Prep U NCLEX Psychosocial

Two days after undergoing a modified radical mastectomy, a client tells the nurse, "Now I won't be sexually attractive to my spouse." How should the nurse respond?

"Can you tell me more about what your goals for a sexual relationship with your spouse are?"

Which question would the nurse ask to determine a client's coping abilities during a lengthy hospital stay?

"How is this illness impacting you and your family?"

A client who recently had a colostomy expresses concerns about the sexual relationship with the client's spouse. Which statement made by the nurse is appropriate?

"I can refer you to a support group so that you can speak with others with similar problems."

The nurse is caring for a client with a terminal illness who is awaiting transfer to hospice. The client states, "It is all out of my hands now." How should the nurse respond?

"I hear you saying things are out of your hands. Can you tell me more about what has you feeling this way?"

A nurse is caring for a client who is experiencing alcohol withdrawal. Which statement best indicates that the client understands the need for long-term treatment?

"I will begin with inpatient treatment and participate in an aftercare program."

The client who has a history of angry outbursts when frustrated begins to curse at the nurse during an appointment after being informed that she will have to wait to have her medication refilled. Which response by the nurse is most appropriate?

"I won't continue to talk with you if you curse."

A client whose child has died is withdrawn, has flat affect, makes minimal eye contact, and states, "I can't live without my child." What is the most appropriate response by the nurse?

"I would like to sit with you and talk about your child."

A nurse is giving a bed bath to a terminally ill client. The client tells the nurse that the client has great respect and faith in a particular spiritual leader. Which is the best response by the nurse?

"It sounds like that offers you a sense of security."

The nurse is preparing a client for surgery and notices that the client looks sad. The client says, "I am scared of having cancer. It is so horrible, and I brought it on myself. I should have quit smoking years ago." What would be the nurse's best response to the client?

"It's okay to be scared. What is it about cancer that you are afraid of?"

A client says to a nurse, "I know I am going to die." How should the nurse respond?

"Tell me more about what you mean when you say you know you are going to die."

A client gives birth to a neonate at 30 weeks' gestation. The neonate is stable on minimal ventilator settings. The client's previous infant, who was born at 24 weeks gestation, did not survive. The family is Roman Catholic and requests that neonate be baptized as soon as possible. What response by the nurse is most appropriate?

"What would you like me to do to help arrange the baptism?"

A nurse is assessing a client's spiritual needs when the client becomes angry and defensive about the questions being asked. What would the nurse say to make the client comfortable?

"You appear upset about these questions. Is this true?"

The client states, "No one cares about me anymore. All the people I loved are dead." Which response by the nurse is most therapeutic?

"You must be feeling lonely at this time. Would you like to talk about your loss?"

When a nurse enters a client's room, the client frowns and states, "I've had my damn light on for 20 minutes. It's about time you got here. I'm sick of this place and the staff." The nurse's best response would be:

"You seem upset this morning."

The parent of an 18-year-old with chronic renal disease states, "My son has so many problems. I'm really worried that he won't get the right care if he gets sick at college." What is the nurse's best response?

"Your son can make an electronic history to facilitate his care if he gets sick away from home."

A nurse is caring for multiple grieving clients. Which client is most likely to experience disenfranchised grief?

50

A 16-year-old primiparous client has decided to place her baby for adoption. The adoptive parents are on their way to the hospital when the mother says, "I want to see the baby one last time." What should the nurse do?

Allow the client to see and hold the baby for as long as she desires.

A client states, "If my heart stops beating, I do not want to be resuscitated." Which action would the nurse take?

Ask if the client discussed this with the healthcare provider.

The nurse is preparing a client who has pancreatic cancer for surgery, during which the client will have a Whipple procedure. The client says they are Catholic but never really goes to church or prays much. The client is crying and very frightened. What is the most appropriate action the nurse can do for the client before the surgery?

Ask the client if they would like to see a priest.

A mother reports she cannot afford the antibiotic azithromycin, which was prescribed by the health care provider (HCP) for her toddler's otitis media. What is the nurse's best response?

Confer with the HCP about whether a less expensive drug could be prescribed.

The hospice nurse is caring for a client who has been diagnosed with terminal cancer. The client breaks down in tears and shares with the nurse "I should just end it now so my kids can start moving on with their lives. They will be better off without me. When they come to visit tomorrow, just tell them I'm not up for visitors." The nurse understands the client is in which stage of the grief process?

Depression

A client with an infected abdominal wound must be placed on contact precautions for 10 days. What should the nurse do to help meet the client's emotional needs?

