NCLEX-RN exam prep — 2,700 practice questions in timed tests, all explained

A is correct.An emancipated minor is legally treated as an adult for health care decisions, so the client signs the surgical consent form alone, without parental involvement, knowledge or permission. Emancipation is granted by a court or, in many states, follows marriage or active military service, and it gives the minor the same rights to consent, refuse and keep information private that an adult has. The nurse confirms the emancipation status according to facility policy, verifies that the provider has explained the procedure, risks and alternatives, and witnesses the client's signature. A parent signing because the client is younger than 18 reflects the general rule for unemancipated minors, but that rule no longer applies once a court has granted emancipation, and contacting the parents would breach the client's confidentiality. Having the client and one parent act as joint signers adds a person who has no legal authority over the decision and again discloses protected information against the client's wishes. A guardian appointed by the hospital's ethics committee is not a valid choice, because ethics committees do not appoint guardians, and no substitute decision-maker is needed when the client can legally consent independently.

B is correct.An incident or occurrence report is a confidential internal quality-improvement document sent to risk management, not part of the legal medical record. The nurse should chart the event facts but omit any mention of the report, objectively recording where and how the client was found, the assessment findings, the interventions, the provider notification and the client's response. Writing 'incident report filed' in the nursing progress note signals to anyone reviewing the chart, including attorneys, that a separate document exists and may make that report discoverable in litigation, weakening its protected status. Placing a photocopy of the report in the client's chart has the same effect and adds a document that does not belong in clinical records; reports are never copied into, filed in or referenced in the chart. Giving the family a copy of the report at their request is inappropriate because the report belongs to the facility for internal review; the family is still entitled to honest disclosure about what happened, which the provider and nurse give verbally and through the medical record. Completing the report promptly, factually and without blame helps the organization identify system problems and prevent future falls.

C is correct.Phenelzine is a monoamine oxidase inhibitor, and monoamine oxidase in the gut and liver normally breaks down dietary tyramine. When the enzyme is inhibited, tyramine from aged, fermented, cured, smoked or pickled foods enters the circulation, triggers a surge of norepinephrine release and can cause a hypertensive crisis with a severe occipital headache, stiff neck, palpitations, sweating and possible stroke. Fresh roast chicken with rice and carrots is the safe choice, because freshly prepared meat, grains and fresh vegetables contain little tyramine. Aged cheddar and dry salami on a sourdough roll pairs two of the richest tyramine sources, aged cheese and cured, fermented sausage. Miso soup with tofu and extra soy sauce is unsafe because miso and soy sauce are fermented soybean products with high tyramine content. Pickled herring served with a side of sauerkraut combines a pickled fish with fermented cabbage, both classic foods to avoid. The nurse also teaches the client to continue these restrictions for at least 2 weeks after stopping the medication, to avoid tap or draft beer and spoiled or improperly stored leftovers, and to report any sudden severe headache immediately.

A is correct.Toddlers between about 1 and 3 years typically engage in parallel play: they play beside other children, often with similar toys, and may watch or imitate them, but they rarely interact, share, or cooperate. This pattern reflects normal egocentric thinking and limited social language, so the most accurate response reassures the mother that playing beside, rather than with, another child is expected for a 2-year-old. Expecting him to be sharing and taking turns describes associative play, which emerges in the preschool years, or cooperative play with rules, which is typical of school-age children; sharing is hard for toddlers, who are still developing a sense of ownership. Suggesting that ignoring peers is an early sign of delay would alarm the mother without cause, because parallel play is not a red flag; concerning signs at this age include loss of words, no pointing, and poor eye contact, which are checked with routine autism screening at 18 and 24 months. Attributing the behavior to the stress of hospitalization is also inaccurate, since regression can occur but this play is developmentally typical anywhere. Offering duplicate toys reduces conflict during parallel play.

B is correct.Projection is an unconscious defense mechanism in which a person attributes his own unacceptable thoughts, feelings, or impulses to someone else. This client is the one who has been following and flirting with the female peer, yet he describes her as obsessed with him and unable to stop watching him, so recognizing that he is attributing his own attraction to the peer is the accurate interpretation. Projection shields him from the anxiety and guilt of acknowledging his rule-breaking behavior. Redirecting anger at staff onto the peer describes displacement, in which feelings are shifted from a threatening target to a safer one; nothing in the scenario shows anger at staff. Giving a logical excuse for breaking unit rules describes rationalization, which would sound like claiming he was only being friendly or that the rules are unfair; he is not justifying his behavior, he is assigning the desire to her. Acting the opposite of his true feelings describes reaction formation, which would appear as exaggerated rudeness or disgust toward her. The nurse should respond without arguing, restate the limits on his behavior, and help him explore his own feelings in a nonjudgmental way.