RN exams clinical judgment practice questions, set 38
RN exams · clinical judgment
RN exams clinical judgment practice questionsset 38
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
What is the best description of the history of gynecologic care in the United States over the past century?
A. Reproductive health care has been under control of persons AFAB since the 1900s.
B. The health-care system has always been fair to persons AFAB with regard to shared decision making.
C. Activist groups are fighting sexism in health care.
D. Researchers had to stop including persons AFAB in pharmacologic research trials.
Show answer and rationale
Correct answer: C — Activist groups are fighting sexism in health care.
The correct answer is C because activist groups have played a significant role in fighting sexism in gynecologic care over the past century. These groups have advocated for better healthcare access, reproductive rights, and gender equality. This is supported by historical evidence of movements such as the women's rights movement and advocacy for reproductive justice.
Choice A is incorrect as reproductive health care has not always been under the control of persons assigned female at birth (AFAB) since the 1900s, as there have been significant disparities and challenges faced by individuals in accessing quality care. Choice B is incorrect as the healthcare system has not always been fair in shared decision-making with persons AFAB, with historical examples of paternalistic practices. Choice D is incorrect as excluding persons AFAB from research trials would be unethical and discriminatory, which is not reflective of the overall history of gynecologic care.
Question 2
The nurse is caring for a neonate born at 36 weeks, 2 days by primary cesarean birth and weighing 6 pounds, 4 ounces. The infant cried at delivery, had flexion in all extremities, had a heart rate of 135, had acrocyanosis in hands and feet, and was pale. The infant was placed skin-to-skin with the birthing person and has been latching and cuddling for the past 15 minutes. At 45 minutes, the neonate is found grunting and cool to the touch. What are the nurse's next steps?
A. Stimulate the neonate to take some deep breaths.
B. Ask the birthing person to wrap the baby in their blankets and cuddle them closer.
C. Take the neonate to the radiant warmer and check their temperature.
D. Call the NICU staff and activate the staff assist light in the birthing room.
Show answer and rationale
Correct answer: C — Take the neonate to the radiant warmer and check their temperature.
The correct answer is C: Take the neonate to the radiant warmer and check their temperature. This is the appropriate next step because the neonate is showing signs of potential respiratory distress (grunting) and coolness to the touch, which could indicate hypothermia. Placing the neonate in the radiant warmer will help maintain a stable temperature and facilitate further assessment and intervention.
Choice A is incorrect because stimulating the neonate to take deep breaths may not address the underlying issue of potential respiratory distress.
Choice B is incorrect because simply wrapping the baby in blankets and cuddling them closer may not address the potential respiratory distress or hypothermia that the neonate is exhibiting.
Choice D is incorrect because calling the NICU staff and activating the staff assist light should be done after assessing the neonate's immediate needs, such as addressing potential respiratory distress and hypothermia.
Question 3
During an ophthalmoscopic examination of a patient, the examiner notes areas of exudate that look like"cotton wool" or fluffy grey-white cumulus clouds. Which of the possible problems below does this finding indicate?
A. Diabetes
B. Hyperthyroidism
C. Glaucoma
D. Hypotension
Show answer and rationale
Correct answer: A — Diabetes
The correct answer is A: Diabetes. The presence of "cotton wool" or fluffy grey-white cumulus clouds on ophthalmoscopic examination indicates retinal nerve fiber layer infarcts due to microvascular damage, which is a common finding in diabetic retinopathy. This occurs due to ischemia and subsequent axonal swelling. In diabetes, hyperglycemia can lead to damage in the blood vessels supplying the retina, resulting in microaneurysms, hemorrhages, exudates, and ultimately vision loss if left untreated.
Summary of other choices:
B: Hyperthyroidism - This condition primarily affects the thyroid gland and does not directly cause the characteristic retinal findings described.
C: Glaucoma - Glaucoma is a condition characterized by increased intraocular pressure and optic nerve damage, which does not typically present with the specific retinal findings mentioned.
D: Hypotension - Low blood pressure may lead to retinal artery occlusion or ischemic optic neuropathy,
Question 4
Which of the following should the nurse consider when planning care for a client with antisocial personality disorder? Clients with antisocial personality disorder:
A. Demand constant attention
B. Tolerate frustration well
C. Have well-developed superegos
D. Are initially often charming
Show answer and rationale
Correct answer: D — Are initially often charming
The correct answer is D: Are initially often charming. This is because individuals with antisocial personality disorder often exhibit charm and charisma to manipulate others for personal gain. This behavior is known as "charm offensive" and can be used to deceive and exploit others. This initial charm can make it difficult for others to recognize their true motives and manipulative nature.
