Purpose
Next Generation NCLEX
Type Practice Questions
2023
Purpose:
There are no points attached to this homework. However, regardless of one’s intrinsic or
extrinsic motivation, participation matters. The purpose of this assignment is intended to
familiarize students newer NCLEX type questions through examples, and to help students
begin to “think like a nurse”. This is facilitated through: (a) the development of critical
thinking skills, (b) identification of important cues in a clinical situation, (d) identification of
multiple and complex health issues or multiple health problems in the older adult, and (e)
prioritizing goals.
Directions:
● Provide your responses to each of the questions accompanying each clinical situation.
● Students may work individually, in pairs, or small groups of no more than 4 persons.
Students who work in teams are strongly encouraged to review responses together,
and decide, which response(s) will be the final ones. This activity is different than
dividing up tasks, cutting and pasting responses into one document for homework
submission. If there is a different perspective or opinion about which response(s) are
final ones, during the team review justify the choice and present a rationale to the
team.
● If you are working as a pair or on a team of 4, please indicate all of your names on
the assignment, your class section, and delegate one team member to upload a
single completed assignment for the group. Upload to “Turnitin” on Moodle, by
Tuesday, March 15th, 4:00pm.
● Cite resources and references used in completing this assignment in APA format
7 th ed. (see syllabus), including those from library databases such as CINAHL or
Up-to-Date
1. Cultural Cues
a. Highlight the statements below that nurses recognize as exacerbating health
disparities and inequities in this client:
Ms. Yazzie is a 78-year-old long-term care resident. She worked most of her life as a
bartender. Her mother belonged to the Mescalero Apache Tribe in New Mexico. Her
father was Caucasian. Her mother gave her up at birth, hoping she would be
adopted, but she spent her childhood in foster care. As a young adult Ms. Yazzie was
raped and severely beaten, resulting in PTSD. She is aggressive with personal care
and does not allow men to touch her; only female nurses, assistive personnel, and
staff work with her. She has a history of hypothyroidism, hypertension, multi-infarct
dementia, and osteoarthritis with chronic pain. She has a 66-pack year history of
smoking, and typically drank liquor each night while bartending. She is 5′5″ tall and
weighs 110 pounds (BMI 18.30 kg/m2). She is no longer ambulatory. However, she
wheels herself around the facility and can often be heard crying and repeatedly
asking, “do you love me?.” She engages in conversation, and stops crying, when
prompted and talks about her childhood when asked. Ms. Yazzie never married and
has no children.
1
,Purpose
b. In addition to exacerbating health disparities and inequities in this client, what are
other issues that are of concern based on the information provided? List these.
I am concerned about her psychosocial and neurological status given her history with PTSD,
rape, drinking, aggression towards men, and her behavior in the facility (i.e. the crying and
repeated asking: “do you love me?”)
c. Are there other questions you would ask of Ms. Yazzie as you begin your shift with
her? What are they?
How are you feeling today? What kinds of medications do you take? Could you tell me about
your drinking and smoking habits?
Could you please tell me about your PTSD? What tends to trigger your PTSD?
2
, Purpose
d. How would you approach her aggressive behavior?
I would ask her culturally appropriate questions that will elicit a response and understanding
about her aggressive behavior. Questions would include: Why do you think you tend to lash
out when we are providing personal care? Is there something that we do that is triggering to
you, in terms of your PTSD? How can we best support you and always provide personal care?
e. Are there other important assessments or diagnostic tests that should be done?
Which ones would you recommend?
I would recommend assessment by a social worker or psychiatrist following your own
psychosocial assessment. I would also follow through with a neurological assessment given
her history of dementia. In addition, I would perform a musculoskeletal assessment,
determining her functional skills and ADLs given limited mobility due to osteoarthritis and
being confined to a wheelchair. Further, a cardiovascular assessment would be relevant given
her history with hypertension and hypothyroidism.
f. Given the list you have identified as issues of concern, which are immediate
priorities? Immediate priorities include: aggressive behavior and history of PTSD, and
behavior in the facility.
g. Given the list you have identified as issues of concern, which are longer term priorities?
Longer term priorities involve understanding her behavior, and her history of drinking and
smoking.
h. Who are other interprofessionals with whom you would consult in providing effective
care for Ms. Yazzie?
