a 9 year old boy is told that he must stay in the hospital for at least 2 weeks the nurse finds him crying and unwilling to talk which is the priority a 9 year old boy is told that he must stay in the hospital for at least 2 weeks the nurse finds him crying and unwilling to talk which is the priority
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Psychosocial Integrity NCLEX PN Questions

1. A 9-year-old boy is told that he must stay in the hospital for at least 2 weeks. The nurse finds him crying and unwilling to talk. What is the priority nursing care at this time?

Correct answer: Providing privacy to allow him to express his feelings

Rationale: The priority nursing care for a 9-year-old child who is crying and unwilling to talk in the hospital is to provide privacy to allow him to express his feelings. Children need an opportunity to express their emotions in private, and talking about their feelings can be therapeutic. Assurances about the illness not being permanent may not be the child's primary concern at this moment. Distracting the child could give the impression that crying is wrong. Arranging tutoring does not address the immediate emotional needs of the child.

2. A client at a local university claims to be the president of the university. Which type of delusion is the client displaying?

Correct answer: B: Grandiose

Rationale: The correct answer is 'Grandiose.' This type of delusion involves an exaggerated sense of self-importance, where the individual believes they are a prominent figure or possess special abilities. In this scenario, the client claiming to be the president of the university is displaying grandiose delusions. Somatic delusions relate to bodily functions or sensations, which are not present in this case. Erotomanic delusions involve the fixed belief that another person is in love with the individual, which is not applicable here. Persecutory delusions involve the belief that one is being targeted or conspired against, which is also not demonstrated in the given situation.

3. The nurse is planning discharge instructions for the mother of a child following orchiopexy, which was performed on an outpatient basis. Which is a priority in the plan of care?

Correct answer: Wound care

Rationale: Following orchiopexy, the priority in the plan of care for the child's mother is wound care. The most common complications associated with orchiopexy are bleeding and infection. Discharge instructions should focus on demonstrating wound cleansing and dressing, and teaching parents to recognize signs of infection like redness, warmth, swelling, or discharge. It is crucial to prevent movement of the testicles and avoid contamination of the suture line. While analgesics may be prescribed, pain control measures are not the priority among the options presented. Measurement of intake is not essential as the child is likely to resume normal eating habits. Cold and heat applications are not typical prescribed treatments for post-orchiopexy care.

4. Which mental health disorder is most likely to be treated with electroconvulsive therapy (ECT)?

Correct answer: A: Clinical depression

Rationale: Electroconvulsive therapy (ECT) is commonly used to treat severe cases of clinical depression in individuals who have not responded well to psychotropic medications or when immediate intervention is necessary due to the severity of the depression. ECT is not typically a first-line treatment for substance abuse disorders, antisocial personality disorder, or psychosis occurring in schizophrenia. Clients with clinical depression who meet specific criteria and have not benefited from other treatments may be considered for ECT to alleviate symptoms and improve overall functioning.

5. During the first meeting of a therapy group, members exhibit frequent periods of silence, tense laughter, and nervous movements. Which conclusion would the nurse make?

Correct answer: The members are displaying expected behaviors because relationships are not yet established.

Rationale: During the initial stages of a therapy group, it is common for members to exhibit behaviors such as silence, tense laughter, and nervous movements. These behaviors indicate anxiety and insecurity due to the lack of established relationships and trust among the group members. This is a normal part of group development, and it does not necessarily mean that the group process is unhealthy. Intervening or addressing these behaviors immediately is not required as they are expected in the early stages of group interaction. As the group progresses and relationships are built, these behaviors are likely to diminish naturally without the need for active leader intervention. Therefore, the correct conclusion is that the members are displaying expected behaviors because relationships are not yet established. Choices A, B, and D are incorrect because active leader intervention is not necessary, the group process is not unhealthy, and addressing the behaviors immediately is not required as they are part of the early group dynamics and are expected to subside as relationships develop.

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