LVN - Licensed Vocational Nurse Psychosocial Integrity 1 — Questions and Answers
Question 1: A terminally ill patient tells the nurse, 'If God lets me live long enough to see my daughter graduate, I promise I'll volunteer at the hospital every week.' The nurse recognizes this as which stage of Kübler-Ross grief?
- Denial
- Bargaining (Correct answer)
- Depression
- Acceptance
Correct answer: Bargaining
Bargaining is the stage in which patients make deals or promises — often with a higher power — in hopes of postponing death or loss. The patient is offering a future action in exchange for more time, which is the hallmark of this stage.
Question 2: A nurse is caring for a patient who recently lost a limb. The patient states, 'I don't need to talk to anyone — I'm fine.' Which coping mechanism is the patient most likely demonstrating?
- Regression
- Rationalization
- Suppression (Correct answer)
- Intellectualization
Correct answer: Suppression
Suppression is the conscious decision to push distressing thoughts or feelings out of awareness. The patient is actively choosing not to discuss or acknowledge emotional distress, which distinguishes suppression from the unconscious mechanism of repression.
Question 3: An LVN notices that a patient diagnosed with schizophrenia is pacing, clenching their fists, and speaking rapidly. Which nursing action should the LVN take FIRST?
- Administer the patient's scheduled antipsychotic medication
- Escort the patient to a quiet, low-stimulation environment (Correct answer)
- Ask the patient to explain what they are feeling
- Document the behavior and notify the charge nurse
Correct answer: Escort the patient to a quiet, low-stimulation environment
Safety is the priority when a patient shows signs of escalating agitation. Moving the patient to a calm, low-stimulation environment can de-escalate the situation before it becomes dangerous, and is a non-pharmacological first-line intervention.
Question 4: A patient who recently received a cancer diagnosis sits silently with tears rolling down their face. Which response by the LVN is MOST therapeutic?
- 'Try not to cry — you need to stay positive for your treatment.'
- 'I know exactly how you feel; my aunt had cancer too.'
- 'I'm here with you. Take all the time you need.' (Correct answer)
- 'Would you like me to call your doctor to explain the diagnosis again?'
Correct answer: 'I'm here with you. Take all the time you need.'
Sitting with the patient and offering a presence-based response acknowledges their emotions without minimizing, redirecting, or projecting. This demonstrates empathy and uses the therapeutic technique of offering self, which is most appropriate in a moment of acute grief.
Question 5: Which statement by a patient who attempted suicide MOST indicates a continued high risk and should be reported immediately to the charge nurse?
- 'I feel embarrassed that I ended up here.'
- 'I'm glad someone found me in time.'
- 'I've already figured out another way to do it next time.' (Correct answer)
- 'I don't think my family will ever forgive me.'
Correct answer: 'I've already figured out another way to do it next time.'
Verbalization of a specific alternate plan indicates active suicidal ideation with intent, which represents the highest level of immediate risk. This requires urgent reporting and likely a one-to-one safety watch or transfer to a higher level of psychiatric care.
Question 6: An older adult patient in a long-term care facility repeatedly refuses to participate in activities and states, 'What's the point? Nobody visits me anyway.' The LVN should identify this patient as being at risk for which psychosocial problem?
- Acute confusion
- Social isolation (Correct answer)
- Ineffective denial
- Risk for self-directed violence
Correct answer: Social isolation
The patient's statements about lack of visitors, withdrawal from activities, and a sense of hopelessness are classic indicators of social isolation. This nursing diagnosis reflects a perceived or actual aloneness that the patient experiences as negative, and is especially common in long-term care settings.
LVN - Licensed Vocational Nurse Psychosocial Integrity 1
A terminally ill patient tells the nurse, 'If God lets me live long enough to see my daughter graduate, I promise I'll volunteer at the hospital every week.' The nurse recognizes this as which stage of Kübler-Ross grief?