RN exams clinical judgment practice questions, set 66
RN exams · clinical judgment
RN exams clinical judgment practice questionsset 66
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 staff nurse reports an observation of a coworker injecting themselves with a syringe in the bathroom. The coworker admits to stealing narcotics from the medication room. The staff nurse should take which of the following courses of action?
A. Agree to not report the incident if the coworker promises to report themselves to the supervisor.
B. Report the incident to the appropriate person in the chain of command right away.
C. Report the incident to the other RNs on the shift.
D. Agree to not report the incident if the coworker seeks treatment.
Show answer and rationale
Correct answer: B — Report the incident to the appropriate person in the chain of command right away.
Correct Answer: B
Rationale:
1. Reporting the incident to the appropriate person in the chain of command is necessary to ensure patient safety and uphold professional ethics.
2. The coworker's actions pose a serious risk to patient care and safety, and immediate action is required.
3. Reporting to the supervisor allows for proper investigation, intervention, and support for the coworker.
4. Confidentiality and professionalism are maintained by following the appropriate reporting channels.
Summary:
A: Agreeing not to report the incident in exchange for the coworker self-reporting is not appropriate as it compromises patient safety and enables unethical behavior.
C: Reporting to other RNs on the shift may not ensure proper action and escalation of the issue to the appropriate authority.
D: Delaying reporting in exchange for the coworker seeking treatment does not address the immediate risk posed by their actions.
Question 2
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 3
A 67-year-old male client had some serum tests performed during his annual examination. The nurse reviews his results, as follows: testosterone: 680 ng/dL; prostate-specific antigen: 10 ng/mL; prolactin: 5 ng/mL. What action by the nurse is best?
A. Assess for possible galactorrhea with breast discharge.
B. Note the possibility of a testicular tumor.
C. Communicate to the provider that results were normal
D. Prepare the client for further diagnostic testing
Show answer and rationale
Correct answer: D — Prepare the client for further diagnostic testing
The correct answer is D: Prepare the client for further diagnostic testing. A testosterone level of 680 ng/dL is high for a 67-year-old male, which could indicate an underlying medical condition. A prostate-specific antigen level of 10 ng/mL is elevated and could suggest prostate issues. Prolactin level of 5 ng/mL is within normal range but still needs further evaluation due to the other abnormal results. Therefore, preparing the client for further diagnostic testing is crucial to investigate the potential underlying health concerns.
Incorrect options:
A: Assess for possible galactorrhea with breast discharge - Irrelevant as galactorrhea is not indicated by the given results.
B: Note the possibility of a testicular tumor - Testosterone level elevation is more indicative of non-testicular issues.
C: Communicate to the provider that results were normal - Results are not normal, warranting further evaluation.
Question 4
Which one of the following statements regarding muscle contraction and relaxation is correct?
A. It involves movement of Xn... (incomplete)
B. The thickness of the cell layer helps in movement
C. The lining of the vessels inside help in movement
D. The contraction and relaxation of these cells result in movement
Show answer and rationale
Correct answer: D — The contraction and relaxation of these cells result in movement
Muscle contraction and relaxation drive movement through a coordinated process. Contraction occurs when nerve impulses trigger calcium release, enabling myosin heads to bind actin and pull filaments together, shortening the muscle and moving attached structures, like bones in skeletal muscle. Relaxation follows when calcium is pumped back into the sarcoplasmic reticulum, halting myosin-actin interaction, allowing the muscle to lengthen and rest. The incomplete option likely misrepresents a molecular detail (e.g., 'Xn' for ions or proteins), but lacks clarity. Cell layer thickness affects force, not the process itself. Vessel linings support circulation, not contraction mechanics. The contraction-relaxation cycle, powered by ATP and regulated by calcium, is the correct mechanism, universally applicable to skeletal, cardiac, and smooth muscle functions, making it the accurate statement despite the truncated option.
