NCLEX-PN
NCLEX Client Needs Physiologic Adaptation Questions
Question 1 of 5
A nurse is instructing a patient on the order of sensations with the application of an ice water bath for a swollen right ankle. Which of the following is the correct order of sensations experienced with an ice water bath?
Correct Answer: A
Rationale: CBAN, cold, burn, ache, numbness
Question 2 of 5
The nurse is caring for a dying client who has persistently requested that the nurse 'help her to die and be in peace.' According to the Code of Ethics for Nurses, the nurse should:
Correct Answer: D
Rationale: Try to make the client as comfortable as possible but refuse to assist in death. One of the competencies necessary for nurses to have in giving high quality care to clients/families during the end of life care is: apply legal and ethical principles in the analysis of complex issues and end-of-life care, recognizing the influence of personal values, profession codes, and client preferences.
Question 3 of 5
A two-year old has been in the hospital for 3 weeks and seldom seen family members due to isolation precautions. Which of the following hospitalization changes is most likely to be occurring?
Correct Answer: C
Rationale: Separation anxiety can easily occur after six months during hospitalization.
Question 4 of 5
A client was involved in a motor vehicle accident in which the seat belt was not worn. The client is exhibiting crepitus, decreased breath sounds on the left, complains of shortness of breath, and has a respiratory rate of 34/min. Which of the following assessment findings should concern the nurse the most?
Correct Answer: C
Rationale: A mediastinal shift is indicative of a tension pneumothorax along with the other symptoms in the question. Because the individual was involved in an MVA, assessment is targeted at acute traumatic injuries to the lungs, heart, or chest wall rather than other conditions indicated in the other choices.
Question 5 of 5
The nurse wishes to decrease a client's use of denial and increase the client's expression of feelings. To do this the nurse should:
Correct Answer: B
Rationale: The nurse should positively reinforce each expression of feelings.