RN exams clinical judgment practice questions, set 80
RN exams · clinical judgment
RN exams clinical judgment practice questionsset 80
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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 young adolescent—gravida 1, para 0—is admitted to labor and delivery with preterm labor at 29 weeks' gestation. Which nursing interventions would the nurse include? (Select all that apply.)
A. Administration of antenatal glucocorticoid
B. Order a complete liver function profile
C. Bed rest in the left lateral position
D. Administration of bolus intravenous fluids
Show answer and rationale
Correct answer: A — Administration of antenatal glucocorticoid
The correct answer is A: Administration of antenatal glucocorticoid. This intervention is recommended for women at risk of preterm birth before 34 weeks to promote fetal lung maturity. Glucocorticoids help accelerate fetal lung maturation by promoting the production of surfactant. This reduces the risk of respiratory distress syndrome in preterm infants.
Choice B: Ordering a complete liver function profile is not directly related to managing preterm labor at 29 weeks' gestation.
Choice C: Bed rest in the left lateral position is not a standard intervention for preterm labor and may not be supported by evidence-based practice.
Choice D: Administration of bolus intravenous fluids is not a standard intervention for preterm labor. Fluid administration may be indicated if the patient is dehydrated or has other specific medical indications, but it is not a routine intervention for preterm labor.
Question 2
Which of the following is a step taken when a nursing assistant is suspected of abuse?
A. A meeting of staff members and residents is held so that everyone can discuss the problem.
B. The nursing assistant continues to work while the investigation is being completed.
C. The name of the resident or staff member who reported the abuse is announced so opinions can be gathered.
D. The nursing assistant is suspended immediately and an investigation is completed.
Show answer and rationale
Correct answer: D — The nursing assistant is suspended immediately and an investigation is completed.
The correct answer is D because when a nursing assistant is suspected of abuse, it is crucial to prioritize the safety and well-being of the residents. Suspending the nursing assistant immediately helps protect residents from potential harm and allows for a thorough investigation to be conducted without interference. This ensures that the situation is addressed promptly and appropriately.
A: Holding a meeting with staff members and residents may compromise the investigation and confidentiality.
B: Allowing the nursing assistant to continue working can put residents at risk and hinder the investigation process.
C: Revealing the name of the person who reported the abuse can discourage others from coming forward and breach confidentiality.
In summary, choice D is the correct step to take in such a situation to ensure resident safety, conduct a fair investigation, and maintain confidentiality.
Question 3
A nurse in a long-term care setting that is fundedby Medicare and Medicaid is completing standardized protocols for assessment and care planning for reimbursement. Which task is the nurse completing?
A. A minimum data set
B. An admission assessment and acuity level
C. A focused assessment/specific body system
D. An intake assessment form and auditing phase
Show answer and rationale
Correct answer: A — A minimum data set
The correct answer is A: A minimum data set. In a long-term care setting funded by Medicare and Medicaid, completing standardized protocols for assessment and care planning for reimbursement involves using a minimum data set, which is a standardized instrument for assessing residents' health status. This set of data elements is necessary for comprehensive assessment and care planning to ensure appropriate reimbursement. The other choices (B, C, D) do not specifically address the standardized protocols required for reimbursement in this setting. An admission assessment and acuity level would be part of the process, but not the primary task being completed in this scenario. A focused assessment on a specific body system or an intake assessment form and auditing phase are not synonymous with the standardized protocols needed for reimbursement in a Medicare/Medicaid-funded long-term care facility.
Question 4
A nurse begins work in an agency that provides care to members of a minority ethnic population. The nurse will be better able to demonstrate cultural competence after
A. identifying culture-bound issues.
B. implementing scientifically proven interventions.
C. correcting inferior health practices of the population.
D. exploring commonly held beliefs and values of the population.
Show answer and rationale
Correct answer: D — exploring commonly held beliefs and values of the population.
The correct answer is D because exploring commonly held beliefs and values of the population is essential for cultural competence. By understanding the cultural context of the population, the nurse can provide more effective and respectful care. This includes recognizing traditions, preferences, and communication styles.
A: Identifying culture-bound issues may not necessarily lead to cultural competence as it focuses more on recognizing specific cultural practices rather than understanding the broader cultural context.
B: Implementing scientifically proven interventions is important but does not directly relate to cultural competence, which requires a deeper understanding of cultural nuances.
