A victim of a violent rape has been in the emergency department for 3 hours. Evidence collection is complete. As discharge counseling begins, the victim says softly, "I will never be the same again. I can't face my friends. There is no sense of trying to go on." Select the nurse's most important response.
Your friends will understand when you tell them."
"Are you thinking of suicide?"
"It will take time, but you will feel the same as before."
You will be able to find meaning in this experience as time goes on
The Correct Answer is B
A. "Your friends will understand when you tell them." This response, while well-meaning, may minimize the victim's feelings and pressure them to disclose something they might not be ready to share. It does not directly address the immediate emotional crisis the victim is experiencing.
B. "Are you thinking of suicide?" This is the most important response, as it directly addresses the risk of self-harm or suicide, which is a critical concern for victims of violent trauma, especially after a violent assault. The victim's statement, "There is no sense of trying to go on," may indicate feelings of hopelessness or despair, which are warning signs for suicidal ideation. It is essential to assess for any thoughts of suicide immediately to ensure the patient's safety.
C. "It will take time, but you will feel the same as before." While this response is intended to provide reassurance, it is unrealistic and does not acknowledge the trauma and emotional distress the victim is experiencing. Recovery from such an event is complex and often involves long-term emotional and psychological adjustments.
D. "You will be able to find meaning in this experience as time goes on." This response may sound dismissive and may not resonate with the victim at this time. Finding meaning can be part of the healing process later, but this statement may feel like an oversimplification or invalidation of the victim's current emotions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Exelon (rivastigmine) is an FDA-approved medication for Alzheimer's disease. It is a cholinesterase inhibitor that works by increasing levels of acetylcholine, a neurotransmitter important for memory and learning .
B. Risperdal (risperidone) is not approved by the FDA for the treatment of Alzheimer's disease. It is an atypical antipsychotic medication primarily used to treat schizophrenia and bipolar disorder. While it may be prescribed off-label for managing certain behavioral symptoms in Alzheimer's patients, its use in this context carries significant risks, including increased mortality in elderly patients with dementia-related psychosis .
C. Namenda (memantine) is an FDA-approved medication for moderate to severe Alzheimer's disease. It is an NMDA receptor antagonist that helps regulate glutamate activity, which is involved in learning and memory .
D. Aricept (donepezil) is an FDA-approved medication for all stages of Alzheimer's disease. It is a cholinesterase inhibitor that increases levels of acetylcholine in the brain .
Correct Answer is A
Explanation
A. Multiple sclerosis (MS) is a disabling disease of the central nervous system (brain and spinal cord). It involves the immune system attacking the protective myelin sheath covering nerve fibers, causing communication problems between the brain and the rest of the body. This progressive damage can lead to both physical and cognitive disabilities, making it a dementia-related disorder in some advanced cases.
B. Huntington chorea (Huntington’s disease) is a genetic neurodegenerative disorder that affects movement and cognitive function, but it is not primarily defined as a disorder of both the brain and spinal cord.
C. Wernicke-Korsakoff syndrome is a brain disorder linked to chronic alcohol use and thiamine (vitamin B1) deficiency. It affects memory and coordination but is not a disease of the spinal cord.
D. Alzheimer’s disease is the most common form of dementia and is strictly a brain disorder, not one that affects the spinal cord.
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