A nurse is assessing an older adult client who was brought to the emergency department by his adult son, who reports that the client fell at home. The nurse suspects elder abuse. Which of the following actions should the nurse take?

Ask the client's son to go to the waiting area.

Ask the client about his injuries with the son present.

Treat and discharge the client.

File an incident report.

Answer and Explanation

The Correct Answer is A

A.   Asking the client's son to go to the waiting area allows the nurse to have a private conversation with the client, which is crucial in suspected cases of elder abuse to gather information without potential interference or intimidation.
B.   Asking about injuries with the son present might hinder the client from disclosing information due to fear or pressure.
C.   Treating and discharging the client without addressing the suspected elder abuse could potentially put the client in further danger.
D.   Filing an incident report might be necessary but should follow an assessment and investigation of the situation.

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Correct Answer is C

Explanation

A. Notifying the unit manager should happen but discussing the issue with the AP directly is the initial step in addressing the problem.
B. Alerting the infection control department is important, but direct communication with the AP should come first to address the immediate concern.
C. Speaking with the AP allows for immediate clarification and correction of the behavior, aiming to prevent further incidents.
D. Reinforcing facility protocols at a staff meeting is beneficial, but immediate correction at the individual level is more crucial to prevent recurrence of the issue.

A. A client who is 3 days postoperative following abdominal surgery is ready for discharge B. A client who has Alzheimer's disease and bacterial pneumonia with newly onset restlessness C. A client who is 24 hr postoperative following surgical reduction of a hip fracture and reports a pain level of 7 D. A client who is newly admitted with diabetes mellitus and whose fasting blood glucose level is 200 mg/dL

Correct Answer is B

Explanation

A. A client ready for discharge, if stable and prepared for discharge, does not require immediate assessment.
B. Restlessness in a client with Alzheimer's and bacterial pneumonia could indicate a change in condition, potentially signaling an urgent issue that needs immediate assessment.
C. While pain management is important, the sudden onset of restlessness in a client with cognitive impairment and pneumonia takes priority.
D. An elevated fasting blood glucose level in a newly admitted diabetic client requires attention but might not be as immediately critical as the acute change in behavior seen in option B.

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A nurse is assessing an older adult client who was brought to the emergency department by his adult son, who reports that the client fell at home. The nurse suspects elder abuse. Which of the following actions should the nurse take?

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