You practice vitals, infection control, documentation, and the first nursing action when a patient is unstable. 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 fundamentals questions with answers
Cover the key. Write the first action. Then open the rationale and name why the other choices fail.
Question 1
A 36-year-old female presents to the GP with painful hands which started two weeks ago. She describes the pain as constant but worst in the mornings where it takes an hour or so for her hands to loosen up and become fully functional. She has no significant past medical history and is functionally independent. On examination, there is erythema, swelling, and tenderness of the metacarpophalangeal joints on both hands. She is not able to make a tight fist due to the discomfort. On systemic examination, there is nothing else of note and vital signs are all within normal limits.
A. Gout
B. Rheumatoid arthritis
C. Osteoarthritis
D. Septic arthritis
Show answer and rationale
Correct answer: B — Rheumatoid arthritis
The correct answer is B: Rheumatoid arthritis. The key features suggesting rheumatoid arthritis in this case are the symmetrical involvement of the metacarpophalangeal joints, morning stiffness lasting more than an hour, and systemic symptoms such as erythema and swelling. Rheumatoid arthritis is an autoimmune condition that typically presents with these symptoms.
Choice A: Gout typically presents with sudden onset of severe pain, redness, and swelling in a single joint, commonly the big toe. It is unlikely in this case due to the symmetrical joint involvement.
Choice C: Osteoarthritis is characterized by joint pain that worsens with activity and improves with rest. It usually affects weight-bearing joints like the knees and hips, not typically presenting with the described symptoms in the hands.
Choice D: Septic arthritis often presents with acute joint pain, fever, and systemic symptoms. It is less likely in this case as the patient does not have signs of systemic infection.
Question 2
During a visit to the clinic, a patient states, 'The doctor just told me he thought I ought to stop smoking. He doesn't understand how hard I've tried. I just don't know the best way to do it. What should I do?' The nurse's most appropriate response in this case would be:
A. I'd quit if I were you. The doctor really knows what he is talking about.'
B. Would you like some information about the different ways a person can quit smoking?'
C. Stopping your dependence on cigarettes can be very difficult. I understand how you feel.'
D. Why are you confused? Didn't the doctor give you the information about the smoking cessation program we offer?'
Show answer and rationale
Correct answer: B — Would you like some information about the different ways a person can quit smoking?'
The correct answer is B: "Would you like some information about the different ways a person can quit smoking?"
Rationale:
1. Empathy: This response shows empathy by acknowledging the patient's struggle and offering support.
2. Patient-Centered Care: By asking if the patient would like information, the nurse involves the patient in decision-making.
3. Education: Providing information about quitting smoking empowers the patient to make an informed choice.
4. Non-judgmental: This response avoids judgment or pressure, which can help the patient feel more comfortable seeking help.
Summary of Incorrect Choices:
A: This response is directive and lacks empathy, potentially making the patient feel judged or pressured.
C: While empathetic, this response does not offer practical help or information to address the patient's concerns.
D: This response is confrontational and assumes the patient should already know about the smoking cessation program, which may come across as dismissive.
Question 3
A 40-year-old mother of two presents to your office for consultation. She is interested in knowing what her relative risks are for developing breast cancer. She is concerned because her sister had unilateral breast cancer 6 years ago at age 38. The patient reports on her history that she began having periods at age 11 and has been fairly regular ever since, except during her two pregnancies. Her first child arrived when she was 26 and her second at age 28. Otherwise she has had no health problems. Her father has high blood pressure. Her mother had unilateral breast cancer in her 70s. The patient denies tobacco, alcohol, or drug use. She is a family law attorney and is married. Her examination is essentially unremarkable. Which risk factor of her personal and family history most puts her in danger of getting breast cancer?
A. First-degree relative with premenopausal breast cancer
B. Age at menarche of less than 12
C. First live birth between the ages of 25 and 29
D. First-degree relative with postmenopausal breast cancer
Show answer and rationale
Correct answer: A — First-degree relative with premenopausal breast cancer
The correct answer is A: First-degree relative with premenopausal breast cancer. This is the most significant risk factor for the patient because her sister had unilateral breast cancer at a young age of 38, which indicates a potential genetic predisposition. Having a first-degree relative with premenopausal breast cancer significantly increases the patient's risk due to shared genetic factors.
