NCLEX-RN
NCLEX Psychosocial Integrity Questions
1.
- A. Anger
- B. Denial
- C. Bargaining
- D. Acceptance
Correct answer: C
Rationale:
2. A male client is laughing at a television program with his wife when the evening nurse enters the room. He says his foot is hurting and he would like a pain pill. How should the nurse respond?
- A. Ask him to rate his pain on a scale of 1 to 10.
- B. Encourage him to wait until bedtime so the pill can help him sleep.
- C. Attend to the acutely ill client's needs first because this client is laughing.
- D. Instruct him in the use of deep breathing exercises for pain control.
Correct answer: A
Rationale: Obtaining a subjective estimate of the pain experience by asking the client to rate his pain helps the nurse determine which pain medication should be administered and also provides a baseline for evaluating the effectiveness of the medication. Medicating for pain should not be delayed to use it as a sleep medication, so encouraging him to wait until bedtime is incorrect. Option C is judgmental and inappropriate as all clients deserve prompt attention. Option D should be used as an adjunct to pain medication, not instead of medication, so instructing him in deep breathing exercises alone is not the priority in this situation.
3. Which is the most appropriate nursing intervention when providing care for parents who have experienced a stillbirth?
- A. Giving a detailed explanation of possible causes of the stillbirth
- B. Providing the parents the opportunity to say goodbye to their newborn
- C. Explaining that an autopsy is not recommended in the setting of a stillbirth
- D. Arranging follow-up care and providing information to the parents before they leave the hospital
Correct answer: B
Rationale: The most appropriate nursing intervention when caring for parents who have experienced a stillbirth is to provide them with the opportunity to say goodbye to their newborn. This helps in the grieving process and allows the parents closure. Giving a detailed explanation of possible causes of the stillbirth may overwhelm the parents and is not the immediate priority. While an autopsy can be performed in the case of a stillbirth, the decision should be discussed with the parents and their wishes respected. Arranging follow-up care and providing information before the parents leave the hospital is crucial in ensuring they have the necessary support and resources to cope with the loss effectively.
4. During a discussion about glaucoma at the community center, which comment by one of the retirees would the nurse give a supportive comment to reinforce correct information?
- A. ''I usually avoid driving at night since lights sometimes seem to make things blur.''
- B. ''I take half of the usual dose for my sinuses to maintain my blood pressure.''
- C. ''I have to sit at the side of the pool with the grandchildren since I can't swim with this eye problem.''
- D. ''I take extra fiber and drink lots of water to avoid getting constipated.''
Correct answer: D
Rationale: The correct answer is ''I take extra fiber and drink lots of water to avoid getting constipated.'' In individuals with glaucoma, activities that involve straining, such as constipation, should be avoided as they can increase intraocular pressure. Choices A, B, and C are incorrect as they do not align with the management of glaucoma. Driving at night or taking sinus medication are not directly related to glaucoma, and sitting by the pool due to an eye problem does not provide information relevant to managing glaucoma.
5. Which action should the nurse implement when providing wound care instructions to a client who does not speak English?
- A. Ask an interpreter to provide wound care instructions.
- B. Speak directly to the client, with an interpreter translating.
- C. Request the accompanying family member to translate.
- D. Instruct a bilingual employee to read the instructions.
Correct answer: B
Rationale: When providing wound care instructions to a client who does not speak English, the nurse should speak directly to the client with the assistance of an interpreter for accurate translation. The interpreter is trained to provide objective translations in the client's primary language, ensuring the client understands the instructions and can ask questions. Using family members for translation is discouraged as they may alter instructions or feel uncomfortable discussing certain topics. Instructing a bilingual employee to read the instructions is not ideal as they may lack the necessary training in accurate interpretation, which could lead to misunderstandings in crucial wound care instructions.
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