A client in the emergency department who has been raped says repeatedly, “if only I hadn’t worn that sexy dress.” Which response by a nurse is appropriate?

“It wouldn’t have mattered what you had worn.”.

“The current styles are an invitation to disaster.”.

“Never mind about blame.

That will be determined by the court.”.

Answer and Explanation

The Correct Answer is A

“It wouldn’t have mattered what you had worn.” This response by a nurse is appropriate because it validates the client’s feelings and helps to reduce self-blame. It also conveys that rape is not caused by the victim’s clothing or behavior, but by the perpetrator’s violence and lack of respect.

Choice B. “The current styles are an invitation to disaster.” is wrong because it implies that the client is responsible for the rape and that she could have prevented it by dressing differently. This response is judgmental and insensitive, and may increase the client’s guilt and shame.

Choice C. “Never mind about blame.

That will be determined by the court.” is wrong because it dismisses the client’s feelings and does not address her emotional needs.

It also suggests that the nurse does not believe the client or support her. This response may make the client feel isolated and distrustful.

Choice D. “Some people don’t have very good self-control.

We have to help them all we can.” is wrong because it excuses the perpetrator’s behavior and shifts the blame to the victim.

It also implies that rape is a result of sexual desire, rather than an act of violence and domination. This response may make the client feel powerless and helpless.

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Correct Answer is B

Explanation

According to the Addiction Nursing Competencies, antisocial personality traits are one of the risk factors for developing addictive behaviors.

Antisocial personality disorder is characterized by a disregard for the rights and feelings of others, impulsivity, deceitfulness, and lack of remorse.

Choice A is wrong because high self-esteem is not associated with addictive behaviors. On the contrary, low self-esteem, passivity, and inability to relax or defer gratification are some of the personality factors that can predispose a person to substance use disorders.

Choice C is wrong because good communication skills are not related to addictive

behaviors. In fact, poor communication skills, social isolation, and lack of support are some of the psychosocial factors that can contribute to substance use disorders.

Choice D is wrong because aggressive behaviors are not a specific indicator of addictive behaviors.

Aggression can be a result of various factors, such as frustration, anger, stress, or mental illness. Aggression can also be influenced by the type and amount of substance used.

A. Discuss the client’s frequent questions with the family and health care provider. B. Respect the family’s wishes and deny the client has a terminal condition. C. Encourage the client to think positive thoughts and use distraction techniques. D. Honestly tell the client the condition is terminal so preparations can be made.

Correct Answer is A

Explanation

This is the most appropriate action because it respects the client’s right to know and the family’s right to privacy.

It also allows the nurse to collaborate with the family and the healthcare provider to provide the best care for the client.

Choice B is wrong because it violates the client’s autonomy and dignity.

It also prevents the client from making informed decisions about end-of-life care.

Choice C is wrong because it denies the reality of the situation and does not address the client’s concerns.

It also may increase the client’s anxiety and frustration.

Choice D is wrong because it disregards the family’s wishes and cultural values.

It also may cause harm to the client and the family by breaking their trust and creating conflict.

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A client in the emergency department who has been raped says repeatedly, “if only I hadn’t worn that sexy dress.” Which response by a nurse is appropriate?

Nursing Test Bank

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