the nurse is assessing several clients prior to surgery which factor in a clients history poses the greatest threat for complications to occur during
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Nursing Elites

NCLEX-RN

Psychosocial Integrity NCLEX RN Questions

1. The healthcare provider is assessing several clients before surgery. Which factor in a client's history poses the greatest threat for complications during surgery?

Correct answer: B

Rationale: The correct answer is taking anticoagulants for the past year. Anticoagulants increase the risk of bleeding during surgery, which can lead to complications. It is crucial for the healthcare provider to be aware of this medication. While clients taking birth control pills (option A) may be more prone to developing blood clots, these issues typically arise after surgery. Clients who recently completed antibiotic therapy (option C) or have taken laxatives PRN for the last 6 months (option D) are at lower risk compared to those taking anticoagulants (option B) during surgery.

2. During a routine assessment, an obese 50-year-old female client expresses concern about her sexual relationship with her husband. Which is the best response by the nurse?

Correct answer: D

Rationale: Option D is the best response as it allows the client to express her specific concerns, providing the nurse with valuable assessment data. This open-ended question encourages the client to share her worries and feelings, which can guide the nurse in addressing her unique needs. Options A and B make assumptions about the client's concerns based on her weight, potentially invalidating her feelings and inhibiting effective communication. Option C is premature as understanding the client's concerns should precede discussions about the frequency of sexual intercourse, which may not address the core issues the client is facing.

3. Which action often triggers an episode of violence or aggression in a patient with a psychiatric diagnosis involving violent behavior?

Correct answer: C

Rationale: Enforcing rules is often a trigger for patients with psychiatric diagnoses involving violent behavior. Limit-setting or denying patient demands can be perceived as control and intimidation, leading to aggressive responses. Nursing staff must respond calmly and professionally to prevent escalation. Avoiding such patients or matching their emotions can worsen the situation. Therefore, enforcing rules can provoke violent episodes in these patients.

4. Which of the following is a typical assessment finding of a 24-year-old female with anorexia nervosa?

Correct answer: D

Rationale: The correct answer is D: Lack of menstruation. Amenorrhea, or lack of menstruation, is a common occurrence in individuals with anorexia nervosa. The induced starvation from anorexia can disrupt hormone levels, leading to menstrual irregularities. This hormonal imbalance can result in amenorrhea, which can have long-term consequences such as osteoporosis and infertility. Choices A, B, and C are incorrect. Weight loss of more than 2% body fat may be a consequence of anorexia but is not a specific assessment finding. Frequent binge-eating episodes followed by induced vomiting are more characteristic of bulimia nervosa, not anorexia nervosa. A history of poor academic performance and mediocre achievements is not a typical assessment finding related to anorexia nervosa symptoms.

5. A client undergoing presurgical testing before a total abdominal hysterectomy says to the nurse, 'After I have this surgery I know my husband will never come near me again.' Which response would the nurse give?

Correct answer: D

Rationale: The correct response acknowledges the client's expressed concern about her husband's reaction to the surgery, encouraging further discussion without imposing the nurse's assumptions. Choice A reframes the client's concern to focus on the husband's response, aligning more closely with the client's stated worry. Choice B makes an assumption about the client's concerns regarding sexual relations, which may not be the primary focus of her statement. Choice C shifts the attention to how others perceive the client, deviating from the client's specific reference to her husband's reaction, thus not addressing the client's main concern.

Similar Questions

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A client who has multiple sclerosis is admitted to the hospital with increasingly frequent and severe exacerbations. One day, the client's partner confides to the nurse, 'Life is getting very hard and depressing, and I am upset with myself for thinking about a nursing home.' After listening to the partner's concerns, which response would the nurse make?
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