NCLEX-RN
Psychosocial Integrity NCLEX Questions Quizlet
1. An older adult who recently began self-administration of insulin calls the nurse daily to review the steps that should be taken when giving an injection. The nurse has assessed the client's skills during two previous office visits and knows that the client is capable of giving the daily injection. Which response by the nurse is likely to be most helpful in encouraging the client to assume total responsibility for the daily injections?
- A. "I know you are capable of giving yourself the insulin."
- B. "Giving yourself the injection seems to make you nervous."
- C. "When I watched you give yourself the injection, you did it correctly."
- D. "Tell me what you want me to do to help you give yourself the injection at home."
Correct answer: C
Rationale: The most appropriate response by the nurse in this scenario is option C. By acknowledging and affirming the client's demonstrated ability to self-administer the injection correctly, the nurse is providing positive reinforcement. This positive reinforcement helps to build the client's confidence and encourages them to take total responsibility for their daily injections. Option A, while positive, does not specifically reinforce the client's behavior related to giving the injection. Option B focuses on the client's feelings of nervousness, which may not be helpful in promoting independence. Option D, by offering help without assessing the client's actual needs, reinforces dependence on the nurse rather than encouraging self-reliance.
2. Which of the following individuals is at the highest risk of experiencing intimate partner violence?
- A. A 36-year-old woman who is recently divorced
- B. A 22-year-old man who is unemployed but living with friends
- C. A 20-year-old woman who grew up with a psychologically abusive father
- D. A 40-year-old man diagnosed with schizophrenia
Correct answer: C
Rationale: Intimate partner violence is a serious issue encompassing physical, psychological, or sexual abuse within an intimate relationship. Individuals who have experienced psychological abuse in their upbringing are at a higher risk of becoming victims themselves due to the normalization of abusive behaviors. While factors such as age, mental health conditions, and social support can contribute to vulnerability, growing up in an abusive environment can significantly heighten the risk of intimate partner violence. The other options, such as recent divorce (A), unemployment (B), and schizophrenia diagnosis (D), do not directly correlate with the same level of increased risk associated with a history of psychological abuse.
3. What nonverbal action should the nurse implement to demonstrate active listening?
- A. Sit facing the client.
- B. Cross arms and legs.
- C. Avoid eye contact.
- D. Lean back in the chair.
Correct answer: A
Rationale: Active listening is effectively demonstrated through attentive verbal and nonverbal communication strategies. To convey active listening and show the client that the nurse is engaged and attentive, it is essential for the nurse to sit facing the client. This posture communicates openness and willingness to listen. Option B, crossing arms and legs, creates a barrier and can signal defensiveness or disinterest, making it an incorrect choice. Option C, avoiding eye contact, hinders the establishment of a connection and can convey disengagement. Option D, leaning back in the chair, may give the impression of disinterest or lack of engagement. Therefore, maintaining eye contact and sitting facing the client are crucial nonverbal actions to exhibit active listening and promote effective therapeutic communication.
4. A 19-year-old client is paralyzed in a car accident. Which statement used by the client would indicate to the nurse that the client was using the mechanism of "suppression"?
- A. "I don't remember anything about what happened to me."
- B. "I'd rather not talk about it right now."
- C. "It's the other guy's fault! He was going too fast."
- D. "My mother is heartbroken about this."
Correct answer: A
Rationale: The correct answer is "I don't remember anything about what happened to me." This statement indicates the use of suppression, which is the willful act of putting an unacceptable thought or feeling out of one's mind. In this case, the client is deliberately excluding memories of the traumatic event to protect their self-esteem. The other choices do not reflect suppression: Choice B shows avoidance or deflection, Choice C demonstrates blame shifting, and Choice D indicates empathy towards another individual.
5. A client experiences postpartum hemorrhage eight hours after the birth of twins. Following administration of IV fluids and 500 ml of whole blood, her hemoglobin and hematocrit are within normal limits. She asks the nurse whether she should continue to breastfeed the infants. Which of the following is based on sound rationale?
- A. Nursing will help contract the uterus and reduce your risk of bleeding.
- B. Breastfeeding twins will take too much energy after the hemorrhage.
- C. The blood transfusion may increase the risks to you and the babies.
- D. Lactation should be delayed until the 'real milk' is secreted.
Correct answer: A
Rationale: The correct answer is 'Nursing will help contract the uterus and reduce your risk of bleeding.' Stimulation of the breast during nursing releases oxytocin, which contracts the uterus. This contraction is especially important following hemorrhage. Choice B is incorrect because breastfeeding can actually help prevent further bleeding by promoting uterine contractions. Choice C is incorrect as the blood transfusion is aimed at restoring the client's blood volume and should not significantly impact the babies. Choice D is incorrect as lactation should not be delayed, as breastfeeding can provide numerous benefits to both the mother and infants, including aiding in the prevention of postpartum hemorrhage.
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