RN exams clinical judgment practice questions, set 63
RN exams · clinical judgment
RN exams clinical judgment practice questionsset 63
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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 pregnant patient at 30 weeks gestation is complaining of severe heartburn. What should the nurse recommend?
A. Lie down after meals to improve digestion.
B. Drink a large amount of water after eating.
C. Eat smaller meals more frequently and avoid lying down after meals.
D. Take antacids regularly to relieve heartburn.
Show answer and rationale
Correct answer: C — Eat smaller meals more frequently and avoid lying down after meals.
The correct answer is C: Eat smaller meals more frequently and avoid lying down after meals. This is the best recommendation for the pregnant patient experiencing severe heartburn at 30 weeks gestation. Eating smaller meals more frequently can help reduce the amount of stomach acid produced, thus decreasing the likelihood of heartburn. Avoiding lying down after meals can prevent stomach acid from flowing back into the esophagus, further reducing heartburn symptoms.
Rationale for why other choices are incorrect:
A: Lying down after meals can worsen heartburn by allowing stomach acid to flow back into the esophagus.
B: Drinking a large amount of water after eating may worsen heartburn by increasing stomach pressure and pushing stomach acid back up.
D: Taking antacids regularly may provide temporary relief but is not addressing the root cause of the heartburn and may not be safe for long-term use during pregnancy.
Question 2
A 35-year-old mother of three young children has been diagnosed with stage II breast cancer. After discussing treatment options with her physician, the woman goes home to talk to her husband, later calling the nurse for clarification of some points. The patient tells the nurse that the physician has recommended breast conservation surgery followed by radiation. The patients husband has done some online research and is asking why his wife does not have a modified radical mastectomy to be sure all the cancer is gone. What would be the nurses best response?
A. Modified radical mastectomies are very hard on a patient, both physically and emotionally and they really arent necessary anymore.
B. According to current guidelines, having a modified radical mastectomy is no longer seen as beneficial.
C. Modified radical mastectomies have a poor survival rate because of the risk of cancer recurrence.
D. According to current guidelines, breast conservation combined with radiation is as effective as a modified radical mastectomy.
Show answer and rationale
Correct answer: D — According to current guidelines, breast conservation combined with radiation is as effective as a modified radical mastectomy.
The correct answer is D: According to current guidelines, breast conservation combined with radiation is as effective as a modified radical mastectomy.
1. Breast conservation surgery followed by radiation is a standard treatment option for early-stage breast cancer.
2. Studies have shown that breast conservation surgery combined with radiation therapy is equally effective in terms of long-term survival rates compared to mastectomy.
3. Current guidelines recommend considering breast conservation surgery as a viable option for patients with early-stage breast cancer.
4. Modified radical mastectomy is not necessarily needed to ensure complete removal of cancer, as breast conservation surgery followed by radiation can achieve the same goal.
5. Therefore, the nurse should reassure the patient's husband that the recommended treatment plan is based on current guidelines and is as effective as a modified radical mastectomy.
Question 3
What is the function of progesterone support after embryo transfer in IVF?
A. To stimulate egg growth during the next cycle.
B. To maintain the uterine lining and support early pregnancy.
C. To trigger ovulation during the current cycle.
D. To prevent hormonal imbalances during stimulation.
Show answer and rationale
Correct answer: B — To maintain the uterine lining and support early pregnancy.
The correct answer is B: To maintain the uterine lining and support early pregnancy. After embryo transfer in IVF, progesterone support is crucial to ensure the uterine lining remains thick and supportive for the implantation and early development of the embryo. Progesterone helps create a hospitable environment in the uterus for the embryo to implant and grow. It also supports the continued development of the pregnancy until the placenta can take over hormone production.
Choice A is incorrect because progesterone support after embryo transfer is not aimed at stimulating egg growth during the next cycle. Choice C is incorrect as progesterone support does not trigger ovulation during the current cycle; ovulation would have already been induced prior to embryo transfer. Choice D is incorrect as preventing hormonal imbalances during stimulation is not the primary function of progesterone support after embryo transfer.
Question 4
A client in a late stage of acquired immunodeficiency syndrome (AIDS) shows signs of AIDS-related dementia. Which nursing diagnosis takes highest priority?
