The nurse is assisting with patient data collection in a clinic. The nurse is assigned to a young female patient who has an older male friend present at her bedside. The patient is nervous, timid, very thin, and with poor hygiene and lets the friend answer all of the nurse's questions. What actions should the nurse take?
Whisper to patient that she will be saved.
Confront the family friend to allow the patient to ask questions.
Consult the health care team about the suspicions and call local authorities to investigate.
Ask the patient if she feels safe, while the friend is in the room.
The Correct Answer is D
Explanation:
A. Whisper to the patient that she will be saved.
This action is inappropriate and does not address the underlying issues of the patient's condition or the presence of the family friend. Whispering such a statement may also be confusing or alarming to the patient.
B. Confront the family friend to allow the patient to ask questions.
While it's important to facilitate open communication with the patient, confronting the family friend directly may not be the most effective approach initially. It's crucial to first assess the patient's comfort level and safety before addressing the situation with the friend.
C. Consult the healthcare team about the suspicions and call local authorities to investigate.
Jumping to conclusions and involving authorities without gathering more information or assessing the patient's feelings directly could escalate the situation unnecessarily. It's important to handle such concerns with sensitivity and professionalism, involving appropriate resources only when needed.
D. Ask the patient if she feels safe, while the friend is in the room.
This is the most appropriate action initially. By directly asking the patient about her feelings of safety, the nurse can gauge the patient's comfort level and assess any potential concerns or risks. This approach allows the nurse to gather information and address any issues in a supportive and patient-centered manner. If the patient expresses concerns or discomfort, further assessment and appropriate interventions can be implemented, which may include involving other members of the healthcare team or authorities if necessary.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","D","E","F"]
Explanation
Explanation:
A. What were the costs associated with the research?
While the costs associated with research can be important in certain contexts, such as resource allocation or budget considerations, it is not typically a primary consideration in the critical appraisal of research evidence for evidence-based practice.
B. Does the study have reliability?
Reliability refers to the consistency and stability of research findings. It is important to assess whether the study's methods and measurements are reliable to ensure that the results are trustworthy and reproducible.
C. Is the research applicable to other populations?
Applicability or generalizability of research findings refers to whether the results can be applied to populations or settings beyond those directly studied in the research. Evaluating applicability helps determine the relevance of the study findings to different patient populations or clinical scenarios.
D. What methods were used to conduct the research?
Understanding the research methods is crucial for evaluating the quality and rigor of the study. This includes assessing the study design, sampling methods, data collection procedures, interventions or exposures studied, and statistical analyses used.
E. How were the study results analyzed?
Examining how the study results were analyzed helps determine the validity and reliability of the findings. It is important to assess whether appropriate statistical methods were used, whether potential biases were addressed, and whether the results are robust and meaningful.
F. What was the purpose of the study?
Understanding the purpose or research question of the study is fundamental for evaluating its relevance and significance to clinical practice. The research question should be clearly stated and align with the study's objectives, methods, and conclusions.
Correct Answer is D
Explanation
Explanation:
A. A 6-year-old child with a spiral fracture of the tibia and fibula, reportedly occurring while riding a bicycle:
While a spiral fracture can be concerning, it is also a common injury seen in children due to falls or accidents during physical activities such as riding a bicycle. Without further evidence or suspicion, this may not immediately indicate physical abuse.
B. A 14-month-old toddler reportedly learning to walk and has several bruises on bony prominences of the lower legs and elbows:
Bruises on bony prominences can be common in toddlers who are learning to walk and explore their environment. These bruises are often seen on areas such as the lower legs and elbows. Without additional concerning signs or patterns, this may not indicate physical abuse.
C. A 9-month-old infant who sustained near drowning when he reportedly climbed into the tub and turned on the water:
Near drowning incidents can occur accidentally, especially in curious and mobile infants who may explore their surroundings. While this is a serious event, it does not necessarily suggest physical abuse unless there are other suspicious findings or a history of non-accidental injuries.
D. A 3-year-old toddler with scalding burns over the face and chest reportedly sustained when the child pulled on a tablecloth, spilling a cup of tea on himself:
Scalding burns, especially over sensitive areas like the face and chest, can raise concerns about physical abuse, especially when the reported mechanism of injury (spilling a cup of tea) seems inconsistent or disproportionate to the severity of the burns. The pattern and location of burns may not align with accidental spillage, leading to suspicion of abuse.
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