RN exams clinical judgment practice questions, set 82
RN exams · clinical judgment
RN exams clinical judgment practice questionsset 82
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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 baby is born with a penis, a scrotum with no testes, no vagina, and XX chromosomes. This condition is referred to as hermaphroditism. Which of the following could cause this abnormality?
A. Abnormally high levels of human chorionic gonadotropin production by the trophoblast cells
B. Abnormally low rates of estrogen production by the placenta
C. Abnormally high levels of luteinizing hormone in the maternal blood
D. Abnormally high levels of testosterone in the maternal blood
Show answer and rationale
Correct answer: D — Abnormally high levels of testosterone in the maternal blood
The correct answer is D: Abnormally high levels of testosterone in the maternal blood. This can cause virilization of the female fetus, leading to the development of male external genitalia. Testosterone exposure during fetal development can result in the formation of a penis and scrotum without testes in a genetic female (XX).
Rationale:
1. Testosterone is responsible for the development of male external genitalia.
2. XX chromosomes indicate a genetic female.
3. Lack of testes indicates incomplete masculinization.
4. High levels of testosterone can override the default female development pattern.
Other choices are incorrect because:
A: Human chorionic gonadotropin does not directly affect fetal genital development.
B: Estrogen is not responsible for male genital development.
C: Luteinizing hormone does not directly influence the development of external genitalia in the fetus.
Question 2
In the __________ period, teratogens rarely have any impact.
A. germinal
B. embryonic
C. fetal
D. prenatal
Show answer and rationale
Correct answer: A — germinal
In the germinal period of prenatal development, which lasts for about the first two weeks after fertilization, the developing organism is a zygote that has not yet implanted in the uterus. During this period, teratogens rarely have any impact because essential implantation and early cellular division processes are occurring. Teratogens are more likely to have significant effects during the later embryonic and fetal periods of development. Therefore, the correct answer is A. Choice B, embryonic period, is incorrect because teratogens have a higher likelihood of impacting development during this period. Choice C, fetal period, is also incorrect as teratogens can impact development during this stage as well. Choice D, prenatal, is a broad term encompassing the entire period of development from conception to birth and is not a specific developmental stage where teratogens have a minimal impact.
Question 3
A patient with severe chronic obstructive pulmonary disease (COPD) tells the nurse, "I wish I were dead! I'm just a burden on everybody."Â Based on this information, which nursing diagnosis is most appropriate?
A. Complicated grieving related to expectation of death
B. Chronic low self-esteem related to physical dependence
C. Ineffective coping related to unknown outcome of illness
D. Deficient knowledge related to lack of education about COPD
Show answer and rationale
Correct answer: C — Ineffective coping related to unknown outcome of illness
The most appropriate nursing diagnosis is "Ineffective coping related to unknown outcome of illness" (Choice C). This is because the patient's expression of feeling like a burden and wishing to be dead indicates difficulty coping with the uncertainties and challenges of their COPD. The patient's emotional distress and sense of hopelessness suggest ineffective coping mechanisms in dealing with their illness.
Choice A (Complicated grieving) is incorrect because the patient's statement does not indicate grief over an actual loss, but rather a sense of burden and hopelessness. Choice B (Chronic low self-esteem) is incorrect as the patient's statement is more related to the impact of the illness on others rather than self-esteem issues. Choice D (Deficient knowledge) is not the most appropriate as the patient's statement reflects emotional distress rather than a lack of knowledge about COPD.
Question 4
A nurse is preparing a patient for a magneticresonance imaging (MRI) scan. Which nursing action ismostimportant?
A. Ensuring that the patient does not eat or drink 2 hours before the examination.
B. Administering a colon cleansing product 6 hours before the examination.
C. Obtaining an order for a pain medication before the test is performed.
D. Removing all of the patient’s metallic jewelry.
Show answer and rationale
Correct answer: D — Removing all of the patient’s metallic jewelry.
Correct Answer: D - Removing all of the patient’s metallic jewelry.
Rationale:
1. Safety: Metallic objects can be attracted by the MRI magnet, causing harm to the patient and disrupting the imaging process.