A. Self-care deficient: Bathing/hygiene
B. Dysfunctional grieving
C. Ineffective cerebral tissue perfusion
D. Risk for injury
Show answer and rationale
Correct answer: C — Ineffective cerebral tissue perfusion
The correct answer is C: Ineffective cerebral tissue perfusion. In the late stage of AIDS, the client is at risk for neurological complications, including AIDS-related dementia due to decreased blood flow to the brain. This nursing diagnosis takes the highest priority as it directly addresses the client's impaired brain perfusion, which can lead to serious cognitive and functional deficits. Prioritizing this diagnosis ensures timely interventions to optimize cerebral blood flow and prevent further deterioration.
Summary:
A: Self-care deficient: Bathing/hygiene - important but not the highest priority compared to addressing neurological complications.
B: Dysfunctional grieving - while emotional support is essential, it is not the priority when dealing with a life-threatening physiological issue.
D: Risk for injury - while important, it is secondary to addressing the underlying cause of the dementia in this scenario.
Question 5
A pregnant patient at 34 weeks gestation reports sudden swelling of the hands, feet, and face. What is the nurse's priority action?
A. Monitor the patient's blood pressure and check for signs of preeclampsia.
B. Encourage the patient to elevate the legs to reduce swelling.
C. Administer diuretics as prescribed to reduce fluid retention.
D. Instruct the patient to drink more water and reduce sodium intake.
Show answer and rationale
Correct answer: A — Monitor the patient's blood pressure and check for signs of preeclampsia.
The correct answer is A: Monitor the patient's blood pressure and check for signs of preeclampsia.
Rationale:
1. Sudden swelling of the hands, feet, and face in a pregnant patient at 34 weeks gestation can be a sign of preeclampsia.
2. Preeclampsia is a serious condition characterized by high blood pressure and protein in the urine, which can lead to complications for both the mother and the baby.
3. Monitoring the patient's blood pressure and checking for signs of preeclampsia is crucial for early detection and management of the condition.
4. Prompt intervention is necessary to prevent potential severe outcomes such as seizures, stroke, or organ damage.
Summary of Incorrect Choices:
B: Elevating the legs may provide temporary relief but does not address the underlying cause of the sudden swelling, which could be preeclampsia.
C: Administering diuretics without assessing the patient's blood pressure and ruling out
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Question 6
A nurse is caring for a pregnant patient at 34 weeks gestation who has been diagnosed with gestational hypertension. What is the nurse's priority intervention?
A. Encourage the patient to rest and increase fluid intake.
B. Monitor the patient's blood pressure regularly and assess for signs of preeclampsia.
C. Administer antihypertensive medications as prescribed.
D. Instruct the patient to lie on her back to relieve pressure on the uterus.
Correct answer:
The correct answer is B: Monitor the patient's blood pressure regularly and assess for signs of preeclampsia. At 34 weeks gestation with gestational hypertension, monitoring blood pressure and assessing for signs of preeclampsia are crucial to detect any worsening condition. Preeclampsia is a serious complication of gestational hypertension that can lead to adverse outcomes for both the mother and fetus. Regular monitoring allows for timely intervention if necessary.
Choice A is incorrect because simply encouraging rest and increased fluid intake may not address the potential severity of gestational hypertension and preeclampsia.
Choice C is incorrect because administering antihypertensive medications without proper monitoring and assessment can be harmful to the patient and fetus.
Choice D is incorrect because lying on her back can actually worsen the patient's condition by decreasing blood flow to the uterus.
The mother of a teen with an eating disorder tells the nurse, "Our family is pretty well adjusted. It's hard for me to imagine what we could have done to have this happen." The nurse can promote more complete understanding of the etiology of eating disorders by mentioning that young women are also influenced by:
A. the abundance of nutritious foods available.
B. the fashion industry's idealization of thinness.
C. competition in the work place.
D. the biologic tendency to be underweight.
Correct answer:
The correct answer is B: the fashion industry's idealization of thinness. This is because the fashion industry often promotes thinness as the ideal body type, leading to societal pressure on young women to conform to this standard. This can contribute to the development of eating disorders as individuals may engage in unhealthy behaviors to achieve or maintain a thin body shape.
A: the abundance of nutritious foods available - While access to nutritious foods is important for overall health, it does not directly influence the development of eating disorders.
C: competition in the work place - While workplace competition may contribute to stress, it is not a primary factor in the development of eating disorders.
D: the biologic tendency to be underweight - While genetic factors can play a role in susceptibility to eating disorders, it is not the primary influence in the development of these disorders in young women.
