RN exams clinical judgment practice questions, set 68
RN exams · clinical judgment
RN exams clinical judgment practice questionsset 68
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 28-year-old patient has decided to use the patch contraception. The nurse is educating her on the best site to use. Where is the best place to put the patch? Select all that apply.
A. Buttocks
B. Neck
C. Leg
D. Arm
Show answer and rationale
Correct answer: B — Neck
The correct answer is B: Neck. The patch contraception is most effective when applied to a clean, dry, and hairless area of the body. The neck is a suitable site because it is easily accessible, non-occlusive, and less likely to be affected by clothing friction. Placing the patch on the neck also helps avoid skin irritation and allows for optimal absorption of hormones.
Choice A: Buttocks - The buttocks may not be an ideal site as it can be covered by clothing and may not allow for proper adherence and absorption.
Choice C: Leg - The leg is not typically recommended as a site for the patch due to movement and friction from clothing that may affect patch adhesion and hormone absorption.
Choice D: Arm - While the arm is a possible site for the patch, it is not as ideal as the neck because it may be subject to more movement and rubbing against clothing, potentially affecting patch adherence and effectiveness.
Question 2
A nursing student is asked to set goals that will decrease the fetal death outcomes during delivery. What guidelines will the nursing student use to assist in setting her goals?
A. WHO Maternal care guidelines
B. Healthy People 2020
C. AWHONN white papers
D. State Practice Act
Show answer and rationale
Correct answer: B — Healthy People 2020
The correct answer is B: Healthy People 2020. This is because Healthy People 2020 provides specific objectives related to maternal and child health, including reducing fetal death outcomes during delivery. The goals and targets outlined in Healthy People 2020 are evidence-based and nationally recognized, making it a reliable guide for setting healthcare goals.
A: WHO Maternal care guidelines focus more broadly on global maternal health issues and may not provide specific goals related to reducing fetal death outcomes during delivery.
C: AWHONN white papers may offer valuable insights and recommendations, but they are not as comprehensive or widely recognized as the goals outlined in Healthy People 2020.
D: State Practice Acts govern the scope of practice for healthcare providers in a specific state, but they do not typically include specific goals related to reducing fetal death outcomes during delivery.
Question 3
A patient admitted yesterday for injuries sustained while intoxicated believes the window blinds are snakes trying to get into the room. The patient is anxious, agitated, and diaphoretic. Which medication can the nurse anticipate the health care provider will prescribe?
A. Monoamine oxidase inhibitor, such as phenelzine (Nardil)
B. Phenothiazine, such as thioridazine (Mellaril)
C. Benzodiazepine, such as lorazepam (Ativan)
D. Narcotic analgesic, such as morphine
Show answer and rationale
Correct answer: C — Benzodiazepine, such as lorazepam (Ativan)
The correct medication to anticipate for this patient is a benzodiazepine, such as lorazepam (Ativan).
Rationale:
1. Benzodiazepines are commonly used to treat acute agitation and anxiety in patients, which is present in this case.
2. Lorazepam has a rapid onset of action and can help calm the patient quickly.
3. It can help manage the patient's perception of the window blinds as snakes and reduce agitation.
4. Benzodiazepines are safer for patients with alcohol intoxication compared to other sedatives or antipsychotics.
Summary of Incorrect Choices:
A: Monoamine oxidase inhibitors are not typically used for acute agitation and anxiety. They have a slower onset of action and are not first-line for this situation.
B: Phenothiazines may worsen the patient's condition due to their potential side effects like sedation and hypotension.
D: Narcotic analgesics are not appropriate for managing anxiety or agitation
Question 4
Which of the following statements concerning intraosseous infusion is TRUE?
A. Only crystalloid solutions may be safely infused through the needle
B. Aspiration of bone marrow confirms appropriate positioning of the needle
C. Intraosseous infusion is the preferred route for volume resuscitation in small children
D. Intraosseous infusion may be utilized indefinitely
Show answer and rationale
Correct answer: B — Aspiration of bone marrow confirms appropriate positioning of the needle
Rationale for Correct Answer (B):
1. Aspiration of bone marrow confirms appropriate positioning of the needle: This statement is true because when the needle is correctly placed within the bone marrow cavity, aspiration of bone marrow confirms proper positioning and ensures that the infusion will be successful.