The other choices are less significant:
B: Age at menarche of less than 12 is a risk factor, but not as significant as a family history of breast cancer.
C: First live birth between the ages of 25 and 29 is actually a protective factor against breast cancer, as early pregnancies can reduce the risk.
D: First-degree relative with postmenopausal breast cancer is a risk factor, but premenopausal breast cancer in a first-degree relative is a stronger indicator of genetic risk.
In summary, the patient's highest risk factor for developing breast cancer is having a first-degree relative with
Question 4
Which of the following is an appropriate nursing intervention for a client wearing anti-embolic stockings?
A. Measure the legs before applying stockings to assure proper fit
B. Applying the stockings while the client is sitting in a chair
C. Massage the legs when removing the stockings
D. Leave the stockings in place for one week intervals
Show answer and rationale
Correct answer: A — Measure the legs before applying stockings to assure proper fit
Correct Answer: A - Measure the legs before applying stockings to assure proper fit.
Rationale: Proper fit is crucial for the effectiveness of anti-embolic stockings. Measuring the legs ensures a snug but not too tight fit, promoting circulation without causing discomfort or complications. This step helps prevent skin breakdown, nerve compression, and circulation issues.
Summary of Incorrect Choices:
B: Applying the stockings while the client is sitting in a chair - This is incorrect as stockings should be applied when the client is lying down with legs elevated to reduce swelling and make application easier.
C: Massage the legs when removing the stockings - Massaging the legs can dislodge blood clots, which is dangerous for clients wearing anti-embolic stockings.
D: Leave the stockings in place for one week intervals - Stockings should be regularly removed and washed to maintain hygiene and prevent skin irritation or infections. Leaving them on for a week can lead to complications.
Question 5
In an interview, the nurse may find it necessary to take notes to aid his or her memory later. Which statement is true regarding note-taking?
A. Note-taking may impede the nurse's observation of the patient's nonverbal behaviors.
B. Note-taking allows the patient to continue at his or her own pace as the nurse records what is said.
C. Note-taking allows the nurse to shift attention away from the patient, resulting in an increased comfort level.
D. Note-taking allows the nurse to break eye contact with the patient, which may increase his or her level of comfort.
Show answer and rationale
Correct answer: A — Note-taking may impede the nurse's observation of the patient's nonverbal behaviors.
The correct answer is A. Note-taking may impede the nurse's observation of the patient's nonverbal behaviors because when the nurse is focused on writing notes, they may miss important nonverbal cues such as body language, facial expressions, and gestures. These nonverbal behaviors can provide valuable information about the patient's emotional state and overall well-being. By focusing on note-taking, the nurse may not fully engage in active listening or empathetic communication, which can hinder the therapeutic relationship.
Choices B, C, and D are incorrect because note-taking does not necessarily allow the patient to continue at their own pace, shift attention away from the patient, or break eye contact to increase comfort level. In fact, effective communication involves active listening, maintaining eye contact, and being fully present with the patient. Note-taking should be done discreetly and minimally to avoid disrupting the interaction and compromising the quality of care.
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Question 6
Which of the following are examples of breaches of patient confidentiality? Select all that apply.
A. A nurse discusses a patient with a coworker in the elevator.
B. A nurse shares her computer password with a relative of a patient.
C. A nurse checks the medical record of a patient to see who should be called in an emergency.
D. A nurse updates the employer of a patient regarding the patients return to work.
Correct answer:
Correct Answer: A
Rationale: Choice A is a breach of patient confidentiality because discussing patient information in a public area like an elevator violates the patient's right to privacy. Confidential patient information should only be discussed in private, secure locations to protect the patient's confidentiality.
Summary of other choices:
B: Sharing a computer password with a relative of a patient is a breach of security protocols but not necessarily a breach of patient confidentiality unless the password provides access to patient information.
C: Checking a patient's medical record for emergency contact information is not a breach of patient confidentiality as long as it is done for appropriate medical reasons and does not involve sharing the information with unauthorized individuals.