Helmeted motorcyclist struck broadside, unconscious, blood pressure 140/90, heart rate 90 bpm, GCS 6. Immobilization includes all EXCEPT:
A. "Air splints"
B. "Bolstering devices"
C. "A long spine board"
D. "A scoop-style stretcher"
Correct answer:
The correct answer is A: "Air splints." Air splints are not typically used in the immobilization of a patient with suspected spinal cord injury. The rationale behind this is that air splints do not provide adequate support and stabilization for potential spinal injuries.
On the other hand, choices B, C, and D are commonly used in spinal immobilization. "Bolstering devices" help maintain proper alignment of the spine. "A long spine board" is used to safely transfer the patient while keeping the spine in a neutral position. "A scoop-style stretcher" allows for easy and gentle transfer of the patient onto a backboard without compromising spinal alignment.
In summary, the use of air splints is not recommended for spinal immobilization due to inadequate support, while bolstering devices, a long spine board, and a scoop-style stretcher are appropriate tools for immobilizing a patient with suspected spinal cord injury.
A 47 year old house painter is brought to the hospital after falling 6 meters from a ladder and landing straddled on a fence. Examination of his perineum reveals extensive ecchymosis. There is blood in the external urethral meatus. The initial diagnostic study for evaluation of the urinary tract in this patient should be:
A. "Cystoscopy"
B. "Cystography"
C. "IV pyelography"
D. "Retrograde urethrography"
Correct answer:
The correct initial diagnostic study for evaluating the urinary tract in this patient is "Retrograde urethrography" (Choice D).
Rationale:
1. Retrograde urethrography is the appropriate choice because the patient has blood in the external urethral meatus, indicating a possible urethral injury.
2. This imaging technique involves injecting contrast material into the urethra to visualize any urethral abnormalities or injuries.
3. It is a non-invasive and effective method to assess the extent of urethral trauma in cases like this.
4. Cystoscopy (Choice A) is not the initial study of choice in this scenario as it primarily visualizes the bladder and may not provide adequate information about urethral injuries.
5. Cystography (Choice B) and IV pyelography (Choice C) are not appropriate in this case as they focus on assessing the bladder and kidneys, respectively, which are not the primary concerns based on the patient's
Complementary and alternative medicine (CAM) therapies have been growing in popularity and surveys show that they are being used to treat several mental health conditions. With these statistics in mind the nurse is careful to assess which client for the possible use of CAM therapies?
A. The teenager who is dealing with sexual identity issues
B. The older adult who has developed early onset dementia
C. The young adult who is experiencing chronic pain as a result of a knee injury
D. The middle-aged adult who is experiencing depression after the death of a parent
Correct answer:
Rationale: The correct answer is D. The nurse should assess the middle-aged adult experiencing depression after the death of a parent for possible use of CAM therapies because depression is a common mental health condition that CAM therapies can help alleviate. The client's emotional distress and grief may benefit from holistic approaches like mindfulness meditation or acupuncture. It is important to address mental health conditions with appropriate interventions, and CAM therapies can be a valuable supplement to traditional treatments.
Summary:
A: While sexual identity issues are important, they do not necessarily indicate a need for CAM therapies in this context.
B: Early onset dementia is a neurological condition, and CAM therapies may not be the primary focus for treatment.
C: Chronic pain from a knee injury may require more conventional medical interventions before exploring CAM therapies for pain management.
The nurse is preparing a teaching plan for a polycystic ovary syndrome (PCOS) support group.
One of the teaching points will include diet and weight loss to decrease hirsutism and acne. What
is the reasoning for this rationale?
A. Diet and exercise will promote weight loss, which will decrease
hyperandrogenemia
B. Diet and exercise will decrease the risk of type 2 diabetes and gestational diabetes
C. Diet and exercise will decrease serum lipid levels and lower the risk for
cardiovascular disease.
D. Diet and exercise will increase the frequency of ovulation and menstruation and
increase fertility.
Correct answer:
The correct answer is missing from the choices provided. However, I can provide a rationale for each choice:
A: Diet and exercise can help promote weight loss, which can decrease hyperandrogenemia by reducing insulin resistance and decreasing androgen levels.
B: While diet and exercise can decrease the risk of type 2 diabetes and gestational diabetes in women with PCOS, this is not directly related to reducing hirsutism and acne symptoms.
C: Diet and exercise can improve lipid levels and reduce cardiovascular risk in women with PCOS, but this is not the primary goal when addressing hirsutism and acne.
D: Diet and exercise can improve ovulation and menstrual regularity, which may help with fertility in women with PCOS, but this is not directly related to reducing hirsutism and acne.
