RN exams clinical judgment practice questions, set 85
RN exams · clinical judgment
RN exams clinical judgment practice questionsset 85
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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 54-year-old man had been receiving carbamazepine since he was diagnosed with complex partial seizures 5 years earlier. The drug was fully effective in controlling the seizures. Blockade of which of the following molecular targets most likely mediated the therapeutic effect of the drug in the patient's disease?
A. Acetylcholine receptors
B. Glutamate receptors
C. Monoamine receptors
D. Na+ channels
Show answer and rationale
Correct answer: D — Na+ channels
The correct answer is D: Na+ channels. Carbamazepine is an antiepileptic drug that works by blocking voltage-gated sodium channels, thus reducing neuronal excitability and preventing the generation of abnormal electrical discharges that lead to seizures. This mechanism of action is particularly effective in controlling partial seizures.
A: Acetylcholine receptors - Carbamazepine does not directly interact with acetylcholine receptors.
B: Glutamate receptors - Carbamazepine does not directly interact with glutamate receptors.
C: Monoamine receptors - Carbamazepine does not directly interact with monoamine receptors.
In summary, the therapeutic effect of carbamazepine in controlling seizures is mediated by its blockade of Na+ channels, which reduces neuronal excitability. Other choices are incorrect as carbamazepine does not target acetylcholine, glutamate, or monoamine receptors.
Question 2
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
Show answer and rationale
Correct answer: C — Return charts to their proper place after use
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.
Question 3
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
Show answer and rationale
Correct answer: D — Fear of making a mistake
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.
Question 4
What is the most important nursing intervention for patien ts who receive neuromuscular blocking agents?
A. Administer sedatives in conjunction with the neuromu as bc iu rbl .a cor m b /tl eo sc t king agents.
B. Assess neurological status every 30 minutes.
C. Avoid interaction with the patient, because he or she won’t be able to hear.
D. Restrain the patient to avoid self-extubation.
Show answer and rationale
Correct answer: B — Assess neurological status every 30 minutes.
The correct answer is B: Assess neurological status every 30 minutes. This intervention is crucial for patients receiving neuromuscular blocking agents to monitor for any adverse effects such as respiratory depression or paralysis. Regular assessments help ensure early detection of complications and prompt intervention.
A: Administering sedatives in conjunction with neuromuscular blocking agents can potentiate respiratory depression and lead to respiratory compromise.
C: Avoiding interaction with the patient is not appropriate as communication and patient interaction are important aspects of nursing care.
D: Restraint should be avoided as it can increase the risk of complications such as pressure ulcers, anxiety, and decreased respiratory function.
Overall, regular neurological assessments are essential for ensuring patient safety and prompt intervention in case of any complications.
Question 5
Which nursing intervention should be prioritized for a client with congestive heart failure (CHF)?
A. Administer diuretics
B. Limit fluid intake
C. Promote activity
D. Maintain fluid balance
Show answer and rationale
Correct answer: C — Promote activity
Rationale for Correct Answer (C): Promoting activity is the most prioritized nursing intervention for a client with CHF. Activity helps improve cardiac function, decreases fluid accumulation, and enhances overall cardiovascular health. It also prevents complications like muscle weakness and deconditioning. It is crucial in managing CHF symptoms and improving the client's quality of life.
Summary of Incorrect Choices:
A: Administering diuretics helps in reducing fluid overload but does not address the underlying issue of improving cardiac function through physical activity.
B: Limiting fluid intake is important, but promoting activity takes precedence as it directly impacts cardiac function and fluid accumulation.
D: Maintaining fluid balance is necessary but is a broad concept that includes various interventions, with promoting activity being more focused and critical in CHF management.
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Question 6
During height and weight assessments at a school's health fair, a child admits to drinking a cup of coffee with his mother every morning, and another child reports enjoying a morning cup of coffee on the commute to school. These two children are both below average on the height chart, and the nurse states, "Drinking coffee stunts a child's growth." This logical fallacy is referred to as:
A. appeal to common practice.
B. confusing cause and effect.
C. ad hominem abusive.
D. red herring.
Correct answer:
The correct answer is B: confusing cause and effect. The nurse's statement implies that drinking coffee causes the children to be below average in height, which is a logical fallacy. Height is determined by genetics, nutrition, and overall health factors, not by drinking coffee. The nurse is mistakenly attributing the children's height to their coffee consumption without considering other relevant factors. This error in reasoning is known as confusing cause and effect.
A: Appeal to common practice is when an argument is justified based on the fact that many people do it, which is not relevant to the coffee consumption issue.
C: Ad hominem abusive is attacking the person making the argument rather than addressing the argument itself, which is not the case here.
D: Red herring is when irrelevant information is used to distract from the main issue, which is not the case in this scenario.
