A young female client is admitted to the emergency room because she was raped that evening by her date.
How should the registered nurse record the client's chief complaint in the medical record?
Gent clams that she was forced to participate in sexual intercourse by a friend
Client States “my date raped me tonight."
Client has been sexually assaulted last night at 10 pm
Client reported that she had sexual relations against her Will and she feels very bad
The Correct Answer is B
This statement clearly and accurately conveys the client's complaint of being raped by her date.
Option a uses colloquial language and may not accurately convey the severity and trauma of the situation.
Option c uses vague language that does not clearly state the nature of the incident.
Option d uses subjective language that may not be helpful for accurately documenting the client's complaint.
It's important for healthcare providers to use appropriate language when documenting sensitive situations like sexual assault to ensure clear communication among the healthcare team and accurate documentation for legal and forensic purposes.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Involuntary hospitalization for mental illness is typically reserved for situations where an individual poses an immediate danger to themselves or others due to a severe mental illness. In option A, the individual is experiencing command hallucinations, which are often a symptom of a severe mental illness such as schizophrenia. The fact that they want to hurt their neighbor is a clear indication that they pose a danger to others and require emergency intervention.
Option B may indicate a mental illness such as schizophrenia or bipolar disorder, but it does not necessarily pose an immediate danger to the individual or others.
Option C may indicate a relapse in addiction, but again, it does not necessarily pose an immediate danger to the individual or others.
Option D may indicate a need for follow-up and intervention, but it does not indicate an immediate danger to the individual or others.
Correct Answer is A
Explanation
This response is appropriate because it seeks clarification and more information to help the nurse better understand the patient's statement. By asking for an example, the nurse can gain a better understanding of the patient's experience and identify appropriate interventions to help the patient manage their anxiety.
Option b is not an appropriate response as it does not seek clarification and instead asks the patient to repeat themselves.
Option c is partially appropriate but could be improved by asking more specific questions to help the patient articulate their feelings and needs.
Option d is not an appropriate response as it dismisses the patient's feelings and may cause the patient to feel unsupported and isolated.
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