RN exams clinical judgment practice questions, set 83
RN exams · clinical judgment
RN exams clinical judgment practice questionsset 83
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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
When the client is unable to make medical decisions for himself or herself, authorization that allows another person to make these decisions is called:
A. living will.
B. durable power of attorney.
C. informed consent.
D. immunity.
Show answer and rationale
Correct answer: B — durable power of attorney.
The correct answer is B: durable power of attorney. This legal document grants authority to another person, known as the healthcare proxy or agent, to make medical decisions on behalf of the client when they are unable to do so themselves. This is essential for ensuring that the client's wishes are respected and that appropriate medical care is provided.
A: A living will is a document that outlines a person's preferences for medical treatment in case they become incapacitated, but it does not appoint someone to make decisions on their behalf.
C: Informed consent is the process of ensuring that a patient understands the risks and benefits of a medical treatment before giving consent, but it does not authorize someone to make decisions on their behalf.
D: Immunity refers to protection from legal liability and is not relevant to authorizing someone to make medical decisions for a client.
Question 2
Following a kidney transplant, the nurse notes that a patient’s urine is cloudy. What should the nurse do about this finding?
A. Record the finding
B. Notify the physician
C. Irrigate the urinary catheter
D. Increase the intravenous flow rate Chapter 38 (Adult)
Show answer and rationale
Correct answer: A — Record the finding
Cloudy urine following a kidney transplant may be a common occurrence and could be due to various factors such as dehydration, medication side effects, or the presence of mucus, cells, or proteins in the urine. The nurse should first record the finding and then further assess the patient by checking for other signs and symptoms like pain, fever, or abnormal odors in the urine. If the cloudy urine is persistent or accompanied by other concerning symptoms, then the nurse should notify the physician for further evaluation. However, initially recording the finding allows for documentation and monitoring of the patient's condition, providing a baseline for further assessment and intervention if necessary. It is important to remember that cloudy urine alone may not always indicate a serious issue, but thorough assessment and documentation are essential steps in ensuring the patient's well-being.
Question 3
Which of the following was most likely one of the postreceptor mechanisms triggered by methadone?
A. Inhibition of the synthesis of inositol triphosphate/diacylglycerol (IP3/DAG)
B. Blockade of Ca2+ channels on presynaptic nerve terminals
C. Opening of Na+ channels on neuronal cell membrane
D. Stimulation of adenylyl cyclase activity
Show answer and rationale
Correct answer: D — Stimulation of adenylyl cyclase activity
The correct answer is D because methadone stimulates adenylyl cyclase activity as a postreceptor mechanism. Methadone is an opioid receptor agonist that activates G-protein coupled receptors, leading to the activation of adenylyl cyclase and subsequent increase in cAMP levels. This increased cAMP signaling pathway results in various downstream effects, including modulation of neurotransmitter release and neuronal excitability.
A: Inhibition of the synthesis of inositol triphosphate/diacylglycerol (IP3/DAG) is not a postreceptor mechanism triggered by methadone.
B: Blockade of Ca2+ channels on presynaptic nerve terminals is not a postreceptor mechanism triggered by methadone.
C: Opening of Na+ channels on neuronal cell membrane is not a postreceptor mechanism triggered by methadone.
In summary, methadone's stimulation of adenylyl cyclase activity is the correct choice as it align
Question 4
The nurse working in labor and delivery is reviewing messages to be returned to clients. Which statement made by the client alerts the nurse to call that client first?
A. I'm 32 weeks pregnant and taking calcium carbonate for my heartburn. Is there anything else I can take?
B. I'm 38 weeks pregnant and taking ibuprofen for my backache. Should I take aspirin too?
C. I'm 8 weeks pregnant and taking folic acid. Will it hurt me or the baby if I stop?
D. I checked my blood glucose with a friend's machine and it was 120 mg. I'm not diabetic. Is that normal?
Show answer and rationale
Correct answer: B — I'm 38 weeks pregnant and taking ibuprofen for my backache. Should I take aspirin too?