Incorrect options:
A: Demand constant attention - Individuals with antisocial personality disorder may appear self-centered and manipulative but not necessarily demand constant attention.
B: Tolerate frustration well - Clients with antisocial personality disorder often have difficulty managing frustration and may resort to aggressive or impulsive behavior.
C: Have well-developed superegos - Individuals with antisocial personality disorder typically lack empathy and have a weak or underdeveloped superego, leading to a disregard for social norms and the rights of others.
Question 5
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.
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Question 6
A patient presents with noticeable swelling in the neck area and difficulty breathing. Which key observation should be prioritized during the neck examination to assess the underlying issue?
A. Thyroid fullness
B. Pulsation
C. Respiratory difficulty
D. Trachea position
Correct answer:
The correct answer is D: Trachea position. This is the key observation to prioritize during the neck examination because in a patient presenting with noticeable swelling in the neck area and difficulty breathing, a deviated trachea indicates a potential emergency situation such as a mediastinal mass or tension pneumothorax. Assessing the trachea position helps in identifying any life-threatening conditions that may be causing the respiratory distress.
A: Thyroid fullness may indicate thyroid issues, but in this case, the focus should be on the trachea position due to the acute presentation of difficulty breathing.
B: Pulsation may be relevant in other contexts but is not the priority when assessing a patient with difficulty breathing and neck swelling.
C: Respiratory difficulty is already mentioned in the patient presentation, and the focus should be on identifying the cause of this difficulty, which is best assessed by evaluating the trachea position.
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.
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
Correct answer:
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.
The nurse is developing a teaching plan for a 64-year-old patient with coronary artery disease (CAD). Which factor should the nurse focus on during the teaching session?
A. Family history of coronary artery disease
B. Elevated low-density lipoprotein (LDL) level
C. Greater risk associated with the patient’s gender
D. Increased risk of cardiovascular disease with aging
Correct answer:
The correct answer is B (Elevated low-density lipoprotein (LDL) level) because it directly correlates with the patient's CAD condition. Elevated LDL cholesterol is a major risk factor for developing CAD. By focusing on lowering the LDL level through lifestyle changes and medication, the nurse can effectively manage and prevent further progression of the disease.
A (Family history of coronary artery disease) while important, is a non-modifiable risk factor and may not be as impactful in the teaching plan as addressing the patient's current elevated LDL level.
C (Greater risk associated with the patient's gender) is not as relevant in this case because the patient's specific risk factors should be the main focus rather than general gender-related risks.
D (Increased risk of cardiovascular disease with aging) is a common risk factor, but in this case, addressing the patient's elevated LDL level would be more specific and beneficial for managing CAD.
A pregnant patient at 32 weeks gestation reports increased pressure in the pelvic area and mild cramping. What should the nurse assess first?
A. The fetal heart rate and signs of labor.
B. The patient's blood pressure and urine for protein.
C. The presence of vaginal discharge or bleeding.
D. The patient's dietary intake and hydration status.
Correct answer:
The correct answer is A: The fetal heart rate and signs of labor. At 32 weeks gestation, any pelvic pressure and cramping could be indicative of preterm labor, which is a critical concern. Assessing the fetal heart rate can help determine fetal well-being and signs of distress. Monitoring for signs of labor such as contractions, cervical changes, and rupture of membranes is essential for timely intervention.
Choice B: Assessing blood pressure and urine for protein is important in monitoring for preeclampsia, but it is not the priority in this case where signs of preterm labor are reported.
Choice C: Vaginal discharge or bleeding could indicate various conditions, but in this scenario, the focus should be on ruling out preterm labor first.
Choice D: Dietary intake and hydration status are important aspects of prenatal care, but they are not the priority when assessing a pregnant patient reporting pelvic pressure and cramping at 32 weeks gestation.
The sister of a patient in the ICU has been at the patients bedside non-stop for 48 hours. The nurse suggests to her that she return home to rest. Which of the following is the proper rationale for the nurse making such a suggestion?
A. The sister is in the way of the health care providers.
B. The patient may become annoyed by her continual presence.
C. The patient will recover more easily in peace and quiet.
D. The sister needs to maintain her own health during this time.
Correct answer:
The correct answer is D: The sister needs to maintain her own health during this time. It is essential for the sister to take care of her own health and well-being to be able to provide the best support to the patient. Continuous stress and lack of rest can negatively impact her ability to support the patient effectively. Encouraging her to rest will ensure she remains physically and mentally well to continue supporting the patient in the long run.
Incorrect Choices:
A: The sister is in the way of the health care providers - This is incorrect as the primary concern is the well-being of the sister and her ability to provide support.
B: The patient may become annoyed by her continual presence - This is not the main reason for suggesting the sister to rest, as the focus is on her own health.
