RN exams clinical judgment practice questions, set 99
RN exams · clinical judgment
RN exams clinical judgment practice questionsset 99
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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 nurse is caring for an adolescent who has experienced abuse and neglect since early childhood. The nurse should understand that this is an example of which of the following types of trauma?
A. Vicarious trauma
B. Acute trauma
C. Chronic trauma
D. Historical trauma
Show answer and rationale
Correct answer: C — Chronic trauma
Step 1: Chronic trauma refers to repeated exposure to traumatic events over a prolonged period, such as ongoing abuse and neglect in this case.
Step 2: The adolescent has experienced abuse and neglect since early childhood, indicating a long-term and persistent traumatic experience.
Step 3: Vicarious trauma involves indirect exposure to trauma through witnessing or hearing about others' experiences.
Step 4: Acute trauma refers to a single traumatic event with immediate impact, not a prolonged pattern like chronic trauma.
Step 5: Historical trauma relates to collective trauma experienced by a group over generations, not an individual's ongoing abuse and neglect.
Summary: Choice C is correct because it best describes the repeated and prolonged nature of the adolescent's traumatic experiences, while the other choices do not align with the specific circumstances presented.
Question 2
A patient with diabetes should be advised to avoid which type of carbohydrate?
A. Simple carbohydrates
B. Complex carbohydrates
C. Fiber-rich carbohydrates
D. All carbohydrates
Show answer and rationale
Correct answer: A — Simple carbohydrates
The correct answer is A: Simple carbohydrates. Simple carbohydrates can cause rapid spikes in blood glucose levels, which can be problematic for patients with diabetes. These carbohydrates are quickly broken down and absorbed by the body, leading to sharp increases in blood sugar levels. In contrast, complex carbohydrates and fiber-rich carbohydrates are generally better choices for individuals with diabetes because they are digested more slowly, resulting in a more gradual rise in blood glucose levels. Choice B, complex carbohydrates, are a better option for diabetic patients compared to simple carbohydrates. Choice C, fiber-rich carbohydrates, can also be beneficial for individuals with diabetes as they help in regulating blood sugar levels. Choice D, all carbohydrates, is too broad of a statement as not all carbohydrates have the same impact on blood glucose levels.
Question 3
V. is a 75-year-old male patient who, during a recent wellness evaluation, was found to have a new onset grade IIVI crescendo-decrescendo cardiac murmur at the 2nd intercostal space, right sternal border. He is symptom free and reports no limitations to his usual daily activity. He specifically denies activity intolerance or near syncope, and he is very active physically. Echocardiography reveals a mild aortic calcification. The AGACNP knows that ongoing management for R. V. must include
A. Annual or biannual serial echocardiography
B. Modification of activity level
C. Baseline cardiac catheterization
D. Statin therapy
Show answer and rationale
Correct answer: C — Baseline cardiac catheterization
The correct answer is C: Baseline cardiac catheterization. Given the presence of a new onset grade IIVI crescendo-decrescendo cardiac murmur, a baseline cardiac catheterization is necessary to assess the severity and etiology of the murmur. This procedure will provide crucial information on the structure and function of the heart, helping to determine the appropriate management plan.
A: Annual or biannual serial echocardiography is not necessary as the patient is currently asymptomatic and echocardiography has already revealed mild aortic calcification.
B: Modification of activity level is not the immediate priority as the patient is very active physically and not reporting any limitations to daily activities.
D: Statin therapy is not indicated based solely on the presence of a new murmur without further assessment of cardiac function through cardiac catheterization.
Question 4
Jake is a 32-year-old patient who is recovering from major abdominal surgery and organ resection following a catastrophic motor vehicle accident. Due to the nature of his injuries, a large portion of his jejunum had to be resected. In planning for his recovery and nutritional needs, the AGACNP considers that
A. He will probably be able to transition to oral nutrition but will have lifetime issues with diarrhea
B. His procedure has put him at significant risk for B12 absorption problems
C. Most jejunum absorption functions will be assumed by the ileum
D. Enteral nutrition will need to be delayed for 3 to 6 months to facilitate adaptation
Show answer and rationale
Correct answer: B — His procedure has put him at significant risk for B12 absorption problems
The correct answer is B: His procedure has put him at significant risk for B12 absorption problems.