Question 5
Which characteristic would the nurse use to define culture? (Select all that apply)
A. Learned and shared lifeways of a particular group.
B. Social identity influenced by language and religion.
C. Belief in superiority of one's own ethnic group.
D. Values influence both thinking and actions.
Show answer and rationale
Correct answer: A — Learned and shared lifeways of a particular group.
The correct answer is A because culture is defined as the learned and shared lifeways of a particular group. This includes traditions, customs, beliefs, and practices that are passed down from generation to generation within a community. This definition aligns with the concept of culture being a set of learned behaviors and beliefs that are commonly practiced and shared among individuals in a society.
Choice B is incorrect because while social identity can be influenced by language and religion, it does not fully encompass the complexity of culture. Choice C is incorrect as it refers to ethnocentrism, which is the belief in the superiority of one's own ethnic group and is not a defining characteristic of culture. Choice D is incorrect because while values do influence thinking and actions within a culture, it does not capture the entirety of what culture entails, such as traditions, customs, and shared beliefs.
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Question 6
The nurse has recently set limits for a patient with borderline personality disorder. The patient tells the nurse, 'You used to care about me. I thought you were wonderful. Now I can see I was mistaken. You're hateful.' Which phenomenon is represented by this response?
A. Splitting
B. Denial
C. Reaction formation
D. Projection
Correct answer:
The correct answer is A: Splitting. Splitting is a defense mechanism commonly seen in individuals with borderline personality disorder where they perceive others as either all good or all bad. In this scenario, the patient's sudden shift from viewing the nurse as wonderful to hateful demonstrates splitting. The patient is unable to integrate both positive and negative aspects of the nurse's behavior, leading to extreme and polarized perceptions.
Choice B: Denial involves refusing to accept reality to protect oneself from uncomfortable truths, which is not demonstrated in this response.
Choice C: Reaction formation is a defense mechanism where an individual behaves in a way that is opposite to their true feelings, which is not evident in the patient's response.
Choice D: Projection involves attributing one's own unacceptable thoughts or feelings onto someone else, which is not the case in this scenario.
Which of the following is a characteristic feature of Gram-positive bacteria?
A. Outer membrane
B. Thin peptidoglycan layer
C. Thick peptidoglycan layer
D. Presence of LPS
Correct answer:
The correct answer is C: Thick peptidoglycan layer. Gram-positive bacteria have a thick peptidoglycan layer in their cell wall, which retains the crystal violet stain during Gram staining. This thick layer is a key characteristic feature that helps differentiate Gram-positive bacteria from Gram-negative bacteria.
Rationale:
1. Gram-positive bacteria retain the crystal violet stain due to their thick peptidoglycan layer.
2. This thick layer provides structural support and protection to the cell.
3. Gram-positive bacteria lack an outer membrane, which is a feature of Gram-negative bacteria (Choice A).
4. Thin peptidoglycan layer is a characteristic of Gram-negative bacteria, not Gram-positive (Choice B).
5. Presence of LPS (lipopolysaccharide) is a feature of Gram-negative bacteria, not Gram-positive (Choice D).
In summary, the presence of a thick peptidoglycan layer is a characteristic feature of Gram-positive
Mrs. LaFarge is a 60-year-old who presents with urinary incontinence. She is unable to get to the bathroom quickly enough when she senses the need to urinate. She has normal mobility. Which of the following is most likely?
A. Stress incontinence
B. Urge incontinence
C. Overflow incontinence
D. Functional incontinence
Correct answer:
Urge incontinence, also known as overactive bladder, is characterized by a sudden and strong urge to urinate which is difficult to control. In this case, Mrs. LaFarge is unable to get to the bathroom quickly enough when she senses the need to urinate, which indicates a lack of control over the urge to urinate. This is typically caused by involuntary contractions of the bladder muscle. Stress incontinence, on the other hand, is leakage of urine during activities that increase intra-abdominal pressure, such as coughing or exercising. Overflow incontinence is characterized by urinary retention and constant dribbling of urine due to the bladder being unable to empty properly. Functional incontinence occurs when a person has normal bladder control but is unable to reach the bathroom in time due to physical or cognitive impairments. Since Mrs. LaFarge is experiencing a sudden and strong urge to urinate that she cannot
Your adult patient is experiencing lightheadedness and shortness of breath. He is found to be bradycardic with a second-degree type II AV heart block on the electrocardiogram. His heart rate is 44, he is breathing 20 times per minute, and has a blood pressure of 90 systolic. He is cool and pale but denies chest pain. Which of the following would be most appropriate if the patient fails to respond to atropine?
