a 60 year old widower is hospitalized after complaining of difficulty sleeping extreme apprehension shortness of breath and a sense of impending doom

NCLEX-PN

Nclex Practice Questions 2024

1. A 60-year-old widower is hospitalized after complaining of difficulty sleeping, extreme apprehension, shortness of breath, and a sense of impending doom. What is the best response by the nurse?

A. "You have nothing to worry about. You are in a safe place. Try to relax."?
B. "Has anything happened recently or in the past that might have triggered these feelings?"?
C. "We have given you a medication that helps to decrease feelings of anxiety."?
D. "Take some deep breaths and try to calm down."?

Correct answer: B

Rationale: Choice B is the best response as it shows empathy, acknowledges the patient's feelings, and opens the door for discussion about potential triggers for anxiety. This approach helps the patient explore the root cause of his anxiety and provides an opportunity for therapeutic communication. Choice A dismisses the patient's feelings and offers false reassurance, which may not address the underlying issue. Choices C and D do not encourage the patient to express his emotions or delve into the reasons behind his anxiety, hindering the therapeutic process.

2. As a type of quality indicator, an example of a structure standard is:

A. a written philosophy.
B. a procedure for a straight catheterization.
C. a protocol for treatment of a client with chest pain.
D. the diagnostic work-up for a client with abdominal pain.

Correct answer: A

Rationale: The correct answer is 'a written philosophy.' Structure standards define the conditions needed to operate a system and do not directly involve client care. Examples include philosophy, objectives, goals, hours of operation, and management responsibility. Choices B, C, and D involve specific procedures and protocols related to client care, which are not structure standards.

3. A client can receive the mumps, measles, rubella (MMR) vaccine if he or she:

A. is pregnant.
B. is immunocompromised.
C. is allergic to neomycin.
D. has a cold.

Correct answer: D

Rationale: A client can receive the MMR vaccine if he or she has a cold. A simple cold without fever does not preclude vaccination. Pregnant women and immunocompromised individuals cannot receive the MMR vaccine due to the live rubella component, which may lead to birth defects or disease. Choice C is incorrect because individuals with anaphylactic reactions to neomycin should not receive the measles vaccine according to the American Academy of Pediatrics.

4. While admitting a client to an acute-care psychiatric unit, the nurse asks about substance abuse based on:

A. psychiatric disorders' higher prevalence in addicted populations
B. individuals with psychiatric disorders' increased susceptibility to substance abuse
C. the importance of detecting and diagnosing substance disorders in acute-care psychiatric settings
D. the significant impact of undetected substance problems on the treatment of psychiatric disorders

Correct answer: B

Rationale: The correct answer is 'individuals with psychiatric disorders' increased susceptibility to substance abuse.' It is crucial to inquire about substance abuse during admission to an acute-care psychiatric unit because individuals with psychiatric disorders are more prone to experiencing substance abuse issues. Addressing substance abuse is vital for effective treatment and to prevent relapse in psychiatric disorders. Option A is incorrect as it focuses on the prevalence of psychiatric illness in addicted populations rather than the relationship between psychiatric disorders and substance abuse. Option C is incorrect as it exaggerates the ease of detecting and diagnosing substance disorders in acute-care psychiatric settings. Option D is incorrect as undetected substance problems can indeed significantly impact the treatment of psychiatric disorders, but the main reason for inquiring about substance abuse is the increased susceptibility of individuals with psychiatric disorders to such issues.

5. A client has been taking alprazolam (Xanax) for four years to manage anxiety. The client reports taking 0.5 mg four times a day. Which statement indicates that the client understands the nurse's teaching about discontinuing the medication?

A. "I can drink alcohol now that I am decreasing my Xanax."?
B. "I should not take another Xanax pill. Here is what is left of my last prescription."?
C. "I should take three pills per day next week, then two pills for one week, then one pill for one week."?
D. "I can expect to be sleepy for several days after stopping the medicine."?

Correct answer: C

Rationale: The correct answer is that the client should take three pills per day next week, then two pills for one week, and then one pill for one week. This statement indicates a gradual tapering schedule, which is crucial when discontinuing alprazolam (Xanax) to prevent withdrawal symptoms. Choice A is incorrect because alcohol should be avoided while tapering off benzodiazepines due to the increased risk of respiratory depression. Choice B is incorrect because abruptly stopping alprazolam can lead to withdrawal symptoms. Choice D is incorrect because while drowsiness can be a side effect of alprazolam, it is not the primary concern when discontinuing the medication; preventing withdrawal symptoms is the priority.