NCLEX-PN Test #4 3 — Questions and Answers
Question 1: A client with generalized anxiety disorder reports, "I can't stop worrying about everything — my job, my family, everything." Which therapeutic response is most appropriate?
- "I wouldn't worry so much if I were you. Things usually work out."
- "You shouldn't let stress control your life."
- "It sounds like you're feeling overwhelmed by worry. Can you tell me more?" (Correct answer)
- "Have you tried relaxation techniques? They work really well."
Correct answer: "It sounds like you're feeling overwhelmed by worry. Can you tell me more?"
The therapeutic response validates the client's feelings and uses an open-ended question to encourage further expression. This demonstrates empathy and active listening. Giving advice (options A, B, D) dismisses the client's experience and can inhibit therapeutic communication.
Question 2: A client with bipolar disorder is in a manic episode. Which nursing intervention is the priority?
- Encourage group therapy activities to channel energy
- Provide a low-stimulation environment and set limits on behavior (Correct answer)
- Administer a prescribed SSRI antidepressant
- Schedule structured activities throughout the day
Correct answer: Provide a low-stimulation environment and set limits on behavior
During mania, reducing environmental stimulation is the priority to prevent escalation. Clients in manic states are highly distractible and at risk for exhaustion, impulsive behavior, and self-harm. Group activities can over-stimulate. SSRIs are contraindicated in mania as they can worsen the episode.
Question 3: The PN is caring for a client with anorexia nervosa who is being re-fed. Which complication must the nurse monitor for most closely?
- Hyperkalemia
- Refeeding syndrome (hypophosphatemia) (Correct answer)
- Hyponatremia
- Metabolic alkalosis
Correct answer: Refeeding syndrome (hypophosphatemia)
Refeeding syndrome is a potentially fatal complication of nutritional rehabilitation after starvation. Rapid carbohydrate intake triggers insulin release and shifts phosphate, potassium, and magnesium into cells, causing severe hypophosphatemia. The nurse must monitor electrolytes closely during refeeding.
Question 4: A client is prescribed lithium carbonate for bipolar disorder. Which symptom indicates lithium toxicity?
- Polyuria and polydipsia (early side effects)
- Coarse hand tremor, ataxia, and confusion (Correct answer)
- Mild weight gain and acne
- Dry mouth and constipation
Correct answer: Coarse hand tremor, ataxia, and confusion
Coarse tremor (vs. fine tremor which is a mild side effect), ataxia (loss of coordination), and confusion are signs of lithium toxicity (serum level >1.5 mEq/L). Therapeutic range is 0.6–1.2 mEq/L. Toxicity can progress to seizures and death. Polyuria/polydipsia are common early non-toxic side effects.
Question 5: A client with post-traumatic stress disorder (PTSD) is experiencing a flashback. What is the most therapeutic nursing response?
- Leave the client alone until the episode passes
- Speak in a calm, clear voice, orient the client to the present, and ensure safety (Correct answer)
- Administer a PRN anxiolytic immediately
- Encourage the client to talk about the traumatic event in detail
Correct answer: Speak in a calm, clear voice, orient the client to the present, and ensure safety
During a flashback, grounding techniques help bring the client back to the present moment. The nurse should speak calmly and clearly, provide orienting cues ("You are safe, you are in the hospital"), and ensure the environment is safe. Pressing the client to discuss trauma details during acute distress is contraindicated.
Question 6: A client is admitted for alcohol withdrawal. Which medication is most commonly used to prevent withdrawal seizures?
- Naltrexone (Vivitrol)
- Lorazepam (Ativan) (Correct answer)
- Haloperidol (Haldol)
- Disulfiram (Antabuse)
Correct answer: Lorazepam (Ativan)
Benzodiazepines such as lorazepam or diazepam are the gold standard for alcohol withdrawal management. They act on GABA receptors, reducing CNS excitability and preventing progression to seizures (alcohol withdrawal seizures, delirium tremens). Naltrexone reduces cravings; disulfiram is aversion therapy; haloperidol treats psychosis but not withdrawal.
NCLEX-PN Test #4 3
A client with generalized anxiety disorder reports, "I can't stop worrying about everything — my job, my family, everything." Which therapeutic response is most appropriate?