In summary, the correct answer should focus on how diet and weight loss can specifically impact hirsutism and acne in women with PCOS.
Which nursing diagnosis should the nurse identify as appropriate when working with a client diagnosed with schizoid personality disorder?
A. Altered thought processes related to (R/T) increased stress
B. Risk for suicide R/T loneliness
C. Risk for violence: directed toward others R/T paranoid thinking
D. Social isolation R/T inability to relate to others
Correct answer:
The correct answer is D: Social isolation R/T inability to relate to others. This is because individuals with schizoid personality disorder often have difficulty forming and maintaining relationships, leading to social isolation. This nursing diagnosis directly addresses the primary issue of the disorder.
A: Altered thought processes related to (R/T) increased stress is incorrect because schizoid personality disorder is not typically associated with altered thought processes in the same way as other psychotic disorders.
B: Risk for suicide R/T loneliness is incorrect because while individuals with schizoid personality disorder may experience loneliness, it is not necessarily linked to an increased risk for suicide.
C: Risk for violence: directed toward others R/T paranoid thinking is incorrect as schizoid personality disorder is not typically characterized by violent behavior or paranoid thinking towards others.
A nurse is reviewing the medical history of a client who has angina. Which of the following findings in the client's medical history should the nurse identify as a risk factor for angina?
A. Hyperlipidemia.
B. COPD.
C. Seizure disorder.
D. Hyponatremia.
Correct answer:
The correct answer is A: Hyperlipidemia. Hyperlipidemia, which is an elevated level of lipids (fats) in the blood, is a well-established risk factor for angina. High levels of lipids can lead to atherosclerosis, a condition where fatty deposits build up in the arteries, reducing blood flow to the heart muscle and increasing the risk of angina.
Choice B, COPD (Chronic Obstructive Pulmonary Disease), is not directly linked to an increased risk of angina. COPD primarily affects the lungs and is not a known risk factor for angina.
Choice C, Seizure disorder, and Choice D, Hyponatremia (low sodium levels), are also not typically associated with an increased risk of angina. While medical conditions like hypertension, diabetes, and smoking are other common risk factors for angina, hyperlipidemia is specifically known for its impact on blood vessels, making it a key risk factor to identify in a client's medical history.
During the skill-building session in microbiology the students need to stain the prepared and fixed sputum smears obtained from a tuberculosis patient. What staining technique should be used in this case?
A. Gram
B. Giemsa
C. Ziehl-Neelsen
D. Burry
Correct answer:
The correct staining technique for staining sputum smears from a tuberculosis patient is Ziehl-Neelsen staining. This technique uses a carbol fuchsin stain that specifically stains acid-fast organisms like Mycobacterium tuberculosis. The steps involved include staining with carbol fuchsin, decolorizing with acid-alcohol, counterstaining with methylene blue, and then examining under a microscope. This staining method is crucial for detecting the acid-fast bacilli characteristic of tuberculosis.
Explanation for incorrect choices:
A: Gram staining is used to differentiate bacteria into Gram-positive and Gram-negative, not suitable for acid-fast organisms like Mycobacterium tuberculosis.
B: Giemsa staining is used for detecting parasites and certain types of white blood cells, not specific for acid-fast bacteria.
D: Burry staining is not a recognized staining technique in microbiology for staining acid-fast organisms.
George is a junior college student. Recently he has felt anxious and jittery. He decides that he will swim during his lunch hour. After several days he notices a decrease in feeling anxious. What type of stress management did George use?
A. Exercise.
B. Deep breathing.
C. Guided imagery.
D. Progressive muscle relaxation.
Correct answer:
The correct answer is A: Exercise. George used exercise as a stress management technique. Swimming during his lunch hour helped him reduce his anxiety and jitteriness. Exercise is known to release endorphins, which are chemicals in the brain that act as natural painkillers and mood elevators. It also helps in reducing stress hormones like cortisol. By engaging in physical activity, George was able to alleviate his feelings of anxiety.
Summary:
- Choice B: Deep breathing focuses on controlling breathing patterns to reduce stress, but it was not mentioned in the scenario that George used this technique.
- Choice C: Guided imagery involves visualizing calming and peaceful images to reduce stress, which was not mentioned in George's case.
- Choice D: Progressive muscle relaxation involves tensing and relaxing different muscle groups to reduce stress, but George did not use this technique as mentioned in the scenario.
RN exams clinical judgment practice questions, set 63 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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