Describe why the client is on contact precautions and what will occur there, and reassure the client.

A nurse is caring for an infant who is to be administered an enema. What spiritually oriented interventions could the nurse follow with newborns and infants?

Encourage parents to be present during the treatment.

A mastectomy is recommended for a 68-year-old client diagnosed with breast cancer a week ago. When approached about giving consent for the mastectomy, the client says, "What's the use in trying to get rid of the cancer? It will just come back! I can't handle another thing—having diabetes is enough. Besides, I'm getting old. It would be different if I were younger and had more energy." What should the nurse do

Explore with the client her feelings about her health problems and proposed surgery.

What question would the nurse ask to assess coping abilities of a family dealing with a chronic illness?

How is your condition affecting your family members and their usual roles?

A client's spouse has arrived prior to surgery. When the client is transferred to the operating room, what would be appropriate for the nurse to tell the spouse?

Inform the spouse that the client will be going to the recovery room after the operation, and that someone will notify the unit when the client is ready to come back.

The family of a client who dies lives an hour away from the facility. What should the nurse do to support the family at this time?

Keep the client in the bed until the family arrives.

A nurse is assessing available support systems for a client in the community mental health clinic. The client is divorced, has no siblings, and both parents died last year. The client has contact with once-supportive former in-laws; however, the client describes a strained relationship since the divorce. With regard to the relationship with the in-laws, what knowledge does the nurse use to plan care?

Low-quality support relationships often negatively affect coping in a crisis.

The nurse cares for a client of a different cultural background. What is the best way for the nurse to provide culturally competent care to the client?

Plan and implement care in a way that is sensitive to the needs of the client.

The nurse provides care to a verbally unresponsive client diagnosed with terminal cancer. The client's family refuses palliation on religious grounds. The nurse experiences great anxiety and distress when caring for the client due to the level of suffering perceived. What action should the nurse take?

Speak to the charge nurse about the nurse's moral conflict.

An 80-year-old client with severe kidney damage is placed on life support and dialysis. Care decisions are being made by his wife, who is showing signs of early Alzheimer's disease. The client's daughter arrives from out of town with a copy of the client's living will, which states that the client did not want to be on life support. What action should the nurse take next?

Suggest to the daughter that she discuss her father's wishes with her mother.

A nurse is working on a medical unit at a hospital with an ethics review board. Which situation(s) would be appropriate for the nurse to forward for ethics committee review? Select all that apply.

The comatose client with a feeding tube and no advanced directive whose children want it removed and spouse does not. jenovah

A nurse is caring for a terminally ill client who believes that death and reincarnation are the ultimate gifts from God to humankind. How can the nurse provide spiritual support to this client?

The nurse would support and build on the clients' faith.

After the spouse has visited, a client begins crying and saying that the spouse is a mean person. When the client starts pounding on the overbed table and using incomprehensible language, the nurse feels incapable of handling the situation. What should the nurse do at this time?

Use the call system to request assistance.

An older adult client is speaking to the nurse about the expected death of a spouse due to cancer 3 weeks ago. The client says, "My spouse is in a better place now, and I'm happy my spouse is not hurting anymore. But I just miss my spouse!" How should the nurse respond?

Validate the client's statement as evidence of a normal grieving process.

The nurse is caring for a client who recently lost an infant to sudden infant death syndrome (SIDS). The client talks about how going back to work last week and that the couple want to become pregnant again soon to have another baby. The client reports feeling sad sometimes, but also feeling happy sometimes. What stage of grief does this client demonstrate?

acceptance

A client was brought to the hospital in an agitated state and admitted to a psychiatric unit for observation and treatment. On admission, the client was found to be talking rapidly and folding and unfolding garments several times while putting personal belongings away. The client is unable to settle down. Which assessment of the client would have highest priority at this time?

anxiety

A client with multiple serious chronic illnesses says to the nurse, "I would like to strengthen my faith, but I am struggling." What action(s) by the nurse would assist the client in strengthening faith? Select all that apply.

asking the client about original spiritual beliefs identifying current or past spiritual supports exploring factors that are creating conflict with client's beliefs

A child with a nut allergy presents with a severe reaction for the third time in 3 months. The parent says, "I am having trouble with the food labels." What should the nurse do first?

assess ability to read

A client expresses experiencing stress when working but enjoys the challenges this work presents. What would the nurse suggest?

classes

A client is admitted with fatigue, anorexia, weight loss, and inability to sleep, which started 1 month after the death of their spouse. Which nursing diagnosis is most appropriate for this client?

complicated grievi

A client, age 22, is admitted in a psychotic episode. The client's frequent requests to speak with the hospital chaplain are interspersed with profanities regarding God and the devil. The most therapeutic nursing intervention would be to

continue providing safe, effective care and give anti-psychotic medications as ordered to reduce symptoms of psychosis.

