NCLEX-RN
Psychosocial Integrity NCLEX PN Questions
1. A neonate born at 32 weeks' gestation and weighing 3 lb (1361 g) is admitted to the neonatal intensive care unit (NICU). When would the nurse take the neonate's mother to visit the infant?
- A. When the infant's condition has stabilized
- B. When the infant is out of immediate danger
- C. When the primary health care provider has provided written permission
- D. When the mother is well enough to be taken to the NICU
Correct answer: D
Rationale: The mother should see her infant as soon as possible to acknowledge the reality of the birth and begin bonding. Delaying the visit may impede maternal-infant bonding. The timing of the mother's visit should be based on her physical and emotional readiness, not solely on the infant's condition or the need for written permission. The nurse can independently facilitate the mother's visit without requiring a prescription from the primary healthcare provider.
2. What step should be taken when administering ear drops to an adult client?
- A. Place the client in a side-lying position.
- B. Hold the dropper 1 cm above the ear canal.
- C. Place a cotton ball into the outermost canal.
- D. Pull the auricle down and back.
Correct answer: A
Rationale: The correct step when administering ear drops to an adult client is to place the client in a side-lying position (A). This position allows for easier administration of the drops and helps prevent spillage. The dropper should be held approximately 1 cm (½ inch) above the ear canal (B) to ensure accurate delivery of the medication. Placing a cotton ball into the outermost canal (C) is unnecessary and may interfere with the absorption of the ear drops. Pulling the auricle down and back (D) is a technique used for children younger than 3 years old to straighten the ear canal, but it is not necessary for adults and may cause discomfort.
3. A client is having difficulty applying for a job due to panic and anxiety. A nurse is helping by pretending to be the job supervisor while the client practices answering questions during an imaginary interview. This technique is an example of:
- A. Reinforcement
- B. Presenting reality
- C. Role playing
- D. Summarizing
Correct answer: C
Rationale: Role-playing is the correct answer. It involves practicing appropriate behaviors during imaginary scenarios that simulate real-life situations. In this scenario, the nurse is helping the client prepare for a job interview by acting as the job supervisor. Role-playing allows the client to practice and develop strategies to cope with anxiety and panic during the actual interview. Reinforcement (Choice A) involves providing consequences to strengthen a behavior. Presenting reality (Choice B) involves helping the client differentiate between real and unreal experiences. Summarizing (Choice D) involves condensing information. In this context, role-playing is the most appropriate technique to address the client's anxiety and panic related to job interviews.
4. Based on the nursing diagnosis of risk for infection, which intervention is best for the nurse to implement when providing care for an older incontinent client?
- A. Maintain standard precautions.
- B. Initiate contact isolation measures.
- C. Insert an indwelling urinary catheter.
- D. Instruct the client in the use of adult diapers.
Correct answer: A
Rationale: The correct intervention for a nursing diagnosis of risk for infection in an older incontinent client is to maintain standard precautions. The best way to reduce the risk of infection in vulnerable clients is through proper handwashing and adherence to standard precautions. Option B, initiating contact isolation measures, is excessive unless the client has a confirmed infection requiring isolation. Option C, inserting an indwelling urinary catheter, actually increases the risk of infection due to the introduction of a foreign body. Option D, instructing the client in the use of adult diapers, does not directly address the risk of infection and is not as effective as maintaining standard precautions in preventing infection transmission.
5. Which term refers to a comprehensive set of thoughts or images of oneself?
- A. Global self
- B. Core self-concept
- C. Personal identity
- D. Ideal self
Correct answer: A
Rationale: The term 'Global self' specifically refers to a comprehensive set of thoughts or images about oneself. It encompasses a person's overall perception of themselves, including their beliefs, values, and self-image. 'Core self-concept' is more focused on the fundamental beliefs individuals hold about themselves, 'Personal identity' relates to the characteristics and qualities that distinguish a person from others, and 'Ideal self' represents the person an individual aspires to be rather than their current self-perception. Therefore, 'Global self' is the most appropriate term for the description provided in the question.
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