NCLEX-RN
Psychosocial Integrity NCLEX RN Questions Questions
Extract:
Question 1 of 5
The client with cholecystitis is being instructed about dietary choices. Which meal best meets the dietary needs of this client?
Correct Answer: B
Rationale: Clients with cholecystitis, which is inflammation of the gallbladder, should follow a low-fat diet to reduce symptoms. Broiled fish, green beans, and an apple (Option
B) is the most suitable choice as it is low in fat. Steak, baked beans, and a salad (Option
A) provide a high amount of fat and protein, which may exacerbate symptoms of cholecystitis. Pork chops, macaroni and cheese, and grapes (Option
C) and avocado salad, milk, and angel food cake (Option
D) contain high-fat foods that are not recommended for individuals with cholecystitis.
Therefore, Option B is the most appropriate choice for a client with cholecystitis.
Question 2 of 5
The nurse is caring for a client with schizophrenia who is having active hallucinations. The nurse implements which actions to manage the client during the episode? Select all that apply.
Correct Answer: A,D,E
Rationale: Medications help manage hallucinations, distraction can reduce focus on hallucinations, and assessing for command hallucinations ensures safety.
Touch may increase anxiety, reinforcing hallucinations is nontherapeutic, and going along with delusions can worsen confusion.
Question 3 of 5
A 20-year-old female client with noticeable body odor has refused to shower for the last 3 days. She states, 'I have been told that it is harmful to bathe during my period.' Which action should the nurse take first?
Correct Answer: D
Rationale: The correct answer is to teach the importance of personal hygiene during menstruation to the client. While respecting the client's beliefs, it is essential to provide education on maintaining hygiene during menstruation. This empowers the client with knowledge to make informed decisions. Options A and B can be considered after providing education. Option C, obtaining brochures, is not the priority as direct communication and teaching would be more effective in addressing the client's concerns.
Question 4 of 5
The client is 5 feet from the bathroom door when he states, 'I feel faint.' Before the nurse can get the client to a chair, the client starts to fall. What is the priority action for the nurse to take?
Correct Answer: D
Rationale: The priority action for the nurse is to gently lower the client to the floor (Option
D). This action is crucial to prevent injury to both the client and the nurse. Lowering the client to the floor should be done when the client is unable to support his own weight, ensuring a safe position to prevent falls. Checking the client's carotid pulse (Option
A) is important, but it should be performed after ensuring the client's safety. Encouraging the client to get to the toilet (Option
B) is impractical as the client is already falling. Calling for help in a loud voice (Option
C) may cause chaos and alarm other clients, making it a less suitable immediate action in this scenario.
Question 5 of 5
A client has a nursing diagnosis of Altered sleep patterns related to nocturia. Which client instruction is important for the nurse to provide?
Correct Answer: A
Rationale: Nocturia is characterized by urination during the night, disrupting sleep patterns. Instructing the client to decrease intake of fluids after the evening meal (Option
A) can help reduce the production of urine, thereby decreasing the need to void at night. Cranberry juice (Option
B) is beneficial for preventing bladder infections but does not address the issue of nocturia. While warm decaffeinated beverages (Option
C) may promote sleep, consuming fluids close to bedtime can exacerbate nocturia. Consulting the healthcare provider about a sleeping pill (Option
D) is not the first-line intervention and may lead to urinary incontinence if the client is sedated and unable to awaken to void, worsening the nocturia issue.