A nurse is caring for a client in the emergency department who states that she was beaten and sexually assaulted by her partner.
After a rapid assessment, which of the following actions should the nurse plan to take next?
Offer prophylactic medication to prevent STIs.
Provide a trained advocate to stay with the client.
Conduct a pregnancy test.
Request a mental health consultation for the client.
The Correct Answer is B
Choice A rationale:
Offering prophylactic medication to prevent STIs is an important intervention in cases of sexual assault; however, it is not the next immediate step. The priority at this stage is to ensure the client's safety and emotional support.
Choice B rationale:
Providing a trained advocate to stay with the client is the most appropriate and immediate action. This helps ensure the client's emotional well-being and provides support during a traumatic experience. Advocates can also help the client navigate the healthcare system and legal processes.
Choice C rationale:
Conducting a pregnancy test is important, but it is not the next immediate step. Safety and emotional support should be the priority.
Choice D rationale:
Requesting a mental health consultation for the client is important, but it should not be the next immediate action. Safety and support should come first.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Correct Answer is A
Explanation
Choice A rationale:
"Identify and schedule alternative group activities for the client.”. This is the most appropriate response as it focuses on engaging the client in alternative group activities. Social isolation is a common issue in individuals with major depressive disorder, and offering alternative group activities can help the client to socialize and find enjoyment in different ways, potentially improving their mood.
Choice B rationale:
"Discourage the client from expressing feelings of anger.”. This choice is not suitable because it discourages the client from expressing feelings of anger. While it's essential to guide the client in managing their anger appropriately, discouraging the expression of emotions can be counterproductive and may lead to emotional suppression, which is not recommended.
Choice C rationale:
"Keep a bright light on in the client's room at night.”. This option is not directly related to managing major depressive disorder. While light therapy can be beneficial for certain conditions like seasonal affective disorder, it may not be the most appropriate intervention for every client with major depressive disorder.
Choice D rationale:
"Encourage physical activity for the client during the day.”. This is a valid intervention for managing major depressive disorder. Regular physical activity has been shown to have a positive impact on mood and can be an effective part of a treatment plan for individuals with depression. However, choice A is more specific to addressing social isolation, which is a common concern in major depressive disorder.
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