C: Correcting inferior health practices of the population is ethnocentric and disrespectful, going against the principles of cultural competence that emphasize respect for diverse beliefs and practices.
Question 5
Karen, a 28-year-old female patient, has a hysterosalpingogram ordered but not scheduled. What should the nurse tell the patient?
A. When your next menses starts, call the office to schedule your procedure.
B. You may experience uterine cramping during the procedure.
C. Radiation exposure will be avoided through the use of ultrasound imaging.
D. The purpose of the test is to evaluate the inside of your uterus and your fallopian tubes.
Show answer and rationale
Correct answer: A — When your next menses starts, call the office to schedule your procedure.
Rationale for Correct Answer (A):
- A is correct because the nurse should instruct the patient to call the office when her next menstrual cycle starts to schedule the hysterosalpingogram. This is essential as the test needs to be performed during a specific phase of the menstrual cycle for accurate results.
Summary of Incorrect Choices:
- B: While uterine cramping may be a possible side effect of the procedure, this information is not the most crucial to communicate to the patient at this time.
- C: While it is important to address concerns about radiation exposure, the use of ultrasound imaging doesn't eliminate the need for the patient to schedule the procedure at the appropriate time in her menstrual cycle.
- D: While this choice provides some information about the purpose of the test, it does not address the immediate action the patient needs to take to schedule the procedure correctly.
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Question 6
The nurse has made it a goal to increase the rate at which women begin prenatal care in the first trimester. The nurse relates this decision to national goals for better maternal and infant outcomes. What guidelines will the nurse use to guide her maternal health goals?
A. WHO Maternal care guidelines
B. State Practice Acts
C. AWHONN white papers
D. Healthy People 2020
Correct answer:
The correct answer is D: Healthy People 2020. The nurse will use Healthy People 2020 guidelines because they are evidence-based, nationally recognized objectives that focus on improving the health and well-being of individuals, families, and communities. These guidelines specifically address maternal and infant health outcomes, making them the most relevant choice for the nurse's goal.
Incorrect Choices:
A: WHO Maternal care guidelines - While WHO guidelines are important, they are not specific to the national goals and objectives the nurse is trying to align with.
B: State Practice Acts - State Practice Acts govern the scope of practice for nurses and do not provide specific guidelines for maternal health goals.
C: AWHONN white papers - AWHONN provides valuable resources, but they may not be as comprehensive or nationally recognized as Healthy People 2020 for setting maternal health goals.
A nurse is caring for a 2-day-old newborn who was born at 35 weeks of gestation. Which of the following actions should the nurse the nurse takes? (Click on the "Exhibit" Button for additional information about the newborn. There are three tabs that contain separate categories of date.)
A. Administer nitric oxide inhalation therapy to the newborn
B. Insert an orogastric decompression tube with low wall suction.
C. Provide the newborn with an iron-rich formula containing vitamin B12 every 2 hr.
D. Measure the abdominal circumference at the level of the newborn's umbilicus every 2 hr.
Correct answer:
Since the newborn was born at 35 weeks of gestation, with a birth weight of 2.3 kg and exhibiting clinical signs of hypoglycemia, one of the key priorities in caring for this newborn is monitoring for complications related to prematurity. Measuring the abdominal circumference at the level of the newborn's umbilicus every 2 hours is important in assessing for signs of abdominal distention, which could indicate necrotizing enterocolitis (NEC), a serious condition commonly seen in premature infants. Early detection through frequent abdominal circumference measurements can aid in timely intervention and management to prevent significant complications. Administering nitric oxide inhalation therapy, inserting an orogastric decompression tube with low wall suction, and providing iron-rich formula containing vitamin B12 every 2 hours are not indicated based on the information provided in the exhibit.
Nurse Lourdes is teaching a client recovering from addisonian crisis about the need to take fludrocortisone acetate and hydrocortisone at home. Which statement by the client indicates an understanding of the instructions?