Despite the presence of a large cohort of elderly residents of Asian heritage, a long-term care facility has not integrated the Asian concepts of hot and cold into meal planning. The nurses at the facility should recognize this as an example of what?

cultural blidness

A client from Pakistan informs the nurse of cultural dietary requests. The nurse responds to the special dietary needs by stating, "You are now living in the United States and you should try to start eating those foods common to an American diet." This inappropriate response is an example of

cultural imposition.

When a nurse reflects on questions such as "Why am I here?" the nurse is attempting to

develop a philosophical base for clearer thinking.

A client who comes to the crisis center in a very distressed state tells the nurse, "I just can't get over being fired last week. I've asked for help. I've talked to friends. I've tried everything to get through this, but nothing is working. Help me!" Which initial crisis intervention strategy should the nurse use?

emotion mgm

Which activity would be most appropriate to include in a playroom that will be used by children aged 13 months to 6 years?

free pla6y

A client scheduled to have a surgery for a hernia the next day is anxious about the procedure. The nurse assures the client that surgery for hernias is very common and that the prognosis is very good. What skill is the nurse demonstrating?

interpersonal skills

During the termination phase of a nurse-client relationship, which intervention may lead to client confusion?

introducing new issues to the client

What short-term goal for a client hospitalized with a stress related disorder is most realistic?

list of strengths

The nurse refers the parents of a child with cystic fibrosis to an organization that helps families with children who have this disease. What does the nurse determine is the desired outcome from this referral?

meeting with other parents of children with cystic fibrosis for mutual support

A nurse cares for a client who believes in Hinduism. The nurse understands that Hindus believe illness is caused by which type of behavior?

past and current life

The nurse is assessing a client of a different culture who is being admitted to the hospital. What assessment would the nurse prioritize to best develop a culturally congruent plan of care?

personal values/beliefs

Arrangements are made for a member of the colostomy support group to meet with a client before bowel surgery. What is accomplished by having a representative from the group meet the client preoperatively?

providing the client with support and realistic information on the colostomy

Which statement about religion and spirituality is most accurate?

religion is an organized system

The home health nurse is completing a screening for elder abuse during a client visit. Which findings would require action by the nurse? Select all that apply.

scheduling, exxcessive sleepines, less talkative

In her first postpartum month, a client has developed mastitis secondary to breast-feeding. Her nurse, a mother who developed and recovered from mastitis after the birth of her third child, says, "I remember the discomfort I had and how quickly it resolved when I began getting treatment." The therapeutic communication the nurse is using is

self dislosure

A 42-year-old client was admitted from a homeless shelter with a diagnosis of tuberculosis and alcoholism. It is essential that which health care team member attends the care conference to discuss discharge planning and community resources?

social worker

When preparing for a spiritual counselor to visit a hospitalized client, the nurse should

take measures to ensure privacy during the counselor's visit.

Which factors should be the primary factor in a nurse's decision whether to pray with a client?

the client's openness to being prayed for

Before preparing a client for surgery, the nurse assists in developing a teaching plan. What is the primary purpose of preoperative teaching?

to reduce the risk of postoperative complications

In which situation can a client's confidentiality be breached legally?

when a client near discharge is threatening to harm an ex-partner

A client admitted for treatment of a colon tumor, asks, "Do I have cancer?" Which response by the nurse would be most therapeutic?

you sound concernced

Upon assessment, the nurse is addressing the beliefs of a newly admitted client who reports practicing the Adventist religion. Based upon the nurse's familiarity with this religion, the nurse appropriately asks the patient:

"What are your beliefs about the use of narcotics for pain?"`

Which would be most helpful when coaching a client to stop smoking?

Establish the client's daily smoking pattern.

The nurse manager has employed three nurses from a culture that is different from that of most of the nurses who currently work on this unit. Which strategy would help the newly employed nurses socialize into the team and promote the cultural competence of all of the nurses?

Hold a culture sharing session at monthly meetings.