The correct answer is B because taking ibuprofen during pregnancy, especially in the third trimester like at 38 weeks, can pose risks to the baby. Ibuprofen is not recommended in late pregnancy as it can lead to complications such as premature closure of a crucial blood vessel in the baby's heart. Therefore, the nurse should call this client first to educate them on the risks and advise against taking aspirin along with ibuprofen.
A: Taking calcium carbonate for heartburn during pregnancy is generally safe, so there is no urgent need to call this client first.
C: Stopping folic acid at 8 weeks may not be ideal, but it is less urgent than the potential risks associated with ibuprofen in late pregnancy.
D: Blood glucose of 120 mg may be normal, and the client's non-diabetic status indicates less urgency compared to the potential harm from mixing ibuprofen and aspirin during late pregnancy.
Question 5
You are responding to a possible assault call. You choose to park down the block from the house, as police have not yet made the scene safe. However, you see what looks to be a patient in distress in the upper story window. What would be the safest approach in this situation?
A. Wait for responding police to control the situation and say that it is safe for EMS
B. Wait for police to arrive, then grab your gear and go in with police to treat the patient
C. Drive up to the driveway to get a better view of the patient's condition
D. Head into the house to treat the patient since he could be critically hurt
Show answer and rationale
Correct answer: A — Wait for responding police to control the situation and say that it is safe for EMS
The correct approach is A: Wait for responding police to control the situation and say that it is safe for EMS. This is the safest option because the scene has not been secured by law enforcement, and your safety is paramount. By waiting for the police to arrive and ensure the scene is safe, you are minimizing the risk of potential harm to yourself and allowing for a coordinated and controlled response. It is crucial to prioritize personal safety and follow established protocols in such high-risk situations.
Summary of other choices:
B: Waiting for police to arrive before entering is important, but going in with them could still expose you to unnecessary risk.
C: Driving up to the driveway without police presence could put you in harm's way and compromise scene safety.
D: Heading into the house without police clearance is extremely dangerous and could escalate the situation further.
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Question 6
The following measure can minimise pituitary-adrenal suppression during long-term corticosteroid therapy:
A. Use of betamethasone in place of prednisolone
B. Use of prednisolone on alternate days
C. Division of the daily dose in three equal 8hourly doses
D. Administration of the total daily dose at bed time
Correct answer:
The correct answer is C: Division of the daily dose in three equal 8-hourly doses. Dividing the daily dose helps maintain more stable blood levels of corticosteroids, reducing the risk of pituitary-adrenal suppression. By spreading the dose evenly throughout the day, the body is less likely to experience sudden peaks and troughs in cortisol levels. This approach mimics the body's natural cortisol production pattern, promoting a more balanced hormonal environment.
Explanation for other choices:
A: Using betamethasone instead of prednisolone does not address the issue of minimizing pituitary-adrenal suppression.
B: Using prednisolone on alternate days may lead to fluctuating cortisol levels, which can contribute to pituitary-adrenal suppression.
D: Administering the total daily dose at bedtime does not provide the consistent cortisol levels needed to minimize pituitary-adrenal suppression.
The nurse can best ensure that communication is understood by:
A. speaking slowly and clearly in the patient's native language.
B. asking the family members whether the patient understands.
C. obtaining feedback from the patient that indicates accurate comprehension.
D. checking for signs of hearing loss or aphasia before communicating. The best way to determine understanding is to ask the patient. Factors such as anxiety, hearing acuity, language, aphasia, or lack of familiarity with medical jargon or routines can all contribute to misunderstanding.
Correct answer:
The correct answer is C: obtaining feedback from the patient that indicates accurate comprehension. This is the best way to ensure effective communication because it directly involves the patient in the communication process, allowing for clarification if needed. By receiving feedback from the patient, the nurse can confirm whether the information has been understood correctly. This approach promotes active listening and engagement from the patient, enhancing the likelihood of accurate communication.
Incorrect choices:
A: Speaking slowly and clearly in the patient's native language may help, but it does not guarantee comprehension.
B: Asking family members may not accurately reflect the patient's understanding and could lead to miscommunication.
D: Checking for signs of hearing loss or aphasia is important, but it does not directly assess the patient's understanding of the communication.
A 55-yr-old patient with increasing dyspnea is being evaluated for a possible diagnosis of chronic obstructive pulmonary disease (COPD). When teaching a patient about pulmonary spirometry for this condition, what is the most important question the nurse should ask?
