A client is pacing in the hallway with clenched fists and a flushed face. They are yelling and cursing loudly. Which phase of the aggression cycle is this client in?

Triggering

Escalation

Anger

Crisis

Answer and Explanation

The Correct Answer is B

A. Triggering: This phase involves initial stressors or triggers leading to aggression but lacks the intense behavioral and physical symptoms described.

B. Escalation: The escalation phase is characterized by increasing tension, verbal aggression, and physical manifestations like pacing or clenched fists. The client’s behavior suggests they are moving toward a potential crisis.

C. Anger: Anger is an emotion, not a phase of the aggression cycle. It may be present during multiple phases.

D. Crisis: The crisis phase involves loss of control and actual aggressive or violent actions, which has not occurred yet in this scenario.

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Correct Answer is ["A","B","C","E"]

Explanation

A. The client has anal bleeding: Physical trauma such as bleeding may occur from sexual abuse.

B. The client complains of pelvic soreness: Pelvic soreness is a common physical manifestation following sexual assault.

C. The client has bruising around the breasts: Bruising in areas commonly targeted during assault can indicate abuse.

D. The client has a scar on their inner thigh: A scar is indicative of past injury but does not directly confirm recent sexual abuse.

E. The client's underwear is bloody: Blood-stained undergarments may be evidence of trauma.

A. Check the bruises at the next visit to the client's home. B. Follow the agency's guidelines for reporting suspected abuse. C. Institute more frequent visits to the client's home. D. Arrange referral for family therapy to deal with home stressors.

Correct Answer is B

Explanation

A. Check the bruises at the next visit to the client's home: Delaying action could place the client at further risk of harm. Immediate reporting is necessary.

B. Follow the agency's guidelines for reporting suspected abuse. Nurses are mandatory reporters, and suspected abuse must be reported immediately according to the agency's protocols. This ensures the safety of the client and initiates the appropriate investigation.

C. Institute more frequent visits to the client's home: While increased visits may provide additional monitoring, this is not the priority when abuse is suspected.

D. Arrange referral for family therapy to deal with home stressors: Referring for therapy may be beneficial long-term but is not the first step when abuse is suspected.

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A client is pacing in the hallway with clenched fists and a flushed face. They are yelling and cursing loudly. Which phase of the aggression cycle is this client in?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse in the emergency department is caring for a client who reports having experienced sexual abuse. The nurse should identify which of the following findings are consistent with the client's report? (Select All that Apply.)

Correct Answer is ["A","B","C","E"]

Explanation

Correct Answer is B

Explanation

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