RN exams clinical judgment practice questions, set 89
RN exams · clinical judgment
RN exams clinical judgment practice questionsset 89
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 client with supraglottic cancer undergoes a partial laryngectomy. Postoperatively, a cuffed tracheostomy tube is in place. When removing secretions that pool above the cuff, the nurse should instruct the client to:
A. Cough as the cuff is being deflated
B. Take a deep breath as the nurse deflates the cuff
C. Hold the breath as the cuff is being re-inflated
D. Exhale deeply as the nurse re-inflates the cuff
Show answer and rationale
Correct answer: B — Take a deep breath as the nurse deflates the cuff
The correct answer is B: Take a deep breath as the nurse deflates the cuff. This is the correct choice because asking the client to take a deep breath while the cuff is deflated helps prevent aspiration of secretions into the lower airway. When the cuff is deflated, the tracheostomy tube provides a direct pathway for secretions to travel upwards, and taking a deep breath facilitates the movement of secretions out of the trachea.
Choice A (Cough as the cuff is being deflated) is incorrect because coughing while the cuff is being deflated can increase the risk of aspiration as secretions may be forced into the lower airway.
Choice C (Hold the breath as the cuff is being re-inflated) is incorrect as holding the breath while the cuff is being re-inflated can hinder the clearance of secretions from the trachea.
Choice D (Exhale deeply as the nurse re-inflates the cuff) is incorrect
Question 2
A patient is admitted for a hysterectomy, and the RN develops and implements the plan of care but also delegates to the LPN/LVN the responsibility of administering oral medications. While off duty, this RN receives a call requesting a change in the plan of care because the patient has developed deep vein thrombosis. The nurse who originally planned the care is practicing which type of nursing care delivery?
A. Modular
B. Primary
C. Team
D. Functional
Show answer and rationale
Correct answer: B — Primary
The correct answer is B: Primary nursing care delivery. In primary nursing, one nurse assumes 24-hour responsibility for planning, implementing, and evaluating the care of a patient. In this scenario, the RN developed and implemented the plan of care and delegated specific tasks to the LPN/LVN. The RN remains responsible for the overall care even while off duty, as evidenced by receiving a call regarding a change in the plan of care. The other choices are incorrect because:
A: Modular nursing involves a team of healthcare providers working together, sharing responsibilities, and providing care collectively.
C: Team nursing involves a team of healthcare providers with different levels of expertise working collaboratively to deliver patient care.
D: Functional nursing divides tasks among different team members based on their skill sets, which is not the case in the scenario provided.
Question 3
Which of the following is a care guideline for visual impairments?
A. Use the face of an imaginary clock to explain object positions.
B. Keep the room as dark as possible.
C. Walk behind the resident while touching his back.
D. Touch the resident before identifying yourself.
Show answer and rationale
Correct answer: A — Use the face of an imaginary clock to explain object positions.
The correct answer is A because using the face of an imaginary clock to explain object positions is a helpful technique for individuals with visual impairments to understand spatial relationships. This method is clear and easy to visualize, making it effective in communication. It promotes independence and enhances the person's understanding of their surroundings.
Explanation of why other choices are incorrect:
B: Keeping the room dark can further hinder the individual's ability to see and navigate their environment.
C: Walking behind the resident and touching their back can startle or make them uncomfortable. It's important to offer support from the side to maintain their sense of safety.
D: Touching the resident before identifying yourself can be alarming and invade their personal space. It's crucial to introduce yourself first to establish trust and ensure clear communication.
Question 4
A nurse is admitting a client who is at 35 weeks of gestation and is experiencing mild vaginal bleeding due to placenta previa. Which of the following actions should the nurse plan to take?
A. Initiate continuous monitoring of the FHR.
B. Administer a dose of betamethasone.
C. Check the cervix for dilation every 8 hr.
D. Request that the provider prescribe misoprostol PRN.
Show answer and rationale
Correct answer: A — Initiate continuous monitoring of the FHR.
