A son brings his elderly mother to the emergency department and states that she fell today. The nurse notes multiple bruises in all stages of healing all over the client’s body. Which action should the nurse take first?.

Provide an elder abuse brochure and teach the client.

Interview the client privately and ask if anyone is harming her.

Observe the interaction between the mother and the son throughout stay.

Report the abuse without confirming

Answer and Explanation

The Correct Answer is B

Interview the client privately and ask if anyone is harming her.

This is because the nurse has a duty to assess the client for possible elder abuse and report any suspicions to the appropriate authorities.

The nurse should not assume that the son is the abuser or that the client will disclose the abuse without being asked directly.

The nurse should also respect the client’s autonomy and privacy and not confront the son or provide an elder abuse brochure without the client’s consent.

Choice A is wrong because it may imply that the client is responsible for preventing the abuse or that the nurse has already made a judgment about the situation.

It may also be ineffective if the client is unable or unwilling to read the brochure or seek help. Choice C is wrong because it may delay the assessment and intervention for the client.

It may also be biased and unfair to observe the son without interviewing him or the client first.

Choice D is wrong because it may violate the client’s rights and preferences.

It may also be premature to report the abuse without confirming it with the client or obtaining more evidence.

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Correct Answer is C

Explanation

This is because hepatitis C is a viral infection that spreads through contaminated blood and body fluids. IV drug use is one of the most common ways to get hepatitis C, especially if people share needles or other equipment.

Choice A is wrong because drinking contaminated water is not a risk factor for hepatitis

C. Hepatitis A and E are transmitted by the fecal-oral route, which can happen through contaminated water.

Choice B is wrong because eating raw chicken is not a risk factor for hepatitis C. Hepatitis E can be transmitted by eating undercooked meat from infected animals, but not chicken.

Choice D is wrong because unprotected intercourse is not a major risk factor for hepatitis

C. Hepatitis B and D are more likely to be transmitted by sexual contact than hepatitis

C. However, having multiple sexual partners or having sexually transmitted diseases can increase the risk of hepatitis

C. Normal ranges for hepatitis C tests depend on the type of test and the laboratory that performs it.

Some common tests are:

Anti-HCV antibody test: This test detects antibodies to the hepatitis C virus in the blood.

A positive result means that the person has been exposed to the virus, but does not necessarily mean that they have an active infection. A negative result means that the person has never been exposed to the virus or has cleared it from their body.

HCV RNA test: This test measures the amount of hepatitis C virus in the blood.

A positive result means that the person has an active infection and can transmit the virus to others. A negative result means that the person does not have an active infection or has cleared it from their body.

HCV genotype test: This test identifies the strain or type of hepatitis C virus that the person has. There are six major genotypes of hepatitis C, numbered 1 to 6, and each one may respond differently to treatment.

A. Adding a nursing diagnosis of lowered self-esteem to the care plan. B. Giving praise for every decision the client makes. C. Eliciting client input into planning care. D. Modeling competent care for the client.

Correct Answer is C

Explanation

This would help the client to feel valued, respected and involved in their own care, which can enhance their self-esteem.

Choice A is wrong because adding a nursing diagnosis of lowered self-esteem to the care plan does not address the underlying causes of the problem or provide any interventions to improve it.

It may also label the client and make them feel worse.

Choice B is wrong because giving praise for every decision the client makes is not realistic or sincere.

It may also undermine the client’s confidence and autonomy by implying that they need constant approval from others.

Choice D is wrong because modeling competent care for the client does not necessarily help them to maintain their self-esteem.

It may even make them feel inadequate or dependent on the nurse.

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A son brings his elderly mother to the emergency department and states that she fell today. The nurse notes multiple bruises in all stages of healing all over the client’s body. Which action should the nurse take first?.

Nursing Test Bank

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Explanation

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