NCLEX-PN Test #12 3 — Questions and Answers
Question 1: The PN is performing a mental status examination. Which question best assesses the client's orientation?
- "What is 7 minus 3, and subtract 3 from that?"
- "Can you tell me what day, month, and year it is, where you are, and what your name is?" (Correct answer)
- "What does the phrase 'don't cry over spilled milk' mean to you?"
- "Please copy this design on a piece of paper."
Correct answer: "Can you tell me what day, month, and year it is, where you are, and what your name is?"
Orientation is assessed by asking about person (name), place (where they are), and time (day/month/year). Serial subtraction tests concentration; interpretation of proverbs assesses abstract thinking; drawing tests visuospatial ability. Orientation × 3 (person, place, time) is a standard component of the mental status exam.
Question 2: A client with opioid use disorder is being treated with buprenorphine/naloxone (Suboxone). The client asks why naloxone is included. What is the correct explanation?
- "Naloxone treats depression, which commonly accompanies opioid addiction."
- "Naloxone is inactive when taken sublingually but precipitates severe withdrawal if the tablet is crushed and injected, deterring misuse." (Correct answer)
- "Naloxone reverses the effects of buprenorphine if you take too much."
- "Naloxone eliminates the need for counseling as part of your treatment."
Correct answer: "Naloxone is inactive when taken sublingually but precipitates severe withdrawal if the tablet is crushed and injected, deterring misuse."
Naloxone (an opioid antagonist) in Suboxone is an abuse-deterrent. When taken as directed sublingually, naloxone has poor bioavailability and does not significantly block buprenorphine's effects. However, if the tablet is crushed and injected IV, the naloxone becomes active and precipitates acute opioid withdrawal, deterring IV misuse.
Question 3: A client with borderline personality disorder frequently says, "You are the only nurse who truly understands me — all the other nurses are awful." The nurse recognizes this as:
- Transference
- Splitting (Correct answer)
- Manipulation for secondary gain
- Reaction formation
Correct answer: Splitting
Splitting is a primitive defense mechanism characteristic of borderline personality disorder in which people and situations are viewed as all good or all bad, with no middle ground. Idealization of one staff member while devaluing others is classic splitting. The therapeutic response is to maintain consistent boundaries and avoid being drawn into the idealization.
Question 4: A client on the psychiatric unit says, "I have a plan to end my life — I've been saving my medications." What is the priority nursing action?
- Document the statement and discuss in the next treatment team meeting
- Immediately conduct a room search for stockpiled medications and implement 1:1 continuous observation (Correct answer)
- Contact the client's family to inform them of the risk
- Encourage the client to discuss their plan in group therapy
Correct answer: Immediately conduct a room search for stockpiled medications and implement 1:1 continuous observation
This client has disclosed a specific suicide plan with means (stockpiled medications). This is an imminent safety crisis. Priority actions: immediate room and belongings search for stockpiled medications, implement 1:1 continuous observation, notify the provider, and document all actions. Family notification follows safety implementation.
Question 5: A client with schizophrenia is prescribed risperidone (an atypical antipsychotic). Which side effect should the nurse specifically monitor for?
- Agranulocytosis requiring weekly CBC
- Tardive dyskinesia and extrapyramidal symptoms (EPS) (Correct answer)
- Serotonin syndrome
- Anticholinergic toxicity with urinary retention and dry mouth
Correct answer: Tardive dyskinesia and extrapyramidal symptoms (EPS)
Although atypical antipsychotics have lower EPS risk than typical antipsychotics, risperidone has a higher EPS profile among atypicals. Tardive dyskinesia (involuntary repetitive movements) and extrapyramidal symptoms (akathisia, parkinsonism, dystonia) require monitoring. Clozapine specifically requires weekly CBC monitoring for agranulocytosis.
Question 6: The nurse is caring for a client withdrawing from cocaine. Which symptoms should the nurse anticipate?
- Hypertension, tachycardia, agitation, and tremors
- Fatigue, dysphoria, increased sleep, increased appetite, and cocaine cravings (Correct answer)
- Diaphoresis, gooseflesh, muscle cramps, and yawning
- Seizures and life-threatening delirium
Correct answer: Fatigue, dysphoria, increased sleep, increased appetite, and cocaine cravings
Cocaine withdrawal (crash phase) is characterized by fatigue, hypersomnia, increased appetite, depression/dysphoria, irritability, and intense cocaine cravings. Unlike opioid or alcohol withdrawal, cocaine withdrawal is not physically dangerous (no seizures or delirium) but poses high risk of relapse due to severe psychological craving.
NCLEX-PN Test #12 3
The PN is performing a mental status examination.
Which question best assesses the client's orientation?