Question 1

In preparation for discharge, a client diagnosed with schizophrenia was taught symptom self-management as part of a relapse prevention program. Which statement indicates to the nurse that the client understands symptom monitoring?

Accepted Answer

Answer reason:  Relapse-prevention symptom monitoring focuses on recognizing early warning signs (often rising stress, sleep disruption, increased anxiety) and responding with planned coping strategies to reduce symptom escalation. This statement shows the client identifies stress as a trigger and uses a concrete, adaptive technique (quiet environment and guided imagery) to manage it. The other responses reflect fear, limited family involvement, or avoidance rather than active self-monitoring paired with a therapeutic action plan. Effective self-management emphasizes early recognition plus a specific coping response and help-seeking plan to prevent decompensation.

Question 2

The nurse is explaining to parents the social behavior of children with hypopituitarism. The nurse determines further teaching is necessary when a parent makes which statement?

Accepted Answer

Answer reason:  Children with hypopituitarism often have normal intelligence and language development, but their short stature can lead others to misperceive them as younger and treat them differently socially and academically. Assuming that strong vocabulary will prevent differential treatment shows misunderstanding of the common psychosocial impact of being significantly smaller than peers. This can contribute to anxiety, low self-esteem, and lowered expectations from others, which are realistic concerns that require anticipatory guidance. The other statements appropriately acknowledge potential social stressors and altered expectations that may occur with short stature.

Question 3

A patient is kept off food and fluids for 10 hours before surgery. His oral temperature at 8 a.m. is 99.8 F (37.7 C) This temperature reading probably indicates?

Accepted Answer

Answer reason: A 10-hour pre-op fast commonly increases anxiety, and 99.8°F (37.7°C) is not a true fever by typical clinical definitions, making infection less likely based on this value alone. Dehydration from short-term NPO may cause thirst, dry mucosa, and tachycardia, but it does not typically produce an isolated mild temperature rise at this level. Hypothermia would present with a decreased temperature, not a mild elevation.

Question 4

The nurse is counseling a client who has breast cancer. Which tertiary prevention measure should the nurse recommend?

Accepted Answer

Answer reason: Tertiary prevention focuses on reducing the impact of an established disease by optimizing function, supporting coping, and preventing complications or deterioration in quality of life. A support group provides ongoing psychosocial support, improves adjustment, and can enhance adherence to treatment and symptom-management strategies during and after cancer therapy. Options about risk-factor education and genetic screening are aimed at preventing disease development in others (primary prevention), not reducing disability in the affected client. Assessing the other breast aligns more with surveillance/early detection (secondary prevention) rather than rehabilitation/support after diagnosis.

Question 5

A pediatric clinic nurse is providing education to the parent of a 5-year-old boy with hypopituitarism and growth hormone deficiency. Which of the following statements indicates an understanding of the teaching?

Accepted Answer

Answer reason: ” Children with growth hormone deficiency often have short stature that can make them a target for peer teasing, so anticipatory guidance about psychosocial risks and early intervention reflects accurate teaching. Recombinant growth hormone is typically administered subcutaneously in the evening to mimic normal nocturnal secretion, making morning dosing incorrect. Treatment improves linear growth velocity but does not guarantee the child will match peers’ growth timing exactly, especially if therapy starts later. Disproportionately large facial features are associated with excess growth hormone (eg, acromegaly/gigantism), not untreated deficiency.

Question 6

The client is diagnosed with acute kidney failure. Which of the following is an appropriate psychosocial problem for the nurse to include in the care plan?

Accepted Answer

Answer reason: This is the correct psychosocial problem because it addresses the client’s emotional response to acute kidney failure, including fear, uncertainty, and concern about the illness and its outcome. The other options describe physiological or safety problems rather than a psychosocial nursing problem.

Question 7

You are the charge nurse on a medical-surgical unit. You have noticed over the last several weeks that one of the nurses on your team is displaying anger and negative feelings, which is not at all characteristic of this experienced nurse. What is this nurse most likely experiencing?

Accepted Answer

Answer reason: Burnout is characterized by emotional exhaustion, cynicism, and negative attitudes over time, especially in experienced staff. The pattern described—persistent anger and negativity over weeks—is classic for burnout rather than temporary fatigue or role confusion.

Question 8

The client is hospitalized for HF secondary to alcohol-induced cardiomyopathy. The client is started on milrinone and placed on a transplant waiting list. The client has been curt and verbally aggressive in expressing dissatisfaction with the medications, overall care, and the need for energy conservation. Which nursing interpretation of the client's behavior is most appropriate?

Accepted Answer

Answer reason: Clients facing serious, life-threatening conditions such as heart failure requiring transplant often experience significant fear and anxiety. This fear may manifest as irritability, anger, or verbal aggression. Recognizing fear as the underlying emotion allows the nurse to respond therapeutically and provide appropriate emotional support. Option A (denial) would present differently, often as minimization or refusal to acknowledge illness. Option C is judgmental and not supported by the data. Option D is unlikely, as milrinone does not typically cause behavioral changes like aggression.

Question 9

The female client, who has Hodgkin’s lymphoma with cervical and axillary node involvement, is to receive chemotherapy and radiation. The nurse evaluates that the client is coping positively when the client makes which statement?

Accepted Answer

Answer reason: The client acknowledges the reality of treatment effects (hair loss) while taking adaptive action (obtaining a wig). This reflects effective coping and emotional processing.  Option B shows denial. Option C is factually incorrect. Option D reflects unrealistic expectations rather than adaptive coping.

Question 10

A client is hospitalized at 35 weeks’ gestation with placenta previa and placed on strict bedrest. She states, “I lost my last baby at 24 weeks.” What is the priority nursing diagnosis?

Accepted Answer

Answer reason: The client’s statement reflects fear and emotional distress related to a prior pregnancy loss and current high-risk condition. Addressing psychological needs is the priority because anxiety can impact both maternal and fetal well-being.

Question 11

The nurse provides care for a client who is diagnosed with progressive multiple sclerosis (MS) and prescribed interferon beta. Which statement indicates a need to further assess the client for maladaptive coping?

Accepted Answer

Answer reason: This statement reflects emotional fatigue and possible frustration with a constant focus on illness and infection risk. It suggests the client may be struggling to maintain psychological balance and could be developing maladaptive coping patterns, such as fixation on stressors without relief. The other statements demonstrate acceptance, understanding, and adaptive coping behaviors.

Question 12

A client has multiple myeloma. Which action should alert the nurse that he may be having difficulty coping with his prognosis?

Accepted Answer

Answer reason: Avoidance of discussion about one’s illness is a maladaptive coping mechanism that may indicate denial or inability to process the diagnosis. In contrast, expressing emotions, asking questions, and showing concern for family are typical and adaptive responses to a serious illness.

Question 13

The nurse knows that families require coping skills to manage illness recovery at home. Which is an appropriate coping skill shown by the family?

Accepted Answer

Answer reason: Effective coping is reflected in the ability to manage stressors through organized thinking and problem-solving. This shows the family can adapt to the demands of illness recovery. The other options indicate ineffective coping behaviors.

Question 14

An example of internal family coping strategies includes?

Accepted Answer

Answer reason: Internal family coping strategies refer to adaptive mechanisms that occur within the family system itself, such as role flexibility, open communication, and mutual support. Role flexibility allows family members to adjust responsibilities during stress, improving resilience. The other options involve external coping strategies, including community resources, spiritual systems, and professional support.

Question 15

A pregnant client at 20 weeks gestation expresses concern about her changing body image and the emotional impact of physiological changes associated with pregnancy. Which of the following interventions would be most appropriate for the nurse to implement?

Accepted Answer

Answer reason: Supportive, coping-focused interventions help clients adapt to expected pregnancy-related body and emotional changes while promoting self-efficacy and stress reduction. Offering safe self-care strategies (e.g., prenatal yoga, mindfulness) provides concrete tools that can decrease anxiety, improve mood, and enhance acceptance of physiologic changes. Dismissing concerns is nontherapeutic and can damage rapport and discourage further disclosure. Advising comparison with others may worsen body dissatisfaction, and promoting suppression of emotions is maladaptive because it discourages healthy emotional processing.

Question 16

A nurse is educating clients about relaxation techniques. Which action should the nurse take first?

Accepted Answer

Answer reason: Effective relaxation training begins with assessment and insight into what precipitates the stress response so the client can apply techniques at the right time and in the right situations. Identifying triggers also helps tailor the intervention (eg, breathing, guided imagery, progressive muscle relaxation) to the client’s specific patterns and coping needs. Family education can be helpful but is not the initial priority when teaching an individual self-management skill. A routine physical assessment is not typically required to start basic relaxation strategies, and these noninvasive techniques generally do not require a provider order.

Question 17

The LPN/LVN is assisting with discharging a client from an inpatient alcohol treatment unit. Which of the following statements by the client’s wife indicates the family is coping adaptively?

Accepted Answer

Answer reason: Adaptive coping involves setting healthy boundaries and focusing on one’s own well-being rather than trying to control the behavior of the person with substance use disorder. This statement reflects independence and realistic coping. The other options show enabling, denial, or overcontrol, which are maladaptive patterns commonly seen in families of clients with addiction.

Question 18

The client has been diagnosed with a cardiovascular disease. When the nurse is teaching the client about disease management techniques, the nurse should emphasize strategies for reducing which of the following?

Accepted Answer

Answer reason: A time-urgent, “always in a hurry” style reflects high stress reactivity and is linked with increased cardiovascular strain. Teaching relaxation, pacing, prioritization, and reframing time pressure directly targets this maladaptive stress pattern. In contrast, simply changing the number of social encounters or solitary time is not a primary, evidence-based stress target unless social isolation or conflict is specifically identified.

Question 19

The home health nurse is assessing the stress level of a spouse who is the primary caregiver for a client diagnosed with Alzheimer’s disease. Which of the following questions would be most appropriate to effectively assess the caregiver’s stress level?

