RN exams clinical judgment practice questions, set 35
RN exams · clinical judgment
RN exams clinical judgment practice questionsset 35
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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
On a certain territory mass death of rodents was registered. It was suspected that their death might have been caused by plague. What serological reaction should be applied for quick identification of antigen of the causative agent of this epizooty?
A. Precipitation
B. Agglutination
C. Passive hemagglutination
D. Complement binding
Show answer and rationale
Correct answer: B — Agglutination
The correct answer is B: Agglutination. During a suspected plague outbreak, agglutination testing is used to quickly identify the antigen of the causative agent. In this test, specific antibodies are added to a sample containing the suspected antigen. If the antigen is present, it will clump together (agglutinate) with the antibodies, indicating a positive result. This method is rapid and efficient for identifying the presence of the plague-causing agent.
Choice A: Precipitation involves the formation of a visible precipitate when antigen and antibody react, but it is not as quick or specific as agglutination for identifying the antigen in this scenario.
Choice C: Passive hemagglutination is a variation of agglutination that uses red blood cells as carriers for antigens or antibodies. While it can be useful in certain situations, it is not typically the first choice for rapid identification of plague antigen.
Choice D: Complement binding is a different type of
Question 2
A patient with chronic obstructive pulmonary disease (COPD) has poor gas exchange. Which action by the nurse would support the patient's ventilation?
A. Have the patient rest in bed with the head elevated to 15 to 20 degrees.
B. Encourage the patient to sit up at the bedside in a chair and lean forward.
C. Ask the patient to rest in bed in a high-Fowler's position with the knees flexed.
D. Ask the patient to rest in bed in a high-Fowler's position with the knees flexed.
Show answer and rationale
Correct answer: B — Encourage the patient to sit up at the bedside in a chair and lean forward.
The correct answer is B: Encourage the patient to sit up at the bedside in a chair and lean forward. This position, known as the orthopneic position, helps improve ventilation in COPD patients by reducing the pressure on the diaphragm and allowing for better expansion of the lungs. By sitting up and leaning forward, the patient can maximize their lung capacity and facilitate better gas exchange.
A: Having the patient rest in bed with the head elevated to 15 to 20 degrees may help with breathing comfort but does not provide the same level of lung expansion as the orthopneic position.
C: Resting in bed in a high-Fowler's position with the knees flexed may help with respiratory effort but does not promote optimal ventilation like sitting up in a chair and leaning forward.
D: This is a duplicate of option C.
In summary, option B is the best choice as it directly supports improved ventilation and gas exchange in COPD patients compared to the other options.
Question 3
The administration at a local medical center examines the trends in health problems when developing long-range plans for staffing and space allocation. Which of the following sources of information would be most helpful?
A. Local data drawn from a professional survey in the city
B. The National Health Interview Survey
C. The National Hospital Discharge Survey
D. The state’s vital statistics
Show answer and rationale
Correct answer: C — The National Hospital Discharge Survey
The correct answer is C: The National Hospital Discharge Survey. This source provides comprehensive data on hospital discharges, including diagnoses and procedures. It offers a broad overview of health problems and treatment trends on a national level, which can be valuable for long-range planning at a local medical center.
A: Local data from a professional survey in the city may not capture a comprehensive picture of health trends compared to a national survey like the National Hospital Discharge Survey.
B: The National Health Interview Survey focuses more on health behaviors and access to healthcare, rather than specific health problems and treatment trends, which may not be as directly relevant for staffing and space allocation planning.
D: State vital statistics provide information on births, deaths, and other vital events but may not offer detailed data on specific health problems and treatment trends, as needed for staffing and space allocation planning.
Question 4
The public health nurse is studying the proportion of the population in a certain county that had pneumonia during the winter months. Which epidemiological measure will the nurse use?
A. Attack rate
B. Incidence rate
C. Prevalence rate
D. Risk ratio
Show answer and rationale
Correct answer: C — Prevalence rate
The correct answer is C: Prevalence rate. In this case, the nurse is studying the proportion of the population that had pneumonia during the winter months. Prevalence rate measures the total number of existing cases in the population at a specific point in time, which aligns with the nurse's objective to study the proportion of the population affected by pneumonia during the winter months.
Incorrect choices:
A: Attack rate measures the proportion of people exposed to a particular factor who develop the disease.
B: Incidence rate measures the number of new cases of a disease that develop in a population over a specific period.
D: Risk ratio compares the risk of developing a disease in the exposed group to the risk in the non-exposed group.
