A nurse in an emergency department is caring for a client who recently experienced partner violence.

Exhibits

The nurse is reviewing the client’s medical record at discharge. For each finding, specify whether the finding indicates a potential improvement in or a worsening of the client’s physical or psychological status.

Client states that the partner will not be violent in the future.

Client agrees to an appointment with a social worker.

Client’s reported pain level of the left wrist.

Client requests help developing a safety plan.

Client claims responsibility for the physical altercation.

Answer and Explanation

The Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"A"}}

Choice A Reason: The belief that a partner will not be violent in the future can be a form of denial or wishful thinking, especially without any evidence of change or intervention. It is not uncommon for individuals in abusive relationships to hope for change, but without concrete actions, such as therapy or other interventions, this hope does not indicate an improvement in the client’s situation.

Choice B Reason: Agreeing to an appointment with a social worker is a positive step towards addressing the situation and seeking help. Social workers can provide support, resources, and guidance, which can be crucial for someone experiencing partner violence. This choice indicates a potential improvement in the client’s psychological status as it shows a willingness to engage with support services.

Choice C Reason: A decrease in reported pain levels can indicate physical improvement. Pain scales are subjective but provide a measure of the client’s comfort and can reflect healing or the effectiveness of pain management strategies.

Choice D Reason: Requesting help to develop a safety plan is a proactive step in ensuring personal safety and preparing for potential future incidents of violence. It shows the client’s awareness of the risks and a desire to protect themselves, which is a positive indicator of psychological improvement.

Choice E Reason: While claiming responsibility for the physical altercation may seem negative, it can also be seen as the client’s attempt to make sense of the situation. It is important to note that responsibility for violence lies with the perpetrator, not the victim. However, recognizing the dynamics of the relationship and the events leading up to the violence can be part of the healing process and taking control of one’s life.

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Free Nursing Study Resources

Correct Answer is ["1.4"]

Explanation

Step 1 is to identify the required dose, which is 7 mg of haloperidol.

Step 2 is to identify the concentration of the available haloperidol injection, which is 5 mg/mL.

Step 3 is to calculate the volume to be administered using the formula: Volume = Dose ÷ Concentration.

So, let's calculate:

Volume = 7 mg (Dose) ÷ 5 mg/mL (Concentration)

This gives us:

Volume = 1.4 mL

However, we need to round the answer to the nearest tenth and use a leading zero if it applies. So, the final volume to be administered is 1.4 mL. The nurse should administer 1.4 mL of haloperidol injection.

A. "If you attend counseling, you will get your child back." B. "We can ask the physician to prescribe a sedative." C. "Have you thought about harming yourself?" D. "Can a family member try to obtain temporary custody of your child?"

Correct Answer is C

Explanation

Choice A reason: This response is not therapeutic as it provides false assurance and may not be accurate. The return of the child depends on many factors beyond just attending counseling.

Choice B reason: While sedatives may be used to manage acute distress, this response does not address the client's expressed feelings of hopelessness and the risk of self-harm.

Choice C reason: This response directly addresses the client's statement about not wanting to live, which could indicate suicidal ideation. It is important to assess for the risk of self-harm or suicide.

Choice D reason: This response may be helpful in a long-term plan but does not address the immediate risk of harm to the client. It is also not guaranteed that a family member can obtain custody.

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Naxlex Comprehensive Predictor Exams

A nurse is preparing to administer 7 mg of haloperidol IM to a client who is severely agitated. Haloperidol injection of 5 mg/mL is available. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

Correct Answer is ["1.4"]

Explanation

A nurse is caring for a client who has a substance use disorder. The client states, "The state took my child away after my overdose. I don't want to go on living without them." Which of the following therapeutic responses should the nurse make?

Correct Answer is C

Explanation

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