a woman seeks assistance because she recently remembered childhood sexual abuse the nurse should include which of the following goals for this client

NCLEX-PN

PN Nclex Questions 2024

1. A woman seeks assistance because she recently remembered childhood sexual abuse. The nurse should include which of the following goals for this client?

A. prosecuting the perpetrator
B. managing symptoms of anxiety and fear
C. determining if the memories are real
D. collaborating with the client's story

Correct answer: B

Rationale: The correct answer is 'managing symptoms of anxiety and fear.' When a client remembers childhood sexual abuse, the nurse's primary goal should be to help the client cope with the emotional distress and symptoms such as anxiety and fear. Prosecuting the perpetrator is not within the nurse's scope of practice and is a legal matter. Determining if the memories are real is not the nurse's role; the focus should be on providing support and care. Collaborating with the client's story is vague and does not address the immediate emotional needs of the client.

2. A client with cancer is to undergo an intravenous pyelogram. The nurse should:

A. Ensure adequate fluid intake 24 hours before the procedure
B. Ask the client to void immediately before the study
C. Administer medication that affects the central nervous system as prescribed
D. Position the client appropriately for the procedure

Correct answer: B

Rationale: The correct answer is to ask the client to void immediately before the study. For an intravenous pyelogram, the client may have orders for laxatives or enemas, so ensuring the client voids before the test is important to prevent obscuring visualization of the kidney, ureters, and bladder. Choice A is incorrect because there is no need to force fluids before the procedure. Choice C is incorrect as medications affecting the central nervous system should not be held unless specified by the healthcare provider. Choice D is incorrect as covering the reproductive organs with an x-ray shield is not necessary for an intravenous pyelogram.

3. How does the ANA define the psychiatric nursing role?

A. a specialized area of nursing practice that employs theories of human behavior as its science and the powerful use of self as its art
B. assisting the therapist to relieve the symptoms of clients
C. to solve clients' problems and give them the answers
D. having a client committed to long-term therapy with the nurse

Correct answer: A

Rationale: The correct answer aligns with the ANA's definition of the psychiatric nursing role. According to the ANA, psychiatric nursing is a specialized area of nursing practice that incorporates theories of human behavior as its foundational science and utilizes the self as its essential art. This definition emphasizes the importance of understanding human behavior and leveraging therapeutic communication and relationships to provide effective care for individuals with mental health concerns. Choices B, C, and D are incorrect because they do not accurately represent the ANA-defined role of psychiatric nursing. Psychiatric nurses primarily focus on delivering holistic care, promoting mental health, and supporting individuals with mental health challenges using evidence-based practices and therapeutic interventions.

4. What is a common characteristic of a batterer?

A. Grew up in a loving, secure home
B. Was an only child
C. Was physically or psychologically abused
D. Admits they have a problem with anger

Correct answer: C

Rationale: The correct answer is that a batterer is typically someone who was physically or psychologically abused. Research shows that many individuals who engage in abusive behavior report a history of being abused themselves. Choices A, B, and D are incorrect. While it is possible for a batterer to have grown up in a loving, secure home, been an only child, or acknowledge their anger issues, the most common factor associated with becoming a batterer is a history of being abused.

5. In the emergency room, a nurse is responsible for triaging four clients injured in a motor vehicle accident. Which of the following clients should receive priority in care?

A. A 10-year-old with lacerations on the face
B. A 15-year-old with sternal bruises
C. A 34-year-old with a fractured femur
D. A 50-year-old with a dislocated elbow

Correct answer: B

Rationale: The 15-year-old with sternal bruises should receive priority in care as this client might be experiencing airway and oxygenation problems. Airway issues take precedence in triage. The 10-year-old with lacerations on the face, although looking bad, is not in immediate distress. The 34-year-old with a fractured femur should be immobilized but can be seen after the client with sternal bruising. The 50-year-old with a dislocated elbow can also be seen later as dislocated elbows are not life-threatening compared to potential airway compromise.