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NCLEX-RN Exam Questions - Part 41
1. A 16-year-old client with anorexia nervosa is on an inpatient psychiatric unit. She has a fear of gaining weight and is refusing to eat sufficient amounts to maintain body weight for her age, height, and stature. To assist with the problem of powerlessness and plan for the client to no longer need to withhold food to feel in control, the nurse uses the following strategy:
A) Establish a structured environment with routine tasks and activities. Also, serve meals at the same time each day.
B) Distract the client during meals to get her to eat because she must take in sufficient amounts to keep from starving.
C) Do frequent room checks to be sure that the client is not hiding food or throwing it away.
D) Listen attentively and participate in in-depth discussions about food, because these actions may encourage her to eat.
2. A 45-year-old male client was admitted to a chemical dependency treatment center following legal problems related to alcohol abuse. He states, 'I know that alcohol is a problem for some people, but I can stop whenever I want to. I - m never sick or miss work, and no one can complain about me.' During the initial assessment, the best response by the nurse would be:
A) 'The fact is you are an alcoholic or you wouldn - t be here.'
B) 'I understand it took strength to admit yourself to the unit, and I will do my part to help you to stay alcohol- free.'
C) 'If you can stop drinking when you want to, why don - t you stop?'
D) 'It - s good that you can stop drinking when you want to.'
3. A 79-year-old client with Alzheimer - s disease is exhibiting significant memory impairment, cognitive impairment, extremely impaired judgment in social situations, and agitation when placed in a new situation or around unfamiliar people. The nurse should include the following strategy in the client - s care:
A) Maintain routines and usual structure and adhere to schedules.
B) Encourage the client to attend all structured activities on the unit, whether she wants to or not.
C) Ask the client to go to an activity once. If she gives no response right away, change the question around, asking the same thing.
D) Give the client two or three choices to decide what she wants to do.
4. The nurse working with a client who is out of control should follow a model of intervention that includes which of the following?
A) Approach the client on a continuum of least restrictive care.
B) Challenge client - s behavior immediately with steps to prevent injury to self or others.
C) Leave the aggressive client to himself or herself, and take other clients away.
D) To ensure safety of other clients, place client in seclusion immediately when he or she begins shouting.
5. When planning care for the passive-aggressive client, the nurse includes the following goal:
A) Allow the client to use humor, because this may be the only way this client can express self.
B) Allow the client to express anger by using 'I' messages, such as 'I was angry when . . .,' etc.
C) Allow the client to have time away from therapeutic responsibilities.
D) Allow the client to give excuses if he forgets to give staff information.
A) Establish a structured environment with routine tasks and activities. Also, serve meals at the same time each day.
B) Distract the client during meals to get her to eat because she must take in sufficient amounts to keep from starving.
C) Do frequent room checks to be sure that the client is not hiding food or throwing it away.
D) Listen attentively and participate in in-depth discussions about food, because these actions may encourage her to eat.
2. A 45-year-old male client was admitted to a chemical dependency treatment center following legal problems related to alcohol abuse. He states, 'I know that alcohol is a problem for some people, but I can stop whenever I want to. I - m never sick or miss work, and no one can complain about me.' During the initial assessment, the best response by the nurse would be:
A) 'The fact is you are an alcoholic or you wouldn - t be here.'
B) 'I understand it took strength to admit yourself to the unit, and I will do my part to help you to stay alcohol- free.'
C) 'If you can stop drinking when you want to, why don - t you stop?'
D) 'It - s good that you can stop drinking when you want to.'
3. A 79-year-old client with Alzheimer - s disease is exhibiting significant memory impairment, cognitive impairment, extremely impaired judgment in social situations, and agitation when placed in a new situation or around unfamiliar people. The nurse should include the following strategy in the client - s care:
A) Maintain routines and usual structure and adhere to schedules.
B) Encourage the client to attend all structured activities on the unit, whether she wants to or not.
C) Ask the client to go to an activity once. If she gives no response right away, change the question around, asking the same thing.
D) Give the client two or three choices to decide what she wants to do.
4. The nurse working with a client who is out of control should follow a model of intervention that includes which of the following?
A) Approach the client on a continuum of least restrictive care.
B) Challenge client - s behavior immediately with steps to prevent injury to self or others.
C) Leave the aggressive client to himself or herself, and take other clients away.
D) To ensure safety of other clients, place client in seclusion immediately when he or she begins shouting.
5. When planning care for the passive-aggressive client, the nurse includes the following goal:
A) Allow the client to use humor, because this may be the only way this client can express self.
B) Allow the client to express anger by using 'I' messages, such as 'I was angry when . . .,' etc.
C) Allow the client to have time away from therapeutic responsibilities.
D) Allow the client to give excuses if he forgets to give staff information.
1. Right Answer: A
Explanation: (A) Anorexia nervosa clients feel out of control. Providing a structured environment offers safety and comfort and can help them to develop internal control, thus reducing their need to control by self-starvation. (B) Distraction does not focus on the clients need for control. (C) Doing frequent room checks reinforces feelings of powerlessness and the need to continue with the dysfunctional behavior. (D) Participating in long discussions about food does not make the client want to eat, but rather this strategy allows her to indulge in her preoccupation and to continue with the dysfunctional behavior.