Rationale:
1. Jejunum is primarily responsible for nutrient absorption, including B12.
2. Resection of a large portion of the jejunum can lead to malabsorption of B12.
3. B12 is essential for neurological function and red blood cell production.
4. Patients with significant jejunum resection are at high risk for B12 deficiency.
5. Monitoring B12 levels and potentially requiring supplementation is crucial for patients like Jake.
Summary of other choices:
A: Incorrect. Lifetime issues with diarrhea are not necessarily expected following jejunum resection.
C: Incorrect. The ileum may assume some functions of the jejunum but cannot fully compensate.
D: Incorrect. Enteral nutrition should not be delayed for months as it is essential for Jake's recovery and nutritional needs.
Question 5
How long should clamping of the cord be delayed in an uncomplicated delivery to increase the newborn's hemoglobin levels and improve circulation?
A. 30–60 seconds
B. 15–30 seconds
C. 30 seconds
D. Delayed cord clamping is not recommended.
Show answer and rationale
Correct answer: A — 30–60 seconds
The correct answer is A (30-60 seconds) for delayed cord clamping in an uncomplicated delivery. Delaying cord clamping for 30-60 seconds allows more blood to flow from the placenta to the baby, increasing the baby's hemoglobin levels and improving circulation. This extra blood transfer can provide the baby with essential nutrients and oxygen, reducing the risk of anemia and improving overall health outcomes.
Choice B (15-30 seconds) may not provide enough time for sufficient blood transfer compared to the optimal window of 30-60 seconds.
Choice C (30 seconds) is within the recommended range, but 30-60 seconds is considered more beneficial for maximizing blood flow to the newborn.
Choice D (Delayed cord clamping is not recommended) is incorrect as delayed cord clamping has been shown to have various benefits for newborns when done in uncomplicated deliveries.
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Question 6
A patient diagnosed with Bells palsy is being cared for on an outpatient basis. During health education, the nurse should promote which of the following actions?
A. Applying a protective eye shield at night
B. Chewing on the affected side to prevent unilateral neglect
C. Avoiding the use of analgesics whenever possible
D. Avoiding brushing the teeth
Correct answer:
Rationale for Correct Answer A: Applying a protective eye shield at night is crucial for a patient with Bell's palsy to prevent corneal abrasions due to incomplete eyelid closure. This action helps protect the eye from dryness and injury, which can occur due to decreased blinking and moisture. It is essential to maintain eye health and prevent complications.
Summary of Incorrect Choices:
B: Chewing on the affected side does not prevent unilateral neglect in Bell's palsy. Instead, encouraging balanced chewing and facial exercises would be more beneficial.
C: Avoiding the use of analgesics is not necessary for Bell's palsy management unless contraindicated, as pain management may be required for associated symptoms.
D: Avoiding brushing the teeth is not recommended. Good oral hygiene is important for overall health, including maintaining oral health during Bell's palsy.
Laboratory studies indicate a client’s blood pressure level is 185mg/dl. Two hours have passed since the client ate breakfast. Which test would yield the most occlusive diagnostic information about the client’s glucose utilization?
A. A fasting blood glucose test
B. A test of serum glycosylated hemoglobin (HbA1c)
C. A 6-hour glucose tolerance test
D. A test for urine ketones
Correct answer:
The correct answer is C: A 6-hour glucose tolerance test. This test involves measuring blood glucose levels at specific intervals after consuming a glucose solution, providing a comprehensive assessment of glucose utilization over time. This test is particularly useful in evaluating how the body processes glucose after a meal and can help diagnose conditions such as diabetes.
A: A fasting blood glucose test would not provide a comprehensive picture of glucose utilization over time since it only measures glucose levels in a fasted state.
B: A test of serum glycosylated hemoglobin (HbA1c) reflects average blood glucose levels over the past 2-3 months but does not directly assess glucose utilization after a meal.
D: A test for urine ketones is used to detect ketones in the urine, which can indicate diabetic ketoacidosis but does not directly measure glucose utilization.
Jim is a 47-year-old man who is having difficulties with sexual function. He is recently separated from his wife of 20 years. He notes that he has early morning erections but otherwise cannot function. Which of the following is a likely cause for his problem?
