A nurse is caring for a client who was admitted for suspected abuse. The client is quiet and withdrawn. Which of the following actions should the nurse take to promote client communication?
Invite a family member to be present for the nursing history.
Provide basic wound care for obvious physical injuries.
Be direct and honest when speaking with the client.
Probe the client to offer a factual account of the abuse.
The Correct Answer is C
Rationale for A: Inviting a family member to be present may hinder communication, especially if the family member is involved in the abuse or the client feels unsafe speaking in their presence. Privacy is crucial for encouraging open communication.
Rationale for B: Providing basic wound care is important for physical injuries, but it does not directly address promoting communication. The nurse should focus on creating a safe environment for the client to talk.
Rationale for C: Being direct and honest when speaking with the client promotes trust and open communication. Clients who are suspected of being abused may be fearful or reluctant to share information, so clear, respectful communication helps create a supportive environment.
Rationale for D: Probing the client for a factual account of the abuse may make the client feel pressured or overwhelmed. The nurse should allow the client to share information at their own pace without feeling forced to disclose details.
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Related Questions
Correct Answer is D
Explanation
A. Avoiding exposure to bright sunlight is not specifically related to SSRIs; it may be a
consideration with certain medications due to photosensitivity but isn't a primary concern with SSRIs.
B. Restricting sodium intake isn't a directive associated with SSRI antidepressant therapy.
C. Maintaining a tyramine-free diet is a concern with certain antidepressants like MAOIs (Monoamine Oxidase Inhibitors) but not typically with SSRIs.
D. Reporting increased suicidal thoughts is a crucial directive because SSRIs may initially increase the risk of suicidal ideation, especially in the early stages of treatment.
Correct Answer is A
Explanation
A. This statement refers to the "duty to warn," a legal obligation to protect third parties if a client expresses a serious threat of harm to others. It's a crucial exception to confidentiality.
B. This statement is inaccurate as there are scenarios where healthcare workers are legally required to provide information to the court.
C. This statement is not entirely accurate; there are legal boundaries and requirements for disclosing client information to attorneys.
D. Confidentiality extends even after a client's death in many situations, but there are exceptions based on state laws and ethical guidelines.
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