A nurse is caring for a client whose left foot was surgically removed due to gangrene. The client tells the nurse that focusing more on their spiritual life helped overcome the loss of a foot. Which statement appropriately describes the spiritual dimension?

being in harmony with the universe

The client is Asian and does not speak English. The nurse arranges for the interpreter who can speak the client's dialect and begins the health assessment. The client is describing symptoms as numbness, feeling "hot under the skin," and thinking too much. The nurse should next ask specific questions about which symptom?

pain

A teen client, who is one week postpartum, is concerned about the possibility of postpartum depression because she has a history of depression. Which comment by the client would indicate that she understood the nurse's teaching about the postpartum period and her risks for postpartum depression?

"If I'm feeling guilty or not capable of caring for the baby and am not sleeping or eating well, I need to contact the office."

The nurse is caring for a client who reports that the common-law spouse sexually assaulted the client. Which statement by the nurse would hinder the therapeutic relationship between the nurse and this client?

"You may want to have an abortion if you find out you are pregnant."

The family of a client who was receiving hospice care contacts the facility every week to talk with the nurse who was the client's primary caregiver. What action should be taken to support the family?

Contact the hospice agency to provide grief support for the family.

A nurse is developing a care plan for a client who is a single parent. The client is experiencing anxiety after the loss of a job and is verbalizing concerns regarding the ability to meet role expectations and financial obligations. Which is most important for the nurse to include in the plan of care?

Determine the client's ability to cope with the job loss and family obligations.

Nurses are aware that variety and diversity occur both within and across groups. Which factor leads to cultural benefits as a result of diversity?

Equal opportunity exists for various cultural perspectives.

The nurse is caring for a young adult with end stage leukemia. The client asks the nurse to "help end my suffering in this life because it has gotten to be too much to endure." Based on the ANA Code of Ethics for nurses, what would the nurse do next? Select all that apply.

Explain to the client that nurses cannot participate in assisted suicide. Allow the client to discuss their feelings and explore other options for comfort.

A client tells the nurse on admission that she is uneasy about having to leave her children with a relative while being in the hospital for surgery. What should the nurse do?

Gather more information about the client's feelings about the childcare arrangements.

A client with chronic renal failure was recently told by the healthcare provider of being a poor candidate for a transplant because of chronic uncontrolled hypertension and diabetes mellitus. Now the client tells the nurse, "I want to go off dialysis. I'd rather not live than be on this treatment for the rest of my life." Which responses are appropriate? Select all that apply.

Take a seat next to the client and sit quietly to reflect on what was said. Say to the client, "You're feeling upset about the news you got about the transplant."

Which statement best explains why the nurse should acknowledge differences between the nurse's culture and the client's culture?

The nurse may hold values that could influence the care of the client.

A client who was involved in a motor vehicle accident is admitted to the hospital. His wife arrives on the unit 6 hours after her husband's accident, explaining that she has been out of town. She is distraught because she was not with her husband when he needed her. The nurse should:

allow her to verbalize

The nurse is counseling the family of an older adult who died today. Which factor facilitates attainment of a positive bereavement outcome?

possessing adequate financial resources

A daughter is concerned that her mother is in denial because when they discuss the diagnosis of breast cancer, the mother says that breast cancer is not that serious and then changes the subject. The nurse can tell the daughter that denial can be a healthy defense mechanism if it is used when?

to allow her mother

The nurse is trying to establish a trusting relationship with a client experiencing pain. When the client asks for pain medication, the nurse notes that it is not time to give the medication. What is the best action by the nurse to facilitate a trusting relationship?

Tell the client when the medication is due and return promptly at that time.

The nurse is caring for a young adult with hepatitis A. The client is crying and saying that they hate the way they look with yellow skin. Which response is most appropriate?

"If you start to get well and feel better, the skin will return to its normal color."

The home health nurse attends to a terminally ill client whose older adult spouse is the primary caregiver. The spouse states, "I am so ashamed to admit that sometimes I wish it would all just end. I am so tired." How should the nurse respond?

"It sounds like you are overwhelmed. How can we better support you through this process?"

The nurse at a health fair is evaluating a client's completed questionnaire about stress-related life events. The client scored 168 points on the Holmes and Rahe stress scale. Which statement by the nurse provides appropriate interpretation of the impact of stressors on the client's health?

"These life stressors place you at moderate risk for illness."

A stable older adult client is comatose following a cerebral vascular accident. The primary healthcare provider believes a gastrostomy tube should be placed for long-term nutrition. No family members have been located. What would be done to obtain informed consent for the procedure?

The nurse should contact the person identified as the healthcare power of attorney.