A. Decreased testosterone levels
B. Psychological issues
C. Abnormal hypogastric arterial circulation
D. Impaired neural innervation
Correct answer:
Given the information provided about Jim's recent separation from his wife after a long marriage, coupled with the fact that he still experiences early morning erections, the likely cause for his sexual function difficulties is psychological issues. Separation, divorce, or relationship problems can have a significant impact on a person's sexual function due to emotional stress, anxiety, depression, or other mental health issues. In Jim's case, the presence of early morning erections suggests that there may not be a physiological issue like decreased testosterone levels, abnormal circulation, or impaired neural innervation. Instead, the situation seems more related to his emotional state and psychological well-being following the separation. It would be advisable for Jim to seek counseling or therapy to address these psychological factors affecting his sexual function.
When performing an initial pulmonary artery occlusion pr essure (PAOP), what are the best nursing actions? (Select all that apply.)
A. Inflate the balloon for no more than 8 to 10 seconds w hile noting the waveform change.
B. Inflate the balloon with air, recording the volume nece ssary to obtain a reading.
C. Maintain the balloon in the inflated position for 8 hours following insertion.
D. Zero reference and level the air-fluid interface of the tr ansducer at the level of the phlebostatic axis.
Correct answer:
The correct answer is A: Inflate the balloon for no more than 8 to 10 seconds while noting the waveform change. This is because inflating the balloon within this time frame allows for accurate measurement of PAOP without causing complications like pulmonary edema. Noting the waveform change helps in determining the accurate pressure reading.
Explanation of why other choices are incorrect:
B: Inflating the balloon with air and recording the volume necessary is not a recommended practice as it can lead to inaccurate readings and potential harm to the patient.
C: Maintaining the balloon inflated for 8 hours following insertion is unnecessary and could lead to complications such as vascular damage or thrombosis.
D: Zero referencing and leveling the transducer at the phlebostatic axis are important steps but not directly related to performing an initial PAOP measurement.
The nurse has decided to administer the Set Test to Mr. C., age 70 years. To administer this test the nurse needs to:
A. Ask him to name 10 each of fruits, animals, colours, and towns. The nurse will tell him she will be available to help if he gets stuck.
B. Ask him to name 10 items based on the categories in the acronym FACT. The nurse will tell him that he can do this without any hurry.
C. Ask him to name 10 items based on the categories in the acronym FACT. If he has difficulty doing this, the nurse may prompt his memory.
D. Ask him to name 10 items based on the categories in the acronym FACT. The nurse will tell him that this test is timed and he has only 2 minutes to complete it.
Correct answer:
The correct answer is B because the Set Test typically involves naming 10 items based on specific categories, such as those in the FACT acronym (Fruit, Animal, Color, and Town). The nurse should inform Mr. C. that he can complete the task without any hurry, which helps reduce stress and allows him to focus on recalling the items. This approach aligns with the standard administration procedure of the Set Test, promoting a relaxed and supportive environment for the patient.
Choice A is incorrect because the nurse should not offer direct assistance or mention availability to help unless Mr. C. explicitly requests it. Choice C is incorrect as prompting the patient's memory may interfere with the natural cognitive process being assessed. Choice D is incorrect because imposing a time limit can induce unnecessary pressure and potentially affect the accuracy of the results.
Nutrition is an integral part of the Bradley Method. What important nutrition advice is taught in this method?
A. Only eat low-fat foods.
B. Increase protein to 100 g per day.
C. Do not eat dairy because it causes food allergies.
D. Eat a low-protein diet.
Correct answer:
The correct answer is B because the Bradley Method emphasizes the importance of increasing protein intake to support a healthy pregnancy. Protein is essential for fetal development and maternal health. It is recommended to consume around 100g of protein per day during pregnancy. Adequate protein intake helps in the growth of the baby and helps to maintain the health of the mother.
Explanation of why the other choices are incorrect:
A: Only eat low-fat foods - This is incorrect as fat is also important for a healthy pregnancy and should not be eliminated entirely.
C: Do not eat dairy because it causes food allergies - Dairy is a good source of calcium and other essential nutrients during pregnancy, so this advice is not recommended.
D: Eat a low-protein diet - This is incorrect as protein is crucial for the development of the baby and overall health during pregnancy.