Summary of Incorrect Choices:
A: Only crystalloid solutions may be safely infused through the needle - Incorrect, as both crystalloid and colloid solutions can be infused through the intraosseous route.
C: Intraosseous infusion is the preferred route for volume resuscitation in small children - Incorrect, as while it is commonly used in pediatric emergencies, it may not always be the preferred route depending on the situation.
D: Intraosseous infusion may be utilized indefinitely - Incorrect, as intraosseous infusion is typically considered a temporary measure and is not meant for long-term use.
Question 5
In a village, a case of anthrax had been registered. Medical services began epidemiologically indicated specific prophylaxis of population against anthrax. What preparation was used for this purpose?
A. Anatoxin
B. Inactivated vaccine
C. Chemical vaccine
D. Genetically engineered vaccine
Show answer and rationale
Correct answer: A — Anatoxin
The correct answer is A: Anatoxin. An anatoxin is a preparation that contains inactivated toxins produced by the anthrax-causing bacteria. By administering anatoxin, the population can develop immunity against the toxin without being exposed to the live bacteria. This specific prophylaxis approach helps prevent the development of anthrax infection by targeting the toxin itself.
Summary:
- Choice B (Inactivated vaccine) is incorrect because an inactivated vaccine typically contains killed or inactivated whole bacteria, not just the toxins.
- Choice C (Chemical vaccine) is incorrect as there is no such thing as a chemical vaccine; vaccines are biological preparations.
- Choice D (Genetically engineered vaccine) is incorrect because while vaccines can be genetically engineered, the specific term "genetically engineered vaccine" does not accurately describe the prophylaxis used against anthrax in this scenario.
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Question 6
A 67-year-old woman is diagnosed with breast cancer. She is fully alert and very specifically both verbally and in writing tells you that she does not want to have surgery on her breast to remove the tumor. She fully understands her condition and treatment options. This is a decision her husband and son both disagree with. Over the next several weeks the patient becomes confused and loses the capacity to understand the details of her medical care. The husband and son now approach you to perform the surgery. Which of the following is most appropriate?
A. Refuse to do surgery and follow the original advance directive.
B. Perform the surgery only if the request is in writing.
C. Honor the family's request and perform the surgery.
D. Consult the ethics committee.
Correct answer:
The patient in this question gave a clear advance directive while she still had decision-making capacity. This must be followed. This case is especially clear because it states there is both a clear verbal as well as written advance directive. Cases in which there is no clear advance directive are much harder. It does not matter if the family's request is in writing. The case would be considered too straightforward to warrant the intervention of an ethics committee. Even if the ethics committee for some reason recommended the surgery, you would still have to refuse because your duty is to follow the patient's wishes, no one else's. You cannot refuse a decision made while competent simply because the patient later becomes incompetent. If this were not so, then all wills would be invalid. A person's will is a form of advance directive for their property after they become unable to speak for themselves directly.
Which assessment finding of a newborn requires prompt action by the nurse?
A. Respiratory rate of 50 breaths per minute
B. Cyanosis of the extremities
C. Pause in breathing lasting 20 seconds
D. Pause in breathing for 15 seconds followed by rapid respirations
Correct answer:
The correct answer is C: Pause in breathing lasting 20 seconds. This finding indicates a potential apnea episode in the newborn, which requires immediate attention to prevent further complications like hypoxia. The pause in breathing lasting 20 seconds exceeds the normal range for apnea in newborns, typically defined as a pause lasting more than 15 seconds. Prompt action is necessary to assess and address the underlying cause of the apnea episode.
Choice A (Respiratory rate of 50 breaths per minute) is within the normal range for newborns (30-60 breaths per minute) and does not require immediate action. Choice B (Cyanosis of the extremities) may indicate poor circulation but is not as urgent as a prolonged pause in breathing. Choice D (Pause in breathing for 15 seconds followed by rapid respirations) is incorrect as it does not meet the criteria for apnea in newborns and does not require immediate action.
The nurse cares for a patient with lung cancer in a home hospice program. Which action by the nurse is most appropriate?
A. Discuss cancer risk factors and appropriate lifestyle modifications.
B. Encourage the patient to discuss past life events and their meaning.
C. Teach the patient about the purpose of chemotherapy and radiation.
D. Accomplish a thorough head-to-toe assessment several times a week.
Correct answer:
The correct answer is B because in a home hospice program, it is essential for the nurse to provide holistic care that includes addressing the patient's emotional and psychological needs. Encouraging the patient to discuss past life events and their meaning can help them process emotions, find closure, and improve their quality of life. This approach aligns with the principles of palliative care, which focus on enhancing comfort and well-being.
Choice A is incorrect because discussing cancer risk factors and lifestyle modifications may not be relevant or beneficial for a patient in a hospice program. Choice C is incorrect because chemotherapy and radiation are typically not part of hospice care, which focuses on comfort rather than curative treatments. Choice D is incorrect because a thorough head-to-toe assessment multiple times a week may not be necessary or appropriate for a patient in a hospice program.
Faculty comes to class to present information about joining the Student Nurses Association (SNA). A student is heard saying, "Why join this organization? It is just a bunch of students like us. I'll wait and join the real nursing organization after graduation." This student is not aware of which benefits of SNA? (select all that apply)
A. Members are eligible to sit for the licensure examination at a reduced rate.
B. Leadership skills can be refined by working with other schools of nursing.
C. The National SNA provides discounted rates for study abroad opportunities.
D. A global view of nursing can be obtained through networking internationally.
Correct answer:
The correct answer is A: Members are eligible to sit for the licensure examination at a reduced rate. This benefit is specific to the Student Nurses Association (SNA) and is not available in other nursing organizations. It provides a tangible advantage for members to pursue licensure after graduation, which is a critical step in their nursing career.
Incorrect choices:
B: While leadership skills can be refined by working with other schools of nursing through SNA, this is not a unique benefit that distinguishes SNA from other organizations.
C: The National SNA providing discounted rates for study abroad opportunities is a beneficial offering, but it does not address the immediate benefit of reduced licensure examination rates.
D: Obtaining a global view of nursing through networking internationally is a valuable experience, but it does not directly relate to the licensure examination benefit provided by SNA.
A nurse has heard rumors that other nurses are interested in unionizing but knows little about the purpose of unions. The nurse's first action is to:
A. contact an arbitrator who has worked with other nurses in unions.
B. picket the agency where employed to gain inside information as to why unionization is sought.
C. sign the dual-purpose union authorization card.
D. review the National Nurses United website for collective bargaining information.
Correct answer:
The correct answer is D because reviewing the National Nurses United website for collective bargaining information is the most appropriate first action. This option allows the nurse to educate themselves on the purpose of unions and understand the benefits of collective bargaining. It promotes informed decision-making and empowers the nurse with knowledge before taking any further actions.
A: Contacting an arbitrator may be premature as the nurse needs to first understand the basics of unions.
B: Picketing the agency is counterproductive and may create a hostile environment without proper information.
C: Signing a union authorization card without understanding the implications is not advisable and may lead to unintended consequences.
Summary: Option D is correct as it promotes education and informed decision-making, while the other choices are premature, potentially harmful, or lack necessary information.
A patient asks about the purpose of AMH (Anti-Müllerian Hormone) testing. What should the nurse explain?
A. AMH testing predicts the exact time of ovulation.
B. AMH levels indicate ovarian reserve and egg quantity.
C. AMH is used to confirm pregnancy success after IVF.
D. AMH determines sperm quality in male partners.
Correct answer:
The correct answer is B: AMH levels indicate ovarian reserve and egg quantity. This is because Anti-Müllerian Hormone (AMH) is primarily secreted by the ovaries and its levels in the blood reflect the number of remaining follicles in the ovaries, which correlates with ovarian reserve and egg quantity. This information is vital for assessing a woman's fertility potential, especially in the context of fertility treatments such as in vitro fertilization (IVF). Choice A is incorrect as AMH testing does not predict the exact time of ovulation, it assesses ovarian reserve. Choice C is incorrect as AMH testing is not used to confirm pregnancy success after IVF, but rather to determine the likelihood of successful response to ovarian stimulation. Choice D is incorrect as AMH does not determine sperm quality in male partners, as it is a hormone produced by the ovaries and is not related to male reproductive function.
Virgie with a positive Mantoux test result will be sent for a chest X-ray. The nurse is aware that which of the following reasons this is done?
