NURSING 4590
Nursing Clinical
Judgement Practicum
Q & A w/ Rationales
2024
,1. A nurse is caring for a patient with chronic obstructive
pulmonary disease (COPD) who is experiencing an acute
exacerbation. The nurse notices that the patient's oxygen
saturation is 88% on room air. What is the most appropriate
action for the nurse to take?
a) Administer oxygen via nasal cannula at 2 L/min
b) Administer oxygen via non-rebreather mask at 15 L/min
c) Administer oxygen via simple face mask at 6 L/min
d) *Administer oxygen via venturi mask at 24%*
Rationale: The correct answer is d. A venturi mask delivers
a precise concentration of oxygen and is preferred for
patients with COPD who are at risk of carbon dioxide
retention. A nasal cannula, a non-rebreather mask, and a
simple face mask deliver variable concentrations of oxygen
and may cause oxygen toxicity or hypercapnia in patients
with COPD.
2. A nurse is conducting a health history interview with a
patient who has a history of hypertension, diabetes
mellitus, and hyperlipidemia. The nurse asks the patient
about his medication adherence and lifestyle modifications.
The patient states that he sometimes forgets to take his
medications and that he does not follow a specific diet or
exercise regimen. What is the best response by the nurse?
a) *"It is important to take your medications as prescribed
and to make some changes in your diet and physical
activity to prevent complications from your chronic
conditions."*
b) "You should not skip your medications or eat unhealthy
, foods because you are putting your health at risk."
c) "How do you feel about your current health status and
your ability to manage your chronic conditions?"
d) "What are some of the barriers that prevent you from
taking your medications and following a healthy lifestyle?"
Rationale: The correct answer is a. This response is
educational, supportive, and non-judgmental. It emphasizes
the benefits of medication adherence and lifestyle
modifications for the patient's health outcomes. Option b is
confrontational and may elicit defensiveness from the
patient. Option c is open-ended and may facilitate further
exploration of the patient's feelings, but it does not provide
any information or guidance. Option d is also open-ended
and may help identify some of the factors that affect the
patient's behavior, but it does not address the importance of
medication adherence and lifestyle modifications.
3. A nurse is preparing to administer an intramuscular
injection of vitamin B12 to a patient who has pernicious
anemia. The nurse selects a 25-gauge, 1-inch needle and a
3-mL syringe. The nurse locates the ventrogluteal site as
the injection site and cleanses the skin with an alcohol
swab. What is the next step for the nurse to perform?
a) Inject the medication slowly at a 90-degree angle
b) Aspirate for blood before injecting the medication
c) *Z-track the skin before injecting the medication*
d) Massage the injection site after injecting the medication
Rationale: The correct answer is c. Z-tracking is a
technique that prevents leakage of medication into the
subcutaneous tissue and reduces pain and irritation at the
Nursing Clinical
Judgement Practicum
Q & A w/ Rationales
2024
,1. A nurse is caring for a patient with chronic obstructive
pulmonary disease (COPD) who is experiencing an acute
exacerbation. The nurse notices that the patient's oxygen
saturation is 88% on room air. What is the most appropriate
action for the nurse to take?
a) Administer oxygen via nasal cannula at 2 L/min
b) Administer oxygen via non-rebreather mask at 15 L/min
c) Administer oxygen via simple face mask at 6 L/min
d) *Administer oxygen via venturi mask at 24%*
Rationale: The correct answer is d. A venturi mask delivers
a precise concentration of oxygen and is preferred for
patients with COPD who are at risk of carbon dioxide
retention. A nasal cannula, a non-rebreather mask, and a
simple face mask deliver variable concentrations of oxygen
and may cause oxygen toxicity or hypercapnia in patients
with COPD.
2. A nurse is conducting a health history interview with a
patient who has a history of hypertension, diabetes
mellitus, and hyperlipidemia. The nurse asks the patient
about his medication adherence and lifestyle modifications.
The patient states that he sometimes forgets to take his
medications and that he does not follow a specific diet or
exercise regimen. What is the best response by the nurse?
a) *"It is important to take your medications as prescribed
and to make some changes in your diet and physical
activity to prevent complications from your chronic
conditions."*
b) "You should not skip your medications or eat unhealthy
, foods because you are putting your health at risk."
c) "How do you feel about your current health status and
your ability to manage your chronic conditions?"
d) "What are some of the barriers that prevent you from
taking your medications and following a healthy lifestyle?"
Rationale: The correct answer is a. This response is
educational, supportive, and non-judgmental. It emphasizes
the benefits of medication adherence and lifestyle
modifications for the patient's health outcomes. Option b is
confrontational and may elicit defensiveness from the
patient. Option c is open-ended and may facilitate further
exploration of the patient's feelings, but it does not provide
any information or guidance. Option d is also open-ended
and may help identify some of the factors that affect the
patient's behavior, but it does not address the importance of
medication adherence and lifestyle modifications.
3. A nurse is preparing to administer an intramuscular
injection of vitamin B12 to a patient who has pernicious
anemia. The nurse selects a 25-gauge, 1-inch needle and a
3-mL syringe. The nurse locates the ventrogluteal site as
the injection site and cleanses the skin with an alcohol
swab. What is the next step for the nurse to perform?
a) Inject the medication slowly at a 90-degree angle
b) Aspirate for blood before injecting the medication
c) *Z-track the skin before injecting the medication*
d) Massage the injection site after injecting the medication
Rationale: The correct answer is c. Z-tracking is a
technique that prevents leakage of medication into the
subcutaneous tissue and reduces pain and irritation at the
