A client presents to the emergency department (ED reporting abdominal pain. The nurse observes the client's right cheek and eye are bruised and suspects possible domestic violence. Which approach is best for the nurse to use when interviewing the client?

Share personal values to put the client at ease.

Get the most difficult questions over with first.

Ask questions in a vague, non-specific format.

Begin with questions that are less sensitive in nature.

Answer and Explanation

The Correct Answer is D

A.   Share personal values to put the client at ease: Sharing personal values may not be appropriate and could potentially alienate the client or make them feel judged.
B.   Get the most difficult questions over with first: Starting with difficult questions may increase the client's defensiveness and resistance to sharing information.
C.   Ask questions in a vague, non-specific format: Being vague may not elicit the necessary information and could lead to misunderstandings or incomplete responses.
D.   Begin with questions that are less sensitive in nature: Starting with less sensitive questions helps build rapport and trust with the client before addressing more sensitive topics like domestic violence. It allows the client to feel more comfortable and may increase the likelihood of obtaining accurate information.

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Correct Answer is D

Explanation

A. Administering aspirin may be appropriate for suspected ischemic stroke; however, it should not be done without confirmation of diagnosis and evaluation by the stroke team.
B. Initiating pneumatic compression devices is not the priority in this situation. Acute assessment and management of the suspected stroke take precedence.
C. Placing an indwelling urinary catheter and measuring strict intake and output may be necessary for ongoing care but is not the priority when the client is presenting with symptoms suggestive of a stroke.
D. Notifying the stroke team to assist with acute assessment and management is the priority intervention. Time is crucial in the management of stroke, and early intervention can help minimize neurological damage and improve outcomes.

A. Monitor skin elasticity. B. Assess body temperature. C. Measure urinary output. D. Observe aspiration site.

Correct Answer is D

Explanation

A. Monitoring skin elasticity is important for assessing hydration status but is not directly related to the risk of bleeding after a bone marrow biopsy in a client with thrombocytopenia.
B. Assessing body temperature is important for detecting signs of infection but is not the most immediate concern following a bone marrow biopsy in a client with thrombocytopenia.
C. Measuring urinary output is important for assessing renal function but is not the most immediate concern following a bone marrow biopsy in a client with thrombocytopenia.
D. Observing the aspiration site is the most important assessment following a bone marrow biopsy in a client with thrombocytopenia because thrombocytopenia increases the risk of
bleeding at the site. It is crucial to monitor for signs of bleeding, such as hematoma formation or continued bleeding, and to apply pressure as needed to prevent or control bleeding.

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A client presents to the emergency department (ED reporting abdominal pain. The nurse observes the client's right cheek and eye are bruised and suspects possible domestic violence. Which approach is best for the nurse to use when interviewing the client?

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Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

A client with leukemia undergoes a bone marrow biopsy. The client's laboratory values indicate the client has thrombocytopenia. Based on this data, which nursing assessment is most important following the procedure?

Correct Answer is D

Explanation

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