In placenta previa, the placenta partially or completely covers the cervix, which can lead to vaginal bleeding. Continuous monitoring of the fetal heart rate (FHR) is crucial in this situation to assess the well-being of the fetus. Any signs of distress or changes in the FHR can indicate potential complications, such as fetal hypoxia. This monitoring allows for prompt intervention if necessary to ensure the safety of both the mother and the baby. Administering betamethasone may be indicated to promote fetal lung maturity in cases of anticipated preterm birth, but it is not the priority in this scenario where monitoring the fetal well-being is crucial. Checking the cervix for dilation every 8 hours is not necessary and may increase the risk of further bleeding. Misoprostol, a medication used to induce labor, is contraindicated in cases of placenta previa because it can cause further
Question 5
The nurse is caring for a patient has just been given a 6-month prognosis following a diagnosis of extensive stage small-cell lung cancer. The patient states that he would like to die at home, but the team believes that the patients care needs are unable to be met in a home environment. What might you suggest as an alternative?
A. Discuss a referral for rehabilitation hospital.
B. Panel the patient for a personal care home.
C. Discuss a referral for acute care.
D. Discuss a referral for hospice care.
Show answer and rationale
Correct answer: D — Discuss a referral for hospice care.
The correct answer is D: Discuss a referral for hospice care. Hospice care provides specialized care for patients with terminal illnesses, focusing on comfort and quality of life. This option aligns with the patient's wish to die at home and ensures his care needs are met. Hospice care also provides emotional and spiritual support for both the patient and family.
A: Discuss a referral for rehabilitation hospital - This option focuses on rehabilitation, which is not suitable for a patient with a terminal illness like extensive stage small-cell lung cancer.
B: Panel the patient for a personal care home - Personal care homes may not provide the level of specialized care needed for a terminally ill patient.
C: Discuss a referral for acute care - Acute care is more focused on treating acute illnesses and injuries, not providing end-of-life care for a patient with a terminal illness.
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Question 6
A student AGACNP just beginning his clinical rotation is observing his preceptor perform a physical survey on a patient who is brought in following a serious motor vehicle accident. The student observes that the physical examination includes rectovaginal examination, inspection of the urethral meatus, and palpation of the pelvic landmarks. The student knows the patient is being assessed for
A. Peritoneal bleeding
B. Retroperitoneal bleeding
C. Paresthesia
D. Pelvic fracture
Correct answer:
The correct answer is B: Retroperitoneal bleeding. The physical survey described focuses on assessing for internal bleeding within the retroperitoneal space following a serious motor vehicle accident. The rectovaginal examination, inspection of the urethral meatus, and palpation of pelvic landmarks help evaluate for signs of pelvic fracture and internal bleeding. These assessments help identify potential sources of retroperitoneal bleeding, which can be a life-threatening complication of trauma. Peritoneal bleeding (choice A) involves bleeding within the abdominal cavity, which is less likely in this scenario. Paresthesia (choice C) refers to abnormal sensations like tingling or numbness, which are not typically assessed through physical examination in this context. Pelvic fracture (choice D) is a possible outcome of trauma but does not directly assess for retroperitoneal bleeding.
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
Correct answer:
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.
An RN with a diploma preparation wants to participate in decisions about health care and decides the first step is to obtain a BSN. The nurse enrolls in a nursing program offering self-scheduling and a self-paced curriculum. This nurse is taking advantage of:
A. educational mobility.
B. a traditional nursing program.
C. training for advanced practice nursing.
D. credit by examination.
Correct answer:
Rationale for Correct Answer (A - educational mobility):
1. Educational mobility refers to the ability to move between different levels of education in nursing.
2. The nurse with a diploma seeking a BSN is utilizing educational mobility by advancing to a higher level of education.
3. Choosing a program with self-scheduling and a self-paced curriculum allows for flexibility, facilitating educational mobility.
Summary of Incorrect Choices:
B: Traditional nursing programs typically have fixed schedules and structured curricula, not aligned with self-paced learning.