Accepted Answer

Answer reason: "So, describe your typical day. What is it like to you?" Open-ended assessment questions best elicit an accurate picture of caregiver burden by exploring routines, responsibilities, supports, and emotional responses without leading the person. This prompt invites the caregiver to describe day-to-day demands and how they are experiencing them, which allows the nurse to identify stressors, coping capacity, and red flags for burnout. In contrast, asking how they “manage” stress presumes stress is already recognized and may miss unacknowledged strain, while the “Isn’t it stressful” question is leading and can shut down disclosure. Offering to arrange part-time help is an intervention rather than an assessment and should follow identification of needs and readiness.

Question 20

The nurse taught the client about meditation. Which statement by the client demonstrates a correct understanding of this activity?

Accepted Answer

Answer reason: Meditation is a mind–body practice that trains attention and awareness while promoting a relaxation response. This description matches core elements used in clinical stress-management teaching: intentional focusing (e.g., breath, mantra, body sensations) plus physiologic calming. Focusing “on the future” is not a defining goal and can even increase rumination or worry. It is also not inherently religious and is not a single, rigidly defined technique, since multiple evidence-based methods exist (mindfulness, transcendental, guided imagery-based practices).

Question 21

The nurse is evaluating the effectiveness of guided imagery for a client with preoperative anxiety. Which client statement should indicate to the nurse that the therapy has been successful?

Accepted Answer

Answer reason:  Effective guided imagery is reflected by the client’s engagement and willingness to use the technique independently as a coping strategy. Planning to schedule practice indicates the client found the method helpful, acceptable, and feasible to continue, which supports sustained anxiety reduction. By contrast, statements about difficulty concentrating or worry about negative aftereffects suggest ongoing anxiety or poor tolerance of the intervention. A statement explaining the purpose of guided imagery demonstrates knowledge, but it does not show that the client’s anxiety has improved.

Question 22

The nurse decides to teach a client with hypertension the progressive relaxation technique. Which instructions should the nurse give to the client when using this relaxation method?

Accepted Answer

Answer reason: Progressive muscle relaxation is based on systematically tensing and then releasing muscle groups to reduce sympathetic arousal and promote a relaxation response, which can help lower stress-related blood pressure elevations. The stepwise approach through muscle groups (commonly head-to-toe or toe-to-head) is the defining instruction for this technique. Using forehead sensors describes biofeedback rather than progressive muscle relaxation. Repeating a word/phrase while focusing on breathing aligns more with meditation/mantra-based relaxation.

Question 23

A female client with amyotrophic lateral sclerosis (ALS) tells the nurse, “Sometimes I feel so frustrated. I can’t do anything without help!” This comment best supports which nursing diagnosis?

Accepted Answer

Answer reason: The client’s statement reflects a perceived loss of control and dependence due to progressive physical decline. Expressions such as “I can’t do anything without help” are classic indicators of powerlessness rather than anxiety, denial, or a physical-risk diagnosis like disuse syndrome.

Question 24

Which of the following nursing diagnosis is appropriate for your client when your client is not coping with a progressive disease in an adaptive manner?

Accepted Answer

Answer reason: Progressive diseases commonly lead to declining function and loss of independence, requiring significant role adjustments. Difficulty adapting to these changes results in ineffective coping. Role ambiguity and role conflict are organizational concepts, and fear alone does not fully capture the underlying coping difficulty associated with progressive illness.

Question 25

The nurse is preparing a nursing care plan for a client with a spinal cord injury (SCI) for whom problems of decreased mobility and inability to perform activities of daily living (ADLs) have been identified. The client tells the nurse, "I don't know why we're doing all this. My life's over." Based on this statement, which additional nursing concern takes priority?

Accepted Answer

Answer reason: The client’s statement reflects hopelessness and an inability to adapt to a life-changing condition, which are hallmark signs of ineffective coping. This psychosocial response takes priority because it directly affects the client’s motivation to participate in care, rehabilitation, and recovery. While body image disturbance and other physical risks may be present, the immediate concern is the client’s emotional and psychological adjustment to the spinal cord injury.

Question 26

How do you control your anger?

Accepted Answer

Answer reason: Taking space supports impulse control and gives time to use healthier coping skills (deep breathing, reframing, problem-solving) before re-engaging. By contrast, insulting escalates conflict and can worsen safety and interpersonal outcomes. Staying silent can be appropriate short-term, but without disengaging it may not reduce arousal and can increase rumination; stepping away is the safer, more consistently effective immediate intervention.

Question 27

The nurse provides care for a school-age client who requires airborne and contact precautions due to a diagnosis of mumps. Which action by the nurse is best to decrease the child's level of stress due to the need for transmission-based isolation precautions?

Accepted Answer

Answer reason: Child life specialists are trained to assess coping needs and provide therapeutic play, education, and distraction strategies tailored to a school-age child while maintaining infection-control restrictions. This approach addresses both emotional support and engagement, which is more effective than a single generic activity. Options like a coloring book or gaming may help some children but are not individualized and may not be feasible or sufficient over time. Statements that guilt the child or minimize feelings can worsen stress and undermine therapeutic communication.

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