The nurse who is working in the emergency department is obtaining evidence for a rape kit from a woman who reports that she was raped while returning to her dormitory from the university library. Which intervention is most important for the nurse to implement?

Listen attentively to the client's description of the event.

Report the incident to the university's security department.

Do not allow client to shower until all evidence is obtained.

Determine the client's personal reaction to the reported rape.

Answer and Explanation

The Correct Answer is C

A.   Listen attentively to the client's description of the event. While important for providing emotional support, it is secondary to preserving forensic evidence.
B.   Report the incident to the university's security department. This is necessary but not as immediately critical as preserving evidence.
C.   Do not allow client to shower until all evidence is obtained. Preserving evidence is the highest priority in this situation to ensure a thorough forensic investigation and legal process.
D.   Determine the client's personal reaction to the reported rape. Understanding the client's emotional state is important for providing support, but it should be done after ensuring that critical forensic evidence is collected.

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Correct Answer is A

Explanation

A. Keep diabetic medication on schedule as prescribed.

This is the correct answer because maintaining a regular schedule for diabetic medication is crucial for managing blood glucose levels and preventing complications.

B. Limit maximum daily fat intake to 15% of total calories.

While reducing fat intake can be beneficial for overall health, it is not directly related to managing acute blood glucose levels or preventing immediate complications of diabetes.

C. Check blood sugar levels every four to six hours every day.

Frequent monitoring of blood sugar levels is important, but checking every four to six hours may not be necessary for all clients, especially if they are not on insulin or if their diabetes is well-controlled. It depends on individual needs and physician recommendations.

D. Restrict alcoholic beverages to no more than 1-2 per week.

Limiting alcohol intake is good advice for overall health and diabetes management, but it is not the most critical action compared to keeping medications on schedule to prevent complications.

A. Determine type of chemical exposure. B. Call poison control emergency number. C. Assess child for altered sensorium. D. Obtain equipment for gastric lavage. E. None F. None

Correct Answer is A

Explanation

A. Determining the type of chemical exposure is critical as it guides subsequent treatment and interventions. Different chemicals require different management strategies, including whether to induce vomiting or administer activated charcoal.

B. Calling poison control is important but should occur after identifying the specific chemical involved, as the poison control guidelines often depend on the substance the child was exposed to.

C. Assessing for altered sensorium is important, but the immediate priority is to identify the type of chemical exposure to implement appropriate interventions.

D. Obtaining equipment for gastric lavage may be necessary in certain cases, but this is based on the type of chemical ingested and the child's condition. Identifying the chemical exposure must occur first to determine if gastric lavage is appropriate.

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The nurse who is working in the emergency department is obtaining evidence for a rape kit from a woman who reports that she was raped while returning to her dormitory from the university library. Which intervention is most important for the nurse to implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is providing teaching to a client admitted with a blood glucose level of 580 mg/dL about preventing complications related to diabetes mellitus. Which information reported by the client indicates understanding?

Correct Answer is A

Explanation

Correct Answer is A

Explanation

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Exhibits Based on the client's status at 1400, the nurse should plan to do which of the following? Select all that apply.