Test Prep NCLEX-PN Exam (page: 40)
Test Prep National Council Licensure Examination(NCLEX-PN)
Updated on: 12-Feb-2026

Viewing Page 40 of 204

A woman asks, “How much alcohol can I safely drink while pregnant?” The nurse’s best response is ______________.

  1. “The amount of alcohol that is safe during pregnancy is unknown.”
  2. “Consuming one or two beers or glasses of wine a day is considered safe for a healthy pregnant woman.”
  3. “Drinking three or more drinks on any given occasion is the only harmful type of drinking during pregnancy.”
  4. “You can have a drink to help you relax and get to sleep at night.”

Answer(s): A

Explanation:

The amount of alcohol that is safe during pregnancy is unknown.
Fetal alcohol syndrome is a combination of mental and physical abnormalities present in infants born to mothers who have consumed alcohol during pregnancy.



A client is taking hydrocodone (Vicodin) for chronic back pain. The client has required an increase in the dose and asks whether this means he is addicted to Vicodin.

The nurse should base her reply on the knowledge that ______________.

  1. the client’s body has developed tolerance, requiring more drug to produce the same effect.
  2. the client is preoccupied with getting the drug and is experiencing loss of control, indicating drug dependence.
  3. addiction is the term used to describe physical dependence with withdrawal symptoms and tolerance.
  4. the client has a dual diagnosis of substance abuse and chronic back pain.

Answer(s): A

Explanation:

Drug tolerance is characterized by the ability to ingest a larger dose without adverse effect and decreased sensitivity to the substance.
Substance dependence is a severe condition indicating physical problems and disruption of the person’s social, family, and work life. The psychological behaviors related to substance use are termed addiction.
Dual diagnosis is the coexistence of substance abuse and psychiatric disorders.



A nurse observes a client sitting alone and talking. When asked, the client reports that he is “talking to the voices.”

The nurse’s next action should be ______________.

  1. touching the client to help him return to reality
  2. leaving the client alone until reality returns
  3. asking the client to describe what is happening
  4. telling the client there are no voices

Answer(s): C

Explanation:

Nurses might observe behavioral cues that can indicate the presence of hallucinations. Talking about the hallucinations is reassuring and validating to the client who has them. Focusing on the symptoms and asking about the hallucinations helps the client gain control.



A nurse observes a client sitting alone and talking. When asked, the client reports that he is “talking to the voices.”

The nurse’s next action should be ______________.

  1. touching the client to help him return to reality
  2. leaving the client alone until reality returns
  3. asking the client to describe what is happening
  4. telling the client there are no voices

Answer(s): A

Explanation:

Nurses need to inform clients that there is a difference in perceptions and pay attention to the content of hallucinations.
The other options are not therapeutic.



A 12-year-old male is brought to his primary care provider to determine whether sexual abuse has occurred. The mother states, “Because there is no permanent physical damage, he does not need any more treatment.”

The nurse’s response should be based on which of the following pieces of information?

  1. Male victims of sexual abuse seldom have long-term psychological problems.
  2. Survivors of male sexual abuse might become confused about their sexual identity.
  3. Unless treated, all male sex abuse survivors grow up to abuse other children.
  4. All children who have been sexually abused have the same needs, regardless of gender.

Answer(s): B

Explanation:

Male children are sexually abused nearly as often as female children. Perpetrators are usually men but can be women.
Needs of male children who have been sexually abused might be different from the needs of female survivors. Male survivors might respond in anger, their sexuality, use alcohol and other drugs, and might try to prove their masculinity by performing daring acts.



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