2. Right Answer: B
Explanation: (A) Direct confrontation initially is nontherapeutic and may result in the client becoming frustrated and wanting to leave. (B) A positive, supportive attitude builds trust, and identifying positive strength raises self-esteem. Offering help allows the client to feel that he is not alone in dealing with problems. (C) Asking the client why or to give an explanation for his behavior puts him in a position of having to justify his behavior to the nurse. (D) Giving approval or placing a value on feelings or a behavior may limit the clients freedom to behave in a way that may displease another. This response may lead to seeking praise instead of progress.
3. Right Answer: A
Explanation: (A) Alzheimers clients cope poorly with changes in routine because of memory deficits. Schedule changes cause confusion and frustration, whereas adhering to schedules is helpful and supports orientation. (B) Insisting that the client go to all unit activities may antagonize her and increase her agitation because of cognitive impairments. It may be better to allow the client time for calming down or distraction rather than to insist that she attend every activity. (C) When repeating a question, allow time first for a response; then use the same words the second time to avoid further confusion. (D) The nurse should avoid giving several choices at once. Cognitively impaired clients will become more frustrated with making decisions.
4. Right Answer: A
Explanation: (A) Approaching a clients aggressive behavior on a continuum of least restrictive care is in agreement with his or her rights (i.e., verbal methods to help maintain control, medication, seclusion, and restraints, as necessary). (B) Approaching a client in a challenging manner is threatening and inappropriate. A nonchallenging and calm approach reflects staff in control and may increase clients internal control. (C) It is inappropriate to leave an aggressive client who is acting out alone.The nurse should acquire qualified help to prevent client from harm or injury to self or others. (D) Moving a client to seclusion immediately for shouting is inappropriate. The nurse should offer the client an opportunity to control self with limit setting. The client should understand that the staff will assist with control if necessary (i.e., quietly accompany out of environment to decrease stimulation and allow for verbalization) employing the least restrictive care model of intervention.
5. Right Answer: B
Explanation: (A) Ceasing to use humor and sarcasm is a more appropriate goal, because this client uses these behaviors covertly to express aggression instead of being open with anger. (B) Use of 'I' messages demonstrates proper use of assertive behavior to express anger instead of passive-aggressive behavior. (C) Client is expected to complete share of work in therapeutic community because he has often obstructed others efforts by failing to do his share. (D) Client has used conveniently forgetting or withholding information as a passive-aggressive behavior, which is not acceptable.
Explanation: (A) Anorexia nervosa clients feel out of control. Providing a structured environment offers safety and comfort and can help them to develop internal control, thus reducing their need to control by self-starvation. (B) Distraction does not focus on the clients need for control. (C) Doing frequent room checks reinforces feelings of powerlessness and the need to continue with the dysfunctional behavior. (D) Participating in long discussions about food does not make the client want to eat, but rather this strategy allows her to indulge in her preoccupation and to continue with the dysfunctional behavior.
2. Right Answer: B
Explanation: (A) Direct confrontation initially is nontherapeutic and may result in the client becoming frustrated and wanting to leave. (B) A positive, supportive attitude builds trust, and identifying positive strength raises self-esteem. Offering help allows the client to feel that he is not alone in dealing with problems. (C) Asking the client why or to give an explanation for his behavior puts him in a position of having to justify his behavior to the nurse. (D) Giving approval or placing a value on feelings or a behavior may limit the clients freedom to behave in a way that may displease another. This response may lead to seeking praise instead of progress.
3. Right Answer: A
Explanation: (A) Alzheimers clients cope poorly with changes in routine because of memory deficits. Schedule changes cause confusion and frustration, whereas adhering to schedules is helpful and supports orientation. (B) Insisting that the client go to all unit activities may antagonize her and increase her agitation because of cognitive impairments. It may be better to allow the client time for calming down or distraction rather than to insist that she attend every activity. (C) When repeating a question, allow time first for a response; then use the same words the second time to avoid further confusion. (D) The nurse should avoid giving several choices at once. Cognitively impaired clients will become more frustrated with making decisions.
4. Right Answer: A
Explanation: (A) Approaching a clients aggressive behavior on a continuum of least restrictive care is in agreement with his or her rights (i.e., verbal methods to help maintain control, medication, seclusion, and restraints, as necessary). (B) Approaching a client in a challenging manner is threatening and inappropriate. A nonchallenging and calm approach reflects staff in control and may increase clients internal control. (C) It is inappropriate to leave an aggressive client who is acting out alone.The nurse should acquire qualified help to prevent client from harm or injury to self or others. (D) Moving a client to seclusion immediately for shouting is inappropriate. The nurse should offer the client an opportunity to control self with limit setting. The client should understand that the staff will assist with control if necessary (i.e., quietly accompany out of environment to decrease stimulation and allow for verbalization) employing the least restrictive care model of intervention.
5. Right Answer: B
Explanation: (A) Ceasing to use humor and sarcasm is a more appropriate goal, because this client uses these behaviors covertly to express aggression instead of being open with anger. (B) Use of 'I' messages demonstrates proper use of assertive behavior to express anger instead of passive-aggressive behavior. (C) Client is expected to complete share of work in therapeutic community because he has often obstructed others efforts by failing to do his share. (D) Client has used conveniently forgetting or withholding information as a passive-aggressive behavior, which is not acceptable.
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