NCLEX-PN
NCLEX Physiological Adaptation Questions
Extract:
Question 1 of 5
An adolescent female reports being raped at a party where alcohol was served. The client admits to drinking alcohol before being raped by an acquaintance. The nurse should:
Correct Answer: C
Rationale: Supporting the client and affirming that the rape was not her fault is critical, as acquaintance rape is serious and not negated by alcohol consumption.
Question 2 of 5
After the client discusses her relationship with her father, the nurse says, 'Tell me whether I am understanding your relationship with your father. You feel dominated and controlled by him?' This is an example of:
Correct Answer: B
Rationale: Consensual validation is a technique used to check one's understanding of what the client has said. Consensual validation is the process by which people come to agreement about the meaning and significance of specific symbols. Through this experience, individuals develop the ability to relate effectively.
Question 3 of 5
When assessing a client in the Emergency Department whose membranes have ruptured, the nurse notes that the fluid is a greenish color. What is the cause of this greenish coloration?
Correct Answer: B
Rationale: Greenish amniotic fluid passed when the fetus is in a cephalic (head) presentation might indicate fetal distress. A fetus in the breech presentation passes meconium due to compression on the intestinal tract.
Question 4 of 5
In performing a psychosocial assessment, the nurse begins by asking questions that encourage the client to describe problematic behaviors and situations. The next step is to elicit the client's:
Correct Answer: B
Rationale: Eliciting the client's thoughts after describing issues provides insight into their perspective and interpretation, guiding further assessment. Feelings and solutions come later.
Question 5 of 5
When discussing the patterns of use of alcohol and other drugs, the nurse should include which piece of information?
Correct Answer: C
Rationale: Alcohol and drug use peaks in the mid-20s and decreases with age. Men have higher prevalence, Caucasians report more alcohol use, and heavy use is more common among less educated or unemployed groups.