Published - Fri, 03 Mar 2023

NCLEX-RN Exam Questions - Part 39

1. A 23-year-old borderline client is admitted to an inpatient psychiatric unit following an impulsive act of self-mutilation. A few hours after admission, she requests special privileges, and when these are not granted, she stands up and angrily shouts that the people on the unit do not care, and she storms across the room. The nurse should respond to this behavior by:

A) Placing her in seclusion until the behavior is under control
B) Walking up to the client and touching her on the arm to get her attention
C) Communicating a desire to assist the client to regain control, offering a one-to-one session in a quiet area
D) Confronting the client, letting her know the consequences for getting angry and disrupting the unit

2. A 56-year-old client is admitted to the psychiatric unit in a state of total despair. She feels hopeless and worthless, has a flat affect and very sad appearance, and is unable to feel pleasure from anything. Her husband has been assisting her at home with the housework and cooking; however, she has not been eating much, lies around or sits in a chair most of the day, and is becoming confused and thinks her family does not want her around anymore. In assessing the client, the nurse determines that her behavior is consistent with:

A) Transient depression
B) Mild depression
C) Moderate depression
D) Severe depression

3. A 56-year-old psychiatric inpatient has had recurring episodes of depression and chronic low self-esteem. She feels that her family does not want her around, experiences a sense of helplessness, and has a negative view of herself. To assist the client in focusing on her strengths and positive traits, a strategy used by the nurse would be to:

A) Tell the client to attend all structured activities on the unit
B) Encourage or direct client to attend activities that offer simple methods to attain success
C) Increase the client - s self-esteem by asking that she make all decisions regarding attendance in group activities
D) Not allow any dependent behaviors by the client because she must learn independence and will have to ask for any assistance from staff

4. A 42-year-old client on an inpatient psychiatric unit comments that he was brought to the hospital by his wife because he had taken too many pills and states, 'I just couldn - t take it anymore.' The nurse - s best response to this disclosure would be:

A) 'You shouldn - t do things like that, just tell someone you feel bad.'
B) 'Tell me more about what you couldn - t take anymore.'
C) 'I - m sure you probably didn - t mean to kill yourself.'
D) 'How long have you been in the hospital.'

5. A 42-year-old client with bipolar disorder has been hospitalized on the inpatient psychiatric unit. She is dancing around, talking incessantly, and singing. Much of the time the client is anorexic and eats very little from her tray before she is up and about again. The nurses intervention would be to:

A) Confront the client with the fact that she will have to eat more from her tray to sustain her
B) Try to get the client to focus on her eating by offering a detailed discussion on the importance of nutrition
C) Let her have snacks and drinks anytime that she wants them because she will not eat at regular meal times
D) Not expect the client to sit down for complete meals; monitor intake, offering snacks and juice frequently

1. Right Answer: C
Explanation: (A) Threatening a client with punitive action is violating a clients rights and could escalate the clients anger. (B) Angry clients need respect for personal space, and physical contact may be perceived as a threatening gesture escalating anger. (C) Client lacks sufficient self-control to limit own maladaptive behavior; she may need assistance from staff. (D) Confronting an angry client may escalate her anger to further acting out, and consequences are for acting out anger aggressively, not for getting angry or feeling angry.

2. Right Answer: D
Explanation: (A) Transient depression manifests as sadness or the 'blues' as seen with everyday disappointments and is not necessarily dysfunctional. (B) Mild depression manifests as symptoms seen with grief response, such as denial, sadness, withdrawal, somatic symptoms, and frequent or continuous thoughts of the loss. (C)Moderate depression manifests as feelings of sadness, negativism; low self-esteem; rumination about lifes failures; decreased interest in grooming and eating; and possibly sleep disturbances. These symptoms are consistent with dysthymia. (D) Severe depression manifests as feelings of total despair, hopelessness, emptiness, inability to feel pleasure; possibly extreme psychomotor retardation; inattention to hygiene; delusional thinking; confusion; self-blame; and suicidal thoughts. These symptoms are consistent with major depression.

3. Right Answer: B
Explanation: (A) The nurse should encourage activities gradually, as clients energy level and tolerance for shared activities improve. (B) Activities that focus on strengths and accomplishments, with uncomplicated tasks, minimize failure and increase self-worth. (C) Asking a client to set a goal to make all decisions about attending group activities is unrealistic, and such decisions are not always under the clients control; this sets up the client for further failure and possibly decreased self-worth. (D)Encouragement toward independence does promote increased feelings of selfworth; however, clients may need assistance with decision making and problem solving for various situations and on an individual basis.

4. Right Answer: B
Explanation: (A) Disapproving gives the impression that the nurse has a right to pass judgment on the clients thoughts, actions, or ideas. (B) Giving a broad opening gives the client encouragement to continue with verbalization. (C) Failing to acknowledge the clients feelings conveys a lack of understanding and empathy. (D) Changing the subject takes the conversation away from the client and is indicative of the nurses anxiety or insensitivity.

5. Right Answer: D
Explanation: (A) The manic clients mood may easily change from euphoric to irritable. The nurse should avoid confrontation and let the client know what she can do, rather than what she cannot. (B) Although helpful to refocus or redirect the manic client to discuss only one topic at a time, distractibility is very high and its best to avoid long discussions. (C) Manic clients have a tendency to manipulate persons in their environment. Staff should monitor intake, including at mealtime and snacks, and be consistent in their approach to meeting nutritional needs. (D) Manic clients may not sit and eat complete meals, but they can carry foods and liquids from regular meals with them. Staff can monitor and give high-caloric and high-energy snacks and liquids.

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