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
A nurse discovers a client's suicide note that details the time, place and means to commit suicide. What is the priority nursing intervention and accompanying rationale for this action?
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Calling an emergency treatment team meeting because the client's threat must be addressed
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Establishing room restrictions because the client's threat is an attempt to manipulate the staff
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Placing the client on one-to-one suicide precautions because the more specific the plan, the more likely the client will attempt suicide
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Administering lorazepam (Ativan) as needed because the client is angry about the discovery of the note
Explanation
A suicide note that identifies time, place, and means indicates a high-lethality, high-intent situation. The strongest predictor of suicide attempt is a specific and organized plan, so the immediate priority is safety through constant one-to-one observation. This intervention ensures continuous monitoring, reduces access to means, and allows the nurse to intervene immediately if the client attempts self-harm.
A Nursing student comes down with a sinus infection toward the end of every semester. Which stage of stress is the student most likely experiencing when this occurs?
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Fight or flight
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Resistance
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Exhaustion
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Alarm reaction
Explanation
The exhaustion stage of the General Adaptation Syndrome (GAS) occurs after prolonged exposure to stress when the body’s adaptive mechanisms are depleted. Toward the end of the semester, the student has endured sustained academic stress, weakening the immune system. This makes the body more susceptible to infections, such as sinus infections. This reflects the stage where chronic stress overwhelms the system, leading to physical illness, fatigue, and decreased immunity.
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?
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Set firm limits on the behavior.
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Help the client to explore the source of their anger.
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Avoid reinforcement of the behavior.
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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.
A client diagnosed with a neurocognitive disorder (NCD) is exhibiting behavioral problems every day. At the change of shift, the client's behavior escalates from pacing to screaming and flailing. Which action would the nurse implement first?
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Anticipating the behavior and restraining when pacing begins
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Medicating the client with prn antianxiety medication
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Assessing environmental triggers and potential unmet needs
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Consulting the psychologist regarding behavior modification techniques
Explanation
When a client with a neurocognitive disorder shows escalating behaviors, the priority is to assess for possible environmental stressors and unmet needs such as pain, hunger, fatigue, overstimulation, or confusion. Change of shift can be overstimulating. Identifying and removing triggers, and addressing needs early, often prevents further escalation. Assessment and non-pharmacologic interventions are first-line before restraints or medications.
A suicidal client says to a nurse, "There's nothing to live for anymore." Which is the best nursing reply?
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"Have you considered doing volunteer work?"
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"It sounds like you are feeling pretty hopeless."
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"Things will look better to you in the morning."
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"Let's discuss the negative aspects of your life."
Explanation
This response reflects therapeutic communication by acknowledging and validating the client's feelings without judgment or false reassurance. It encourages the client to explore and express emotions, which is essential in suicide assessment. Validating despair demonstrates empathy and opens the door for deeper discussion regarding suicidal thoughts and safety planning.
During a one-to-one session, the client states, "Nothing will ever get better," and "Nobody can help me." Which nursing diagnosis is most appropriate for the nurse to assign at this time?
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Powerlessness related to (R/T) altered mood AEB client statements
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Hopelessness R/T altered mood AEB client statements
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Risk of suicide R/T altered mood AEB client statements
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Risk of injury R/T altered mood AEB client statements
Explanation
Hopelessness involves a subjective state where an individual feels a lack of future expectations and belief that positive outcomes are impossible. Statements like "Nothing will ever get better" and "Nobody can help me" reflect loss of hope and belief that circumstances cannot improve. This diagnosis directly fits the client's verbalizations, identifying a key emotional component requiring therapeutic intervention.
A client diagnosed with major depressive disorder with psychotic features hears voices commanding self-harm. The client refuses to commit to developing a safety plan. Which is the nurse's priority intervention at this time?
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Encouraging the client to express feelings related to suicide
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Conducting 15-minute checks to ensure safety
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Placing the client on one-to-one observation while monitoring suicidal ideation
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Obtaining an order for locked seclusion until the client is no longer suicidal
Explanation
A patient with command hallucinations to self-harm who refuses to agree to safety measures is at high and imminent risk for suicide. This requires the highest level of safety intervention: constant one-to-one observation. Continuous monitoring allows the nurse to protect the client from acting on dangerous impulses and respond immediately to any self-harm attempts, emphasizing safety as the top priority.
Patient S.R. presents to your clinic today for treatment of depression. They were started on fluoxetine (Prozac) 3 weeks ago and this is your first time meeting them. Which nursing action demonstrates the appropriate phase of the therapeutic nurse-patient relationship during this initial visit?
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Maintaining the trust and rapport that were established during the previous phase
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Obtaining available information about the patient from their chart, significant others, or other health team members
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Continuously evaluating progress toward goal attainment
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Promoting insight and perception of reality
Explanation
This action belongs to the pre-interaction phase, which occurs before first meeting a patient. During this phase, the nurse gathers background information from available sources to prepare for the initial encounter and establish an informed, therapeutic foundation.
A nurse is assessing a client who is experiencing occasional feelings of sadness because of the recent death of a beloved pet. The client's appetite, sleep patterns, and daily routine have not changed. The nurse determines the client's behaviors:
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Show common symptoms of grief and do not indicate mental illness
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Are clinically significant and indicate serious mental illness
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Are incongruent with cultural norms and indicate mental illness
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Demonstrate typical variations in daily mood, not mental illness
Explanation
The client is experiencing normal grief related to the loss of a beloved pet. The sadness is situational, occasional, and does not impair daily functioning, appetite, or sleep. Grief is a normal emotional response to loss and not indicative of mental illness unless symptoms are severe, prolonged, or significantly disrupt functioning.
A client hates her mother because of childhood neglect. The nurse determines which client statement represents the use of the defense mechanism of reaction formation.
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"My mom always loved my sister more than she loved me."
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"My mother hates me."
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"I have a very wonderful mother whom I love very much."
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"I don't like to talk about my relationship with my mother."
Explanation
Reaction formation occurs when a person unconsciously replaces true unacceptable feelings with their opposite. Although the client harbors resentment and hatred due to childhood neglect, she expresses exaggerated positive feelings toward her mother. This defense mechanism protects the client from acknowledging painful emotions by adopting the opposite stance.
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