Mood & Affect #4

What action should the nurse take if abuse of a 10-year-old child is suspected? A. Report the suspicion to local authorities. B. Elicit more information from the parents. C. Refer the parents to a group therapy meeting. D. Notify the health care provider of the suspicion.

A

A client who has been sexually abused tearfully says, "I'm no good now; there's nothing to live for." What is the most therapeutic response by the nurse? A. Tell me more about your feelings B. I can understand why you feel worthless C. Why do you feel that there's nothing to live for? D. Do you feel this way because of what has happened?

A

A nurse may best assist abusing parents in altering their behavior toward their abused 2-year-old child by helping them: A. Recognize what behavior is appropriate for a toddler B. Learn appropriate ways of punishing a toddler's inappropriate behavior C. Identify the specific ways in which the toddler's behavior provokes frustration D. Ignore the toddler's negative nondestructive behavior while supporting acceptable behavior

C

When a diagnosis of child abuse is established, the priority of nursing care is: A. Promoting bonding with the child B. Staying with the parents while they visit C. Protecting the total well being of the child D. Teaching methods of discipline to the parents

C

A 3-year-old child is brought to the emergency department by the mother, who reports that her child fell down the stairs and sustained injuries to the right arm and leg. During the physical assessment the nurse identifies a number of old bruises on the child's back, buttocks, and upper arms. What should the nurse say to the child to obtain additional information? A"Why did you fall down the stairs?" B"Did you really fall down those stairs?" C"Show me how you fell down the stairs." D"Your mommy must have told you to say you fell down the stairs."

C

A client with a history of a short temper and physically abusive behavior becomes violent and is admitted to the psychiatric service. At the time of admission the client is extremely anxious. What is the priority nursing action? A. Sitting quietly with the client B.Encouraging the client to play video games C.Introducing the client to several other clients D.Assigning a staff member to supervise the client

D

A client with a history of violence is becoming increasingly agitated. Which nursing intervention will most likely increase the risk of acting-out behavior? A. Being assertive B. Responding early C. Providing choices D. Teaching relaxation

D, Once the client is agitated, teaching will not be effective

A nurse caring for a pregnant client and her partner suspects domestic violence. Which assessments support this suspicion? Select all that apply. A. The woman has injuries to the breasts and abdomen. B. The partner refuses to come into the examination room. C. The partner answers questions that are asked of the woman. D. The woman has visited the clinic several times in the last month. E. The partner is excessively attentive while the health history is being taken.

A, C, D

The husband of a woman who has been sexually assaulted arrives at the hospital after being called by the police. After reassuring him about his wife's condition, the nurse should give priority to: A. Arranging for the rape counselor to meet with the wife B. Discussing with him his own feelings about the situation C. Helping him understand how his wife feels about the situation D. Making him comfortable until the practitioner has finished examining his wife

B

When presenting a workshop on adolescent suicide, a community health nurse identifies risk factors. Select all that apply. A. Victim of family violence B. Limited or strained family finances C. Member of a single parent household D. Dependence on alcohol, drugs or both E. Uncertainty related to sexual orientation F. Repeated demonstration of poor impulse control

A,D,E,F

A health care provider writes a prescription of "Restraints PRN" for a client who has a history of violent behavior. What is the nurse's responsibility in regard to this order? A. Asking that the order indicate the type of restraint B. Recognizing that PRN order for restraints are unacceptable C. Implementing the restraint order when the client begins to act out D. Ensuring that the entire staff is aware of the order for the restraints

B

A nurse on the pediatric unit is assigned to care for a 2-year-old child with a history of being physically abused. The nurse expects the child to: A. Smile readily at anyone who enters the room B. Be wary of physical contact initiated by anyone C. Begin to scream when the nurse nears the bedside D. Pay little attention to the nurse standing at the bedside

B

A client has had repeated hospitalizations for aggressive, violent behavior. While on the mental health service, the client becomes very angry, starts screaming at the nurse, and pounds the table. What is the priority nursing assessment at this time? A. range of expressed anger B. extent of orientation to reality C. degree of control over the behavior D. determination of whether the anger is justified

C

A nurse in the emergency department is assessing a client who has been physically and sexually assaulted. What is the nurse's priority during assessment? A. The family's feelings about the attack B. The client's feelings of social isolation C. The client's ability to cope with the situation D. Disturbance in the client's thought processes

C

A 2-year-old child is admitted with multiple fractures and bruises, and abuse is suspected. Which nursing assessment findings support this suspicion? Select all that apply. A. Bedwetting B. Thumb-sucking C. Difficulty consoling D. Underdevelopment for age E. Demands for physical closeness

C,D