A. "I'll take my hydrocortisone in the late afternoon, before dinner."
B. "I'll take all of my hydrocortisone in the morning, right after I wake up."
C. "I'll take two-thirds of the dose when I wake up and one-third in the late afternoon."
D. "I'll take the entire dose at bedtime."
Correct answer:
The correct answer is C because it demonstrates an understanding of the dosing schedule for both medications. Fludrocortisone acetate is usually taken in the morning to mimic the body's natural cortisol release, while hydrocortisone is typically taken in divided doses throughout the day to prevent adrenal insufficiency. Option C shows the client plans to take two-thirds of the dose in the morning and one-third in the late afternoon, aligning with the recommended dosing schedule.
Option A is incorrect because taking hydrocortisone in the late afternoon is not ideal for mimicking the body's natural cortisol release. Option B is incorrect as taking all hydrocortisone in the morning may lead to suboptimal control of adrenal insufficiency throughout the day. Option D is incorrect because taking the entire dose at bedtime does not align with the recommended dosing schedules for these medications.
A client with obsessive-compulsive personality disorder is described by other staff as being perfectionistic, inflexible, and a 'master at procrastination.' The nurse learns that the client is nearly immobilized during times that call for the client to make a decision. The nurse realizes that the most likely hypothesis is this behavior is related to:
A. A need to make others uncomfortable
B. Needing to be the center of attention
C. Wanting someone else to be responsible
D. Fear of making a mistake
Correct answer:
The correct answer is D: Fear of making a mistake. This is because individuals with obsessive-compulsive personality disorder often have an intense fear of making errors or mistakes. This fear can lead to indecisiveness and procrastination when faced with decision-making tasks. The client's behavior of being nearly immobilized during times requiring decision-making is characteristic of this fear of making a mistake.
Incorrect choices:
A: A need to make others uncomfortable - This is not related to the fear of making a mistake commonly seen in individuals with obsessive-compulsive personality disorder.
B: Needing to be the center of attention - This is not a typical characteristic of individuals with obsessive-compulsive personality disorder.
C: Wanting someone else to be responsible - This is not directly related to the fear of making a mistake, which is a core feature of the disorder.
What is a primary consideration for complications when planning nursing care for an infant with Meconium aspiration syndrome?
A. Hypoglycemia
B. Bowel obstruction
C. Airway obstruction
D. Carbon dioxide retention
Correct answer:
The correct answer is C: Airway obstruction. When planning nursing care for an infant with Meconium aspiration syndrome, a primary consideration for complications is the potential of airway obstruction. After the passage of meconium into the amniotic fluid, the infant may inhale or swallow the fluid, leading to meconium aspiration into the lower airways and causing a partial airway obstruction. This can result in respiratory distress and hypoxemia. Hypoglycemia (choice A) is a metabolic condition unrelated to meconium aspiration. Bowel obstruction (choice B) with meconium may indicate other conditions like cystic fibrosis or Hirschsprung disease, not directly related to meconium aspiration syndrome. Carbon dioxide retention (choice D) is not a primary consideration in meconium aspiration syndrome; instead, the focus is on addressing the airway obstruction and potential respiratory compromise.
The nurse is caring for a client with pneumonia. Which intervention is most effective in preventing hospital-acquired pneumonia?
A. Administering antibiotics as prescribed.
B. Encouraging ambulation several times daily.
C. Performing frequent oral care.
D. Providing a high-calorie, high-protein diet.
Correct answer:
Rationale for Correct Answer C: Performing frequent oral care is the most effective intervention in preventing hospital-acquired pneumonia. This is because oral care helps to reduce the risk of oral bacteria being aspirated into the lungs, which can lead to pneumonia. By keeping the mouth clean and free of harmful bacteria, the risk of pneumonia is significantly reduced.
Summary of Incorrect Choices:
A: Administering antibiotics as prescribed may be necessary for treating pneumonia, but it does not directly prevent hospital-acquired pneumonia.
B: Encouraging ambulation several times daily is important for preventing complications like deep vein thrombosis in hospitalized patients, but it does not directly prevent pneumonia.
D: Providing a high-calorie, high-protein diet is important for overall nutrition and immune function, but it does not directly prevent hospital-acquired pneumonia.
A nurse is caring for a patient diagnosed with bulimia nervosa. The patient states, 'I feel so ashamed after I eat.' What is the most appropriate response by the nurse?
A. You need to stop purging and focus on eating healthy foods.
B. I understand that you feel ashamed, but we are here to help you.
C. Don't worry about your eating habits. Focus on eating more regularly.
D. You need to accept your eating habits and learn to control them.
Correct answer:
Correct Answer: B
Rationale:
1. Empathy: By acknowledging the patient's feelings of shame, the nurse validates their emotions and shows understanding.
