NURSING RN 101 NL Knowldg & Clinic Judgmt Advanced Rationales.
Test: Knowledge and Clinical Judgement
Advanced Test
Question: 1
A nurse is collecting data on a client who is diagnosed with schizophrenia and is
taking clozapine (Clozaril). Which of the following findings indicates the client is
experiencing an adverse effect of the medication?
Heart rate 64/min
In this item, you need nursing knowledge of clozapine to recall adverse effects
associated with the medication. Based on an understanding of this information, you
can identify which is the correct option. This item requires foundational thinking
because you have to recall knowledge related to adverse effects of clozapine. A
heart rate of 64/min does not indicate the client is experiencing an adverse effect of
the medication. Instead, tachycardia is an adverse effect that can occur in clients
who are taking clozapine because of the blockage of muscarinic cholinergic
receptors.
WBC 2,800/mm3
In this item, you need nursing knowledge of clozapine to recall adverse effects
associated with the medication. Based on an understanding of this information, you
can identify which is the correct option. This item requires foundational thinking
because you have to recall knowledge related to adverse effects of clozapine.
Clozapine is a second-generation antipsychotic used to relieve symptoms of
schizophrenia and to reduce suicidal behaviors in clients who have schizophrenia or
schizoaffective disorder. Adverse effects of clozapine include tachycardia, weight
gain, sedation, and agranulocytosis. Agranulocytosis, which is a decrease in one of
the WBCs called neutrophils, reduces the ability to fight infection and can be fatal.
Because of the potential for agranulocytosis, clients who are taking clozapine are
monitored frequently for a decrease in WBC count below 3,000/mm 3. The client’s
WBC and absolute neutrophil count is monitored weekly during the first 6 months of
therapy, then every 2 weeks during the next 6 months. A WBC level of
2,800/mm3 indicates the client is experiencing an adverse effect of the medication.
Weight loss
In this item, you need nursing knowledge of clozapine to recall adverse effects
associated with the medication. Based on an understanding of this information, you
can identify which is the correct option. This item requires foundational thinking
because you have to recall knowledge related to adverse effects of clozapine.
,Weight loss does not indicate the client is experiencing an adverse effect of the
medication. Instead, weight gain is an adverse effect that can occur in clients who
are taking clozapine because of the blockage of H1 histamine receptors.
Insomnia
In this item, you need nursing knowledge of clozapine to recall adverse effects
associated with the medication. Based on an understanding of this information, you
can identify which is the correct option. This item requires foundational thinking
because you have to recall knowledge related to adverse effects of clozapine.
Insomnia does not indicate the client is experiencing an adverse effect of the
medication. Instead, sedation is an adverse effect that can occur in clients who are
taking clozapine because of the blockage of H1 histamine receptors.
Question: 2
A nurse is caring for a client who weighs 132 lb and has been prescribed gentamicin
(Garamycin) 5mg/kg/day by IV bolus in three equal doses. Available on hand is 40
mg/mL that is to be added to 50 mL 0.9% sodium chloride. How many mL should
the nurse add to the solution per dose?
mL
In this item, you need knowledge of basic mathematic skills and the formula used
for this type of calculation. Based on your understanding of these concepts, you can
determine the milliliters of gentamicin that should be added to the 0.9% sodium
chloride solution. This item requires critical thinking because you have to analyze
the dose on hand, convert the patient’s weight to kilograms, and determine the
dosage. Then you have to select the formula, enter data into the formula, and
perform the needed calculations.
STEP 1: Determine the client’s weight in kg. 2.2 lb / x kg = weight in lb / 1 kg; 2.2
lb / x kg = 132 lb / 1 kg. Cross multiply and solve for x; 132 ÷ 2.2 = x; x = 60 kg.
STEP 2: Find total daily dose: Amount prescribed x kg weight (mg x kg) = total
daily dose; 5 mg x 60 kg = 300 mg. Because the medication was prescribed as
mg/kg/day, 300 mg is the total daily dose.
