Psychosocial Integrity Nclex PN Questions - Nurselytic

Questions 69

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Psychosocial Integrity Nclex PN Questions Questions

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Question 1 of 5

The physician orders the antibiotics ampicillin (Omnipen) and gentamicin (Garamycin) for a newly admitted client with an infection. The nurse should:

Correct Answer: B

Rationale: A client with an infection needs both antibiotics as soon as possible. However, the pH of ampicillin is 8-10, and the pH of gentamicin is 3-5.5, making them incompatible when given together. Flushing well between drugs is necessary to prevent interaction.
Choice C is incorrect because the nurse, not the physician or pharmacy, should determine the correct administration sequence. Consulting with the pharmacist is appropriate if uncertain.
Choice D is incorrect because delaying the second medication by several hours can slow the treatment of the client's infection, as both antibiotics are needed promptly to address the infection effectively.
Therefore, the correct action is to give the medications sequentially and flush well between them to prevent any potential interactions.

Question 2 of 5

What significant event occurs in the orientation phase of a nurse-client relationship?

Correct Answer: B

Rationale: In the orientation phase of a nurse-client relationship, the significant event is the identification of transference phenomenon. Transference phenomena are intensified in relationships with authority figures like nurses and physicians. Positive transferences may include a desire for affection and dependency, while negative transferences may involve hostility and competitiveness. It is crucial to recognize and address these transferences before progress and positive changes can be made in the working stage. The other choices are incorrect; the establishment of roles may occur in the working phase, placing the client within their family structure is not a key event in the orientation phase, and client agreement on the nurse's authority is not the primary focus during this phase.

Question 3 of 5

A client reports hearing voices. What should the nurse do next?

Correct Answer: C

Rationale: When a client reports hearing voices, it might indicate hallucinations. It is essential for the nurse to ask the client to describe what is happening to gain a better understanding of the hallucinations. This approach helps in assessing the severity and content of the hallucinations, which can guide further interventions.
Touching the client without consent can be intrusive and may escalate the situation, violating the client's personal space. Leaving the client alone may not address the underlying issue of hallucinations and can lead to potential risks if the client is distressed. Telling the client there are no voices denies their experience, invalidates their feelings, and can result in mistrust between the client and the nurse.

Question 4 of 5

What is the profile of an individual who engages in domestic violence?

Correct Answer: D

Rationale: Individuals who engage in domestic violence come from various backgrounds and cannot be stereotyped based on demographic factors like culture, income, or race. Research shows that perpetrators of domestic abuse can be found in any walk of life, regardless of their race, income group, or profession. It is important to note that the majority of domestic violence cases involve male perpetrators and female victims, but the profile of the abuser is not limited to specific demographic features.
Therefore, the correct answer is that individuals who engage in domestic violence can come from any walk of life, race, income group, or profession.

Choices A and B are incorrect as they wrongly associate domestic violence with specific cultural or income groups.
Choice C is incorrect as there is no evidence to support the claim that being disallowed to compete as a child leads to domestic violence.

Question 5 of 5

Ashley and her boyfriend Chris, both 19 years old, are transported to the Emergency Department after being involved in a motorcycle accident. Chris is badly hurt, but Ashley has no apparent injuries, though she appears confused and has trouble focusing on what is going on around her. She complains of dizziness and nausea. Her pulse is rapid, and she is hyperventilating. The nurse should assess Ashley's level of anxiety as:

Correct Answer: C

Rationale: Based on the symptoms described, Ashley's level of anxiety should be assessed as severe. In severe anxiety, individuals have difficulty solving problems and understanding their environment. They often exhibit somatic symptoms like dizziness, nausea, rapid pulse, and hyperventilation. In contrast, mild anxiety may lead to mild discomfort or even enhanced performance. Moderate anxiety involves grasping less information, mild difficulty in problem-solving, and slight changes in vital signs. Panic, on the other hand, is characterized by markedly disturbed behavior and a potential loss of touch with reality.
Therefore, in Ashley's case, the presence of somatic symptoms and vital sign changes indicates severe anxiety.

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