In summary, prevalence rate is the appropriate measure as it focuses on the total number of existing cases of pneumonia in the population, while the other choices do not match the nurse's objective in this scenario.
Question 5
You are discussing the care of an elderly woman with her family. Although she is awake and alert, the patient is very ill and physically fragile. You are awaiting the results of a biopsy for what will likely be cancer, which has already metastasized throughout the body. The family asks that you inform them first about the results of the biopsy. They are very loving and caring and are constantly surrounding the patient. They do not want to depress the patient further, and because there will be no hope for a cure they see no reason to ruin her remaining life with this information. What should you tell them?
A. You will honor their wishes.
B. You agree with their wishes and you ask them to give you the necessary written request.
C. You ask them to involve the ethics committee for the hospital.
D. You tell them that you are obligated to inform the patient of all the findings.
Show answer and rationale
Correct answer: D — You tell them that you are obligated to inform the patient of all the findings.
Your first duty is to keep the patient fully informed about her health care. Unless there is significant evidence of possible psychological harm to a patient, you have an absolute duty to the patient first, not the family. One of the only examples of possible psychological harm to a patient would be an actively suicidal person who was given significant bad news. The motives of the family members are irrelevant. Whether they are kind and loving or vindictive and evil makes no difference. This is true whether their request to withhold information is in writing or is from the hospital ethics committee. In this case, the ethics committee is not necessary because there is no substantive question of the right action to inform the patient first. The health-care proxy's opinion and participation are only mandated if the patient loses decision-making capacity. If the patient has decision-making capacity, the health-care proxy's opinion is not different from anyone else's.
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Question 6
The nurse discusses smoking cessation with a client. Which action, if taken by the nurse, would most likely result in a behavior change?
A. The nurse should advise the client to contact the national telephone quitline.
B. The nurse should recommend nicotine replacement and behavioral interventions.
C. The nurse should collaborate with the client to develop an individualized plan of action.
D. The nurse should implement a strategy that has been validated by research.
Correct answer:
The correct answer is C: The nurse should collaborate with the client to develop an individualized plan of action. This is the most likely action to result in a behavior change because it involves actively involving the client in the process, taking into account their unique needs, preferences, and circumstances. By collaborating with the client, the nurse can tailor the smoking cessation plan to be more personalized and therefore more effective.
Choice A (contact the national telephone quitline) may be helpful but lacks individualization. Choice B (recommend nicotine replacement and behavioral interventions) is a good approach but may not address the client's specific needs. Choice D (implement a strategy validated by research) is important but may not be as effective if it does not consider the client's individual factors. Overall, choice C is the best option as it promotes client engagement and customization for a higher chance of successful behavior change.
The nurse is reviewing a chart in the newborn nursery. An RN was ordered to take blood glucose (BG) recordings on a newborn delivered that morning. BG readings are as follows: 50 mg/dL at 7:00 a.m.; 57 mg/dL at 10:00 a.m.; 62 mg/dL at 12:00 p.m.; 67 mg/dL at 2:00 p.m.; and 68 at 4:00 p.m. What action should the nurse perform with these recordings?
A. Notify the physician immediately that the BG readings on this newborn are low.
B. Immediately give the newborn glucose water.
C. Confirm the readings with the laboratory.
D. Review orders for the timing of next BG reading.
Correct answer:
The correct answer is D: Review orders for the timing of next BG reading. This is the correct action because the nurse should follow the protocol and guidelines set by the healthcare provider regarding the frequency and timing of blood glucose monitoring in newborns. By reviewing the orders, the nurse ensures that the newborn's blood glucose levels are monitored appropriately and at the right intervals. This helps in maintaining the newborn's health and identifying any potential issues promptly.
Other choices are incorrect:
A: Notify the physician immediately that the BG readings on this newborn are low - Premature action without assessing the situation or following protocol.
B: Immediately give the newborn glucose water - Inappropriate and potentially harmful intervention without proper evaluation.
C: Confirm the readings with the laboratory - Unnecessary step as the nurse can follow the established protocol without involving the laboratory unnecessarily.
The Affordable Care Act (ACA) is a complex law that has multiple provisions. The ACA was passed by congress and signed into law on March 23, 2010. Which of the following is a major provision that is focused on reshaping the healthcare sector?