A. Are you claustrophobic?
B. Have you taken any bronchodilators today?
C. Have you had frequent streptococcal throat infections?
D. Do you use antihistamines for upper airway congestion?
Correct answer:
The correct answer is C: Have you had frequent streptococcal throat infections? This is the most important question to ask because repeated streptococcal throat infections can lead to bronchiectasis, which is a risk factor for COPD. Bronchiectasis causes permanent dilation of the bronchi, leading to airflow obstruction. It is crucial to assess this history as it can provide valuable information on the patient's risk for developing COPD.
A: Are you claustrophobic? - This question is not directly related to the assessment for COPD through pulmonary spirometry.
B: Have you taken any bronchodilators today? - While important for assessing current medication use, it is not as crucial as determining the history of streptococcal throat infections.
D: Do you use antihistamines for upper airway congestion? - Antihistamine use may not be directly linked to the risk factors for COPD development.
A nurse is caring for a patient who has a history of myocardial infarction. The nurse should prioritize which of the following assessments?
A. Blood pressure and heart rate.
B. Temperature and respiratory rate.
C. Bowel sounds and abdominal girth.
D. Urine output and skin integrity.
Correct answer:
The correct answer is A: Blood pressure and heart rate. This is crucial in assessing the cardiac function of a patient with a history of myocardial infarction. Monitoring blood pressure and heart rate helps in evaluating cardiovascular status and detecting any potential complications. Abnormal values in these parameters can indicate inadequate perfusion to the heart or other organs, which can be life-threatening.
Other choices are incorrect because:
B: Temperature and respiratory rate are important assessments but not the priority for a patient with a history of myocardial infarction.
C: Bowel sounds and abdominal girth are more relevant for gastrointestinal issues and not a priority in this scenario.
D: Urine output and skin integrity are important assessments for overall health but do not directly relate to the cardiovascular status in a patient with a history of myocardial infarction.
Warning signs that can assist the critical care nurse in reco gnizing that an ethical dilemma may exist include which of the following? (Select all that apply.)
A. Family members are confused about what is happening to the patient.
B. Family members are in conflict as to the best treatmen t options. They disagree with each other and cannot come to consensus.
C. The family asks that the patient not be told of treatmenatb iprbl.aconms./t est
D. The patient’s condition has changed dramatically for the worse and is not responding to conventional treatment.
Correct answer:
The correct answer is A because when family members are confused about the patient's condition or treatment, it can indicate a lack of communication or understanding, leading to a potential ethical dilemma. This confusion may result in conflicting views on what is best for the patient, potentially leading to disagreements and ethical conflicts.
Choice B is incorrect because although family conflict can lead to ethical dilemmas, it is not a direct warning sign that an ethical dilemma exists.
Choice C is incorrect because the family asking not to inform the patient about treatment is more related to communication preferences rather than a clear indication of an ethical dilemma.
Choice D is incorrect because a deteriorating patient condition, while concerning, does not directly signal an ethical dilemma unless there are specific ethical considerations involved in the treatment decisions.
What can the paramedic expect to find when evaluating the pupillary response of a patient suspected of suffering from herniation?
A. Bilateral pupil dilation
B. A unilaterally, unequal and non-reactive pupil
C. Bilaterally, unequal and non-responsive pupils
D. Sluggish response, but equal pupils
Correct answer:
The correct answer is A: Bilateral pupil dilation. When evaluating a patient suspected of suffering from herniation, the paramedic can expect to find bilateral pupil dilation due to increased intracranial pressure affecting the oculomotor nerve. This dilation is a result of the pressure compressing the nerve fibers, leading to loss of parasympathetic tone and unopposed sympathetic tone causing the pupils to dilate.
Choices B, C, and D are incorrect:
B: A unilaterally, unequal and non-reactive pupil - This is more indicative of a localized eye injury or nerve damage, not herniation.
C: Bilaterally, unequal and non-responsive pupils - This may indicate severe neurological damage or brainstem dysfunction, not specifically related to herniation.
D: Sluggish response, but equal pupils - This response is unlikely in cases of herniation where rapid changes in pupillary response are more common.
