NUR 422 Worchester Fall at Massachusetts College of Pharmacy and Health Sciences Fall 2025
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Free NUR 422 Worchester Fall at Massachusetts College of Pharmacy and Health Sciences Fall 2025 Questions
1. An involuntarily committed client, when offered a dinner tray, pushes it off the bedside table onto the floor. Which is the nurse's priority intervention?
- Set firm limits on the behavior.
- Help the client to explore the source of their anger.
- Avoid reinforcement of the behavior.
- Initiate forced medication protocol.
Explanation
The priority in managing aggressive or destructive behavior on an inpatient unit is to set clear, firm, and consistent limits. The nurse must maintain safety, establish structure, and communicate that such behavior is unacceptable. Limit-setting helps the client understand expectations and supports safe unit functioning. Once safety and boundaries are established, the nurse can later address underlying emotions and coping strategies.
2. A 25-year-old man barely avoids a motor vehicle accident. His heart is pounding, his palms are sweaty, and his respirations are increasing. This is an example of which stage of the general adaptation syndrome?
- Stage of biological stress
- Stage of resistance
- Alarm reaction stage
- Stage of exhaustion
Explanation
The alarm reaction stage is the initial response to a stressor. The sympathetic nervous system activates the “fight-or-flight” response, causing physical changes such as increased heart rate, sweating, and rapid breathing. These immediate physiological responses prepare the body to react to danger. In this scenario, narrowly avoiding a car accident triggers those acute stress reactions, clearly demonstrating the alarm stage of the general adaptation syndrome.
3. 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?
- Ignore initial derogatory remarks.
- Respond to angry expressions with matching verbalizations.
- Offer support using empathy and therapeutic touch.
- 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.
4. Which of the following is the priority nursing action during the orientation (introductory) phase of the nurse-client relationship?
- Explore how thoughts and feelings may adversely impact nursing care.
- Establish rapport and develop mutually agreeable treatment goals
- Attempt to find alternative placement for the client.
- Acknowledge the client's action and generate alternative behaviors.
Explanation
During the orientation (introductory) phase, the nurse’s priority is to build trust, establish rapport, and collaboratively create treatment goals with the client. This phase sets the foundation for the therapeutic relationship by clarifying roles, expectations, and the plan of care. Establishing a safe, trusting environment encourages open communication and supports successful treatment throughout the relationship.
5. A mental health technician asks the nurse, "How do psychiatrists determine which diagnosis to give a client?" Which is the nurse's best response?
- "Psychiatrists use one of the 10 diagnostic labels from the American Medical Association (AMA)."
- "Psychiatrists are required to follow hospital policy to diagnose mental disorders."
- "Psychiatrists make diagnoses based on the client's behavior and other factors."
- "Psychiatrists use criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM)."
Explanation
Psychiatrists diagnose mental disorders using standardized diagnostic criteria found in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association. The DSM outlines specific symptoms, duration, and functional impairment requirements for each diagnosis, ensuring consistent, objective, and evidence-based assessment across clinicians and settings.
6. 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?
- Assisting the client with bathing and toileting
- Designing a bulletin board to represent the current season
- Labeling the client's room with name and number
- 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.
7. 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?
- Address only serious suicide threats to avoid the possibility of secondary gain.
- Be available to actively listen, support, and accept the client's feelings.
- Offer a private environment to provide needed time alone at least once a day.
- 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.
8. The client is hospitalized with coronary artery disease and demonstrates other conditions often associated with diseases of adaptation, including headaches and depression. Currently, the client is demonstrating anxiety and states he is "worried" about his spouse. Which is the most appropriate nursing response to the situation?
- Ask the client if he has a pet he would like to see while in the hospital.
- Teach the client how to meditate when he is feeling anxious.
- Encourage the client to talk through his concerns about his spouse.
- Inform the client that he has to learn to cope with stressors.
Explanation
Encouraging the client to verbalize concerns is a primary therapeutic communication strategy for anxiety. Discussing worries about his spouse helps the nurse assess emotional needs, offer support, and reduce anxiety through expression. Verbalization provides emotional release and promotes coping while maintaining trust. This client is experiencing stress-related illness; exploring worries can reduce sympathetic arousal and improve adaptation.
9. At which time during 24 hours should a nurse expect clients with Alzheimer's disease to exhibit more pronounced symptoms?
- After taking medications
- In the middle of the night
- At twilight / Sundowning
- 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.
10. Which outcome does the nurse expect during the working phase of the nurse-client relationship?
- The client explores personal strengths and weaknesses that impact behaviors.
- The client and nurse establish rapport and mutually develop treatment goals.
- The client explores feelings related to reentering the community.
- The client gains insight and incorporates alternative behaviors.
Explanation
The working phase focuses on implementing the treatment plan and facilitating change. During this phase, the client confronts ineffective coping patterns, gains insight into problem behaviors and emotions, and practices healthier alternatives. This is the core therapeutic phase where real behavioral and emotional growth occurs through active participation and therapeutic interaction.
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