2. Therapeutic Communication: Expressing empathy creates a supportive environment and encourages the patient to open up about their struggles.
3. Building Trust: Acknowledging the patient's emotions helps in building a trusting nurse-patient relationship, essential for effective care.
4. Encouraging Help-Seeking Behavior: By stating "we are here to help you," the nurse encourages the patient to seek assistance and engage in treatment.
Summary:
A: This response oversimplifies the issue and doesn't address the patient's emotional needs.
C: Ignoring the patient's feelings and focusing solely on eating habits may be counterproductive.
D: This response lacks empathy and fails to provide the necessary support for the patient's emotional well-being.
Nurse Oliver is working in a out patient clinic. He has been alerted that there is an outbreak of tuberculosis (TB). Which of the following clients entering the clinic today most likely to have TB?
A. A 16-year-old female high school student
B. A 33-year-old day-care worker
C. A 43-yesr-old homeless man with a history of alcoholism
D. A 54-year-old businessman
Correct answer:
The correct answer is C, the 43-year-old homeless man with a history of alcoholism. This choice is most likely to have TB due to the increased risk factors associated with homelessness, alcoholism, and compromised immune system. Homeless populations are at higher risk for TB due to crowded living conditions and poor access to healthcare. Alcoholism can weaken the immune system, making individuals more susceptible to TB infection. The other choices do not have the same level of risk factors for TB compared to the homeless man with alcoholism. A, the 16-year-old high school student, is less likely to have TB as younger age groups typically have lower rates of TB. B, the 33-year-old day-care worker, may have some exposure risk, but it is not as high as the homeless man with alcoholism. D, the 54-year-old businessman, does not have the same risk factors for TB as the homeless man with alcoholism.
Nurse Oliver is working in a out patient clinic. He has been alerted that there is an outbreak of tuberculosis (TB). Which of the following clients entering the clinic today most likely to have TB?
A. A 16-year-old female high school student
B. A 33-year-old day-care worker
C. A 43-yesr-old homeless man with a history of alcoholism
D. A 54-year-old businessman
Correct answer:
The correct answer is C, the 43-year-old homeless man with a history of alcoholism. This choice is most likely to have TB due to the increased risk factors associated with homelessness, alcoholism, and compromised immune system. Homeless populations are at higher risk for TB due to crowded living conditions and poor access to healthcare. Alcoholism can weaken the immune system, making individuals more susceptible to TB infection. The other choices do not have the same level of risk factors for TB compared to the homeless man with alcoholism. A, the 16-year-old high school student, is less likely to have TB as younger age groups typically have lower rates of TB. B, the 33-year-old day-care worker, may have some exposure risk, but it is not as high as the homeless man with alcoholism. D, the 54-year-old businessman, does not have the same risk factors for TB as the homeless man with alcoholism.
The wife of a client newly diagnosed with paranoid schizophrenia asks the nurse, 'My husband was well adjusted until a month ago, and then, after a lot of work stress, he got sick. What can I expect? Will he be this sick for the rest of his life?' What information can the nurse provide about prognosis?
A. This disorder responds well to treatment and, with follow-up, may not recur.'
B. All types of schizophrenia are chronic relapsing disorders.'
C. Outcomes are poor related to client prehospital disorganization.'
D. The usual outcome is that only partial remission is achieved.'
Correct answer:
Step 1: Paranoid schizophrenia is a subtype that tends to have a better prognosis compared to other types.
Step 2: The statement that the disorder responds well to treatment and may not recur aligns with the typical course of paranoid schizophrenia.
Step 3: With proper medication and therapy, individuals with paranoid schizophrenia can experience significant improvement and have periods of stability.
Step 4: Recurrence of symptoms is less likely compared to other types of schizophrenia.
Step 5: Therefore, choice A is correct as it provides accurate information about the prognosis of paranoid schizophrenia.
Summary: Choice B is incorrect because not all types of schizophrenia are chronic relapsing disorders. Choice C is incorrect as outcomes are not solely determined by prehospital disorganization. Choice D is incorrect as partial remission is not the usual outcome for paranoid schizophrenia.
RN exams clinical judgment practice questions, set 80 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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