D: Updating an employer about a patient's return to work does not violate patient confidentiality if done with the patient's consent and does not disclose sensitive medical information.
The nurse is assessing a patient's skin during an office visit. What part of the hand and technique should be used to best assess the patient's skin temperature?
A. Fingertips; they are more sensitive to small changes in temperature.
B. Dorsal surface of the hand; the skin is thinner on this surface than on the palms.
C. Ulnar portion of the hand; increased blood supply in this area enhances temperature sensitivity.
D. Palmar surface of the hand; this surface is the most sensitive to temperature variations because of its increased nerve supply in this area.
Correct answer:
The correct answer is B: Dorsal surface of the hand; the skin is thinner on this surface than on the palms.
Rationale:
1. The dorsal surface of the hand has thinner skin compared to the thicker skin on the palmar surface, making it more sensitive to temperature changes.
2. Thinner skin allows for better detection of subtle temperature variations, making it ideal for accurately assessing the patient's skin temperature.
3. The fingertips (choice A) may be more sensitive to touch, but for temperature assessment, the dorsal surface is more reliable due to its thinner skin.
4. The ulnar portion of the hand (choice C) having increased blood supply does not necessarily enhance temperature sensitivity; it is more related to vascular function.
5. The palmar surface (choice D) may have increased nerve supply, but its thickness can dampen the sensitivity to detect subtle temperature changes.
In summary, the correct choice (B) is supported by the anatomical characteristics of the dorsal hand
Which of the following patients best fits the criteria for a critical burn?
A. A 10-year-old patient with superficial burns over 60% of the body
B. A 15-year-old patient with full-thickness burns on the left upper/lower arm, non-circumferential
C. A 60-year-old patient with partial-thickness burns across 25% of the body, not involving the hands, feet, face, or genitals
D. A 20-year-old patient with partial-thickness burns on 25% of the body, not including the hands, feet, face, or genitals
Correct answer:
The correct answer is A because a 10-year-old patient with superficial burns over 60% of the body is considered a critical burn due to the extent of body surface area involved and the age of the patient. Young children have less physiological reserve and are more prone to fluid loss and complications. Superficial burns over a large body surface area can lead to significant fluid loss, electrolyte imbalances, and potential systemic complications.
Choice B is incorrect as full-thickness burns are more severe than superficial burns, but the extent of burns on the left upper/lower arm is limited compared to Choice A.
Choice C is incorrect because although the patient has partial-thickness burns over 25% of the body, the age of the patient is not as critical as in Choice A.
Choice D is incorrect for the same reasons as Choice C; the extent of burns is similar but the age of the patient is different, and the patient's age is a crucial factor in determining the severity of burns.
In an interview, the nurse may find it necessary to take notes to aid his or her memory later. Which statement is true regarding note-taking?
A. Note-taking may impede the nurse's observation of the patient's nonverbal behaviors.
B. Note-taking allows the patient to continue at his or her own pace as the nurse records what is said.
C. Note-taking allows the nurse to shift attention away from the patient, resulting in an increased comfort level.
D. Note-taking allows the nurse to break eye contact with the patient, which may increase his or her level of comfort.
Correct answer:
The correct answer is A. Note-taking may impede the nurse's observation of the patient's nonverbal behaviors because when the nurse is focused on writing notes, they may miss important nonverbal cues such as body language, facial expressions, and gestures. These nonverbal behaviors can provide valuable information about the patient's emotional state and overall well-being. By focusing on note-taking, the nurse may not fully engage in active listening or empathetic communication, which can hinder the therapeutic relationship.
Choices B, C, and D are incorrect because note-taking does not necessarily allow the patient to continue at their own pace, shift attention away from the patient, or break eye contact to increase comfort level. In fact, effective communication involves active listening, maintaining eye contact, and being fully present with the patient. Note-taking should be done discreetly and minimally to avoid disrupting the interaction and compromising the quality of care.