The patient is to receive multiple medications via the nasogastric tube. The nurse is concerned that the tube may become clogged. Which action isbestfor the nurseto take?
A. Instill nonliquid medications without diluting.
B. Irrigate the tube with 60 mL of water after all medications are given.
C. Mix all medications together to decrease the number of administrations.
D. Check with the pharmacy for availability of the liquid forms of medications.
Correct answer:
Rationale for Correct Answer (D): Checking with the pharmacy for availability of liquid forms of medications is the best action because it reduces the risk of clogging the nasogastric tube. Liquid medications are less likely to cause blockages compared to nonliquid medications. Additionally, liquid forms are easier to administer through the tube. By using liquid medications, the nurse can ensure that the medications flow smoothly through the tube without causing any obstructions.
Summary of Incorrect Choices:
A: Instilling nonliquid medications without diluting can increase the risk of tube clogging.
B: Irrigating the tube with water after all medications are given may not prevent clogging effectively and could introduce unnecessary moisture into the tube.
C: Mixing all medications together can lead to potential drug interactions and may not address the issue of tube clogging effectively.
What is the primary function of progesterone during pregnancy?
A. Stimulate uterine contractions
B. Support the development of the fetus
C. Maintain the uterine lining for implantation
D. Promote breast development
Correct answer:
The correct answer is C: Maintain the uterine lining for implantation. Progesterone plays a crucial role in preparing and maintaining the uterine lining to support the implantation and growth of the fertilized egg. This hormone helps create a suitable environment for the developing embryo by thickening the uterine lining and preventing its shedding.
Explanation for other choices:
A: Stimulate uterine contractions - This is incorrect as progesterone actually inhibits uterine contractions during pregnancy to prevent premature labor.
B: Support the development of the fetus - While progesterone indirectly supports fetal development by maintaining the uterine environment, its primary function is not directly related to fetal development.
D: Promote breast development - Progesterone does play a role in breast development during pregnancy, but its primary function is not focused on this aspect.
A nurse is assessing a laboring person and notes the presence of meconium-stained amniotic fluid. What is the priority nursing action?
A. prepare for an emergency cesarean section
B. document the amount of meconium
C. notify the healthcare provider
D. prepare the person for a blood transfusion
Correct answer:
The correct answer is D: prepare the person for a blood transfusion. Meconium-stained amniotic fluid indicates fetal distress, which can lead to hypoxia and potential blood loss in the laboring person. The priority action is to prepare for a potential blood transfusion to address any hemorrhage that may occur during delivery. This is crucial for ensuring the safety and well-being of both the laboring person and the baby.
Incorrect options:
A: Prepare for an emergency cesarean section - While meconium-stained amniotic fluid may indicate fetal distress, the priority is addressing potential maternal blood loss.
B: Document the amount of meconium - Documenting is important but not the priority when the person's health is at risk.
C: Notify the healthcare provider - While important, immediate action to address potential blood loss takes precedence over notifying the healthcare provider.
The main function of progesterone in the menstrual cycle is to CHAPTER 4: REPRODUCTION COMPILED BY: ZAIDI YAACOB UNAUTORIED DUPLICATION IS PROBIHITED, FOR THE CIRCULATION OF BIO095 STUDENTS ONLY
A. stimulate development of corpus luteum .
B. stimulate development of the follicl
C. maintain endometrium lining.
D. trigger ovulation.
Correct answer:
The correct answer is C because progesterone's main function in the menstrual cycle is to maintain the endometrium lining. Progesterone is produced by the corpus luteum after ovulation, and it helps prepare the endometrium for implantation of a fertilized egg. This hormone ensures that the endometrium is thick and ready to support a potential pregnancy.
Choice A is incorrect because progesterone is not responsible for stimulating the development of the corpus luteum; instead, it is produced by the corpus luteum itself.
Choice B is incorrect because progesterone does not stimulate the development of the follicle. The follicle is primarily influenced by estrogen during the follicular phase of the menstrual cycle.
Choice D is incorrect because ovulation is triggered by a surge in luteinizing hormone (LH), not progesterone. LH surge causes the release of the egg from the follicle.
RN exams clinical judgment practice questions, set 83 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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