NCLEX NCLEX Certifications NCLEX-PN Questions & Answers

• Question 861:

  After group therapy, the female victim of intimate partner violence confides to the nurse that she does not feel in any immediate danger.

  Which of the following statements about victims of domestic violence is true?

  A. Victims of domestic violence are often the best predictors of their risk of harm.

  B. Victims of domestic violence often overestimate their safety risk.

  C. Victims of domestic violence are typically in a state of denial.

  D. Victims of domestic violence know that keeping peace with their partner is the best method of preventing another attack.

  Correct Answer: A

  Victims of domestic violence are often correct at predicting their risk of harm. However, the nurse should

  ensure that the client is expressing herself authentically and is not trying to convince the nurse that there is

  no immediate danger.

  Further, proper authorities, such as the police, should be alerted to this reportable offense.

• Question 862:

  A client who recently lost 50 pounds just received news that she is pregnant.

  A possible nursing diagnosis is __________.

  A. Actual Chronic Low Self-Esteem (related to obesity)

  B. Potential Chronic Low Self-Esteem (related to obesity)

  C. Actual Situational Low Self-Esteem (related to fear of weight regain and pregnancy)

  D. Potential Situational Low Self-Esteem (related to fear of weight regain and pregnancy)

  Correct Answer: D

  If there are indications of a body image disturbance, the nursing care plan should include body

  disturbances, related to a functional or physical problem.

  The disturbance might be an anticipated one ?that is, weight gain and pregnancy.

  Stressors can include a change in physical appearance, sexuality concerns, or an unrealistic ideal self.

• Question 863:

  A successful resolution of the nursing diagnosis Negative Self-Concept (related to unrealistic self-expectations) is when the client can __________.

  A. report a positive self-concept

  B. identify negative thoughts

  C. recognize positive thoughts

  D. give one positive cue with each negative cue

  Correct Answer: A

  The problem statement is Negative Self Concept. A successful resolution of the problem is when the client can report a positive self-concept. When the nurse determines how the client perceives himself, effort should be directed to reinforce self-worth and promote a positive self-concept, including helping a client to identify areas of strength. Assisting the client to evaluate himself and make behavior changes is a nursing

  intervention.

• Question 864:

  During the work phase of the nurse-client relationship, the client says to her primary nurse, "You think that I could walk if I wanted to, don't you?"

  What is the best response by the nurse?

  A. "Yes, if you really wanted to, you could."

  B. "Tell me why you're concerned about what I think."

  C. "Do you think you could walk if you wanted to?"

  D. "I think you're unable to walk now, whatever the cause."

  Correct Answer: D

  This response answers the question honestly and nonjudgmentally and helps to preserve the client's self-

  esteem.

  Choice "Yes, if you really wanted to, you could." is an open and candid response but diminishes the

  client's self-esteem.

  Choice "Tell me why you're concerned about what I think." doesn't answer the client's question and is not

  helpful.

  Choice "Do you think you could walk if you wanted to?" increases the client's anxiety because her inability

  to walk might be directly related to an unconscious psychological conflict that has not been resolved.

• Question 865:

  A client tells the nurse that his wife's nagging really gets on his nerves. He asks the nurse to talk with her

  about her nagging during their family session tomorrow afternoon.

  Which of the following responses is the most therapeutic for the client?

  A. "Tell me more specifically about her complaints."

  B. "Can you think why she might nag you so much?"

  C. "I'll help you think about how to bring this up yourself tomorrow afternoon."

  D. "Why do you want me to initiate this in tomorrow's session rather than you?"

  Correct Answer: C

  The client needs to learn how to communicate directly with his wife about her behavior. The nurse's assistance enables him to practice a new skill and communicates confidence in his ability to confront this situation. Choices "Tell me more specifically about her complaints." and "Can you think why she might nag you so much?" inappropriately direct attention away from the client and toward his wife, who isn't present. Choice "Why do you want me to initiate this in tomorrow's session rather than you?" implies that there might be a legitimate reason for the nurse to assume responsibility for something that rightfully belongs to the client. Instead of focusing on his problems, he'll waste precious time convincing the nurse that he or she should do his work.

• Question 866:

  Mrs. Owens is the 81-year-old mother of Jonathan, who is 54 years old. Jonathan has had schizophrenia since he was 16 years old.

  Which of Mrs. Owens's concerns is likely to predominate?

  A. "Will my retirement funds outlast me?"

  B. "Who will handle my funeral arrangements?"

  C. "What will become of Jonathan when I am gone?"

  D. "How can I get Jonathan's physician to talk to me?"

  Correct Answer: C

  The mother's most prominent concern is likely to be what becomes of her son after she dies. Choice "Will my retirement funds outlast me?" is important but is not likely to be her most prominent concern. Choice "Who will handle my funeral arrangements?" is also not likely to be her primary concern because the welfare of her son with schizophrenia is more important. Choice "How can I get Jonathan's physician to talk to me?" is incorrect because Mrs. Owens has likely confronted and handled concerns about getting the physician to talk to her after 38 years of managing her son's care.

• Question 867:

  Support systems during the grieving process include all of the following except __________.

  A. a despondent friend

  B. a nurse

  C. a social worker

  D. a family member

  Correct Answer: A

  A despondent friend, even though this could be a support to the grieving person, is in a state of

  despondency.

  Therefore, he or she might not do well with a grieving friend.

• Question 868:

  A client is having psychological counseling for problems communicating with his mother.

  Which model of stress is the most useful in reference to this stressor?

  A. Adaptation Model

  B. Stimulus-Based Model

  C. Transaction-Based Model

  D. Selye's Model of Stress

  Correct Answer: C

  The Transaction-Based Model is, according to R.S. Lazarus, a state that Stimulus theory and Response theory do not consider individual differences. He takes into account cognitive processes that intervene between the encounter and the reaction and the factors that affect the nature of this process. He includes mental and psychological components or responses as part of his concept of stress (Person ?Environment Transactions).

• Question 869:

  A client is assessed by the nurse as experiencing a crisis.

  The nurse plans to __________.

  A. allow the client to work through independent problem-solving.

  B. complete an in-depth evaluation of stressors and responses to the situation.

  C. focus on immediate stress reduction.

  D. recommend ongoing therapy.

  Correct Answer: C

  A crisis is an acute, time-limited state of disequilibrium resulting from a situational, developmental, or societal source of stress. Utilizing the nursing process, the nurse should assist clients to work through a crisis to its resolution and restore their precrisis level of functioning.

• Question 870:

  A female having her first child is experiencing __________ crisis event.

  A. situational

  B. maturational

  C. adventitious

  D. reactive

  Correct Answer: B

  A maturational crisis occurs when an individual arrives at a new stage of development and must develop

  new coping strategies.

  Situational arises from sources external to individuals.

  Adventitious occurs when some event external to a person (floods, hurricanes) disrupts his or her coping

  behaviors.

  Reactive is not a crisis intervention.