropriate to assign to this nurse?
A. A client with a Dopamine drip IV with vital signs monitored every 5 minutes
B. A client with a myocardial infarction that is free from pain and dysrhythmias
C. A client with a tracheotomy of 24 hours in some respiratory distress
D. A client with a pacemaker inserted this morning with intermittent capture
Show answer and rationale
Correct answer: B — A client with a myocardial infarction that is free from pain and dysrhythmias
In this scenario, it is more appropriate to assign a stable client, such as the one with a myocardial infarction who is free from pain and dysrhythmias, to a nurse who lacks specialized critical care experience. This client's condition is relatively stable and does not require immediate critical interventions. Choices A, C, and D involve clients with more complex and critical conditions that would be better managed by a nurse with specialized critical care training. Choice A involves a client on a Dopamine drip with frequent vital sign monitoring, Choice C has a client with a tracheotomy in respiratory distress, and Choice D describes a client with a pacemaker experiencing intermittent capture, all of which require a higher level of critical care expertise.
Question 3
A patient of African descent is in the critical care unit to be monitored for shock after an accident. What skin characteristics would the nurse expect to find in this patient?
A. Ruddy blue
B. Generalized pallor
C. Ashen, grey, or dull
D. Patchy areas of pallor
Show answer and rationale
Correct answer: C — Ashen, grey, or dull
The correct answer is C: Ashen, grey, or dull. In patients of African descent, skin characteristics may appear ashen, grey, or dull when experiencing shock due to reduced blood flow and oxygen delivery. This is because the skin may appear pale or lacking in color due to decreased perfusion.
The other choices are incorrect because:
A: Ruddy blue - Ruddy blue skin color is not typically associated with shock in patients of African descent.
B: Generalized pallor - Generalized pallor refers to an overall paleness of the skin, which is not commonly seen in patients of African descent during shock.
D: Patchy areas of pallor - Patchy areas of pallor suggest uneven skin color changes, which are not typically characteristic of shock in patients of African descent.
Question 4
The patient weighs 75 kg and is receiving IV fluids at a rate of 50 mL/hour, having consumed 100 mL orally in the past 24 hours. What action will the nurse take?
A. Contact the provider to ask about increasing the IV rate to 90 mL/hour.
B. Discuss with the provider the need to increase the IV rate to 150 mL/hour.
C. Encourage the patient to drink more water so the IV can be discontinued.
D. Instruct the patient to drink 250 mL of water every 8 hours.
Show answer and rationale
Correct answer: A — Contact the provider to ask about increasing the IV rate to 90 mL/hour.
The recommended daily fluid intake for adults is 30 to 40 mL/kg/day. For a patient weighing 75 kg, the minimum intake should be 2250 mL/day. The patient is currently receiving 1200 mL IV and 100 mL orally, totaling 1300 mL. Increasing the IV rate to 90 mL/hour would provide a total of 2160 mL, which could meet the patient's needs if oral intake continues. Option B suggests increasing the IV rate to 150 mL/hour, resulting in an excessive fluid intake of 3600 mL/day, surpassing the recommended amount. Option C, encouraging increased fluid intake, is not recommended as the patient is already struggling with fluid intake. Option D, instructing the patient to drink 250 mL of water every 8 hours, would still fall short of the required fluid intake of 2250 mL/day.
Question 5
The residents with the longest average stay in long-term care facilities are
A. Residents admitted for terminal care
B. Residents admitted for rehabilitation or temporary illness
C. Residents who are developmentally disabled
D. Residents who have dementia
Show answer and rationale
Correct answer: D — Residents who have dementia
The correct answer is D because residents with dementia tend to have longer stays in long-term care facilities due to the progressive nature of the condition and the need for ongoing specialized care. Residents admitted for terminal care (choice A) typically have shorter stays as they are in the final stages of life. Residents admitted for rehabilitation or temporary illness (choice B) stay for a shorter duration as they receive treatment and recover. Residents who are developmentally disabled (choice C) may have varying lengths of stay but typically not as long as those with dementia due to different care needs. In summary, the correct answer is D because dementia requires long-term care, while the other choices involve shorter stays for different reasons.