2. Artifact Prevention: Metallic objects can produce artifacts on the MRI images, affecting the diagnostic quality.
3. Patient Comfort: Removing jewelry ensures the patient's comfort during the scan, avoiding discomfort or injury.
Summary of Incorrect Choices:
A: Not eating or drinking before an MRI is important, but it is not the most crucial action compared to patient safety and image quality.
B: Colon cleansing may be necessary for certain types of MRI scans, but it is not universally required and is not the most important action.
C: Pain medication may be important for patient comfort, but it is not essential for the actual MRI procedure and does not impact safety or image quality.
Question 5
Which of the ff factors makes it important for the nurse to provide special care to older clients with an immune system disorder?
A. Age-related changes
B. Use of multiple drugs (Polypharmacy)
C. Poor diet
D. Reduced activity levels
Show answer and rationale
Correct answer: A — Age-related changes
The correct answer is A: Age-related changes. Older clients are more susceptible to immune system disorders due to age-related changes such as a weakened immune response, increased inflammation, and decreased production of immune cells. Providing special care is important to address these specific vulnerabilities.
Incorrect choices:
B: Use of multiple drugs (Polypharmacy) - While polypharmacy can impact the immune system, it is not the primary factor for providing special care to older clients with immune system disorders.
C: Poor diet - While diet plays a role in overall health, it is not the main factor necessitating special care for older clients with immune system disorders.
D: Reduced activity levels - Although physical activity is important for overall health, reduced activity levels are not the primary reason for providing special care to older clients with immune system disorders.
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Question 6
A man tells the nurse that his father died of prostate cancer and he is concerned about his own risk of developing the disease, having heard that prostate cancer has a genetic link. What aspect of the pathophysiology of prostate cancer would underlie the nurses response?
A. A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer.
B. HNPCC is a mutation of two genes that causes prostate cancer in men and it is autosomal dominant.
C. Studies have shown that the presence of the TP53 gene strongly influences the incidence of prostate cancer.
D. Recent research has demonstrated that prostate cancer is the result of lifestyle factors and that genetics are unrelated.
Correct answer:
The correct answer is A because several studies have indeed shown an association between BRCA-2 mutation and an increased risk of prostate cancer. BRCA-2 mutation is known to be linked to an increased risk of various cancers, including prostate cancer. This genetic mutation can be inherited and passed down through generations, leading to a higher likelihood of developing prostate cancer.
Choices B, C, and D are incorrect because:
B: HNPCC (Hereditary Nonpolyposis Colorectal Cancer) is not specifically associated with prostate cancer, and it is not an autosomal dominant mutation causing prostate cancer in men.
C: TP53 gene is associated with other types of cancers, such as breast cancer, but not strongly linked to prostate cancer.
D: Research has shown that genetics do play a role in the development of prostate cancer, contradicting the statement that genetics are unrelated to the disease.
The nurse is gathering data on a patient. Which data will the nurse report as objective data?
A. States “doesn’t feel good”
B. Reports a headache
C. Respirations 16
D. Nauseated
Correct answer:
Objective data in nursing refers to measurable and observable information. Respirations at 16 per minute are a specific, quantifiable measurement that the nurse can directly observe, making it objective data. This information is vital for assessing the patient's respiratory status accurately.
Choice A is incorrect because stating "doesn't feel good" is a subjective statement based on the patient's perception and cannot be directly measured or observed. Choice B, reporting a headache, is also subjective as it relies on the patient's description of their symptoms. Choice D, being nauseated, is subjective as well, as it is a symptom reported by the patient and not a quantifiable measurement.
In summary, choice C is correct as it represents objective data due to its quantifiable and observable nature, while the other choices are subjective and based on the patient's perceptions or feelings.
After birth, the nurse immediately dries a neonate's face and hair with a clean, prewarmed towel. After drying, the nurse covers the neonate's hair with a cap. What type of heat loss is the nurse preventing?
A. convection
B. conduction
C. evaporation
D. radiation
Correct answer:
The correct answer is C: evaporation. After birth, drying the neonate's face and hair with a towel and covering the hair with a cap prevents heat loss through evaporation. Evaporation occurs when moisture on the skin evaporates into the air, leading to cooling of the body. By drying the neonate's hair and covering it with a cap, the nurse reduces the potential for heat loss through evaporation, helping to maintain the neonate's body temperature.
