NCLEX-PN
Psychosocial Integrity Nclex PN Questions
1. Which statement reflects a primary belief of psychiatric mental health nursing?
- A. Most people have the potential to change and grow.
- B. Every person is worthy of dignity and respect.
- C. Human needs are individual to each person.
- D. Some behaviors have no meaning and cannot be understood.
Correct answer: B
Rationale: The correct answer reflects a primary belief of psychiatric mental health nursing, which is that every person is worthy of dignity and respect. This belief forms the foundation of providing holistic and compassionate care in mental health nursing. While it is true that most people have the potential to change and grow, this choice does not directly address a core belief of mental health nursing. Human needs being individual to each person is a general principle of nursing care but does not specifically capture a primary belief in psychiatric mental health nursing. The statement that some behaviors have no meaning and cannot be understood contradicts the fundamental principle that all behavior has meaning and can be understood from the client's perspective in psychiatric mental health nursing.
2. The nurse is making initial rounds on a client with a C5 fracture and crutch field tongs. Which equipment should be kept at the bedside?
- A. A pair of forceps
- B. A torque wrench
- C. A pair of wire cutters
- D. A screwdriver
Correct answer: B
Rationale: A torque wrench is essential equipment to keep at the bedside for a client with a C5 fracture and crutch field tongs. This tool is used to tighten and loosen the screws of the crutch field tongs, allowing the nurse to adjust the pressure on the screws for proper support and alignment. A pair of forceps (choice A), wire cutters (choice C), and a screwdriver (choice D) are not required for managing crutch field tongs and, therefore, are incorrect choices in this scenario.
3. In the context of milieu therapy, what is its primary purpose?
- A. exploring the client's perception of reality
- B. enhancing social interaction abilities
- C. addressing maladaptive behaviors
- D. providing routine daily experiences
Correct answer: D
Rationale: Milieu therapy aims to provide routine daily experiences to clients. By offering a structured and predictable environment, it helps individuals feel safe and secure, reducing disruptive behaviors. Exploring the client's perception of reality (choice A) may be part of therapy but not the primary focus. Enhancing social interaction abilities (choice B) and addressing maladaptive behaviors (choice C) are important aspects of therapy but not the primary purpose of milieu therapy.
4. A 50-milliliter (ml) bolus of normal saline fluid is ordered by the physician. The physician wants it to infuse in 30 minutes. The nurse should set the pump rate at:
- A. 100 ml per hour for one hour.
- B. 60 ml per hour for one-half hour
- C. 120 ml per hour for one hour.
- D. 50 ml per hour for one hour.
Correct answer: A
Rationale: To infuse a 50 ml bolus in 30 minutes, the rate should be calculated as follows: 50 ml / 30 min = 100 ml per hour. Therefore, the correct answer is to set the pump rate at 100 ml per hour for one hour. Choice A is the correct rate based on the calculation. Choices B, C, and D all provide incorrect rates that do not match the physician's order. Choice B would only deliver 30 ml in 30 minutes, not the ordered 50 ml. Choice C would deliver 120 ml in one hour, which is 20 ml more than ordered. Choice D would only provide 25 ml over 30 minutes, not the full 50 ml prescribed.
5. A teenage client is admitted to the hospital because of an acetaminophen (Tylenol) overdose. Overdoses of acetaminophen can precipitate life-threatening abnormalities in which of the following organs?
- A. lungs
- B. liver
- C. kidneys
- D. adrenal glands
Correct answer: B
Rationale: Acetaminophen is extensively metabolized in the liver. An acetaminophen overdose can lead to severe liver damage and even liver failure, which can be life-threatening. Choices A, C, and D are incorrect. Acetaminophen overdose does not typically cause life-threatening problems in the lungs, kidneys, or adrenal glands. While prolonged acetaminophen use may increase the risk of renal dysfunction, a single overdose primarily affects the liver.
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