A 36-year-old female presents to the GP with painful hands which started two weeks ago. She describes the pain as constant but worst in the mornings where it takes an hour or so for her hands to loosen up and become fully functional. She has no significant past medical history and is functionally independent. On examination, there is erythema, swelling, and tenderness of the metacarpophalangeal joints on both hands. She is not able to make a tight fist due to the discomfort. On systemic examination, there is nothing else of note and vital signs are all within normal limits.
A. Gout
B. Rheumatoid arthritis
C. Osteoarthritis
D. Septic arthritis
Correct answer:
The correct answer is B: Rheumatoid arthritis. The key features suggesting rheumatoid arthritis in this case are the symmetrical involvement of the metacarpophalangeal joints, morning stiffness lasting more than an hour, and systemic symptoms such as erythema and swelling. Rheumatoid arthritis is an autoimmune condition that typically presents with these symptoms.
Choice A: Gout typically presents with sudden onset of severe pain, redness, and swelling in a single joint, commonly the big toe. It is unlikely in this case due to the symmetrical joint involvement.
Choice C: Osteoarthritis is characterized by joint pain that worsens with activity and improves with rest. It usually affects weight-bearing joints like the knees and hips, not typically presenting with the described symptoms in the hands.
Choice D: Septic arthritis often presents with acute joint pain, fever, and systemic symptoms. It is less likely in this case as the patient does not have signs of systemic infection.
With auscultation she has distant air sounds and she has late inspiratory crackles in both lower lobes. On cardiac examination the S and S are distant and an S is heard over the apex. 1 2 3 What disorder of the chest best describes her symptoms?
A. Pneumonia
B. Chronic obstructive pulmonary disease (COPD)
C. Pleural pain
D. Left-sided heart failure
Correct answer:
The given symptoms of distant air sounds, late inspiratory crackles in both lower lobes, distant S1 and S2 heart sounds, and an S3 heart sound heard over the apex are all characteristic findings of left-sided heart failure. Distant air sounds and late inspiratory crackles indicate pulmonary congestion due to fluid accumulation in the lungs as a result of left-sided heart failure. The distant heart sounds and presence of an S3 are signs of left ventricular dysfunction. In contrast, pneumonia would typically present with more localized abnormal breath sounds and other symptoms such as fever and productive cough. Chronic obstructive pulmonary disease (COPD) would manifest with prolonged expiratory phase and wheezing, not late inspiratory crackles. Pleural pain is typically associated with sharp chest pain exacerbated by breathing movements, and it does not explain the constellation of symptoms described in this case. Therefore, the most likely diagnosis based on the provided symptoms
You are obtaining an arterial blood gas in the radial artery on a retired cab driver who has been hospitalized in the intensive care unit for a stroke. You are concerned about the possibility of arterial insufficiency. You perform the Allen test. This means that you:
A. Checked for patency of the radial artery
B. Checked for patency of the brachial artery
C. Checked for patency of the ulnar artery
D. Checked for patency of the femoral artery
Correct answer:
The correct answer is C: Checked for patency of the ulnar artery. The Allen test is used to assess the collateral circulation of the hand before arterial blood sampling from the radial artery. This involves occluding both the ulnar and radial arteries and then releasing pressure on the ulnar artery while observing the return of color to the hand. If the ulnar artery is patent, the hand should regain color within 5-10 seconds, indicating adequate collateral circulation. This is important to prevent ischemic complications.
Choice A (Checked for patency of the radial artery) is incorrect because the Allen test specifically evaluates the ulnar artery's patency, not the radial artery.
Choice B (Checked for patency of the brachial artery) is incorrect because the Allen test focuses on the collateral circulation in the hand, not the brachial artery.
Choice D (Checked for patency of the femoral artery) is incorrect because the Allen test is not used to assess the femoral artery
A 40-year-old mother of two presents to your office for consultation. She is interested in knowing what her relative risks are for developing breast cancer. She is concerned because her sister had unilateral breast cancer 6 years ago at age 38. The patient reports on her history that she began having periods at age 11 and has been fairly regular ever since, except during her two pregnancies. Her first child arrived when she was 26 and her second at age 28. Otherwise she has had no health problems. Her father has high blood pressure. Her mother had unilateral breast cancer in her 70s. The patient denies tobacco, alcohol, or drug use. She is a family law attorney and is married. Her examination is essentially unremarkable. Which risk factor of her personal and family history most puts her in danger of getting breast cancer?
