When should intimate partner violence (IPV) screening occur?

Only when a client presents with an unexplained injury.

As soon as the clinician suspects a problem.

Once the clinician confirms a history of abuse.

As a routine part of each health care encounter.

Answer and Explanation

The Correct Answer is D

A. Only when a client presents with an unexplained injury: Waiting for physical signs misses many victims, especially those experiencing emotional or sexual abuse without visible injuries.

B. As soon as the clinician suspects a problem: While suspicion should prompt further evaluation, relying on suspicion alone delays early detection and intervention for many at-risk individuals.

C. Once the clinician confirms a history of abuse: Screening is a preventive tool used to detect abuse early; waiting for confirmation defeats the purpose and allows ongoing harm.

D. As a routine part of each health care encounter: Routine screening normalizes the process, reduces stigma, and increases the likelihood of identifying and helping those experiencing IPV.

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Correct Answer is D

Explanation

A. Ask family members to remain with the client in the evenings from 1700 to 2100: While family presence can offer comfort, it is not always feasible and doesn’t directly address the environmental management needed for sundowning behaviors.

B. Administer a prescribed PRN benzodiazepine at the onset of a confused state: Though medications may help in acute cases, routine pharmacologic management is not the first-line intervention due to risks like oversedation and increased fall risk in older adults.

C. Postpone administration of nighttime medications until after 2300: Delaying medications may interfere with sleep hygiene and the efficacy of routine medications that aid in rest or symptom management.

D. Ensure that the client is assigned to a room close to the nurses' station: Proximity to staff allows for more frequent monitoring and faster intervention during episodes of confusion, helping prevent injury and manage behaviors associated with sundowning.

A. Demonstrate to the PN how to position the client more effectively for the procedure. B. Arrange for unlicensed assistive personnel to assist the PN during the procedure. C. Acknowledge that the PN has positioned the client safely and correctly. D. Assume care of the client and assign the PN to the care of a different client.

Correct Answer is A

Explanation

A. Demonstrate to the PN how to position the client more effectively for the procedure:
The correct position for a sigmoidoscopy is the left lateral or Sims' position to allow easier access to the sigmoid colon. Demonstrating the correct position supports patient safety and provides teaching for the PN.

B. Arrange for unlicensed assistive personnel to assist the PN during the procedure: Assistance is not the issue in this scenario; the problem lies in incorrect positioning. Assigning additional help does not address the need to correct the client's position.

C. Acknowledge that the PN has positioned the client safely and correctly: The flat prone position is not appropriate for a sigmoidoscopy. Acknowledging incorrect positioning would be unsafe and potentially delay the procedure or increase the risk of injury.

D. Assume care of the client and assign the PN to the care of a different client: This is an excessive response that undermines the PN’s role. The more constructive approach is to guide and support the PN through demonstration rather than reassignment.

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When should intimate partner violence (IPV) screening occur?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

An older adult client is admitted to the psychiatric unit for assessment of a recent onset of dementia. The nurse notices that in the evening this client often becomes restless, confused, and agitated. Which intervention is most important for the nurse to implement?

Correct Answer is D

Explanation

The nurse is setting up the equipment to assist with a sigmoidoscopy while the practical nurse (PN) positions the client in a flat prone position. Which action should the nurse implement?

Correct Answer is A

Explanation

The nurse is caring for a client who underwent a right lobectomy for lung cancer 24 hours ago and has a single chest tube on the right side. Which intervention(s) should the nurse plan to implement? Select all that apply.

Exhibits The nurse considers the brief interaction with the client and the triage report. Which finding(s) should the nurse investigate further? Select all that apply.

The nurse is caring for a client with chronic kidney disease (CKD). Which meal selection should the nurse recommend to the client?

The nurse assesses a client being treated for Herpes zoster (shingles). Which assessment(s) should the nurse include when evaluating the effectiveness of treatment? Select all that apply.

After receiving report on an inpatient acute care unit, which client should the nurse assess first?

The nurse observes the external genitalia of a female client in preparation for inserting an indwelling urinary catheter. At which location should the catheter be inserted? (Mark location on image)

Exhibits Complete the diagram by dragging from the choices area to specify which condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client's progress.