A. Administer 1 milligram of epinephrine
B. Synchronized cardioversion at 10 joules
C. Transcutaneous pacing
D. Administer a 500-milliliter IV bolus of normal saline
Correct answer:
The correct answer is C: Transcutaneous pacing. In this scenario of a patient with bradycardia and a second-degree type II AV block, transcutaneous pacing is the most appropriate next step if the patient fails to respond to atropine. Transcutaneous pacing involves placing external electrodes on the patient's chest to deliver electrical impulses to stimulate the heart, effectively pacing the heart and maintaining an adequate heart rate. This is crucial in a patient with symptomatic bradycardia and heart blocks as it can quickly and effectively increase the heart rate and improve cardiac output.
The other choices are incorrect:
A: Administering 1 milligram of epinephrine may be too aggressive and can further worsen the heart block in this case.
B: Synchronized cardioversion at 10 joules is not indicated for bradycardia and can be harmful in this scenario.
D: Administering a 500-milliliter IV bolus of normal
It has been estimated that 20%, or 45 million, adults ages 18 or older in the United States have experienced a mental illness in the past year. Which nursing intervention is directed toward addressing the greatest barrier to successful treatment outcomes for these individuals?
A. Educating clients as to the importance of completing their treatment recommendations
B. Identifying resources where medications can be secured at reduced or no cost
C. Actively involving the client in the planning of his or her mental health care
D. Evaluating the client for compliance with his or her plan of care frequently
Correct answer:
The correct answer is A: Educating clients as to the importance of completing their treatment recommendations. This intervention is crucial because lack of understanding about the importance of completing treatment can lead to non-compliance, which is a significant barrier to successful treatment outcomes. By educating clients, nurses can empower them to take ownership of their health and adhere to their treatment plans.
Choice B is incorrect because while identifying resources for medications is important, it may not address the underlying issue of non-compliance. Choice C, involving the client in planning care, is important but may not directly address non-compliance. Choice D, evaluating compliance frequently, is necessary but does not address the root cause of non-compliance. Therefore, the most effective intervention is to educate clients about the importance of completing their treatment recommendations.
Which theme is most likely during family therapy with parents, siblings, and a teen patient with anorexia nervosa who engages in provocative behavior?
A. Stable coalitions between family members
B. Interpreting negative messages as positive
C. Competition between the patient and father
D. Lack of trust in the patient by family members
Correct answer:
The correct answer is C: Competition between the patient and father. In family therapy with a teen patient with anorexia nervosa, the theme of competition between the patient and a parental figure, often the father, can be prominent. The rationale is that the father's influence and expectations can contribute to the teen's feelings of inadequacy and drive for control through anorexic behaviors. This dynamic can be explored and addressed in therapy to improve family relationships and support the patient's recovery.
A: Stable coalitions between family members - This is less likely as anorexia nervosa often disrupts family dynamics.
B: Interpreting negative messages as positive - While this can be a relevant theme, it is not as central to the specific scenario described.
D: Lack of trust in the patient by family members - While trust issues may exist, the theme of competition is more relevant in this context.
A nurse is a prenatal clinic is completing a skin assessment for a pregnant client in the second trimester. Which clinical findings should the nurse expect (select all that apply)?
A. Eczema
B. Psoriasis C.Linea nigra
C. Chloasma
D. Striae gravidarum C, D, E
Correct answer:
The correct answer is C: Linea nigra. During the second trimester of pregnancy, hormonal changes can lead to the development of Linea nigra, a dark vertical line that appears on the abdomen. This is a common skin change in pregnant women.