C: The patient will recover more easily in peace and quiet - While peace and quiet can be beneficial for the patient, the main focus here is on the sister's well-being.
A patient who is receiving positive pressure ventilation is scheduled for a spontaneous breathing trial (SBT). Which finding by the nurse is most important to discuss with the health care provider before starting the SBT?
A. New ST segment elevation is noted on the cardiac monitor.
B. Enteral feedings are being given through an orogastric tube.
C. Scattered rhonchi are heard when auscultating breath sounds.
D. HYDROmorphone (Dilaudid) is being used to treat postoperative pain.
Correct answer:
The correct answer is A: New ST segment elevation is noted on the cardiac monitor. This finding is concerning because it may indicate myocardial ischemia or infarction, which can be exacerbated by the physiological stress of weaning from mechanical ventilation. It is crucial to address any cardiac issues before initiating a spontaneous breathing trial to prevent potential cardiac complications during the weaning process.
Explanation for why the other choices are incorrect:
B: Enteral feedings being given through an orogastric tube are not contraindicated for starting a spontaneous breathing trial.
C: Scattered rhonchi heard when auscultating breath sounds may indicate retained secretions but are not a contraindication for a spontaneous breathing trial.
D: The use of HYDROmorphone to treat postoperative pain is not a contraindication for a spontaneous breathing trial unless it is causing respiratory depression, which would need to be addressed separately.
A catatonic patient admitted in a stuporous condition begins to demonstrate increased motor activity. During his assessment, the psychiatrist raises the patient's arm above his head and releases it. The patient maintains the position his arm was placed in, immobile in that position for 15 minutes, moving only when the nurse gently lowers his arm. What symptom is demonstrated by this assessment technique?
A. Echopraxia
B. Waxy flexibility
C. Depersonalization
D. Thought withdrawal
Correct answer:
The correct answer is B: Waxy flexibility. This symptom is demonstrated by the patient's ability to maintain the position his arm was placed in, immobile, for an extended period of time. This is characteristic of catatonia, where individuals exhibit increased motor activity and abnormal posturing. Waxy flexibility refers to the tendency of catatonic patients to maintain positions that they are placed in by others, almost as if their limbs are made of wax and can be molded into different positions.
Explanation for other choices:
A: Echopraxia involves mimicking the movements of others, which is not demonstrated in this scenario.
C: Depersonalization refers to feeling detached from oneself, which is not evident in the patient's behavior during the assessment.
D: Thought withdrawal is a symptom of schizophrenia where thoughts are believed to be removed from one's mind by an external force, which is not relevant to the patient's motor behavior in this case.
The highest priority for assessment by nurses caring for older adults who self-administer medications is
A. use of multiple drugs with anticholinergic effects.
B. overuse of medications for erectile dysfunction.
C. missed doses of medications for arthritis.
D. trading medications with acquaintances.
Correct answer:
The correct answer is A: use of multiple drugs with anticholinergic effects. This is the highest priority because anticholinergic medications are commonly prescribed to older adults and can lead to serious adverse effects such as confusion, memory issues, and falls. Nurses must assess for these effects to prevent harm.
Choice B (overuse of medications for erectile dysfunction) is not as high a priority as anticholinergic effects, as it is not as common and typically has less immediate serious consequences for older adults.
Choice C (missed doses of medications for arthritis) is important but not as critical as assessing for anticholinergic effects, as missed doses can generally be managed through education and adherence support.
Choice D (trading medications with acquaintances) is a serious concern but is not as high a priority as assessing for anticholinergic effects, as the immediate risks associated with anticholinergic medications are more severe.
A client is to be discharged from an acute care facility after treatment for right leg thrombophlebitis. The nurse notes that the client's leg is pain-free, without redness or edema. The nurse's actions reflect which step of the nursing process?
A. Assessment
B. Analysis
C. Implementation
D. Evaluation
Correct answer:
The correct answer is D: Evaluation. In the nursing process, evaluation is the final step where the nurse determines if the goals and outcomes of care have been achieved. In this scenario, the nurse is assessing the client's condition before discharge to ensure there are no signs of thrombophlebitis. The absence of pain, redness, and edema indicates successful treatment. This step aligns with the evaluation phase as the nurse is assessing the client's response to treatment.
A: Assessment is incorrect because the nurse has already assessed the client's leg and is now determining the effectiveness of the treatment.
B: Analysis is incorrect as this step involves interpreting the data collected during assessment to identify problems and make nursing diagnoses.
C: Implementation is incorrect as this step involves carrying out the nursing interventions to achieve the established goals. The nurse has already implemented the treatment plan in this scenario.
RN exams clinical judgment practice questions, set 38 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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