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 The client is quiet and withdrawn.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 A
Explanation
A. For a client with severe depression, a calm and direct approach is beneficial. Sitting with the client and offering simple, clear information can help establish trust and rapport.
B. Attending group therapy immediately might overwhelm the client, especially if they are newly admitted and experiencing severe depression.
C. Taking the client on a tour and introducing all staff members might be overwhelming or excessive for someone with severe depression.
D. While explaining unit policies is important, a direct informational approach might be more effective initially given the severity of the client's condition.
Correct Answer is D
Explanation
A. Extrapyramidal symptoms are more commonly associated with antipsychotic medications rather than SSRIs.
B. SSRIs might have varying effects on motor activity, but this is not a primary outcome for their use.
C. While SSRIs may indirectly contribute to cognitive improvements, the primary expected outcome revolves around mood changes rather than thought processes.
D. SSRIs are primarily used to treat mood disorders like depression and anxiety, and the main goal of their use is to improve mood and emotional symptoms. Therefore, the expected outcome criteria often relate to mood improvement.
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