NUR 422 Exam # 1 Worcester Fall 2025
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Free NUR 422 Exam # 1 Worcester Fall 2025 Questions
1. A despondent client who recently lost her husband of 30 years tearfully states, "I'll feel a lot better if I sell my house and move away." Which nursing reply is most appropriate?
- A. "Tell me why you want to make this change."
- B. "This may not be the best time for you to make such an important decision."
- C. "Your children will be terribly disappointed to lose their childhood home."
- D. "I'm confident you know what's best for you."
Explanation
Immediately after a major loss, clients are often in an acute phase of grief, experiencing intense emotions that can impair judgment. Major life decisions should generally be postponed until the individual has begun to process the loss. This response gently encourages the client to delay irreversible decisions while providing support and acknowledging the emotional impact of grief. It promotes safety and stability without being dismissive.
2. At which time during 24 hours should a nurse expect clients with Alzheimer's disease to exhibit more pronounced symptoms?
- A. After taking medications
- B. In the middle of the night
- C. At twilight / Sundowning
- D. When they first awaken
Explanation
Clients with Alzheimer's disease often experience sundowning, a phenomenon in which confusion, agitation, restlessness, and behavioral disturbances worsen during the late afternoon and evening hours (twilight). This is related to circadian rhythm disruption, fatigue, decreased sensory input, and changes in lighting. Nurses anticipate and plan care to reduce stimulation and promote calm during this time.
3. The family of a suicidal client is supportive and requests more facts related to caring for their family member after discharge. Which information should the nurse provide?
- A. Address only serious suicide threats to avoid the possibility of secondary gain.
- B. Be available to actively listen, support, and accept the client's feelings.
- C. Offer a private environment to provide needed time alone at least once a day.
- D. Promote trust by not sharing suicide attempt information outside the family.
Explanation
Following discharge, individuals with suicidal ideation or attempts require a strong support system, emotional availability, and nonjudgmental listening. Encouraging family to actively listen and validate the client’s feelings helps reduce isolation, increases safety, and promotes open communication. Providing emotional presence and support is one of the most effective protective factors against suicide.
4. A nursing instructor is teaching about suicide in the elderly population. Which information is appropriate to include?
- A. Elderly men use less lethal means to commit suicide.
- B. Single elderly individuals are less likely to attempt and succeed at suicide.
- C. Suicide is the second leading cause of death among the elderly.
- D. The second highest rates of suicide are among those 85 years and older.
Explanation
Older adults, particularly those aged 85 and older, have some of the highest suicide rates of any age group. Increased risk is associated with social isolation, chronic illness, bereavement, functional decline, and untreated depression. This demographic often uses highly lethal means, and suicide attempts in this group are more frequently fatal, making awareness and prevention crucial.
5. A nurse's statement, "You remind me a lot of my grandmother, so I am sure we will get along very well," is an example of what?
- A. Sympathy
- B. Countertransference
- C. The working phase
- D. Transference
Explanation
Countertransference occurs when the nurse unconsciously transfers feelings or attitudes from past relationships onto the client. In this case, the nurse is associating the client with their grandmother and assuming the relationship will be positive based on that personal emotional connection. This can interfere with objective care and appropriate therapeutic boundaries, making it countertransference.
6. A client has not received what was expected for lunch and directs an angry verbal outburst at the nurse. What is an accurate description of this display of emotion?
- A. Expression of anger and aggression are closely related.
- B. Anger is a psychological arousal.
- C. Expression of anger can come under personal control.
- D. Anger is a primary emotion that is automatically experienced.
Explanation
Anger itself may arise automatically in response to frustration or unmet needs, but the expression of anger is a behavior that can be controlled. In nursing and therapeutic practice, we understand that people can learn to manage and communicate anger constructively. The client’s verbal outburst shows anger expression, not uncontrollable reflex. Teaching coping strategies and emotional regulation is part of promoting healthy anger expression.
7. A new nursing graduate asks the psychiatric-mental health nurse manager how to best classify suicide. Which is the nurse manager's best reply?
- A. "Suicide is a medical diagnosis."
- B. "Suicide is an antisocial affliction."
- C. "Suicide is a behavior."
- D. "Suicide is a mental disorder."
Explanation
Suicide is classified as a behavior, specifically an act of self-harm with intent to die. It is not a psychiatric diagnosis but rather an outcome or action that may result from various psychiatric, psychological, environmental, and social factors. Mental health professionals assess suicide risk as a behavioral manifestation of underlying distress and intervene accordingly.
8. A client diagnosed with a neurocognitive disorder (NCD) due to late-stage Alzheimer's disease is incapable of performing activities of daily living (ADLs). Which intervention is the nurse's priority?
- A. Assisting the client with bathing and toileting
- B. Designing a bulletin board to represent the current season
- C. Labeling the client's room with name and number
- D. Presenting evidence of objective reality to improve cognition
Explanation
In late-stage Alzheimer's disease, the client experiences severe cognitive and functional decline, often losing the ability to perform basic ADLs such as bathing, dressing, toileting, and feeding. The priority is meeting basic physiological and self-care needs first, which ensures safety, hygiene, and comfort. Supporting ADLs promotes dignity and prevents complications like skin breakdown, incontinence-related infections, and dehydration.
9. An angry patient states to the nurse, "You redheaded skinny witch. You can't tell me what to do." Which appropriate interventions would the nurse implement during this outburst?
- A. Ignore initial derogatory remarks.
- B. Respond to angry expressions with matching verbalizations.
- C. Offer support using empathy and therapeutic touch.
- D. Reprimand the patient for poor judgment and derogatory remarks.
Explanation
During an anger outburst, the nurse should not personalize insults or escalate the situation. Ignoring the initial name-calling focuses on de-escalation, maintaining safety, and remaining therapeutic. Addressing the underlying emotion rather than reacting to hostility helps prevent power struggles and keeps the environment calm. Once the patient is calmer, boundaries about respectful communication can be reinforced.
10. The nurse is interviewing a newly admitted psychiatric client. Which nursing statement is an example of offering a general lead?
- A. "Can you chronologically order the events that led to your admission?"
- B. "Are you feeling depressed or anxious?"
- C. "Yes, I see. Go on."
- D. "Do you know why you are here?"
Explanation
Offering a general lead encourages the client to continue speaking and express thoughts without directing the conversation. Statements like "Go on" or "Tell me more" show active interest and support client expression. This therapeutic communication technique fosters exploration of feelings and experiences, and helps the nurse gather information in a client-centered, non-pressuring manner.
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