practices answering questions during an imaginary interview. This technique is an example of:

NCLEX-RN#A*Ct#3 1.A nurse is using therapeutic techniques to help a client who is having difficulty applying for a job because of panic and anxiety. The nurse pretends to be the job supervisor while the client practices answering questions during an imaginary interview. This technique is an example of:

• Reinforcement
• Presenting reality
• Role playing
• Summarizing

ANSWER C: Role-playing involves practicing appropriate behaviors during imaginary scenarios that would be similar to what the client will experience.

Role-playing allows the client to prepare how he would act or what he would say if the situation were real. This technique is useful for clients who feel paralyzed by feelings or thoughts that cause inaction.

2.A client is undergoing treatment for alcoholism. Twelve hours after his last drink, he develops tremors, increased heart rate, hallucinations, and seizures. Which stage of withdrawal is this client experiencing?

• Stage 1
• Stage 2
• Stage 3
• Stage 4

ANSWER C: With recovery of significant alcoholism, stage 3 of alcohol withdrawal typically begins approximately 12-48 hours after the last drink. Stage 3 encompasses the symptoms associated with stages 1 and 2, such as tremor, tachycardia, mild hallucinations, hyperactivity, and confusion. By stage 3, the client may have severe hallucinations and seizures.

3.Which of the following is a symptom associated with sensory overload?

• Disorientation
• Drowsiness
• Emotional lability
• Depression

ANSWER A: A client who is experiencing sensory overload may become disoriented when the brain becomes overloaded with too much information. The client may be unable to concentrate and he may develop racing thoughts and restless behavior. Sensory overload occurs when a person is either unable to control the amount of environmental stimuli he is experiencing, or he is unable to process the stimuli that he takes in.

4.Which of the following is an example of passive aggression?

• Clenched fists
• Yelling
• Jealousy
• Intimidation

ANSWER C: Passive aggression involves directing anger to others in a way that is not overt. A person who exhibits passive aggression may not be openly hostile and this type of anger may be difficult to recognize or treat. Examples of passive aggression include jealousy, resentment, stubbornness, and pouting.

5.A client is being treated for anxiety and desires to be free from anxious feelings and despair.According to Maslow's hierarchy of needs, which level does this client need to meet?

• Physiological
• Safety
• Belonging
• Self esteem

ANSWER B: An individual's need for safety includes feelings of security. This includes a desire to be free from anxiety or those feelings that make a client feel unsafe or unsure of himself.Treating anxiety and moving beyond anxious feelings to a feeling of safety will meet a client's needs to move on to the next level in the hierarchy.

6.The primary reason that people act out with disturbed behavior in a healthcare facility is because the person has a problem.

• social
• spousal
• thinking
• physical

ANSWER C: The primary reason that people act out with disturbed behavior in a healthcare facility, like a nursing home, is because the resident has a thinking problem, like dementia or Alzheimer's disease. Social problems, spousal issues and physical problems may, at times, lead to some degree of poor behavior. However, it is thinking problems that most often lead to disturbed behavior.

7.A nurse is attempting to find the ventrogluteal muscle to administer an intramuscular medication.In which method does the nurse find this site?

• The nurse places her palm on the client's hip at the level of the greater trochanter,

pointing the thumb toward the client's groin and administering the injection between the first and second fingers

• The nurse measures two finger-widths below the acromion process and administers the

injection at this point

• The nurse estimates the upper and outer quadrant of the buttock and gives the injection 3

inches below the iliac crest

• The nurse grasps the muscle of the upper thigh and administers the injection 6 inches

above the knee ANSWER A: The ventrogluteal muscle is a location for an intramuscular injection that can be found by placing a palm on the client's hip. The index finger should point toward the anterior iliac spine, while the thumb should point toward the client's groin. The nurse administers the injection between the first and second fingers in this position.

8.A nurse is caring for a client who has low blood pressure. The physician has ordered dopamine 2 mcg/kg/min on a continuous infusion. The nurse notes that the client weights 186 pounds. What is the appropriate rate for this infusion?

• 168 mcg/min
• 372 mcg/min
• 168 mg/min
• 372 mg/min

ANSWER A: When administering medications that require dosage calculation based on kilograms, the nurse may need to convert the client's weight in pounds. In this example, the client's weight is 186 pounds, which is approximately 84 kg. This weight, multiplied by 2 micrograms (mcg) of dopamine, is equal to 168 mcg administered per minute.

9.A nurse needs to administer 15 units of regular insulin and 20 units of NPH subcutaneously to a client with diabetes. In what order does the nurse draw these medications?

• Draw 20 units of NPH, then 15 units of regular, in the same syringe
• Draw 15 units of regular, then 20 units of NPH, in the same syringe
• Draw 15 units of regular, then 20 units of NPH, in different syringes