C: Training for advanced practice nursing involves pursuing education beyond a BSN to become an advanced practice nurse, not directly related to obtaining a BSN.
D: Credit by examination allows students to earn credits based on prior knowledge, but it does not specifically relate to pursuing a BSN for educational mobility.
In assessing clients for pernicious anemia, the nurse should be alert for which of the following risk factors?
A. Positive family history
B. Infectious agents or toxins
C. Acute or chronic blood loss
D. Inadequate dietary intake
Correct answer:
The correct answer is A: Positive family history. Pernicious anemia is an autoimmune condition where the body attacks its own intrinsic factor, leading to vitamin B12 deficiency. Genetic predisposition plays a significant role in the development of pernicious anemia. Family history is a key risk factor as individuals with a family history of pernicious anemia are more likely to develop the condition.
Summary of why the other choices are incorrect:
B: Infectious agents or toxins do not directly cause pernicious anemia, although they can lead to other types of anemia.
C: Acute or chronic blood loss can result in iron-deficiency anemia, not pernicious anemia.
D: Inadequate dietary intake of vitamin B12 can lead to vitamin B12 deficiency anemia, but pernicious anemia specifically involves the body's inability to absorb B12 due to intrinsic factor deficiency, not dietary intake alone.
The nurse is auscultating the fetal heart rate (FHR) on a patient at 37 weeks’ gestation. The nurse notes a line of darkened pigmentation on the pregnant person’s abdomen starting at the symphysis pubis and ending at the sternum. How does the nurse document this finding?
A. cholasma
B. linea nigra
C. spider nevi
D. striae gravidarum
Correct answer:
The correct answer is B: linea nigra. The linea nigra is a darkened pigmented line that runs from the symphysis pubis to the sternum in pregnant individuals. This line is a normal finding in pregnancy due to hormonal changes. It is important for the nurse to document this finding accurately as it is a common physiological change.
Rationale:
1. Cholasma (A) is also known as the mask of pregnancy, presenting as dark patches on the face.
2. Spider nevi (C) are small, dilated blood vessels on the skin, not related to the linea nigra.
3. Striae gravidarum (D) are stretch marks that occur due to rapid stretching of the skin during pregnancy, not related to the pigmented line.
In summary, the correct answer is B because the darkened line described is characteristic of linea nigra, a common finding in pregnancy, while the other choices are unrelated to this specific observation.
B. The thickness of the cell layer helps in movement
C. The lining of the vessels inside help in movement
D. The contraction and relaxation of these cells result in movement
Correct answer:
Muscle cells, or fibers, enable movement through their ability to contract and relax, a process driven by actin and myosin interactions. In skeletal muscles, nervous system signals trigger contraction: myosin heads pull actin filaments, shortening the muscle and moving attached bones. Relaxation follows when signals cease, allowing fibers to lengthen, returning bones to rest. This applies to voluntary actions (skeletal muscle), heart pumping (cardiac), and organ functions (smooth muscle). Blood flow delivers oxygen and nutrients, supporting energy production, but doesn't directly cause movement. Cell layer thickness influences strength, not the mechanism. Vessel linings (endothelium) regulate flow, not muscle action. Contraction and relaxation are the core processes, fueled by ATP and coordinated by nerves, making them the fundamental drivers of bodily movement across muscle types.
A patient who has a history of chronic obstructive pulmonary disease (COPD) was hospitalized for increasing shortness of breath and chronic hypoxemia (SaO2 levels of 89% to 90%). In planning for discharge, which action by the nurse will be most effective in improving compliance with discharge teaching?
A. Have the patient repeat the instructions immediately after teaching.
B. Accomplish the patient teaching just before the scheduled discharge.
C. Arrange for the patient's caregiver to be present during the teaching.
D. Start giving the patient discharge teaching during the admission process.
Correct answer:
The correct answer is C: Arrange for the patient's caregiver to be present during the teaching.