STEP 3: Find the amount per dose: Total daily dose / number of doses prescribed per
day = amount per dose; 300 mg / 3 doses = 100 mg. Because the medication is to
be administered in 3 equal doses, 100 mg is the amount per dose.
STEP 4: What is the dose needed? Dose needed = Desired; Desired = 100 mg
STEP 5: What is the dose available? Dose available = Have; Have = 40 mg
STEP 6: Do the units of measure need to be converted? No (mg = mg)
, STEP 7: What is the quantity of the dose available? Quantity = 1 mL
STEP 8: Set up an equation using knowledge about basic equivalents. Desired x
Quantity / Have = Amount to be given; 100 mg x 1 mL / 40 mg = x mL; x = 2.5
mL
STEP 9: Reassess to determine if the amount to be given makes sense. If there are
40 mg in 1 mL and the prescribed dose is 100 mg, it makes sense to add 2.5 mL to
the solution. The nurse should add 2.5 mL gentamicin/dose to the solution.
Question: 3
Tuberculin test
In this item, you need knowledge of the route of transmission and diagnostic criteria
of tuberculosis. Based on an understanding of these concepts, you can identify
the correct option. This item requires foundational thinking because you have to
recall knowledge of the appropriate diagnostic criteria for pulmonary tuberculosis. A
positive tuberculin test indicates the client has been exposed to tuberculosis and
has developed antibodies to the bacillus. While the tuberculin test is an effective
screening tool, it is not helpful in distinguishing between an active case of
tuberculosis and a client who was previously exposed to tuberculosis. This test does
not confirm active pulmonary tuberculosis.
Enzyme-linked immunoassay (ELISA) test
In this item, you need knowledge of the route of transmission and diagnostic criteria
of tuberculosis. Based on an understanding of these concepts, you can identify
the correct option. This item requires foundational thinking because you have to
recall knowledge of the appropriate diagnostic criteria for pulmonary tuberculosis.
The ELISA is a rapid test where an antibody or antigen is linked to an enzyme as a
means of detecting a match between the antibody and antigen, such as the ELISA
screening test performed to detect whether or not a client is HIV positive. There is
Test: Knowledge and Clinical Judgement
Advanced Test
Question: 1
A nurse is collecting data on a client who is diagnosed with schizophrenia and is
taking clozapine (Clozaril). Which of the following findings indicates the client is
experiencing an adverse effect of the medication?
Heart rate 64/min
In this item, you need nursing knowledge of clozapine to recall adverse effects
associated with the medication. Based on an understanding of this information, you
can identify which is the correct option. This item requires foundational thinking
because you have to recall knowledge related to adverse effects of clozapine. A
heart rate of 64/min does not indicate the client is experiencing an adverse effect of
the medication. Instead, tachycardia is an adverse effect that can occur in clients
who are taking clozapine because of the blockage of muscarinic cholinergic
receptors.
WBC 2,800/mm3
In this item, you need nursing knowledge of clozapine to recall adverse effects
associated with the medication. Based on an understanding of this information, you
can identify which is the correct option. This item requires foundational thinking
because you have to recall knowledge related to adverse effects of clozapine.
Clozapine is a second-generation antipsychotic used to relieve symptoms of
schizophrenia and to reduce suicidal behaviors in clients who have schizophrenia or
schizoaffective disorder. Adverse effects of clozapine include tachycardia, weight
gain, sedation, and agranulocytosis. Agranulocytosis, which is a decrease in one of
the WBCs called neutrophils, reduces the ability to fight infection and can be fatal.
Because of the potential for agranulocytosis, clients who are taking clozapine are
monitored frequently for a decrease in WBC count below 3,000/mm 3. The client’s
WBC and absolute neutrophil count is monitored weekly during the first 6 months of
therapy, then every 2 weeks during the next 6 months. A WBC level of
2,800/mm3 indicates the client is experiencing an adverse effect of the medication.
Weight loss
In this item, you need nursing knowledge of clozapine to recall adverse effects
associated with the medication. Based on an understanding of this information, you
can identify which is the correct option. This item requires foundational thinking
because you have to recall knowledge related to adverse effects of clozapine.
