Exam NCLEX-PN topic 1 question 90 discussion

Actual exam question from Test Prep's NCLEX-PN

Question #: 90
Topic #: 1

Ashley and her boyfriend Chris, both 19 years old, are transported to the Emergency Department after being involved in a motorcycle accident. Chris is badly hurt, but Ashley has no apparent injuries, though she appears confused and has trouble focusing on what is going on around her. She complains of dizziness and nausea. Her pulse is rapid, and she is hyperventilating. The nurse should assess Ashleys level of anxiety as:

A. mild.
B. moderate.
C. severe.
D. panic.

Show Suggested Answer

Suggested Answer: C 🗳️
The person whose anxiety is assessed as severe is unable to solve problems and has a poor grasp of whats happening in his or her environment. Somatic symptoms such as those described by Ashley are usually present.
Vital sign changes are observed. The individual with mild anxiety might report being mildly uncomfortable and might even find performance enhanced. The individual with moderate anxiety grasps less information about the situation, has some difficulty problem-solving, and might have mild changes in vital signs. The individual in panic demonstrates markedly disturbed behavior and might lose touch with reality. Psychosocial Integrity

by [deleted] at March 10, 2025, 5:18 a.m.

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