A nurse is caring for a client following reported physical abuse. The client is quiet and withdrawn. Which of the following actions should the nurse take?
Display disapproval toward the perpetrator.
Probe the client to offer a factual account of the abuse.
Be direct and honest when communicating with the client.
Invite a family member to be present for the nursing history.
The Correct Answer is C
"Be direct and honest when communicating with the client." Being direct and honest with the client about the situation is essential to build trust and promote open communication. Protecting client confidentiality and privacy is crucial for client safety and well-being. If the client feels comfortable in a safe and non-threatening environment, then they are more likely to open up and discuss their situation. Displaying disapproval or probing the client can make the situation worse and result in the client withdrawing further. Inviting a family member to be present during the nursing history is not appropriate given the sensitive and personal nature of the discussion.
Option A: "Display disapproval toward the perpetrator" - Not appropriate for the clinical setting
Option B: "Probe the client to offer a factual account of the abuse" May make the client withdraw more, not appropriate for the clinical setting
Option D: "Invite a family member to be present for the nursing history" - Not appropriate for the sensitive nature of the discussion Each of the other options is not appropriate given the sensitive nature of the conversation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Methadone. Methadone is a synthetic opioid that can help reduce the symptoms of opioid withdrawal and prevent relapse.
Methadone acts on the same receptors as other opioids, but it has a longer duration of action and a lower potential for abuse. Methadone is given in controlled doses as part of an opioid treatment program.
The other choices are not correct because:
Choice A. Risperidone is an antipsychotic medication that has no effect on opioid withdrawal.
Choice C. Lithium carbonate is a mood stabilizer that is used to treat bipolar disorder and has no effect on opioid withdrawal.
Choice D. Disulfiram is a medication that inhibits the metabolism of alcohol and causes unpleasant reactions when alcohol is consumed. It has no effect on opioid withdrawal.
Correct Answer is B
Explanation
Narrowing pulse pressure is an early indicator that shock is developing 1. Pulse pressure is the difference between systolic and diastolic blood pressure. As shock progresses, the pulse pressure narrows due to a decrease in systolic blood pressure and an increase in diastolic blood pressure.
Choice A is not an answer because hypotension is a later sign of shock 2.
Choice C is not an answer because a decreased level of consciousness is also a later sign of shock.
Choice D is not an answer because anuria, or the absence of urine production, is also a later sign of shock
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