Incorrect choices:
A: Convection - Heat transfer through the movement of air or liquid. Drying and covering the hair do not directly impact convection heat loss.
B: Conduction - Heat transfer through direct contact with a cooler surface. Drying and covering the hair with a cap do not address conduction heat loss.
D: Radiation - Heat transfer through electromagnetic waves. Drying and covering the hair do not specifically target radiation heat loss.
A patient with schizophrenia has received typical (first-generation) antipsychotics for a year. His hallucinations are less intrusive, but he remains apathetic, has poverty of thought, cannot work, and is socially isolated. To address these symptoms, the nurse might consult the prescribing health care provider to suggest a change to:
A. Haloperidol (Haldol).
B. Olanzapine (Zyprexa).
C. Diphenhydramine (Benadryl).
D. Chlorpromazine (Thorazine).
Correct answer:
The correct answer is B: Olanzapine (Zyprexa). Olanzapine is an atypical (second-generation) antipsychotic that has been shown to effectively target negative symptoms of schizophrenia, such as apathy, poverty of thought, and social isolation. It also helps with mood stabilization and cognitive function, which can improve the patient's ability to work and engage in social interactions.
Choice A: Haloperidol (Haldol) is a typical (first-generation) antipsychotic like the current medication, which is less effective in treating negative symptoms and can potentially worsen them.
Choice C: Diphenhydramine (Benadryl) is an antihistamine and not indicated for treating schizophrenia symptoms.
Choice D: Chlorpromazine (Thorazine) is another typical (first-generation) antipsychotic, similar to the current medication, and may not adequately address the negative symptoms the patient is experiencing.
Which of the following adverse effects is most likely to occur during the therapy?
A. Macrocytic anemia
B. Hallucinations
C. Liver cirrhosis
D. Pancreatitis
Correct answer:
The correct answer is D: Pancreatitis. During therapy, certain medications can cause pancreatitis due to their toxic effects on the pancreas. This can lead to inflammation of the pancreas, resulting in symptoms such as severe abdominal pain, nausea, and vomiting. Pancreatitis is a serious condition that requires immediate medical attention.
Rationale:
- A (Macrocytic anemia): This adverse effect is more commonly associated with deficiencies in vitamin B12 or folic acid, not typically caused by medications during therapy.
- B (Hallucinations): Hallucinations are more likely to occur as a side effect of certain psychiatric medications or in cases of substance abuse, rather than during general therapy.
- C (Liver cirrhosis): Liver cirrhosis is a long-term consequence of chronic liver damage, often due to alcohol abuse or viral hepatitis, not typically a direct adverse effect of therapy.
A nurse is suctioning a client through a tracheostomy tube. During the procedure, the client begins to cough, and the nurse hears a wheeze. The nurse tries to remove the suction catheter from the client's trachea but is unable to do so. What should the nurse do first?
A. Call a code
B. Contact the physician
C. Administer a bronchodilator
D. Disconnect the suction source from the catheter
Correct answer:
Inability to remove a suction catheter is a critical situation that may indicate the presence of bronchospasm and bronchoconstriction, as evidenced by the client coughing and wheezing. The immediate action for the nurse is to disconnect the suction source from the catheter, allowing the catheter to remain in the trachea. By doing so, the nurse can then connect the oxygen source to the catheter to provide essential oxygenation to the client. Contacting the physician is necessary to notify them of the situation and to obtain further orders, typically for an inhaled bronchodilator to relieve the bronchospasm. Administering a bronchodilator without physician's orders is not within the nurse's scope of practice and should not be the first action. Calling a code would be excessive at this point and should only be done if the client's condition deteriorates and immediate resuscitation is required.
A couple is scheduled to have a Huhner test for infertility. In preparation for the test, the nurse will instruct the couple about
A. being sedated during the procedure
B. determining the estimated time of ovulation.
C. experiencing shoulder pain after the procedure.
D. refraining from intercourse before the appointment.
Correct answer:
The correct answer is B because the Huhner test is used to assess the quality of cervical mucus and its ability to support sperm survival and movement. Therefore, determining the estimated time of ovulation is crucial as it ensures that the test is performed during the most fertile period of the woman's cycle. This increases the chances of obtaining accurate and relevant results.