The United States ranks poorly in terms of worldwide infant mortality rates. Which factor has the greatest impact on decreasing the mortality rate of infants?
A. Providing more women’sN sheRlterIs G B.C M U S N T O
B. Ensuring early and adequate prenatal care
C. Resolving all language and cultural differences
D. Enrolling pregnant women in the Medicaid program by their eighth month of pregnancy
Correct answer:
The correct answer is B: Ensuring early and adequate prenatal care. Prenatal care plays a crucial role in monitoring the health of the mother and the developing fetus, detecting and managing any potential health issues early on, and providing essential education on nutrition and healthy practices. This ultimately leads to healthier pregnancies, reduced risks of complications, and improved outcomes for both the mother and the infant. Providing more women's shelters (A) may help address social issues but does not directly impact infant mortality rates. Resolving language and cultural differences (C) is important for effective healthcare delivery but is not the primary factor in reducing infant mortality. Enrolling pregnant women in Medicaid (D) is beneficial for access to healthcare but does not address the importance of early and adequate prenatal care in reducing infant mortality rates.
A patient with severe pain and leg swelling is admitted. What should the nurse assess for?
A. Check for signs of deep vein thrombosis.
B. Assess for compartment syndrome.
C. Increase the patient's fluid intake.
D. Prepare the patient for surgery to relieve pain.
Correct answer:
When a patient presents with severe pain and leg swelling, the nurse should assess for compartment syndrome. Compartment syndrome is a serious condition that can develop due to increased pressure within a muscle compartment, leading to compromised circulation and potential tissue damage. It is crucial to identify compartment syndrome promptly as it may require immediate intervention to prevent further complications. Checking for signs of deep vein thrombosis (Choice A) is also important in a patient with leg swelling, but in this scenario, the focus should be on assessing for compartment syndrome due to the severity of the symptoms. Increasing fluid intake (Choice C) may not address the underlying cause of the patient's symptoms. Preparing the patient for surgery (Choice D) without a comprehensive assessment and diagnosis is premature and may not be the appropriate initial intervention.
An infected client was on an airplane traveling home and it was shedding a virus that can directly
A. Which form of transmission is being described
B. Agent
C. Direct
D. Environment
Correct answer:
The correct answer is C: Direct. In this scenario, the virus is being transmitted directly from the infected client to others on the airplane without any intermediary. The term "direct transmission" refers to the immediate transfer of an infectious agent from an infected individual to a susceptible host. This aligns with the situation described in the question where the virus is being shed by the infected client and directly transmitted to others on the plane.
Choice A (Which form of transmission is being described) is incorrect as it does not provide a specific answer to the type of transmission discussed in the scenario. Choice B (Agent) is incorrect as it refers to the infectious microorganism itself rather than the mode of transmission. Choice D (Environment) is incorrect as it does not directly address the method of transmission from the infected client to others on the airplane.
The nurse is caring for a mechanically ventilated patient an d is charting outside the patient’s room when the ventilator alarm sounds. What is the priorit y order for the nurse to complete these actions? (Put a comma and space between each answer choice.)
A. Check quickly for possible causes of the alarm that can be fixed.
B. After troubleshooting, connect back to mechanical venti lator and reassess patient.
C. Go to patient’s bedside.
D. Manually ventilate the patient while getting respiratory therapist.
Correct answer:
Step-by-step rationale for why choice C is correct:
1. Going to the patient’s bedside is the priority as it allows the nurse to assess the patient's condition directly.
2. By being at the bedside, the nurse can quickly evaluate the patient's breathing, vital signs, and other indicators for immediate action.
3. Direct assessment enables timely intervention and avoids delays in addressing potential life-threatening situations.
4. Checking for possible causes of the alarm and reconnection to the ventilator can follow, but assessing the patient's immediate needs takes precedence.
In summary, choice C is correct because direct patient assessment is the fundamental step in responding to a ventilator alarm to ensure patient safety and timely intervention. Choices A, B, and D are incorrect as they focus on troubleshooting and technical aspects before directly assessing the patient's condition.
The nurse notes the presence of periorbital edema when performing eye assessment on a 70-year-old patient. The nurse will:
A. check for the presence of exophthalmos.
B. suspect that the patient has hyperthyroidism.
C. ask the patient if he or she has a history of heart failure.
D. assess for blepharitis because this is often associated with periorbital edema.
Correct answer:
The correct answer is B: suspect that the patient has hyperthyroidism. Periorbital edema is a common sign of hyperthyroidism due to the accumulation of fluid in the tissues around the eyes. By suspecting hyperthyroidism, the nurse can further assess for other associated symptoms and recommend appropriate diagnostic tests.
Choice A (check for the presence of exophthalmos) is incorrect because exophthalmos refers to bulging eyes, which may be present in hyperthyroidism but is not directly related to periorbital edema.
