A nurse is preparing to discharge a client who was treated for sexual assault. Prior to discharge, which of the following actions should the nurse plan to take?

Provide the client with grooming supplies and a private area to bathe.

Call the client's home for someone to pick up the client

Retain the client's cell phone for evidence.

Send the client's clothes to the laundry before returning the items to the client.

Answer and Explanation

The Correct Answer is A

A. Provide the client with grooming supplies and a private area to bathe: After evidence collection and medical treatment are complete, allowing the client to bathe in privacy supports their dignity and helps restore a sense of control. This is a therapeutic and appropriate step prior to discharge.
B. Call the client's home for someone to pick up the client: Contacting someone without the client's consent could breach confidentiality and potentially endanger the client, especially if the assailant lives in the same household.
C. Retain the client's cell phone for evidence: The nurse does not have the authority to confiscate personal property like a cell phone. Evidence collection must follow legal protocols, typically involving law enforcement and forensic teams.
D. Send the client's clothes to the laundry before returning the items to the client: The client's clothing may be part of the forensic evidence. Washing or returning them before proper processing would compromise the legal chain of custody.

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Correct Answer is D

Explanation

A. Airway obstruction occurs due to thinning mucus: Mucus thinning is typically not associated with airway obstruction. Instead, airway obstruction occurs when the mucus is thickened, leading to blockage of the airways, especially in asthma.
B. Inflammation is reduced due to airway diameter: During bronchospasm, airway inflammation increases, not reduces. The diameter of the airways becomes narrowed due to swelling, mucus production, and muscle contraction, exacerbating asthma symptoms.
C. Decreased mucus production contributes to airway constriction: Mucus production generally increases in asthma, contributing to airway narrowing and constriction. Decreased mucus would not be a direct factor in bronchospasm.
D. Bronchospasm occurs when there is inflammation, edema, and excess mucus: Bronchospasm in asthma is caused by inflammation, edema, and excess mucus production, all of which contribute to airway narrowing and difficulty breathing. This is the most accurate description of the physiological process in asthma exacerbations.

A. Warmth B. Erythema C. Swelling D. Numbness E. Bleeding

Correct Answer is ["A","B","C"]

Explanation

A. Warmth: Warmth over the affected area is a typical sign of DVT. It results from localized inflammation and increased blood flow due to the clot obstructing venous return and irritating the vessel wall.
B. Erythema: Erythema, or redness, often occurs in the area where the thrombus is located. It reflects the inflammatory response triggered by the presence of the clot in the vein.
C. Swelling: Swelling in the affected limb is one of the most common signs of DVT. It results from impaired venous return and fluid buildup due to the obstruction caused by the clot.
D. Numbness: Numbness is not typically associated with DVT. While swelling can sometimes compress nearby nerves and cause discomfort, numbness is not a hallmark feature and would warrant evaluation for other potential causes.
E. Bleeding: Bleeding is not a manifestation of DVT itself. DVT involves clot formation within a vein, not bleeding. However, anticoagulant therapy used to treat DVT can increase the risk of bleeding, but that is a side effect of treatment, not a sign of the condition.

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A nurse is preparing to discharge a client who was treated for sexual assault. Prior to discharge, which of the following actions should the nurse plan to take?

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Naxlex Comprehensive Predictor Exams

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