A nurse is caring for an adolescent who was recently sexually assaulted. Which of the following statements by the adolescent's guardian represents the presence of a positive support system?
"I can encourage my child to think about what they did that allowed this event to happen."
"I should encourage my child to focus solely on the future."
"I will have to do all I can to monitor my child's relationships."
"I anticipate that my child will feel some self-blame."
The Correct Answer is D
A. This statement suggests a potential for victim-blaming or placing responsibility on the adolescent for the assault. It does not reflect a positive support system because it may contribute to feelings of guilt and shame in the adolescent. Victims of sexual assault should not be made to feel responsible for the actions of the perpetrator.
B. While encouraging the adolescent to focus on the future can be positive, solely focusing on the future without acknowledging or processing the trauma of the assault may invalidate the adolescent's current feelings and experiences. A supportive approach involves acknowledging and validating the adolescent's emotions and experiences, both past and present.
C. This statement may come from a place of concern for the adolescent's safety and well-being, which is understandable. However, it can also indicate a lack of trust or an overprotective stance that may not fully empower the adolescent to regain a sense of control over their life and decisions.
D. This statement demonstrates an understanding of common reactions and emotions experienced by individuals who have been sexually assaulted. Acknowledging that the adolescent may feel self-blame can be a way to open up discussions about these feelings and reassure the adolescent that they are not at fault. It shows empathy and readiness to support the adolescent emotionally.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Obsessive behaviors, such as repetitive actions or fixations on specific thoughts or tasks, can be indicative of delirium. Delirium often manifests with altered behavior patterns that are unusual for the individual, including obsessive or compulsive-like behaviors that are not typical of their baseline mental status. However, this is not specific to delirium.
B. Fluctuating orientation, where the client is sometimes alert and oriented and at other times confused or disoriented, is a hallmark of delirium. Unlike dementia, which typically presents with a more steady decline in cognitive function, delirium is characterized by rapid changes in mental status over hours to days. This fluctuation is important to note as it strongly suggests delirium rather than other chronic cognitive impairments.
C. Gradual memory loss reported by family members is more suggestive of chronic conditions such as dementia rather than delirium. Delirium, in contrast, is characterized by acute onset and fluctuating course rather than a gradual decline in cognitive abilities over time.
D. Depression can coexist with delirium, but a consistent state of depression without acute changes in mental status is less indicative of delirium. Delirium is characterized by rapid changes in cognition and behavior rather than a persistent mood disorder. Therefore, while depression should be assessed and managed appropriately, it is not typically a sign of delirium unless there are acute changes in mental status accompanying it.
Correct Answer is C
Explanation
A. Fluoxetine is not indicated for the treatment of seizures. Its primary therapeutic effect is related to mood stabilization through serotonin reuptake inhibition in the brain. Therefore, absence of seizures would not be an expected outcome of fluoxetine therapy.
B. Hand tremors are not typically a direct symptom of depression or anxiety but can occur as a side effect of certain medications or due to anxiety-related physiological responses. Fluoxetine itself does not typically cause or treat hand tremors directly. Therefore, while tremor reduction might occur as a result of improved mood and reduced anxiety, it is not a direct therapeutic outcome of fluoxetine.
C. Improved mood is one of the primary expected outcomes of fluoxetine therapy. SSRIs like fluoxetine work by increasing serotonin levels in the brain, which helps regulate mood and alleviate symptoms of depression and anxiety. Clients typically experience a reduction in feelings of sadness, hopelessness, and anxiety, leading to an overall improvement in mood.
D. Hallucinations are not a typical symptom of depression or anxiety disorders but can occur in conditions such as schizophrenia or psychotic depression. Fluoxetine is not primarily indicated for treating hallucinations.
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