When the nurse observes a resident in a long-term facility pounding his fists on his legs and grinding his teeth, the nurse will validate her perception of the patient's nonverbal expression of anger by:
A. documenting that the patient was agitated and appeared angry.
B. asking the male nursing assistant if it is his perception that the patient appears angry.
C. accessing the nursing care plan to ascertain if there is a nursing diagnosis relative to anger.
D. sitting down near the patient and saying, "You seem upset…can I help?" All perceptions based on the observation of nonverbal behavior should be validated by consulting the patient.
Correct answer:
The correct answer is D because it demonstrates active listening and empathy towards the patient's nonverbal cues. By sitting down near the patient and acknowledging his emotions, the nurse opens up a channel for communication and offers support. This approach allows the patient to express his feelings and needs, leading to better understanding and potential resolution of the underlying issue.
Other choices are incorrect because:
A: Simply documenting the observation does not address the patient's emotional state or provide any opportunity for direct communication.
B: Asking another staff member for their perception does not involve the patient directly and may not accurately reflect the patient's emotions.
C: Referring to the care plan does not involve the patient in the process and may not address the immediate emotional needs expressed through nonverbal behavior.
During a preconception consultation, a patient asks about factors affecting egg quality. What should the nurse explain?
A. Age is the primary factor influencing egg quality.
B. Diet has no impact on egg quality.
C. Hormonal treatments guarantee improvement in egg quality.
D. Exercise is the only way to enhance egg quality.
Correct answer:
The correct answer is A: Age is the primary factor influencing egg quality. As a tutor, I will explain this by stating that the quality of a woman's eggs declines with age due to factors like genetic abnormalities and decreased mitochondrial function. This decline can affect fertility and increase the risk of chromosomal abnormalities in offspring.
For the incorrect choices:
B: Diet can impact egg quality by providing essential nutrients, so this choice is incorrect.
C: Hormonal treatments may help with fertility but do not guarantee improvement in egg quality, making this choice incorrect.
D: Exercise can contribute to overall health but is not the only way to enhance egg quality, making this choice incorrect.
In summary, age is a crucial factor affecting egg quality, while diet, hormonal treatments, and exercise play roles but are not primary influencers.
Antonio with lung cancer develops Horner's syndrome when the tumor invades the ribs and affects the sympathetic nerve ganglia. When assessing for signs and symptoms of this syndrome, the nurse should note:
A. miosis, partial eyelid ptosis, and anhidrosis on the affected side of the face.
B. chest pain, dyspnea, cough, weight loss, and fever.
C. arm and shoulder pain and atrophy of arm and hand muscles, both on the affected side.
D. hoarseness and dysphagia.
Correct answer:
The correct answer is A: miosis, partial eyelid ptosis, and anhidrosis on the affected side of the face. Horner's syndrome results from disruption of sympathetic nerve pathway, leading to these specific symptoms. Miosis (constricted pupil) occurs due to unopposed parasympathetic activity, partial eyelid ptosis (drooping eyelid) due to loss of sympathetic innervation to the eyelid muscle, and anhidrosis (lack of sweating) due to loss of sympathetic innervation to sweat glands. These symptoms are classic in Horner's syndrome.
Choice B is incorrect because the symptoms listed are more indicative of general symptoms of lung cancer rather than specific to Horner's syndrome. Choice C is incorrect as it describes symptoms related to brachial plexopathy, not Horner's syndrome. Choice D is incorrect as hoarseness and dysphagia are not typical symptoms of Horner's syndrome.
In a patient of diabetes mellitus maintained on insulin therapy, administration of the following drug can impair glycaemia control:
A. Prednisolone
B. Prazosin
C. Paracetamol
D. Phenytoin
Correct answer:
Step-by-step rationale for why choice A (Prednisolone) is correct:
1. Prednisolone is a corticosteroid that can cause hyperglycemia by increasing insulin resistance.
2. This drug can lead to elevated blood glucose levels and worsen glycemic control in diabetic patients.
3. Prednisolone can counteract the effects of insulin, making it difficult to maintain stable blood sugar levels.
4. Therefore, in a patient with diabetes mellitus on insulin therapy, the addition of prednisolone can impair glycemic control.
Summary of why the other choices are incorrect:
B: Prazosin is an alpha-blocker used to treat hypertension, it does not directly affect glycemia control.
C: Paracetamol is an analgesic with no direct impact on blood glucose levels.
D: Phenytoin is an antiepileptic drug that does not interfere with glycemic control in diabetes mellitus patients on insulin therapy.
RN exams clinical judgment practice questions, set 99 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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