A nurse is caring for a group of clients in a pediatric clinic. Which of the following clients is at highest risk for physical abuse?

An adolescent who is preparing to leave home for college

A school-age child who wants to go away to summer camp

A preschooler who is reluctant to share

A toddler who has cystic fibrosis

Answer and Explanation

The Correct Answer is D

A.   Adolescents who are preparing to leave home for college are generally more independent and have a higher level of verbal communication compared to younger children. They are less likely to be at high risk for physical abuse because they can potentially seek help or report abuse more readily.

B.   School-age children typically have better verbal communication skills and may express their desires and feelings more clearly compared to younger children. They are generally less vulnerable to physical abuse compared to younger children who may not be able to communicate their experiences as effectively.
C.   Preschoolers are at a higher risk for physical abuse compared to older children and adolescents. They are still developing verbal communication skills and may not be able to express their feelings or report abuse clearly. Their dependence on caregivers for basic needs and care also increases their vulnerability.
D.   Toddlers, especially those with chronic health conditions like cystic fibrosis, are particularly vulnerable to physical abuse. Their young age, dependency on caregivers for basic needs, limited verbal communication skills, and potential health challenges increase their risk. Caregivers may feel overwhelmed or stressed by the child's condition, which could potentially contribute to abusive behaviors.

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Correct Answer is A

Explanation

A. Verbal de-escalation involves using calm, non-confrontational communication techniques to help calm the client. This can include speaking softly, using non-threatening body language, and actively listening to the client's concerns. It is the first-line intervention for managing escalating behavior because it aims to reduce agitation without the use of physical or chemical restraints.
B. Haloperidol is an antipsychotic medication that may be prescribed for acute agitation and aggression in some situations. However, obtaining a prescription requires provider authorization and should not be the first intervention unless the client's agitation poses an immediate threat to safety and verbal de- escalation has been ineffective. It is typically used when other interventions have not successfully managed agitation.

C. Physical restraints should only be used as a last resort and in accordance with institutional policies and legal guidelines. Restraints are intended to prevent harm to the client or others when all other methods of de-escalation have failed and there is an imminent risk of harm. Placing a client in restraints without attempting verbal de-escalation first can escalate the situation further.
D. Seclusion is also a restrictive intervention that should be used judiciously and only when necessary to protect the client or others from harm. It involves placing the client in a designated, secure area where they can be monitored closely. Similar to physical restraints, seclusion should be considered only after attempts at verbal de-escalation have been unsuccessful and there is a clear risk of harm.

A. Witness the client signing the form. B. Discuss alternative treatment options with the client. C. Determine the client is competent to give consent. D. Discuss the benefits of ECT with the client.

Correct Answer is A

Explanation

A. One of the nurse's responsibilities during the informed consent process is to witness the client signing the consent form. This ensures that the client voluntarily agrees to undergo ECT after receiving adequate information about the procedure, its risks, benefits, and alternatives. By witnessing the signature, the nurse confirms that the client's consent is documented appropriately and legally.
B. Nurses may provide general information about ECT and its alternatives, but the detailed discussion about treatment options and their implications usually occurs during the consultation with the provider.
C. Determining if a client is competent to give consent is a legal determination typically made by a healthcare provider or a legal representative, not the nurse.
D. It is not the nurse's role to discuss the specific benefits of ECT, as these discussions are the responsibility of the healthcare provider leading the client's care.

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A nurse is caring for a group of clients in a pediatric clinic. Which of the following clients is at highest risk for physical abuse?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client is becoming increasingly agitated, anxious, and tense. The nurse notes a clenched jaw and a change in the pitch of the client's voice. Which of the following interventions should the nurse implement first?

Correct Answer is A

Explanation

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Correct Answer is A

Explanation

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