NCLEX Practice Questions: Psychosocial Integrity June 13, 2015 By Rana Waqar Leave a Comment 1. The nurse cares for an elderly client who appears fully alert and oriented. As it gets later in the day, the nurse notices the client becoming increasingly confused and agitated. It would be MOST appropriate for the nurse to take which of the following actions?* 1. Reorient the client, and then turn on the lights and television to distract the client from his confusion. 2. Encourage the client’s alert roommate to talk with the client. 3. Tell the client he is at home in his own bed to get him to settle down and go to sleep. 4. Reorient the client, pull the shades down, shut the lights and television off, and promote a quiet environment. 2. On the evening shift, the nurse is caring for a client who will be undergoing a mastectomy in the morning. A call from the front desk alerts the nurse that the client’s family has arrived. It would be MOST appropriate for the nurse to take which of the following actions?* 1. Tell the family that they cannot come in because visiting hours are over. 2. Tell the client you want to make sure she has some alone time to relax. 3. Invite the family in to offer support after confirming with the client. 4. Tell the nursing assistive personnel (NAP) to sit with the client who needs company. 3. The nurse is caring for a young man who has expressed his desire to commit suicide. He has informed the nurse of plans to pursue this. The nurse requests a sitter to stay with the client around the clock, but the client says he does not want this. Which of the following is the MOST appropriate response by the nurse?* 1. The nurse allows the young man to refuse, because clients do have a right to refuse care. 2. The nurse implements the intervention, because protecting the client’s safety trumps the client’s right to refuse care. 3. The nurse checks on the client every hour to be sure he is safe. 4. The nurse asks the NAP to check on the client every 30 minutes to be sure he is safe. 4. A client is scheduled to have surgery the following day. The client tells the nurse, “I’m very scared. I have never had surgery before and am afraid that I might not make it through.” Which of the following responses by the nurse is the MOST appropriate?* 1. “Why do you feel this way?” 2. “Don’t worry, you will be fine.” 3. “Why don’t we take some time to explore why you feel this way?” 4. “It’s completely normal to be scared. You will be taken care of. Tell me how you are feeling.” 5. The nurse is working on a pediatric unit. The client is a 13-month-old child diagnosed with failure to thrive. The parents report that the child cries frequently, does not like to be held, and will not eat. The nurse learns that the child’s uncle lives in the house with the family. When the uncle visits in the hospital, the nurse notices the child acting differently and turning away from the uncle. Sometimes the child’s heart rate increases when the uncle is present. The nurse should take which of the following actions FIRST?* 1. Immediately report the possible situation of abuse to the authorities. 2. Call the physician, who will probably have more long-term knowledge. 3. Discuss it with other nurses to see which approaches they have taken. 4. Encourage the team that’s caring for the client to have a family meeting including the parents, but not the uncle, to gather more information. Δ
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