A. First-degree relative with premenopausal breast cancer
B. Age at menarche of less than 12
C. First live birth between the ages of 25 and 29
D. First-degree relative with postmenopausal breast cancer
Correct answer:
The correct answer is A: First-degree relative with premenopausal breast cancer. This is the most significant risk factor for the patient because her sister had unilateral breast cancer at a young age of 38, which indicates a potential genetic predisposition. Having a first-degree relative with premenopausal breast cancer significantly increases the patient's risk due to shared genetic factors.
The other choices are less significant:
B: Age at menarche of less than 12 is a risk factor, but not as significant as a family history of breast cancer.
C: First live birth between the ages of 25 and 29 is actually a protective factor against breast cancer, as early pregnancies can reduce the risk.
D: First-degree relative with postmenopausal breast cancer is a risk factor, but premenopausal breast cancer in a first-degree relative is a stronger indicator of genetic risk.
In summary, the patient's highest risk factor for developing breast cancer is having a first-degree relative with
A 24-year-old man sustains multiple fractured ribs bilaterally as a result of being crushed in a press at a plywood factory. Examination in the ED reveals a flail segment of the patient's thorax. Primary resuscitation includes high-flow oxygen administration via a nonrebreathing mask
A. and initiation of Ringers lactate solution. The patient exhibits progressive confusion
B. cyanosis
C. and tachypne Management at this time should consist of:
D. Endotracheal intubation and mechanical ventilation.
Correct answer:
The correct answer is D: Endotracheal intubation and mechanical ventilation. In the case of a flail chest, where multiple ribs are fractured causing a segment of the chest wall to move independently from the rest of the thorax, the patient is at high risk of respiratory compromise. Endotracheal intubation and mechanical ventilation are necessary to ensure adequate oxygenation and ventilation, as the flail segment impairs the ability of the chest wall to expand effectively. High-flow oxygen via a nonrebreathing mask alone may not be sufficient to support the patient's respiratory needs. Choice A is incorrect because the patient's confusion is likely due to inadequate oxygenation and ventilation, not fluid resuscitation. Choice B is incorrect because cyanosis is a late sign of respiratory distress and should not be solely relied upon for management decisions. Choice C is incorrect as tachypnea is a compensatory mechanism and not a definitive management strategy for a flail chest.
You are on-scene with an adult patient who was found with an extremely altered level of consciousness, and a small amount of blood noted on his lips. There are no other obvious signs of trauma during the primary assessment other than a small tongue laceration. After ensuring an adequate airway, you discover the patient's small tongue laceration appears consistent with biting his tongue. He also has obviously swollen gums that do not appear to be caused by trauma. His vital signs are found to be within normal limits, and his pupils react to light, but his level of consciousness continues to be decreased to painful stimuli only. With the limited findings, which of the following conditions is most likely to cause the patient presentation?
A. A diabetic seizure most likely caused the patient's presentation
B. A metabolic coma is likely the cause of the patient's presentation
C. An epileptic seizure is likely responsible for causing the patient's condition
D. A cerebrovascular accident is likely the cause of the patient's condition
Correct answer:
The correct answer is C: An epileptic seizure is likely responsible for causing the patient's condition. The rationale for this is as follows:
1. Tongue biting is a common occurrence during seizures, which is consistent with the small tongue laceration observed in the patient.
2. Swollen gums that are not caused by trauma can be a sign of oral injury during a seizure due to forceful clenching of the jaw.
3. The patient's decreased level of consciousness to painful stimuli is typical after a seizure, known as the postictal state.
4. Normal vital signs and reactive pupils suggest no immediate life-threatening emergency like a diabetic seizure, metabolic coma, or cerebrovascular accident.
Summary:
A: A diabetic seizure is unlikely due to the absence of associated signs such as altered blood sugar levels or diabetic history.
B: A metabolic coma is unlikely as vital signs are normal, and the presentation is more indicative of a seizure.
D: A cerebrovascular accident is unlikely as
RN exams fundamentals practice questions, set 9 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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