The nurse is working with another nurse in the emergency department (ED) when a client comes in stating they have been raped during a date. Which statement made by the other nurse privately requires immediate correction?

"We need to offer the client emotional support especially when obtaining specimens."

"Did you see that outfit that the client is wearing? What did they expect?"

The client feels like they won't be believed since there was alcohol involved during the date."

"When the client said "stop." that was enough for the perpetrator to get up and walk away."

Answer and Explanation

The Correct Answer is B

Explanation: This statement is highly inappropriate and victim-blaming. It implies that the client's clothing choices are somehow responsible for the sexual assault they experienced. Victim-blaming is never acceptable and can be harmful to the survivor, making them feel ashamed and responsible for the actions of the perpetrator. As healthcare professionals, nurses should always respond to victims of sexual assault with empathy, compassion, and without judgment.

The other statements (A, C, and D) are all appropriate and acknowledge the seriousness of the situation:

A. "We need to offer the client emotional support especially when obtaining specimens." Explanation: This statement recognizes the need for emotional support during the examination process, which can be distressing for the survivor. Providing emotional support and ensuring the client's comfort and consent during the examination are crucial aspects of caring for a sexual assault survivor.

C. "The client feels like they won't be believed since there was alcohol involved during the date." Explanation: This statement highlights the survivor's feelings and concerns about being believed due to alcohol involvement. It emphasizes the importance of creating a safe and non-judgmental environment for the client, where they can share their experience and receive appropriate care and support.

D. "When the client said 'stop,' that was enough for the perpetrator to get up and walk away." Explanation: This statement indicates an understanding of the importance of consent and acknowledges that the client's clear expression of refusal should have been respected. Understanding and respecting consent is crucial when discussing cases of sexual assault.

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Correct Answer is D

Explanation

A-Positioning in semi-Fowler’s can aid breathing but doesn’t assess crackles’ cause. It’s supportive, not diagnostic, and premature without further data

B-Instructing the client to limit fluid intake to less than 2,000 mL/day is not indicated for crackles. Fluid restriction is more commonly used in conditions like congestive heart failure where there is excessive fluid retention.

C- Preparing to administer antibiotics is not the first intervention for crackles. Crackles can be caused by various conditions, and antibiotics would only be administered if there is an underlying infection requiring treatment.

D- Reassessing after deep breathing and coughing evaluates secretion clearance, aligning with nursing assessment and Maslow’s physiological needs

A. "You can reduce your anger by hitting a punching bag." B. "You need to learn how to be less assertive in your communications." C. "You need to learn to suppress these angry feelings." D. "Anger is a normal feeling, and you can use it to solve problems

Correct Answer is D

Explanation

Option D is the most helpful statement when working with a client who has frequent angry outbursts. It acknowledges that anger is a normal emotion that everyone experiences at times. Additionally, it provides a positive perspective on anger, suggesting that it can be used constructively to solve problems.

Anger itself is not a negative emotion; it becomes problematic when it is expressed inappropriately or disruptively. By validating the client's feelings and reframing anger as a potential tool for problem-solving, the nurse can help the client explore healthier ways to cope with and express their emotions.

Options A, B, and C are not as helpful in this situation:

A. "You can reduce your anger by hitting a punching bag." - While physical activity can help release pent-up emotions, this statement focuses solely on a physical outlet for anger and does not address the underlying issues causing the frequent angry outbursts.

B. "You need to learn how to be less assertive in your communications." - This statement suggests that the client's assertiveness is the problem, which may not be the case. Instead, the nurse should focus on helping the client develop healthier ways to express their emotions and communicate effectively.

C. "You need to learn to suppress these angry feelings." - Encouraging the suppression of emotions is not a healthy coping mechanism. Suppressing anger can lead to increased stress and may result in more intense outbursts later on. The nurse should help the client learn constructive ways to manage and express their anger.

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The nurse is working with another nurse in the emergency department (ED) when a client comes in stating they have been raped during a date. Which statement made by the other nurse privately requires immediate correction?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse auscultates a client's lung sounds and identifies crackles in the left lower lobe. Which of the following interventions should the nurse take

Correct Answer is D

Explanation

A nurse is working with a client who has frequent angry outbursts which is disrupting life at home. Which statement by the nurse is most helpful when working with this client?

Correct Answer is D

Explanation

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The nurse is caring for several clients on the behavioral health unit. Which client will be assessed as demonstrating aggression?

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