A: Being sedated during the procedure is unnecessary as the Huhner test is a simple and non-invasive procedure that does not require sedation.
C: Experiencing shoulder pain after the procedure is not a common side effect of the Huhner test and is not a significant aspect to focus on during preparation.
D: Refraining from intercourse before the appointment is not specifically required for the Huhner test, as the purpose of the test is to evaluate the quality of cervical mucus rather than the presence of sperm.
A nurse obtained a telephone order from a primarycare provider for a patient in pain. Which chart entry should the nurse document?
A. 12/16/20XX 0915 Morphine, 2 mg, IV every 4 hours for incisional pain. VO Dr. Day/J. Winds, RN, read back.
B. 12/16/20XX 0915 Morphine, 2 mg, IV every 4 hours for incisional pain. TO J. Winds, RN, read back.
C. 12/16/20XX 0915 Morphine, 2 mg, IV every 4 hours for incisional pain. TO Dr. Day/J. Winds, RN, read back.
D. 12/16/20XX 0915 Morphine, 2 mg, IV every 4 hours for incisional pain. TO J. Winds, RN.
Correct answer:
The correct answer is C because it includes all necessary components for a complete and accurate chart entry. The nurse documents the date and time of the order, the medication prescribed (Morphine, 2 mg, IV every 4 hours), the indication for use (incisional pain), the intended recipient (Dr. Day), the nurse's name (J. Winds), and confirmation of the read-back procedure. This entry ensures clarity, accountability, and proper communication among healthcare team members.
Choice A is incorrect because it misses the recipient of the order (Dr. Day) and only includes the nurse's name in the read-back. Choice B is incorrect because it lacks the recipient of the order and the confirmation of the read-back procedure with the primary care provider. Choice D is incorrect because it does not specify the primary care provider who gave the order and misses the read-back confirmation with the provider.
Epinephrine is effective in helping reverse the adverse effects of anaphylaxis. It is the drug of choice because it causes bronchodilation and vasoconstriction to improve respiratory effort and improve blood pressure. What other effect does epinephrine have on the patient's body during an anaphylactic reaction?
A. It reduces the release of chemical mediators from the mast cells
B. It is effective in reducing the inflammatory response of the reaction
C. Increases the heart rate to improve peripheral perfusion
D. It causes peripheral vasoconstriction to reduce the itching associated with the reaction
Correct answer:
Step-by-step rationale for the correct answer (A):
1. Epinephrine acts on alpha and beta-adrenergic receptors.
2. By binding to alpha receptors, it causes vasoconstriction which helps in increasing blood pressure.
3. By binding to beta-2 receptors, it causes bronchodilation which improves respiratory effort.
4. Epinephrine also reduces the release of chemical mediators such as histamine from mast cells, which helps in counteracting the allergic response.
5. Therefore, choice A is correct as it highlights an additional beneficial effect of epinephrine in managing anaphylaxis.
Summary of why other choices are incorrect:
B: Epinephrine does not directly reduce the inflammatory response; it mainly acts on vasoconstriction and bronchodilation.
C: While epinephrine can increase heart rate, the primary purpose is not to improve peripheral perfusion, but to counteract the effects of anaphylaxis.
2 Which of the following is the best way for a nursing assistant to keep residents' health information confidential?
A. Discuss a resident's information away from the facility so that other residents cannot hear it
B. Bring family and friends to the facility to meet the residents
C. Return charts to their proper place after use
D. Post updates about favorite residents on her Facebook page to avoid being overheard
Correct answer:
The correct answer is C: Return charts to their proper place after use. This is the best way for a nursing assistant to keep residents' health information confidential because it ensures that sensitive information is stored securely and not left out in the open where unauthorized individuals can access it. By returning charts to their proper place, the nursing assistant is following proper protocol for maintaining confidentiality and upholding the residents' right to privacy.
Choice A is incorrect because discussing a resident's information away from the facility does not guarantee confidentiality and can still risk unauthorized disclosure. Choice B is incorrect as bringing family and friends to the facility can compromise residents' privacy and confidentiality. Choice D is incorrect as posting updates about residents on social media violates their right to privacy and confidentiality.
RN exams clinical judgment practice questions, set 82 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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