NCLEX-PN Test #15 2 — Questions and Answers
Question 1: A client newly diagnosed with breast cancer says, "Why is this happening to me? I've lived a healthy life." The nurse's best response is:
- "Everything happens for a reason. Stay positive."
- "Your healthy lifestyle will help you recover more quickly."
- "It sounds like you're feeling angry and questioning why this happened. That's a very understandable reaction." (Correct answer)
- "You're right to be upset. The healthcare system often fails people."
Correct answer: "It sounds like you're feeling angry and questioning why this happened. That's a very understandable reaction."
This response validates the client's emotional experience without dismissing, deflecting, or providing false reassurance. Acknowledging feelings (anger, confusion) using reflection is a core therapeutic communication technique that builds trust and encourages the client to express further concerns. Platitudes ("everything happens for a reason") block therapeutic communication.
Question 2: The nurse is using motivational interviewing with a client who wants to quit smoking but feels ambivalent. Which nursing statement best reflects a motivational interviewing technique?
- "Smoking will definitely kill you. You really should stop immediately."
- "Tell me about the times you've successfully made other changes in your life." (Correct answer)
- "I'm going to give you a list of all the health risks of smoking."
- "You've tried to quit before and failed — what makes you think this time will be different?"
Correct answer: "Tell me about the times you've successfully made other changes in your life."
Motivational interviewing (MI) is a collaborative, empathetic approach that explores the client's own motivations and strengths. Asking about past successful changes evokes self-efficacy (affirming technique). MI avoids confrontation (options A, D) and one-way information delivery (option C). It focuses on the client's own values and goals.
Question 3: A client experiencing grief after the death of a spouse says, "I keep thinking I hear him in the next room." How should the nurse respond?
- "That is very concerning. I will contact the psychiatrist for an evaluation."
- "Experiencing these sensations is a common and normal part of grief — it doesn't mean anything is wrong with you." (Correct answer)
- "You need to accept that he is gone and focus on moving forward."
- "Let's discuss starting an antidepressant to help with these symptoms."
Correct answer: "Experiencing these sensations is a common and normal part of grief — it doesn't mean anything is wrong with you."
Grief hallucinations (sensing or hearing the deceased) are a common, normal aspect of acute grief, not a sign of psychosis. Normalizing this experience reduces the client's distress and shame. Pathologizing normal grief (options A, D) or dismissing it (option C) is non-therapeutic and can harm the grieving process.
Question 4: A client refuses a blood transfusion on religious grounds despite a life-threatening hemoglobin level of 5.2 g/dL. What is the appropriate nursing response?
- Administer the transfusion as ordered — the provider's order overrides client refusal in emergencies
- Document the refusal, notify the provider and ethics team, and continue to support the client's decision-making autonomy (Correct answer)
- Ask the client's family to convince the client to accept the transfusion
- Withhold all care until the client agrees to the transfusion
Correct answer: Document the refusal, notify the provider and ethics team, and continue to support the client's decision-making autonomy
Competent adult clients have the absolute right to refuse medical treatment, including blood products, even if the refusal may result in death. The nurse must: respect the client's autonomy and informed refusal, document the refusal thoroughly, notify the provider, explore alternatives (cell saver, erythropoietin, iron infusion), and involve ethics consultation.
Question 5: The PN is caring for a client from a culture different from their own. Which approach best demonstrates cultural competence?
- Apply universal Western medical standards and educate the client to conform to them
- Ask the client directly about their cultural beliefs, practices, and preferences related to their care (Correct answer)
- Assume the client's beliefs based on their ethnic background
- Use medical interpreters only when the client explicitly asks for one
Correct answer: Ask the client directly about their cultural beliefs, practices, and preferences related to their care
Cultural competence requires individually assessing each client's beliefs and practices — not assuming based on ethnicity or applying cultural generalizations. Asking the client directly about their cultural health beliefs, dietary restrictions, spiritual needs, and care preferences is the most respectful and accurate approach.
Question 6: A client with advanced dementia begins crying during a bath. Which nursing response is most therapeutic?
- Continue the bath quickly to minimize the client's discomfort duration
- Stop the bath and tell the family the client refuses all hygiene care
- Pause the bath, speak calmly and reassuringly, use gentle touch, and consider whether discomfort or fear is the cause (Correct answer)
- Document that the client was uncooperative and request a PRN sedative
Correct answer: Pause the bath, speak calmly and reassuringly, use gentle touch, and consider whether discomfort or fear is the cause
For clients with dementia, distress during care often indicates pain, fear, cold, or overstimulation — not simply resistance. Pausing, assessing for discomfort, using gentle reassuring communication, and adjusting the approach (warm water temperature, covering areas not being washed, using familiar soap) reduces distress. Person-centered dementia care minimizes the use of sedation.
NCLEX-PN Test #15 2
A client newly diagnosed with breast cancer says, "Why is this happening to me? I've lived a healthy life." The nurse's best response is: