The nurse completes an assessment of a client who is experiencing intimate partner violence (IPV). Which finding of the injuries should the nurse include in the documentation?

The client's significant other's statement.

A general description.

Summary of the client's feelings.

Photographs.

Answer and Explanation

The Correct Answer is D

A. The client's significant other's statement: The abuser's statement should not be included in the client's documentation. The focus should be on the client's account and evidence, not the abuser's perspective.

B. A general description: The documentation should be specific and detailed, including the nature and extent of injuries. A general description may not capture the full scope of the injuries or provide sufficient evidence.

C. Summary of the client's feelings: While the client's feelings may be important for providing emotional support, they are not as critical in the documentation of injuries. The nurse should focus on objective findings and clear descriptions of injuries.

D. Photographs: Photographs of the injuries should be taken and included in the documentation as objective evidence. This provides visual documentation of the injuries and can support legal or healthcare follow-up.

Nursing Test Bank

Test Bank #1: RN Pharmacology Exams Test Bank #2: RN Medical-Surgical Exams Test Bank #3: RN Fundamentals Exams Test Bank #4: RN Maternal-Newborn Exams Test Bank #5: RN Anatomy and Physiology Exams Test Bank #6: RN Obstetrics and Pediatrics Exams Test Bank #7: RN Fluid and Electrolytes Exams Test Bank #9: RN Adult Health Test Bank #10: RN Dosage Calculation Test Bank #11: RN Community Health Exams Test Bank #12: RN Psychology Exams Test Bank #13: RN Nursing Care Of Children Test Bank #14: RN Foundations of Nursing Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Exam #1: RN Comprehensive predictor 2023 proctored exam Exam #2: Ati rn vati comprehensive predictor proctored exam Exam #3: Ati Rn Comprehensive Predictor Proctored Exam 2023 Exam #4: Rn Comprehensive Predictor 2023 Proctored Exam - St. Joseph Exam #5: RN Comprehensive Predictor Proctored Exam (National U CA San Diego) Exam #6: Ati rn comprehensive predictor 2023 retake proctored exam Exam #7: RN Hesi Exit Proctored Exam Exam #8: Hesi RN Exit proctored exam Exam #9: Hesi rn exit proctored exam Exam #10: Hesi Rn compass exit B proctored exam

Free Nursing Study Resources

Correct Answer is D

Explanation

A. A 40-year-old African-American woman who started her menstrual period at age 14: Starting menstruation at a young age is a risk factor for breast cancer, but other factors, such as family history, tend to have a greater impact on overall risk.

B. A 35-year-old woman who had both her children before age 20: Having children early in life can actually reduce the risk of breast cancer, as it reduces the number of menstrual cycles a woman experiences, thus lowering exposure to estrogen.

C. A 50-year-old Caucasian woman who has never had a mammogram: Not having a mammogram is a concern for detecting breast cancer early, but this alone is not a higher risk of developing breast cancer. Screening is important, but it is not a primary risk factor.

D. A 32-year-old woman whose mother had breast cancer: A family history of breast cancer, especially in a first-degree relative like a mother, significantly increases the risk of developing breast cancer. This genetic risk factor makes this woman the highest-risk individual.

A. Palpate the abdomen for uterine enlargement. B. Observe the appearance of the bleeding on the client's pad. C. Measure the client's vital signs. D. Obtain a history of the exact length of each cycle.

Correct Answer is C

Explanation

A. Palpate the abdomen for uterine enlargement: While abdominal palpation may reveal uterine enlargement, it is not the first priority. The nurse needs to assess the client’s current clinical status to determine if there is any immediate risk of complications like hemorrhage.
B. Observe the appearance of the bleeding on the client's pad: Observing the appearance of the bleeding is important for understanding the severity of the condition, but the nurse should first assess the client's vital signs to identify any signs of hemodynamic instability or shock.
C. Measure the client's vital signs: The most immediate assessment is to check the client’s vital signs, especially if the increased bleeding has caused any changes in her hemodynamic status. This step will help determine if the client is experiencing a serious complication such as hypovolemic shock.
D. Obtain a history of the exact length of each cycle: While obtaining a detailed history is helpful, it is not the first action. Vital signs should be checked first to ensure that the client is stable before gathering additional information.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

The nurse completes an assessment of a client who is experiencing intimate partner violence (IPV). Which finding of the injuries should the nurse include in the documentation?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is preparing to teach a class on breast self-examination. In describing the "at-risk" individual, the nurse should describe which woman as having the highest risk of developing breast cancer?

Correct Answer is D

Explanation

A premenopausal client with uterine leiomyomas (fibroids) reports to the clinic nurse that her menstrual bleeding has increased in volume and duration. Which assessment should the nurse perform first?

Correct Answer is C

Explanation

The nurse is providing anticipatory guidance for an African-American client who is at 24-weeks gestation. Which prenatal laboratory assessment, prescribed at 28-weeks, should the nurse include in client teaching?

Exhibits Choose the most likely options for the information missing from the statement by selecting from the list of options provided. The nurse knows that the mastitis in this scenario is most likely caused by dropdownas evidenced bydropdown.

Prior to performing a postpartum assessment, the client tells the nurse, "I have pain in my stitches." The nurse knows that the client had a midline episiotomy. Which action should the nurse take first?

How should the nurse plan to position a client who has just undergone a radical mastectomy?

The nurse is caring for a client with the sexually transmitted infection (STI) human papillomavirus (HPV). The client reports having sex with someone who had many partners. Which response should the nurse provide?

A client delivers a viable infant but begins to have excessive uncontrolled vaginal bleeding after the IV oxytocin is infused. When notifying the healthcare provider of the client's condition, which information is most important for the nurse to provide?

The nurse is reviewing the genetic test report for a pregnant client with a history of several spontaneous abortions. The results show the client has a heterozygous x-linked dominant inheritance disorder. How should the nurse explain the results to the client?