Choice C (ask the patient if he or she has a history of heart failure) is incorrect as periorbital edema is not typically associated with heart failure, which usually presents with generalized edema.
Choice D (assess for blepharitis) is incorrect because while blepharitis can cause eyelid inflammation, it is not typically associated with periorbital edema seen in hyper
When Reggie takes his baby son, Tyson, to his workplace for the first time, Reggie's assistant abruptly picks Tyson up and walks around the office. Tyson cries and reaches out for Reggie. Tyson is expressing __________.
A. sadness
B. stranger anxiety
C. separation anxiety
D. disgust
Correct answer:
Tyson is experiencing stranger anxiety in this situation. Stranger anxiety is a common response in infants when they are exposed to unfamiliar people, causing distress and prompting the infant to seek comfort and familiarity, usually from their primary caregiver. This aligns with Tyson crying and reaching out for Reggie, as he is showing signs of discomfort and wariness towards the assistant, who is a stranger to him. Choice A, sadness, does not fit the scenario as Tyson's reaction is more related to fear and discomfort rather than sorrow. Choice C, separation anxiety, is not the correct answer in this context as separation anxiety pertains to distress when separated from a primary caregiver, not when encountering unfamiliar individuals. Choice D, disgust, is also not applicable as Tyson's behavior is not based on revulsion but rather on being in an unfamiliar and distressing situation.
The United States ranks poorly in terms of worldwide infant mortality rates. Which factor has the greatest impact on decreasing the mortality rate of infants?
A. Providing more women’sN sheRlterIs G B.C M U S N T O
B. Ensuring early and adequate prenatal care
C. Resolving all language and cultural differences
D. Enrolling pregnant women in the Medicaid program by their eighth month of pregnancy
Correct answer:
The correct answer is B: Ensuring early and adequate prenatal care. Prenatal care plays a crucial role in monitoring the health of the mother and the developing fetus, detecting and managing any potential health issues early on, and providing essential education on nutrition and healthy practices. This ultimately leads to healthier pregnancies, reduced risks of complications, and improved outcomes for both the mother and the infant. Providing more women's shelters (A) may help address social issues but does not directly impact infant mortality rates. Resolving language and cultural differences (C) is important for effective healthcare delivery but is not the primary factor in reducing infant mortality. Enrolling pregnant women in Medicaid (D) is beneficial for access to healthcare but does not address the importance of early and adequate prenatal care in reducing infant mortality rates.
The nurse is admitting an oncology patient to the unit prior to surgery. The nurse reads in the electronic health record that the patient has just finished radiation therapy. With knowledge of the consequent health risks, the nurse should prioritize assessments related to what health problem?
A. Cognitive deficits
B. Impaired wound healing
C. Cardiac tamponade
D. Tumor lysis syndrome
Correct answer:
The correct answer is B: Impaired wound healing. Radiation therapy can lead to damage to the skin and blood vessels, affecting wound healing. The nurse should prioritize assessing the patient's skin integrity and any signs of impaired wound healing to prevent complications post-surgery.
A: Cognitive deficits - While radiation therapy can impact cognitive function in some cases, it is not the most immediate concern related to surgery post-radiation therapy.
C: Cardiac tamponade - Although radiation therapy can increase the risk of heart-related issues, such as pericarditis, cardiac tamponade is a rare and acute complication that is not the most likely immediate concern post-radiation therapy.
D: Tumor lysis syndrome - This syndrome is more commonly seen in patients undergoing chemotherapy rather than radiation therapy. It is not typically a concern immediately post-radiation therapy.
A patient with mastoiditis is admitted to the post-surgical unit after undergoing a radical mastoidectomy. The nurse should identify what priority of postoperative care?
A. Assessing for mouth droop and decreased lateral eye gaze
B. Assessing for increased middle ear pressure and perforated ear drum
C. Assessing for gradual onset of conductive hearing loss and nystagmus
D. Assessing for scar tissue and cerumen obstructing the auditory canal
Correct answer:
The correct answer is A: Assessing for mouth droop and decreased lateral eye gaze. After a radical mastoidectomy, the nurse should prioritize assessing for signs of facial nerve damage, such as mouth droop and decreased lateral eye gaze, which can indicate injury to the facial nerve during surgery. This is crucial as immediate intervention may be needed to prevent long-term complications.
Choices B, C, and D are incorrect:
B: Assessing for increased middle ear pressure and perforated ear drum is not the priority postoperative care for a radical mastoidectomy patient.
C: Assessing for gradual onset of conductive hearing loss and nystagmus is not the priority as these are not immediate concerns postoperatively.
D: Assessing for scar tissue and cerumen obstructing the auditory canal is not the priority as these are not immediate postoperative complications that require urgent attention.
RN exams clinical judgment practice questions, set 85 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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