A. A reform in payment methodologies including bundled payments, medical homes, and accountable care organizations
B. Reducing Medicare spending by establishing penalties for readmission rates, reducing payments, incentivizing quality improvements, and establishing an advisory review board
C. Expanding insurance coverage by way of regulations, subsidies, and encouraging state and federal insurance marketplaces
D. All of the above
Correct answer:
The correct answer is D: All of the above. The ACA is a comprehensive law that includes multiple provisions aimed at reshaping the healthcare sector.
A: A reform in payment methodologies such as bundled payments, medical homes, and accountable care organizations is a major provision of the ACA. These payment reforms aim to incentivize providers to deliver high-quality care efficiently.
B: Reducing Medicare spending through penalties for readmission rates, payment reductions, quality improvement incentives, and the establishment of an advisory review board is another key provision. This helps control costs and improve the quality of care.
C: Expanding insurance coverage through regulations, subsidies, and the creation of insurance marketplaces is also a major focus of the ACA. This provision aims to increase access to healthcare for millions of Americans.
Therefore, all of the choices are major provisions of the ACA focused on reshaping the healthcare sector.
A client, age 70, was brought into the Emergency Department by family members who reported a fall. During the assessment the nurse became suspicious that the client had suffered physical abuse. The client denied that she had been abused. Her denial is most likely based on her:
A. Strong belief that nothing could be done to help her
B. Fear of the possibility of being removed from her family
C. Feeling that she deserved the physical abuse
D. Lack of trust that the situation could be changed
Correct answer:
The correct answer is B: Fear of the possibility of being removed from her family. This is because elderly individuals who are experiencing abuse may fear being separated from their family if they disclose the abuse. This fear of losing their support system can lead them to deny or minimize the abuse. This choice is the most likely reason for the client's denial in this scenario.
Choice A: Strong belief that nothing could be done to help her is incorrect because the client's denial is not based on a belief that nothing could be done, but rather on a fear of being removed from her family.
Choice C: Feeling that she deserved the physical abuse is incorrect as victims of abuse often do not feel they deserve the abuse, but rather may feel ashamed or fearful.
Choice D: Lack of trust that the situation could be changed is incorrect because the client's denial is more likely based on a fear of losing her family, rather than a lack of trust in the situation changing.
What intervention does the American College of Rheumatology recommend as first-line therapy for osteoarthritis, rheumatoid arthritis, or something else?
A. Diagnostic workup to rule out rheumatoid arthritis
B. NSAID use at the lowest effective dose
C. Acetaminophen use up to 4 grams/day
D. Exercise and weight loss
Correct answer:
The correct answer is D: Exercise and weight loss. The American College of Rheumatology recommends this intervention as first-line therapy for osteoarthritis and rheumatoid arthritis due to its proven benefits in reducing pain, improving joint function, and overall quality of life. Exercise helps strengthen muscles around the joints, improve flexibility, and reduce stiffness. Weight loss can also alleviate pressure on the joints, especially in weight-bearing joints.
A: Diagnostic workup to rule out rheumatoid arthritis - This is not the first-line therapy but rather a step in the diagnostic process.
B: NSAID use at the lowest effective dose - While NSAIDs may help with pain management, they are not recommended as the first-line therapy due to potential side effects.
C: Acetaminophen use up to 4 grams/day - Acetaminophen can be used for pain relief, but it is not as effective as exercise and weight loss in managing osteoarthritis or rheumatoid arthritis symptoms
A client with a nagging cough makes an appointment to see the physician after reading that this symptom is one of the seven warning signs of cancer. What is another warning sign of cancer?
A. Persistent nausea
B. Indigestion
C. Rash
D. Chronic ache or pain
Correct answer:
The correct answer is D: Chronic ache or pain. Persistent cough and chronic ache or pain are both common warning signs of cancer. Chronic pain can be a symptom of various types of cancer, signaling the presence of a tumor or cancerous growth. It is important for the client to seek medical evaluation to rule out any underlying serious condition.
A: Persistent nausea is not typically considered a common warning sign of cancer. While it can be a symptom in certain types of cancer or due to treatment side effects, it is not as prominent as chronic ache or pain.
B: Indigestion is a common symptom that can be caused by various non-cancer-related issues such as dietary habits, stress, or gastrointestinal disorders. It is not typically considered a direct warning sign of cancer.
C: Rash is generally not a common warning sign of cancer. Rashes are more commonly associated with skin conditions, allergic reactions, or infections rather than being an indicator of cancer.
The nurse is counseling a client on dietary recommendations for dysmenorrhea. Which statement by the client indicates understanding of the recommendations?
