A nurse in an emergency department is caring for a client who recently experienced partner violence.

Exhibits

The nurse is reviewing the client’s medical record at discharge. For each finding, specify whether the finding indicates a potential improvement in or a worsening of the client’s physical or psychological status.

Client states that the partner will not be violent in the future.

Client agrees to an appointment with a social worker.

Client’s reported pain level of the left wrist.

Client requests help developing a safety plan.

Client claims responsibility for the physical altercation.

Answer and Explanation

The Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"A"}}

Choice A Reason: The belief that a partner will not be violent in the future can be a form of denial or wishful thinking, especially without any evidence of change or intervention. It is not uncommon for individuals in abusive relationships to hope for change, but without concrete actions, such as therapy or other interventions, this hope does not indicate an improvement in the client’s situation.

Choice B Reason: Agreeing to an appointment with a social worker is a positive step towards addressing the situation and seeking help. Social workers can provide support, resources, and guidance, which can be crucial for someone experiencing partner violence. This choice indicates a potential improvement in the client’s psychological status as it shows a willingness to engage with support services.

Choice C Reason: A decrease in reported pain levels can indicate physical improvement. Pain scales are subjective but provide a measure of the client’s comfort and can reflect healing or the effectiveness of pain management strategies.

Choice D Reason: Requesting help to develop a safety plan is a proactive step in ensuring personal safety and preparing for potential future incidents of violence. It shows the client’s awareness of the risks and a desire to protect themselves, which is a positive indicator of psychological improvement.

Choice E Reason: While claiming responsibility for the physical altercation may seem negative, it can also be seen as the client’s attempt to make sense of the situation. It is important to note that responsibility for violence lies with the perpetrator, not the victim. However, recognizing the dynamics of the relationship and the events leading up to the violence can be part of the healing process and taking control of one’s life.

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Correct Answer is D

Explanation

Choice A reason: Witnessing an informed consent is a legal process that typically requires a licensed nurse or healthcare provider to ensure that the client fully understands the procedure and its risks. It is not appropriate to delegate this task to assistive personnel.

Choice B reason: Explaining the benefits of light therapy involves providing health education, which should be done by a licensed nurse or healthcare provider who has the necessary knowledge and training to ensure accurate information is conveyed.

Choice C reason: Discussing the adverse effects of medications is part of medication education and should be conducted by a licensed nurse or healthcare provider. Assistive personnel are not trained to provide this level of detailed medical information.

Choice D reason: Participating in solitary activities does not require clinical judgment and can be safely delegated to assistive personnel. This task involves engaging the client in activities that can help manage their mania and provide a therapeutic environment.

A. "List the negative effects of alcohol use in your life." B. "Attend support group meetings as needed." C. "You can get a prescription for lorazepam to prevent relapse." D. "Revisit familiar places for support."

Correct Answer is A

Explanation

Choice A reason: Listing the negative effects of alcohol use can help the client gain insight into the consequences of their actions and reinforce their motivation to remain sober. Reflecting on personal losses and health issues due to alcohol can be a powerful deterrent against relapse.

Choice B reason: While attending support group meetings can be beneficial, saying "as needed" may not provide the structured support necessary for preventing relapse. Regular attendance at support groups like Alcoholics Anonymous (AA) is often recommended for sustained recovery.

Choice C reason: Lorazepam is not typically prescribed to prevent relapse in alcohol use disorder due to its potential for abuse and dependence. Instead, medications like naltrexone or acamprosate may be considered to help maintain abstinence.

Choice D reason: Revisiting familiar places may trigger cravings and is generally not advised. Instead, clients are encouraged to avoid places associated with their past alcohol use to reduce the risk of relapse.

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Naxlex Comprehensive Predictor Exams

A nurse is planning to delegate client care for several clients in a mental health facility. Which of the following tasks should the nurse delegate to an assistive personnel?

Correct Answer is D

Explanation

A nurse is providing teaching for a client who has an alcohol use disorder. Which of the following statements should the nurse make to help prevent relapse?

Correct Answer is A

Explanation

A nurse is teaching the caregiver of a client who has advanced Alzheimer's disease about home safety. Which of the following statements by the caregiver indicates an understanding of the teaching?

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