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Question 6
You are called to assist a pregnant female in the 24th week gestation period according to her due date. The pale 26-year-old patient is found supine in bed, complaining of dizziness/weakness with extreme nausea. The patient denies vaginal bleeding, amniotic fluid leakage, or abdominal pain. There are no signs of imminent birth or active labor. She reports receiving normal prenatal care with no associated problems found during the pregnancy. Her heart rate is 126-130 beats per minute; her blood pressure is 80 mmHg systolic while her skin is cool and pale. Which of the following conditions is most likely to cause the patient's presentation?
A. Uterine rupture
B. Spontaneous abortion
C. Supine hypotension
D. Placenta previa
Correct answer:
The correct answer is C: Supine hypotension. In pregnant women, lying supine can compress the inferior vena cava, reducing venous return and cardiac output, leading to hypotension and symptoms like dizziness, weakness, and nausea. This condition is called supine hypotension syndrome. The patient's symptoms of dizziness and weakness, along with the low blood pressure and cool, pale skin, are indicative of inadequate blood flow due to supine positioning. Choices A, B, and D are incorrect because they do not align with the patient's symptoms and presentation. Uterine rupture, spontaneous abortion, and placenta previa typically present with different signs and symptoms, such as abdominal pain, vaginal bleeding, and fetal distress, which are absent in this case.
A nurse is teaching a patient about managing diabetes. Which of the following actions would the nurse emphasize as most important in preventing complications from diabetes?
A. Monitoring blood glucose levels regularly.
B. Limiting physical activity to prevent injury.
C. Maintaining a low-fat, high-protein diet.
D. Taking insulin as prescribed regardless of blood sugar levels.
Correct answer:
Step-by-step rationale for why choice A is correct:
1. Monitoring blood glucose levels regularly allows for timely adjustments in treatment.
2. It helps in preventing hypoglycemia or hyperglycemia complications.
3. Enables the patient to understand how their lifestyle choices impact their blood sugar levels.
4. Empowers the patient to make informed decisions regarding their diabetes management.
Summary of why the other choices are incorrect:
B: Limiting physical activity can lead to complications like obesity and decreased insulin sensitivity.
C: Diet should focus on balanced nutrition, not just low-fat or high-protein, to manage diabetes effectively.
D: Taking insulin regardless of blood sugar levels can result in hypoglycemia or poor blood sugar control.
A male patient is receiving testosterone therapy for hypogonadism. What serious adverse effect should the nurse monitor for during this therapy?
A. Increased risk of liver dysfunction
B. Increased risk of prostate cancer
C. Increased risk of bone fractures
D. Increased risk of breast cancer
Correct answer:
The correct answer is A: Increased risk of liver dysfunction. Testosterone therapy can lead to liver dysfunction, including cholestatic jaundice and hepatitis. This adverse effect necessitates monitoring of liver function tests during testosterone therapy. Choice B, increased risk of prostate cancer, is incorrect because testosterone therapy does not cause prostate cancer but is contraindicated in patients with known or suspected prostate cancer. Choice C, increased risk of bone fractures, is incorrect as testosterone therapy is actually associated with an increase in bone mineral density, reducing the risk of fractures. Choice D, increased risk of breast cancer, is incorrect because testosterone therapy in males does not increase the risk of breast cancer.
When addressing an ethical dilemma, contextual, physiolo gical, and personal factors of the situation must be considered. Which of the following is an example of a personal factor?
A. The hospital has a policy that everyone must have an aadbvirba.ncocme/dte sdt irective on the chart.
B. The patient has lost 20 pounds in the past month and is fatigued all of time.
C. The patient has expressed their beliefs concerning wha t quality of life means and their wishes.
D. The primary care provider considers care to be futile in a given situation.
Correct answer:
The correct answer is C because the patient's expressed beliefs and wishes regarding quality of life are personal factors that directly influence the ethical dilemma. This factor reflects the individual's values, beliefs, and preferences, which are essential in making ethical decisions that respect the patient's autonomy. Considering the patient's beliefs helps healthcare professionals navigate complex ethical situations by aligning the care provided with the patient's values. Choices A, B, and D do not directly relate to personal factors but rather focus on hospital policies, physiological symptoms, and the provider's perspective, respectively. Personal factors are crucial in ethical decision-making as they center on the patient's autonomy and preferences.
The process of resolving conflicts in a positive manner so that everyone is satisfied is called
A. Outcome resolution
B. Conflict resolution
C. Constructive resolution
D. Continuing resolution
Correct answer:
The correct answer is B: Conflict resolution. Conflict resolution involves addressing and settling conflicts in a positive manner to achieve a satisfying outcome for all parties involved. This process focuses on communication, negotiation, and problem-solving to reach a mutually beneficial agreement.