Social worker, psychiatrist, physical therapist.
i. There is only 1 female RN, in the long term care facility, the nurse manager, where
Ms.Yazzie stays. The RN is in meetings with long term care accreditation representatives
from the State of California, who have made an unannounced visit that morning. The
day shift staff on Ms.Yazzie’s include a male LVN (a licensed vocational nurse) who is
assisting residents with rehabilitation exercises. Another staff member is a female CNA
(certified nursing assistant) who is overseeing and assisting cognitively impaired and
dysphagic residents with breakfast in the common dining room. She cannot leave these
residents unattended. A newly licensed graduate, a male RN is in day one of his
orientation to the facility with the director of staff development. How would you handle
this situation given Ms. Yazzie’s information? Who would you assign to take care of Ms.
Yazzie? Why?
Given the responsibilities of both the CNA and LVN, it would be most appropriate to assign
Ms. Yazzie to the female CNA since she has experience with cognitively impaired residents
like Ms. Yazzie with multi infarct dementia and a history of aggressive behavior when it
comes to personal care which can be attributed to agitation associated with dementias.
2. Patient-centered Care
Highlight the statements below that correspond to a patient-centered culture:
Mrs. Adams is an 87-year-old widowed female. She is being admitted to a rural long-
term care (LTC) facility following hospitalization for uncontrolled hypertension. Prior
to hospitalization, she had been living alone and it was determined she had not been
taking her medications for hypertension, osteoporosis, depression, and coronary
artery disease. The nurse completing her admission interview concludes by asking
Mrs. Adams what time she usually eats, stating the facility serves food cafeteria style
between 0600 and 0800 hours for breakfast, 1100 and 1300 for lunch, and 1700 and
1900 hours for dinner. Residents are assisted to bed by 2200 hours. Her bath days
would be Tuesday, Thursday, and Saturday mornings. The nurse gives Mrs. Adams an
activity schedule with the daily offerings and states that if she did not like any of
them, they would try to find something else she enjoyed.
3. Assessment of Late Life Changes
3
Next Generation NCLEX
Type Practice Questions
2023
Purpose:
There are no points attached to this homework. However, regardless of one’s intrinsic or
extrinsic motivation, participation matters. The purpose of this assignment is intended to
familiarize students newer NCLEX type questions through examples, and to help students
begin to “think like a nurse”. This is facilitated through: (a) the development of critical
thinking skills, (b) identification of important cues in a clinical situation, (d) identification of
multiple and complex health issues or multiple health problems in the older adult, and (e)
prioritizing goals.
Directions:
● Provide your responses to each of the questions accompanying each clinical situation.
● Students may work individually, in pairs, or small groups of no more than 4 persons.
Students who work in teams are strongly encouraged to review responses together,
and decide, which response(s) will be the final ones. This activity is different than
dividing up tasks, cutting and pasting responses into one document for homework
submission. If there is a different perspective or opinion about which response(s) are
final ones, during the team review justify the choice and present a rationale to the
team.
● If you are working as a pair or on a team of 4, please indicate all of your names on
the assignment, your class section, and delegate one team member to upload a
single completed assignment for the group. Upload to “Turnitin” on Moodle, by
Tuesday, March 15th, 4:00pm.
● Cite resources and references used in completing this assignment in APA format
7 th ed. (see syllabus), including those from library databases such as CINAHL or
Up-to-Date
1. Cultural Cues
a. Highlight the statements below that nurses recognize as exacerbating health
disparities and inequities in this client:
Ms. Yazzie is a 78-year-old long-term care resident. She worked most of her life as a
bartender. Her mother belonged to the Mescalero Apache Tribe in New Mexico. Her
father was Caucasian. Her mother gave her up at birth, hoping she would be
adopted, but she spent her childhood in foster care. As a young adult Ms. Yazzie was
raped and severely beaten, resulting in PTSD. She is aggressive with personal care
and does not allow men to touch her; only female nurses, assistive personnel, and
staff work with her. She has a history of hypothyroidism, hypertension, multi-infarct
dementia, and osteoarthritis with chronic pain. She has a 66-pack year history of
smoking, and typically drank liquor each night while bartending. She is 5′5″ tall and
weighs 110 pounds (BMI 18.30 kg/m2). She is no longer ambulatory. However, she
wheels herself around the facility and can often be heard crying and repeatedly
asking, “do you love me?.” She engages in conversation, and stops crying, when
prompted and talks about her childhood when asked. Ms. Yazzie never married and
has no children.
