A nurse is caring for a client who was admitted for suspected abuse. The client is quiet and withdrawn. Which of the following actions should the nurse take to promote client communication?
Invite a family member to be present for the nursing history.
Provide basic wound care for obvious physical injuries.
Be direct and honest when speaking with the client.
Probe the client to offer a factual account of the abuse.
The Correct Answer is C
Rationale for A: Inviting a family member to be present may hinder communication, especially if the family member is involved in the abuse or the client feels unsafe speaking in their presence. Privacy is crucial for encouraging open communication.
Rationale for B: Providing basic wound care is important for physical injuries, but it does not directly address promoting communication. The nurse should focus on creating a safe environment for the client to talk.
Rationale for C: Being direct and honest when speaking with the client promotes trust and open communication. Clients who are suspected of being abused may be fearful or reluctant to share information, so clear, respectful communication helps create a supportive environment.
Rationale for D: Probing the client for a factual account of the abuse may make the client feel pressured or overwhelmed. The nurse should allow the client to share information at their own pace without feeling forced to disclose details.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. While both schizophrenia and PTSD are mental health disorders, the priority in this context for a soldier with a history of combat exposure is to screen for conditions that commonly arise from traumatic experiences, such as PTSD and major depressive disorder.
B. PTSD and major depressive disorder can often co-occur, especially in individuals exposed to trauma. Given the soldier's history of combat exposure and PTSD diagnosis, screening for major depressive disorder is crucial due to its frequent association with PTSD and its potential severity.
C. Bipolar disorder may share some symptoms with PTSD, but given the context of returning from combat and the diagnosis of PTSD, the priority would be to focus on screening for
conditions more directly linked to trauma.
D. Dementia is less likely to be directly related to combat exposure in a returning soldier. While it's essential to assess the soldier's overall mental health, the immediate concern in this scenario would be mental health conditions more commonly associated with trauma.
Correct Answer is B
Explanation
A. Moderate level would suggest a plan that has some risk but may be less imminent or less likely to result in death.
B. A plan involving a loaded gun aimed at a vital organ like the heart, coupled with alcohol consumption and intent, indicates a high level of lethality.
C. This scenario presents a significant risk given the method and the caller's intent, so "No risk" would not be appropriate.
D. Low level would suggest a plan that is less likely to cause severe harm or death, which is not the case here.
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