Choice A - Outcome resolution is incorrect because it only focuses on the end result without considering the process of resolving conflicts.
Choice C - Constructive resolution is incorrect because while conflict resolution aims to be constructive, this choice does not specifically address the act of resolving conflicts.
Choice D - Continuing resolution is incorrect as it does not accurately describe the process of resolving conflicts in a positive manner.
Which policy has been most effective in increasing access to healthcare in rural areas?
A. Medicaid expansion
B. Government tax incentives for rural healthcare providers
C. Increasing urban migration
D. Corporate-sponsored health programs
Correct answer:
The correct answer is A: Medicaid expansion. This policy has been effective in increasing access to healthcare in rural areas by providing coverage to low-income individuals who may not have been able to afford healthcare otherwise. Medicaid expansion helps rural healthcare providers by increasing patient volume and revenue.
B: Government tax incentives may help incentivize healthcare providers to practice in rural areas but may not directly address access issues for rural residents.
C: Increasing urban migration would have the opposite effect by further depleting healthcare resources in rural areas.
D: Corporate-sponsored health programs may benefit employees of specific companies but do not address the broader access issues faced by rural populations.
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.
Correct answer:
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.
The residents with the longest average stay in long-term care facilities are
A. Residents admitted for terminal care
B. Residents admitted for rehabilitation or temporary illness
C. Residents who are developmentally disabled
D. Residents who have dementia
Correct answer:
The correct answer is D because residents with dementia tend to have longer stays in long-term care facilities due to the progressive nature of the condition and the need for ongoing specialized care. Residents admitted for terminal care (choice A) typically have shorter stays as they are in the final stages of life. Residents admitted for rehabilitation or temporary illness (choice B) stay for a shorter duration as they receive treatment and recover. Residents who are developmentally disabled (choice C) may have varying lengths of stay but typically not as long as those with dementia due to different care needs. In summary, the correct answer is D because dementia requires long-term care, while the other choices involve shorter stays for different reasons.
The nurse is planning care for a client with peripheral vascular disease (PVD) who is at risk for Impaired Skin Integrity. Which intervention is appropriate for the nurse to include in the plan of care?
A. Restrict fluids
B. Keep the skin clean and dry, and moisturize areas of dryness
C. Encourage bedrest with legs elevated on pillows
D. Consult a dietitian for low-protein diet
Correct answer:
For a client with peripheral vascular disease (PVD) who is at risk for Impaired Skin Integrity, keeping the skin clean and dry, and moisturizing areas of dryness is crucial. Patients with PVD often have compromised circulation to the extremities, which can lead to decreased oxygen and nutrient delivery to tissues, increasing the risk of skin breakdown and impaired wound healing. Proper skin care helps prevent skin breakdown, decreases the risk of infection, and promotes overall skin health. Keeping the skin clean and dry helps prevent skin breakdown, while moisturizing areas of dryness helps maintain skin integrity. This intervention focuses on maintaining skin health and preventing complications associated with compromised circulation in patients with PVD.
You are called to assist a pregnant female in the 24th week gestation period according to her due date. The pale 26-year-old patient is found supine in bed, complaining of dizziness/weakness with extreme nausea. The patient denies vaginal bleeding, amniotic fluid leakage, or abdominal pain. There are no signs of imminent birth or active labor. She reports receiving normal prenatal care with no associated problems found during the pregnancy. Her heart rate is 126-130 beats per minute; her blood pressure is 80 mmHg systolic while her skin is cool and pale. Which of the following conditions is most likely to cause the patient's presentation?
A. Uterine rupture
B. Spontaneous abortion
C. Supine hypotension
D. Placenta previa
Correct answer:
The correct answer is C: Supine hypotension. In pregnant women, lying supine can compress the inferior vena cava, reducing venous return and cardiac output, leading to hypotension and symptoms like dizziness, weakness, and nausea. This condition is called supine hypotension syndrome. The patient's symptoms of dizziness and weakness, along with the low blood pressure and cool, pale skin, are indicative of inadequate blood flow due to supine positioning. Choices A, B, and D are incorrect because they do not align with the patient's symptoms and presentation. Uterine rupture, spontaneous abortion, and placenta previa typically present with different signs and symptoms, such as abdominal pain, vaginal bleeding, and fetal distress, which are absent in this case.
RN exams clinical judgment practice questions, set 149 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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