1
,Purpose
b. In addition to exacerbating health disparities and inequities in this client, what are
other issues that are of concern based on the information provided? List these.
I am concerned about her psychosocial and neurological status given her history with PTSD,
rape, drinking, aggression towards men, and her behavior in the facility (i.e. the crying and
repeated asking: “do you love me?”)
c. Are there other questions you would ask of Ms. Yazzie as you begin your shift with
her? What are they?
How are you feeling today? What kinds of medications do you take? Could you tell me about
your drinking and smoking habits?
Could you please tell me about your PTSD? What tends to trigger your PTSD?
2
, Purpose
d. How would you approach her aggressive behavior?
I would ask her culturally appropriate questions that will elicit a response and understanding
about her aggressive behavior. Questions would include: Why do you think you tend to lash
out when we are providing personal care? Is there something that we do that is triggering to
you, in terms of your PTSD? How can we best support you and always provide personal care?
e. Are there other important assessments or diagnostic tests that should be done?
Which ones would you recommend?
I would recommend assessment by a social worker or psychiatrist following your own
psychosocial assessment. I would also follow through with a neurological assessment given
her history of dementia. In addition, I would perform a musculoskeletal assessment,
determining her functional skills and ADLs given limited mobility due to osteoarthritis and
being confined to a wheelchair. Further, a cardiovascular assessment would be relevant given
her history with hypertension and hypothyroidism.
f. Given the list you have identified as issues of concern, which are immediate
priorities? Immediate priorities include: aggressive behavior and history of PTSD, and
behavior in the facility.
g. Given the list you have identified as issues of concern, which are longer term priorities?
Longer term priorities involve understanding her behavior, and her history of drinking and
smoking.
h. Who are other interprofessionals with whom you would consult in providing effective
care for Ms. Yazzie?
Social worker, psychiatrist, physical therapist.
i. There is only 1 female RN, in the long term care facility, the nurse manager, where
Ms.Yazzie stays. The RN is in meetings with long term care accreditation representatives
from the State of California, who have made an unannounced visit that morning. The
day shift staff on Ms.Yazzie’s include a male LVN (a licensed vocational nurse) who is
assisting residents with rehabilitation exercises. Another staff member is a female CNA
(certified nursing assistant) who is overseeing and assisting cognitively impaired and
dysphagic residents with breakfast in the common dining room. She cannot leave these
residents unattended. A newly licensed graduate, a male RN is in day one of his
orientation to the facility with the director of staff development. How would you handle
this situation given Ms. Yazzie’s information? Who would you assign to take care of Ms.
Yazzie? Why?
Given the responsibilities of both the CNA and LVN, it would be most appropriate to assign
Ms. Yazzie to the female CNA since she has experience with cognitively impaired residents
like Ms. Yazzie with multi infarct dementia and a history of aggressive behavior when it
comes to personal care which can be attributed to agitation associated with dementias.
2. Patient-centered Care
Highlight the statements below that correspond to a patient-centered culture:
Mrs. Adams is an 87-year-old widowed female. She is being admitted to a rural long-
term care (LTC) facility following hospitalization for uncontrolled hypertension. Prior
to hospitalization, she had been living alone and it was determined she had not been
taking her medications for hypertension, osteoporosis, depression, and coronary
artery disease. The nurse completing her admission interview concludes by asking
Mrs. Adams what time she usually eats, stating the facility serves food cafeteria style
between 0600 and 0800 hours for breakfast, 1100 and 1300 for lunch, and 1700 and
1900 hours for dinner. Residents are assisted to bed by 2200 hours. Her bath days
would be Tuesday, Thursday, and Saturday mornings. The nurse gives Mrs. Adams an
activity schedule with the daily offerings and states that if she did not like any of
them, they would try to find something else she enjoyed.
3. Assessment of Late Life Changes
3
