NCLEX-PN
NCLEX Physiological Adaptation Questions
Extract:
Question 1 of 5
During a well-baby check of a 6-month-old infant, the nurse notes abrasions and petechiae of the palate. The nurse should:
Correct Answer: B
Rationale: Generally oral sex leaves little physical evidence. Injury to the soft palate (such as bruising, abrasions, and petechiae) and pharyngeal gonorrhea are the only signs. Infants are at risk for sexual abuse.
Question 2 of 5
The three major sequential maturational crises for females include:
Correct Answer: A
Rationale: The three major sequential maturational crises affecting females are puberty, pregnancy, and menopause. These are life events that have been studied by many researchers and are considered the major events in a woman's life. Puberty is the onset menarche. Pregnancy is a turning point in one's life from which there is no return. Menopause is the cessation of menses. The nurse has the responsibility to assess, plan, implement appropriate concepts to facilitate effective functioning, and enhance growth and development. Other options are not sequential maturational crises.
Question 3 of 5
A nurse observes a client sitting alone and talking. When asked, the client reports that he is 'talking to the voices.' The nurse's next action should be:
Correct Answer: C
Rationale: Asking the client to describe the hallucinations validates their experience and provides insight into their condition, aiding therapeutic communication.
Touching may be intrusive, leaving them alone is non-therapeutic, and denying the voices dismisses their reality.
Question 4 of 5
Which of the following blood pressure parameters indicates PIH? Elevation over a baseline of:
Correct Answer: A
Rationale: These are the accepted parameters for mild PIH. Mild preclampsia includes an increase in systolic blood pressure higher than 30 mmHg or an increase in diastolic blood pressure higher than 15 mmHg, noted on two readings taken 6 hours apart (or 140/90).
Question 5 of 5
An effective intervention for a client diagnosed with Obsessive-Compulsive Disorder is:
Correct Answer: D
Rationale: Exercise reduces anxiety and redirects attention in OCD, serving as a non-confrontational intervention to decrease compulsive behaviors.