NCLEX-RN
Psychosocial Integrity NCLEX Questions Quizlet
1. Which of the following is an age-related developmental task for a 68-year-old client?
- A. Dealing with loss of friends
- B. Commitment to parenthood
- C. Setting career goals
- D. Solidification of sense of self
Correct answer: A
Rationale: As individuals age, they face various developmental tasks unique to that stage of life. For a 68-year-old client, dealing with the loss of friends becomes a significant aspect of their development. This age group often experiences the passing of peers and friends, leading to feelings of loneliness and the need to adjust to a changing social circle. Commitment to parenthood (Choice B) is more relevant to younger adults in their child-rearing years. Setting career goals (Choice C) is typically associated with early to mid-career stages rather than later in life. Solidification of sense of self (Choice D) is a task that is more commonly associated with earlier adulthood when individuals are establishing their identity. Therefore, the most appropriate developmental task for a 68-year-old client is dealing with the loss of friends.
2. Why might a nurse manager suggest avoiding therapeutic group work for a client with schizophrenia who has paranoid delusions?
- A. Individuals with this disorder respond well to small therapeutic groups.
- B. Therapeutic group work tends to be threatening to individuals who are suspicious.
- C. Compliance with unit rules and medication regimens increases as therapeutic group involvement increases.
- D. Involvement in small therapeutic groups may decrease the regression and dependency associated with institutionalization.
Correct answer: B
Rationale: The nurse manager would suggest avoiding therapeutic group work for a client with schizophrenia who has paranoid delusions because individuals who are suspicious find group settings threatening. Paranoid individuals struggle in groups as they may not trust others enough to engage effectively and tolerate the necessary interactions for group therapy. Therefore, the correct answer is that therapeutic group work tends to be threatening to individuals who are suspicious. Choices A, C, and D are incorrect. While some individuals with schizophrenia may respond well to small therapeutic groups, those with paranoid delusions may find them threatening. Compliance with unit rules and medication regimens may not necessarily increase with group therapy, especially for acutely ill psychiatric clients not ready to accept reality. Involvement in small therapeutic groups is not primarily aimed at decreasing regression and dependency associated with institutionalization, making it an inappropriate option for the client's specific needs.
3. The nurse selects the best site for insertion of an IV catheter in the client's right arm. Which documentation should the nurse use to identify the placement of the IV access?
- A. Left brachial vein
- B. Right cephalic vein
- C. Dorsal side of the right wrist
- D. Right upper extremity
Correct answer: B
Rationale: The correct answer is the right cephalic vein. The cephalic vein is a large and superficial vein commonly used for IV access. Documenting the specific anatomic name of the vein used for IV access, such as the cephalic vein, is essential for accurate medical records. Option A, the left brachial vein, is incorrect as the brachial vein is too deep to be accessed for IV infusion. Option C, the dorsal side of the right wrist, is not a recommended IV access site due to fragile veins and potential pain for the patient. Option D, right upper extremity, is too broad and lacks the specificity necessary for precise documentation of the IV access site.
4. After being medicated for anxiety, the client says to the nurse, 'I guess you are too busy to stay with me.' Which response by the nurse is correct?
- A. I'm so sorry, but I need to see other clients.'
- B. 'I have to go now, but I will come back in 10 minutes.'
- C. You'll be able to rest after the medicine starts working.'
- D. You'll feel better after I've made you more comfortable.'
Correct answer: B
Rationale: The nurse should respond with empathy and reassurance to address the client's emotional needs. The correct response, 'I have to go now, but I will come back in 10 minutes,' acknowledges the client's feelings while providing a timeframe for the nurse's return, showing care and concern. Choice A, 'I'm so sorry, but I need to see other clients,' prioritizes other tasks over the client's emotional needs, which can increase anxiety. Choice C, 'You'll be able to rest after the medicine starts working,' offers false reassurance and does not address the client's immediate emotional distress. Choice D, 'You'll feel better after I've made you more comfortable,' does not acknowledge the client's concerns and fails to establish a supportive connection with the client.
5. 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.
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