A client who underwent cardiac surgery 2 days ago is recovering well. His wife, who is assisting with his care, says, "He's doing too much. I told him to let me help, but he won't let me." The nurse says to the wife, "It sounds like you need to feel you can be more helpful to him." In order to make the nonverbal behavior complement the words, what should the nurse do?

Direct the body and eyes at the wife and client.

When planning discharge instructions with a client who has had an abdominal hysterectomy, what should the nurse do first?

Assess the client's available social supports.

A client at a mental health clinic who has recently emigrated from another country identifies isolation and loneliness as current stressors. The client describes being withdrawn but does not know how to change the situation. Which is the most appropriate step for the nurse to take to help the client?

Support the client in developing attainable socialization goals.

During hospitalization for a suicide attempt, a client informs the nurse that she does not want to return to work because her boss expects sexual favors each week before he pays her. The client informs the nurse that she needs the job but is embarrassed that she performs these favors. The nurse informs the client that this is illegal behavior called

quid pro

A nurse has attended an in-service workshop to address the phenomenon of ageism in the healthcare system. Which practice is indicative of ageism?

speaking to older adults in a way one would with clients who have mild cognitive deficits

A client requests that the nurse assist with spiritual counselling. What is the most important factor for the nurse to apply when determining how to best offer spiritual counselling?

the nurse's comfort and knowledge level related to the process of spiritual counselling

A woman employed full-time wants to request a leave of absence to care for her father who is being treated for colon cancer 300 miles (480 km) away. What should the nurse advise the client to do first?

Contact her employee resources department about policies guiding leaves of absence.

A client who is in the emergency department after a car accident is displaying anxiety, lack of attention, dizziness, nausea, tachycardia, and hyperventilation. Which statement would indicate that the nurse is reacting to the client's relief behavior rather than the client's needs?

"There is nothing physically wrong with you. You need to stop breathing so rapidly."

The nurse is caring for an elderly nursing home client who is anxious and fearful after being admitted to the hospital. Which intervention is the nursing priority?

Explain procedures and unit routines to the client, as well as checking orientation.

A new mother who is breastfeeding her baby has developed a deep vein thrombosis and needs to be started on a heparin drip for treatment. The client states, "I need to nurse my baby." How would the nurse respond to this client?

Explain the importance of the heparin in resolving the thrombosis and examine ways the baby could room in with the mother with assistance.

A community health nurse is caring for a Vietnamese client with a diabetic foot ulcer. The client's children, spouse, and best friend are the only people available that speak English. What should the nurse do to provide optimal client care? Select all that apply.

Request that a health related interpreter to come to the home. Utilize a trained telephone interpreter while providing care.

One evening, the client takes the nurse aside and whispers, "Don't tell anybody, but I'm going to call in a bomb threat to this hospital tonight." Which action is the priority?

explaining to the client that this information will have to be shared immediately with the staff and the health care provider (HCP)

A 42-year-old client was admitted from a homeless shelter with a diagnosis of tuberculosis and alcoholism. It is essential that which health care team member attends the care conference to discuss discharge planning and community resources?

fear of unknown

Which philosophy should the nurse integrate into the plan of care for a client and family to help them best cope during the final stages of the client's illness?

living each day as it comes as fully as possible

A group of nursing students are reviewing current nursing codes of ethics. Such a code is important in the nursing profession because:

nursing practice involves numerous interactions between laws and individual values

A client who is being treated for nonhealing diabetic foot ulcers tells the nurse angrily, "I'm so frustrated with my doctors. The wound care doctor tells me this won't heal and I need to have my toes amputated, and another doctor tells me I need to keep going with the antibiotics and dressing changes so I can save my foot. I just want to go home!" After listening to the client's concerns, what should the nurse do?

conference

The nurse is caring for a client whose spouse has just passed away. The nurse knows that according to the Kubler-Ross Model of Grief, there are five stages of grief that most grieving people progress through in order, although not everyone experiences all stages or in this order. Place the stages of grief in the order that is most commonly observed, and that the nurse would expect to see in this grieving client.

Denial Anger Bargaining Depression Acceptance

A client who has been prescribed chemotherapy wants to take herbal treatments instead. What should the nurse tell the client?

"Tell me about your concerns with chemotherapy."

A client is 36 weeks' gestation and has been admitted to the antenatal unit for gestational hypertension. The client states that she is alone because she has recently moved from another country, and she begins to cry. What is the best response by the nurse?

"Tell me more about how you are feeling."