Psychosocial Integrity NCLEX PN Questions

Psychosocial Integrity NCLEX PN Questions Related

Review Psychosocial Integrity NCLEX PN Questions related questions and content

What is the nurse's priority action when a client receiving a unit of packed red blood cells experiences tingling in the fingers and headache?

  • A. Call the health care provider (HCP).
  • B. Stop the transfusion.
  • C. Slow the infusion rate.
  • D. Assess the intravenous (IV) site for infiltration.
Correct Answer: B

Rationale: When a client receiving a packed red blood cell transfusion experiences tingling in the fingers and headache, these symptoms may indicate an adverse reaction to the transfusion. The nurse's priority action is to immediately stop the transfusion and initiate a normal saline infusion at a keep vein open (KVO) rate. This helps maintain the client's vein patency while addressing the adverse reactions. After stopping the transfusion and initiating the saline infusion, the nurse should assess the client, including vital signs evaluation. Subsequently, the healthcare provider should be notified. Calling the healthcare provider is important, but it should be done after the immediate action of stopping the transfusion. Slowing the infusion rate is not appropriate during a suspected transfusion reaction as it can exacerbate the adverse effects. Assessing the IV site for infiltration is a routine nursing intervention and is not the priority when managing a potential adverse reaction to a blood transfusion.

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A newly diagnosed client with human immunodeficiency virus (HIV) comments to the nurse, 'There are so many rotten people around. Why couldn't one of them get HIV instead of me?' Which statement is the nurse's best response?

  • A. 'I can understand why you are afraid of dying.'
  • B. 'It seems unfair that you contracted this disorder.'
  • C. 'Do you really wish this disorder on someone else?'
  • D. 'Have you thought of speaking with your religious adviser?'
Correct Answer: B

Rationale: The client is expressing feelings of unfairness and questioning why they have HIV. The nurse's best response is to acknowledge the client's emotions. Choice B, 'It seems unfair that you contracted this disorder,' reflects empathy and validates the client's feelings, which can help them move towards acceptance. Choice A, 'I can understand why you are afraid of dying,' introduces the topic of death, which may not be the primary concern at this stage. Choice C, 'Do you really wish this disorder on someone else?' is judgmental and could induce guilt in the client. Choice D, 'Have you thought of speaking with your religious adviser?' deflects the conversation and does not address the client's current emotional needs.

Under what patient conditions or situations are restraints sometimes used?

  • A. As punishment when the patient is uncontrollable
  • B. To prevent the patient from pulling their IV out
  • C. When a patient is a danger to self and others
  • D. Both B and C
Correct Answer: D

Rationale: Restraints are sometimes used to prevent a patient from pulling out their IV or another life-saving tube and when the person poses a serious danger to themselves and/or others. Restraints are never used as a form of punishment. Choice A is incorrect because restraints are not utilized for punishment but for patient safety and care. Choice B and C are correct because they reflect the appropriate and necessary situations where restraints may be used in healthcare settings.

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?

  • A. You're underestimating how your husband will respond to your surgery.
  • B. You're concerned about the effect on your sexual relations.
  • C. You're worried that the surgery will change how others see you.
  • D. You're concerned about how your husband will respond to your surgery.
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.

Which risk factor for suicide is considered the most lethal?

  • A. History of alcohol and drug abuse
  • B. Previous high-lethality suicide attempts
  • C. Recent withdrawal from friends
  • D. Disturbance of family dynamics
Correct Answer: B

Rationale: The correct answer is 'Previous high-lethality suicide attempts.' This is the most lethal risk factor as it indicates that the individual has previously attempted suicide in a manner that could lead to death. This history increases the likelihood of future attempts. While substance abuse, like alcohol and drug use, is a significant risk factor for suicide, it is not considered the most lethal. Withdrawal from friends or social isolation can contribute to suicide risk but is not as directly deadly as high-lethality attempts. Disturbance of family dynamics can also be a stressor but does not represent the immediate lethality associated with a history of high-lethality suicide attempts.

What behavior is expected of members of Alcoholics Anonymous (AA)?

  • A. Speaking at and participating in weekly meetings
  • B. Promising to attend at least 12 meetings yearly
  • C. Maintaining controlled drinking after 6 months
  • D. Acknowledging an inability to control the drinking
Correct Answer: D

Rationale: A fundamental aspect of Alcoholics Anonymous (AA) is the acceptance of one's inability to control their drinking behavior. This acknowledgment is crucial for individuals seeking recovery from alcohol abuse issues. While speaking at and participating in meetings is encouraged, it is not a strict requirement for AA members. Similarly, there is no specific mandate on the number of meetings to attend yearly, as long as the individual finds the support they need. Maintaining controlled drinking after 6 months is not aligned with AA principles, as the group emphasizes complete abstinence from alcohol to support long-term sobriety.

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