Rationale:
1. Involving the patient's caregiver promotes better understanding and support for the patient's care at home.
2. Caregivers can assist in reinforcing teaching, ensuring the patient follows instructions.
3. Caregivers can help monitor the patient for any signs of worsening condition or noncompliance.
4. This approach is effective in addressing potential barriers to compliance and continuity of care.
Summary of other choices:
A: Having the patient repeat instructions may not guarantee understanding or retention of information.
B: Teaching just before discharge may not allow enough time for the patient and caregiver to fully grasp and prepare for home care.
D: Starting teaching during admission may overwhelm the patient and may not address the need for ongoing support at home.
Following treatment with a highly efficient anti-tuberculosis drug a 48-yearold female developed optic nerve neuritis, memory impairment, cramps. Which of these anti-TB drugs had the patient taken?
A. Isoniazid
B. PASA
C. Rifampicin
D. Ethambutol
Correct answer:
Step 1: The symptoms of optic nerve neuritis, memory impairment, and cramps are indicative of ethambutol toxicity.
Step 2: Ethambutol is known to cause optic nerve toxicity leading to neuritis, as well as CNS toxicity causing memory impairment.
Step 3: Ethambutol can also lead to peripheral neuropathy manifesting as cramps.
Step 4: Isoniazid is associated with peripheral neuropathy and hepatotoxicity but not with optic nerve neuritis or memory impairment.
Step 5: PASA is not commonly used for tuberculosis treatment and does not cause the described symptoms.
Step 6: Rifampicin is known for hepatotoxicity and flu-like symptoms, but not specifically for optic nerve neuritis, memory impairment, or cramps.
Summary: Ethambutol is the correct answer due to its known side effects of optic nerve toxicity, CNS toxicity, and peripheral neuropathy, which align with the presented symptoms. Ison
A nurse is admitting a client who is at 35 weeks of gestation and is experiencing mild vaginal bleeding due to placenta previa. Which of the following actions should the nurse plan to take?
A. Initiate continuous monitoring of the FHR.
B. Administer a dose of betamethasone.
C. Check the cervix for dilation every 8 hr.
D. Request that the provider prescribe misoprostol PRN.
Correct answer:
In placenta previa, the placenta partially or completely covers the cervix, which can lead to vaginal bleeding. Continuous monitoring of the fetal heart rate (FHR) is crucial in this situation to assess the well-being of the fetus. Any signs of distress or changes in the FHR can indicate potential complications, such as fetal hypoxia. This monitoring allows for prompt intervention if necessary to ensure the safety of both the mother and the baby. Administering betamethasone may be indicated to promote fetal lung maturity in cases of anticipated preterm birth, but it is not the priority in this scenario where monitoring the fetal well-being is crucial. Checking the cervix for dilation every 8 hours is not necessary and may increase the risk of further bleeding. Misoprostol, a medication used to induce labor, is contraindicated in cases of placenta previa because it can cause further
When reviewing the electronic health record of a female patient, the nurse reads that the patient has a history of adenomyosis. The nurse should be aware that this patient experiences symptoms resulting from what pathophysiologic process?
A. Loss of muscle tone in the vaginal wall
B. Excessive synthesis and release of unopposed estrogen
C. Invasion of the uterine wall by endometrial tissue
D. Proliferation of tumors in the uterine wall
Correct answer:
The correct answer is C: Invasion of the uterine wall by endometrial tissue. Adenomyosis is a condition where endometrial tissue grows into the muscular wall of the uterus, causing symptoms like heavy menstrual bleeding and severe cramping. This process results in inflammation, thickening of the uterine wall, and can lead to enlargement of the uterus.
Choice A: Loss of muscle tone in the vaginal wall is incorrect because adenomyosis does not involve the vaginal wall.
Choice B: Excessive synthesis and release of unopposed estrogen is incorrect because although estrogen can contribute to the growth of endometrial tissue, it is not the primary pathophysiologic process in adenomyosis.
Choice D: Proliferation of tumors in the uterine wall is incorrect because adenomyosis does not involve the growth of tumors, but rather the infiltration of endometrial tissue into the uterine muscle.
RN exams clinical judgment practice questions, set 89 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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