A. I should adopt a vegan diet.
B. I should avoid pretzels and potato chips.
C. I should increase my intake of cranberry juice.
D. I should avoid dairy.
Correct answer:
Correct Answer: B - I should avoid pretzels and potato chips.
Rationale:
1. Pretzels and potato chips are high in salt, which can contribute to bloating and water retention, exacerbating dysmenorrhea symptoms.
2. Avoiding these snacks can help regulate blood sugar levels and reduce inflammation, leading to improved menstrual discomfort.
3. Choosing healthier snack options like fruits, vegetables, and whole grains can provide essential nutrients and support overall well-being.
Incorrect Choices:
A. Adopting a vegan diet may or may not directly impact dysmenorrhea symptoms, as it depends on the individual's specific dietary needs and nutrient intake.
C. Increasing cranberry juice intake is more commonly recommended for urinary tract infections, not specifically for dysmenorrhea.
D. Avoiding dairy is not a universal recommendation for dysmenorrhea, as dairy products can provide essential nutrients like calcium and vitamin D that are beneficial for overall health.
A nurse is caring for a laboring person who is in the third stage of labor. What is the most appropriate nursing intervention during this stage?
A. assist with the delivery of the placenta
B. prepare for a vaginal birth
C. administer oxytocin
D. apply gentle pressure to the uterus
Correct answer:
The correct answer is A: assist with the delivery of the placenta. During the third stage of labor, the placenta needs to be delivered. This is done by gently applying traction to the umbilical cord while supporting the uterus to facilitate the expulsion of the placenta. This step is crucial to prevent postpartum hemorrhage.
Choice B (prepare for a vaginal birth) is incorrect because the person is already in the third stage of labor, which means the baby has been delivered and they are now focusing on delivering the placenta.
Choice C (administer oxytocin) is incorrect because while oxytocin may be used to help control bleeding after the placenta is delivered, it is not the most appropriate intervention during the third stage of labor.
Choice D (apply gentle pressure to the uterus) is incorrect because direct pressure to the uterus is not the primary intervention during the third stage of labor; assisting with the delivery of the placenta takes precedence.
The number of IV site infections has more than doubled on a nursing unit. The staff determine common causes include the site is cleaned using inconsistent methods, dressing frequently becomes wet when patient showers, IV tubing is not changed every 48 hours per protocol, and inadequate hand washing of RN prior to insertion. A bar graph demonstrates the frequency in descending order, with 80% of infections being attributed to inadequate hand washing. The quality tool used is a:
A. cause-and-effect diagram.
B. run chart.
C. Pareto chart.
D. flowchart.
Correct answer:
The correct answer is C: Pareto chart. A Pareto chart is a quality tool used to prioritize issues by identifying the most significant factors contributing to a problem. In this case, the Pareto chart is appropriate because it helps visually show that inadequate hand washing is the primary cause of IV site infections, as it accounts for 80% of all infections. The chart allows the staff to focus their efforts on addressing this key issue first, which is crucial for effectively reducing the overall infection rate.
Incorrect choices:
A: Cause-and-effect diagram - This tool is used to identify and analyze potential causes of a problem, but it does not prioritize them in the same way a Pareto chart does.
B: Run chart - A run chart is used to track data over time to identify trends and patterns, but it does not prioritize the causes of a problem like a Pareto chart.
D: Flowchart - Flowcharts are used to map out a process or workflow, but they do not prioritize issues
Which action highlights Florence Nightingale’s role as an epidemiologist?
A. Dressing soldiers’ infected wounds
B. Connecting poor sanitation with negative health outcomes
C. Developing training schools for nurses and midwives
D. Changing linens and frequently bathing clients
Correct answer:
The correct answer is B: Connecting poor sanitation with negative health outcomes. This highlights Florence Nightingale's role as an epidemiologist because she was one of the first to recognize the link between poor sanitation and disease spread. She conducted studies showing how improving sanitation could reduce infection rates, laying the foundation for modern epidemiology.
A: Dressing soldiers' infected wounds - While this was an important part of Nightingale's work as a nurse, it does not specifically highlight her role as an epidemiologist.
C: Developing training schools for nurses and midwives - Nightingale's contribution to nursing education is significant, but it does not directly relate to her role as an epidemiologist.
D: Changing linens and frequently bathing clients - These actions are important for infection control but do not specifically showcase Nightingale's role as an epidemiologist in identifying the root causes of disease outbreaks.
RN exams clinical judgment practice questions, set 35 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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