A. To confirm the diagnosis
B. To determine if a repeat skin test is needed
C. To determine the extent of lesions
D. To determine if this is a primary or secondary infection
Correct answer:
The correct answer is C: To determine the extent of lesions. A chest X-ray is done to evaluate the presence and extent of lesions in the lungs, which helps in assessing the severity of tuberculosis infection. This is important for determining the appropriate treatment plan and monitoring the progression of the disease.
Incorrect answers:
A: To confirm the diagnosis - Chest X-ray alone cannot confirm the diagnosis of tuberculosis, as other tests such as sputum culture or PCR are needed.
B: To determine if a repeat skin test is needed - Chest X-ray is not used to determine the need for a repeat skin test, as the decision for repeat testing is based on clinical judgment and guidelines.
D: To determine if this is a primary or secondary infection - Chest X-ray may provide some information, but the distinction between primary and secondary infection is usually based on clinical history and other diagnostic tests.
A pregnant patient at 24 weeks gestation reports occasional dizziness and lightheadedness. What should the nurse assess first?
A. The patient's blood pressure and hydration status.
B. The fetal heart rate and activity.
C. The patient's hemoglobin and hematocrit levels.
D. The patient's weight gain and diet history.
Correct answer:
The correct answer is A: The patient's blood pressure and hydration status should be assessed first because dizziness and lightheadedness can be indicative of hypotension or dehydration, common issues during pregnancy. Monitoring blood pressure will help determine if the symptoms are related to low blood pressure, and assessing hydration status can identify if the patient needs to increase fluid intake.
Summary of other choices:
B: Assessing fetal heart rate and activity is important but not the priority in this situation as the focus should be on the maternal health first.
C: Checking hemoglobin and hematocrit levels is important for detecting anemia, but it is not the initial assessment for dizziness and lightheadedness.
D: Monitoring weight gain and diet history are essential aspects of prenatal care but are not the immediate concerns when a pregnant patient is experiencing dizziness and lightheadedness.
The nurse is planning the care of a patient who has a diagnosis of atopic dermatitis, which commonly affects both of her hands and forearms. What risk nursing diagnosis should the nurse include in the patients care plan?
A. Risk for Disturbed Body Image Related to Skin Lesions
B. Risk for Disuse Syndrome Related to Dermatitis
C. Risk for Ineffective Role Performance Related to Dermatitis
D. Risk for Self-Care Deficit Related to Skin Lesions
Correct answer:
The correct answer is D: Risk for Self-Care Deficit Related to Skin Lesions. Patients with atopic dermatitis may experience difficulty performing self-care tasks due to pain, itching, and limitations in hand mobility caused by skin lesions. This diagnosis addresses the potential challenges the patient may face in maintaining personal hygiene and managing their skin condition.
Explanation for why other choices are incorrect:
A: Risk for Disturbed Body Image Related to Skin Lesions - While atopic dermatitis may impact body image, the priority in this case is the patient's ability to perform self-care.
B: Risk for Disuse Syndrome Related to Dermatitis - Disuse syndrome is not typically associated with atopic dermatitis.
C: Risk for Ineffective Role Performance Related to Dermatitis - This diagnosis focuses on the patient's ability to fulfill their roles, which may not be directly impacted by atopic dermatitis.
A nurse is caring for a patient who has just been diagnosed with chlamydia and wants to know when she can have sex with her boyfriend again. What is the best response from the nurse?
A. “You should not have sex until 7 days after you complete treatment and your partner gets treatment.”
B. “You can have sex as soon as you finish the medicine.”
C. “You can have sex once your partner takes the medicine.”
D. “There is no need to wait.”
Correct answer:
The correct answer is A. The rationale is as follows:
1. Chlamydia is a sexually transmitted infection that requires treatment to prevent transmission.
2. The patient should complete the full course of treatment to ensure the infection is cleared.
3. Waiting 7 days after completing treatment allows time for the medication to be effective and for the patient's partner to also receive treatment.
4. Having sex before completing treatment and ensuring the partner is treated can lead to re-infection and further transmission.
Therefore, choice A is the best response.
Summary of incorrect choices:
B: Incorrect as having sex immediately after finishing the medicine without waiting for partner treatment can lead to re-infection.
C: Incorrect as both partners need to complete treatment to prevent re-infection.
D: Incorrect as waiting is necessary to ensure the infection is fully treated and transmission is prevented.
RN exams clinical judgment practice questions, set 68 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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