,Weight loss does not indicate the client is experiencing an adverse effect of the
medication. Instead, weight gain is an adverse effect that can occur in clients who
are taking clozapine because of the blockage of H1 histamine receptors.
Insomnia
In this item, you need nursing knowledge of clozapine to recall adverse effects
associated with the medication. Based on an understanding of this information, you
can identify which is the correct option. This item requires foundational thinking
because you have to recall knowledge related to adverse effects of clozapine.
Insomnia does not indicate the client is experiencing an adverse effect of the
medication. Instead, sedation is an adverse effect that can occur in clients who are
taking clozapine because of the blockage of H1 histamine receptors.
Question: 2
A nurse is caring for a client who weighs 132 lb and has been prescribed gentamicin
(Garamycin) 5mg/kg/day by IV bolus in three equal doses. Available on hand is 40
mg/mL that is to be added to 50 mL 0.9% sodium chloride. How many mL should
the nurse add to the solution per dose?
mL
In this item, you need knowledge of basic mathematic skills and the formula used
for this type of calculation. Based on your understanding of these concepts, you can
determine the milliliters of gentamicin that should be added to the 0.9% sodium
chloride solution. This item requires critical thinking because you have to analyze
the dose on hand, convert the patient’s weight to kilograms, and determine the
dosage. Then you have to select the formula, enter data into the formula, and
perform the needed calculations.
STEP 1: Determine the client’s weight in kg. 2.2 lb / x kg = weight in lb / 1 kg; 2.2
lb / x kg = 132 lb / 1 kg. Cross multiply and solve for x; 132 ÷ 2.2 = x; x = 60 kg.
STEP 2: Find total daily dose: Amount prescribed x kg weight (mg x kg) = total
daily dose; 5 mg x 60 kg = 300 mg. Because the medication was prescribed as
mg/kg/day, 300 mg is the total daily dose.
STEP 3: Find the amount per dose: Total daily dose / number of doses prescribed per
day = amount per dose; 300 mg / 3 doses = 100 mg. Because the medication is to
be administered in 3 equal doses, 100 mg is the amount per dose.
STEP 4: What is the dose needed? Dose needed = Desired; Desired = 100 mg
STEP 5: What is the dose available? Dose available = Have; Have = 40 mg
STEP 6: Do the units of measure need to be converted? No (mg = mg)
, STEP 7: What is the quantity of the dose available? Quantity = 1 mL
STEP 8: Set up an equation using knowledge about basic equivalents. Desired x
Quantity / Have = Amount to be given; 100 mg x 1 mL / 40 mg = x mL; x = 2.5
mL
STEP 9: Reassess to determine if the amount to be given makes sense. If there are
40 mg in 1 mL and the prescribed dose is 100 mg, it makes sense to add 2.5 mL to
the solution. The nurse should add 2.5 mL gentamicin/dose to the solution.
Question: 3
Tuberculin test
In this item, you need knowledge of the route of transmission and diagnostic criteria
of tuberculosis. Based on an understanding of these concepts, you can identify
the correct option. This item requires foundational thinking because you have to
recall knowledge of the appropriate diagnostic criteria for pulmonary tuberculosis. A
positive tuberculin test indicates the client has been exposed to tuberculosis and
has developed antibodies to the bacillus. While the tuberculin test is an effective
screening tool, it is not helpful in distinguishing between an active case of
tuberculosis and a client who was previously exposed to tuberculosis. This test does
not confirm active pulmonary tuberculosis.
Enzyme-linked immunoassay (ELISA) test
In this item, you need knowledge of the route of transmission and diagnostic criteria
of tuberculosis. Based on an understanding of these concepts, you can identify
the correct option. This item requires foundational thinking because you have to
recall knowledge of the appropriate diagnostic criteria for pulmonary tuberculosis.
The ELISA is a rapid test where an antibody or antigen is linked to an enzyme as a
means of detecting a match between the antibody and antigen, such as the ELISA
screening test performed to detect whether or not a client is HIV positive. There is
