While assessing an older adult client, the nurse notes that the client has old and new ecchymotic areas on the extremities and buttocks upon admission. The client states to the nurse in confidence that the family members frequently hit him. Which therapeutic statement should the nurse communicate in response?
Let's get these treated
I'll report this type of abuse
Call the emergency department
I'll keep this in confidence
The Correct Answer is B
Choice A reason: While treating the injuries is important, addressing the root cause of abuse is crucial for the client's safety. Simply treating the injuries without addressing the abuse may allow the cycle of harm to continue.
Choice B reason: Reporting the abuse is a legal and ethical responsibility for healthcare providers. Ensuring the client's safety and providing necessary interventions to stop the abuse is paramount.
Choice C reason: Calling the emergency department is not the correct response. The nurse should follow the proper protocol for reporting abuse, which involves notifying social services or other relevant authorities.
Choice D reason: Keeping the information in confidence is not appropriate when dealing with abuse cases. The nurse must act to protect the client and report the abuse to prevent further harm.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Decreased central venous pressure is not typically associated with glomerulonephritis. This condition often leads to fluid retention and increased pressure within the blood vessels.
Choice B reason: Hypertension is a common manifestation of glomerulonephritis due to fluid retention and impaired kidney function. The kidneys are unable to excrete excess fluid, leading to increased blood pressure.
Choice C reason: Bradycardia is not typically associated with glomerulonephritis. The condition primarily affects kidney function and fluid balance, rather than heart rate.
Choice D reason: Decreased cardiac output can occur in severe cases of acute kidney injury, but it is not a primary manifestation of glomerulonephritis. Monitoring blood pressure and fluid status is more critical in these patients.
Correct Answer is D
Explanation
Choice A reason: Hyperopia, also known as farsightedness, is a condition where distant objects can be seen more clearly than near objects. It is caused by the eyeball being too short or the cornea having too little curvature. In this scenario, the client's ability to adjust and focus on near and distant objects is not indicative of hyperopia.
Choice B reason: Photophobia is an increased sensitivity to light. It can be caused by various eye conditions, infections, or even migraines. The client's ability to focus on objects at different distances does not correlate with sensitivity to light.
Choice C reason: Myopia, or nearsightedness, is the opposite of hyperopia. Individuals with myopia can see near objects clearly but have difficulty focusing on distant objects. The client's ability to focus on both near and far objects rules out myopia.
Choice D reason: Accommodation is the process by which the eye adjusts its focus from near to distant objects (or vice versa). This involves changes in the shape of the lens, controlled by the ciliary muscles. The client's ability to focus on objects at varying distances correctly describes the accommodation process, making it the appropriate answer.
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