during the first meeting of a therapy group members exhibit frequent periods of silence tense laughter and nervous movements which conclusion would th during the first meeting of a therapy group members exhibit frequent periods of silence tense laughter and nervous movements which conclusion would th
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Nursing Elites

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NCLEX Psychosocial Integrity Questions

1. 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.

2. After being medicated for anxiety, the client says to the nurse, 'I guess you are too busy to stay with me.' Which response by the nurse is correct?

Correct answer: 'I have to go now, but I will come back in 10 minutes.'

Rationale: The nurse should respond with empathy and reassurance to address the client's emotional needs. The correct response, 'I have to go now, but I will come back in 10 minutes,' acknowledges the client's feelings while providing a timeframe for the nurse's return, showing care and concern. Choice A, 'I’m so sorry, but I need to see other clients,' prioritizes other tasks over the client's emotional needs, which can increase anxiety. Choice C, 'You’ll be able to rest after the medicine starts working,' offers false reassurance and does not address the client's immediate emotional distress. Choice D, 'You’ll feel better after I’ve made you more comfortable,' does not acknowledge the client's concerns and fails to establish a supportive connection with the client.

3. The healthcare professional has collected the following information on a patient: palpated blood pressure—180 mm Hg; auscultated blood pressure—170/100 mm Hg; apical pulse—60 beats per minute; radial pulse—70 beats per minute. What is the patient’s pulse pressure?

Correct answer: B: 70

Rationale: Pulse pressure is the numerical difference between the systolic and diastolic blood pressure readings. In this case, the systolic blood pressure is 170 mm Hg, and the diastolic blood pressure is 100 mm Hg. Therefore, the pulse pressure is calculated as 170 - 100 = 70 mm Hg. Pulse pressure reflects the stroke volume, the amount of blood ejected from the heart with each beat. Choices A, C, and D are incorrect because they do not accurately represent the difference between the systolic and diastolic blood pressure readings provided.

4. A child is hospitalized because of persistent vomiting. The nurse should monitor the child closely for which problem?

Correct answer: Metabolic alkalosis

Rationale: In the scenario of persistent vomiting, the child is at risk of developing metabolic alkalosis due to the loss of hydrochloric acid. Vomiting leads to the loss of gastric acid, resulting in an imbalance that causes metabolic alkalosis. Metabolic acidosis is incorrect as it would occur in a child with diarrhea due to the loss of bicarbonate. While diarrhea can sometimes be associated with vomiting, in this case, the primary focus is on the effects of vomiting. Hyperactive bowel sounds are not typically associated with vomiting, making this choice less relevant to the situation described.

5. Your elderly patient has a temperature of 98.5 degrees. Is there anything else that a nurse should do, in addition to documenting this temperature?

Correct answer: No, this temperature is within normal limits.

Rationale: No, there is nothing else that a nurse should do. A temperature of 98.5 degrees for an elderly patient falls within normal limits. Other choices are incorrect because the temperature is not hyperthermic (abnormally high) or hypothermic (abnormally low), making choices B, C, and D inaccurate responses in this scenario.

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