QUESTION 44 The RN is caring for a woman who experienced interpersonal violence from her spouse of 15 years. Which nursing intervention would assist


The RN is caring for a woman who experienced interpersonal violence from her spouse of 15 years. Which nursing intervention would assist with empowering this patient?

a.           Ask the patient if she knows why this happened to her.

b.           Help her recognize ways she is dependent on her abuser.

c.            Identify a family member to help solve family problems.

d.           Teach her about the use of conflict resolution.


An LPN reports to the RN that while caring for their Asian client, the client always looks away. The RN informs the LPN that which principle likely explains the client’s behavior?

a.           The client likely feels ashamed about the mental illness.

b.           The client is exhibiting a cultural norm and it should be respected.

c.            The client needs to be left alone for a few hours to cope with the illness.

d.           The client is seriously mentally ill and unable to interact with staff.


What is the priority action that considers both legal and ethical principles when the RN suspects child abuse?

a.           Call the child abuse hotline.

b.           Document suspicions in the medical record.

c.            Ask other nurses to validate any uncertainties.

d.           Wait until more evidence is available.


Which is considered a positive symptom of Schizophrenia?

a.           Withdrawal

 b.          Limited speech

 c.           Associative looseness

 d.          Flat affect


Two RNs are having a discussion. One states, “I have attained the professional goals I have set for myself; I am a nurse manager with national certification in emergency nursing.” Which of Maslow’s hierarchy of needs does this statement represent?

 a.          Physiological

b.           Love and belonging

c.            Safety

d.           Self-actualization


A client tells the unlicensed assistive personnel (UAP) “I am so depressed every year around the holidays.” What is the RN’s appropriate response when the UAP asks the RN what the client’s statement means?

a.           “The client should always try to take vacation at the end of December.”

b.           “It is apparent this client must be seeing a counselor on a regular basis.”

c.            “The client may be experiencing seasonal affective disorder.”

d.           “It is likely a case of moderate anxiety that should be treated.”


Which question should the RN ask of a client who is at risk for suicide?

a.           Have you given away any of your personal belongings recently?

b.           Are you planning on changing jobs in the near future?

c.            How has your life improved over the last month?

d.           Can you describe your plans for retirement?


Which of the following medications would the RN expect to administer to prevent relapse for alcohol abuse?

a.           buproprion (Wellbutrin)

b.           gabapentin (Neurontin)

c.            disulfiram (Antabuse)

d.           methadone (Dolophine)  


The RN observes a school-aged patient with Autism giggling uncontrollably while slapping her head. What is the RN’s appropriate interpretation of this behavior?

 a.          A common manifestation seen with autism.

 b.          An untoward reaction to a medication.

 c.           The existence of a severe headache.

 d.          The development of a seizure disorder.


The RN would expect to assess which behavior in a client admitted with a medical diagnosis of Bipolar Disorder and inappropriate affect?

 a.          Crying and wringing of hands while talking.

 b.          Jumping up and down on the couch while smiling.

 c.           Eyes cast downward with no display of emotion.

 d.          Laughing hysterically while talking about a sad event.


The RN is caring for a client with Schizophrenia who states, “I am an Olympic gold medalist.” How would the RN assess this client statement?

 a.          Delusions of grandeur

 b.          Ideas of reference

 c.           Inappropriate affect

 d.          Hallucinations

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