A nurse is evaluating the effectiveness of the plan of care for a client who has experienced sexual assault. Which of the following findings indicates effectiveness of the plan of care?
Exhibits grief response behaviors
States a desire for revenge
Asks for advice about making life decisions
Demonstrates an increase in regressive behavior
The Correct Answer is C
Choice A rationale:
Exhibiting grief response behaviors may indicate the client is processing emotions related to the assault but may not necessarily indicate effectiveness of the plan of care.
Choice B rationale:
Stating a desire for revenge suggests unresolved anger and is not indicative of effective coping or progress.
Choice C rationale:
A sign of effectiveness in the plan of care for a client who has experienced sexual assault is the client's willingness to seek guidance and support in making important life decisions. This indicates a sense of trust in the nurse and a desire to move forward in a positive way.
Choice D rationale:
Demonstrating an increase in regressive behavior might indicate emotional distress but does not necessarily indicate effectiveness of the plan of care.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale:
Allergic reactions to eggs are a concern with some vaccines, but the varicella vaccine is generally considered safe for children with egg allergies.
Choice B rationale:
The varicella vaccine is typically given in two doses, not three. Choice C rationale:
Children should avoid taking aspirin for about 6 weeks after receiving the varicella vaccine to reduce the risk of Reye's syndrome, a rare but serious condition associated with aspirin use during viral infections.
Choice D rationale:
The varicella vaccine is usually administered subcutaneously, not into the muscle.
Correct Answer is A
Explanation
Choice A rationale:
Methylphenidate has been associated with potential growth suppression in children, which is why this statement is important.
Choice B rationale:
Administering the medication at bedtime might interfere with the child's sleep.
Choice C rationale:
Methylphenidate is more likely to cause decreased appetite and weight loss, not weight gain.
Choice D rationale:
Methylphenidate is a stimulant and is more likely to cause increased alertness rather than drowsiness.
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