Explanation:
1. Eczema (choice A) and Psoriasis (choice B) are chronic skin conditions that are not typically associated with pregnancy. These conditions are not expected findings during the second trimester.
2. Chloasma (choice C) is also known as the "mask of pregnancy" and presents as dark patches on the face. This is a common skin change during pregnancy, especially in the second trimester.
3. Striae gravidarum (choice D) are stretch marks that may develop on the abdomen, breasts, and thighs during pregnancy. While this is a common skin change in pregnancy, it is not one of the expected findings in the second trimester according to the question.
In summary, the correct
Which patient should the nurse notify the organ procureme nt organization (OPO) to evaluate for possible organ donation?
A. A 36-year-old patient with a Glasgow Coma Scale score of 3 with no activity on electroencephalogram
B. A 68-year-old male admitted with unstable atrial fibrillation who has suffered a stroke
C. A 40-year-old brain-injured female with a history of ovabairrbi.acnom c/taenstc er and a Glasgow Coma Scale score of 7
D. A 53-year-old diabetic male with a history of unstable angina status post resuscitation
Correct answer:
The correct answer is A because the patient is a 36-year-old with a Glasgow Coma Scale score of 3 and no activity on electroencephalogram, indicating severe brain injury and likely irreversible neurological damage. This patient meets the criteria for potential organ donation as they are neurologically devastated.
Choice B is incorrect because the patient's condition is related to stroke and atrial fibrillation, not severe brain injury that would make them a candidate for organ donation.
Choice C is incorrect because although the patient has a brain injury and a lower Glasgow Coma Scale score, the history of a reversible cause (ovarian cancer metastasis) and a higher GCS score compared to choice A make this patient less suitable for organ donation evaluation.
Choice D is incorrect as the patient's diabetic and cardiovascular history does not suggest severe brain injury that would qualify for organ donation.
According to a study by Robinson (2014), three parts of our true presence (how we connect with patients) are found in being:
A. Friendly, kind, and sweet
B. Genuine, gifted, and creative
C. Humorous, partial, and grateful
D. Genuine, attentive, and immersed
Correct answer:
The correct answer is D: Genuine, attentive, and immersed. This is because being genuine helps establish trust and rapport with patients, being attentive shows active listening and care, and being immersed means being fully engaged in the interaction. These qualities enhance the connection with patients and create a conducive environment for effective communication and care.
Explanation of other choices:
A: Friendly, kind, and sweet - While these qualities are positive, they do not fully capture the depth of true presence required for effective patient connection.
B: Genuine, gifted, and creative - Being genuine is essential, but being gifted and creative are not directly related to establishing a strong connection with patients.
C: Humorous, partial, and grateful - Humor can be beneficial, but being partial and grateful may not always align with maintaining professionalism and unbiased care for all patients.
A patient is admitted with pneumoniThe case manager refers to a plan of care that specifically identifies dates when supplemental oxygen should be discontinued, positive-pressure ventilation with bronchodilators should be changed to self-administered inhalers, and antibiotics should be changed from intravenous to oral treatment, on the basis of assessment findings. This plan of care is referred to as a:
A. patient classification system.
B. clinical pathway.
C. patient-centered plan of care.
D. diagnosis-related group (DRG).
Correct answer:
The correct answer is B: clinical pathway. A clinical pathway is a detailed plan of care that outlines specific interventions and treatments based on assessment findings to guide patient care in a structured manner. In this case, the plan includes specific dates for discontinuing supplemental oxygen, changing ventilation methods, and transitioning antibiotics.
A. Patient classification system: This refers to categorizing patients based on certain criteria for resource allocation and staffing levels, not specific care plans.
C. Patient-centered plan of care: While patient-centered care focuses on individual preferences and needs, it does not necessarily include the structured timeline and interventions outlined in a clinical pathway.
D. Diagnosis-related group (DRG): DRGs are used for billing and payment purposes based on specific diagnoses, not for detailed care plans like the one described in the question.
RN exams clinical judgment practice questions, set 66 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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