Unit 4 practice questions

2. K calls a rape crisis hotline and reports having been raped. The nurse advises K to go to the nearest emergency department for treatment. K states "I'll think it over while I take a shower." The nurse should question her regarding the circumstances of the rape. advise her not to take too long before seeking treatment. explain that showering or changing clothes will destroy evidence. ask if she may call a police woman to accompany her to the hospital.

explain that showering or changing clothes will destroy evidence. Correct Showering, washing, and changing clothes will destroy evidence such as semen and hairs shed from the perpetrator's body. Victims should be advised regarding what to do to preserve evidence.

The nurse is conducting a lecture about abuse for high school students. Which statement should the nurse include? "Abuse is caused by a need for power and control." "Humiliation and physical injury are unusual components in abusive behaviors." "It is rare for physical abuse to begin as emotional abuse." "Psychologic abuse never occurs with sexual abuse."

"Abuse is caused by a need for power and control." Abuse is often related to control and power, with one individual attempting to control another. Humiliation and physical injuries are quite common characteristics of physical, emotional, and sexual abuse. The different types of abuse often overlap: Both physical and sexual abuse can begin as emotional abuse.

The nurse is caring for a patient who is a victim of rape. Which statement indicates the patient has not reached the reorganization stage of healing? "I can't stop crying when I think about the attack." "I met a new man and went out on a date with him." "I go to the crisis center every other week for group sessions." "I can talk to others about the attack and am not overwhelmed anymore."

"I can't stop crying when I think about the attack." Uncontrolled crying when remembering the attack indicates the victim is still in the acute phase of rape-trauma syndrome. Meeting someone and going on a date indicates trust has occurred. Continuing counseling and being able to talk about the attack without becoming overwhelmed indicate healing.

The nurse is speaking with a woman who has a long history of physical abuse by her spouse. The patient does not want to leave her partner at this time, and the nurse initiates teaching of a safety plan. Which patient statement indicates a need for further learning? "I will teach my children how to dial 911." "I should know the easiest escape route from all rooms in my house." "I should keep my wallet and keys hidden so that he can't find them." "I should give my spouse what he wants to diffuse the situation."

"I should keep my wallet and keys hidden so that he can't find them." Part of a safety plan involves keeping the patient's wallet, purse, or keys in an easily accessible place at all times in case of the need to leave quickly and unexpectedly. The woman should teach her children how to dial 911. The patient should also be able to describe the easiest escape route from all rooms in the house. If a situation were to become serious, the woman should be advised to give the spouse what he wants in an attempt to diffuse the situation.

The nurse is admitting a patient who is a rape victim to the emergency department. Which statement by the nurse is most therapeutic during the admission process? "I want to reassure you that you are safe now." "Would you like me to call someone for you?" "Would you like me to notify the police?" "Can I get you some warm blankets or something to drink?"

"I want to reassure you that you are safe now." When conducting a nursing assessment for a patient who has been raped, nurses first need to ensure the patient's safety. The statement "I want to reassure you that you are safe now" is the most therapeutic. The remaining statements do not address the patient's safety. The nurse can offer to call someone for the patient after a therapeutic relationship has been established. The nurse will discuss the patient's option for notifying the police at a later point during care. Offering warm blankets and something to drink is a comfort measure and can be offered after the evidence has been gathered from clothing and swabbing of the oral cavity.

The nurse is teaching a group of colleagues about the dangers of date-rape drugs. Which statement by one of the colleagues indicates the need for further teaching? "I'll make sure I always keep my drink with me." "I'll let someone know if my friend appears really drunk after only one or two drinks." "I will watch my drink being made by the bartender." "I will inspect my drinks because date-rape drugs always release a blue dye."

"I will inspect my drinks because date-rape drugs always release a blue dye." Date-rape drugs do not always release a blue dye. The statements about always keeping the drink with you, notifying someone if a friend appears more drunk than warranted by the actual amount of alcohol consumed, and watching the drink being made by the bartender all promote safety.

The nurse is caring for a pregnant patient who repeatedly presents to the clinic with multiple bruises. When asked, the patient states that she can deal with what is happening and that her spouse would never hit the baby, even though he didn't want them to have the baby. Which response by the nurse is best? "Most abusers never hit their children or infants." "Infants that are born out of an unwanted pregnancy are at higher risk for abuse or trauma." "Social services can take the baby away after birth if you stay with him." "Men, even abusers, fall in love with and want to protect their babies after they are born."

"Infants that are born out of an unwanted pregnancy are at higher risk for abuse or trauma." Infants are especially prone to neglect or abuse, especially if the pregnancy wasn't wanted. It is not likely that social services will immediately remove the baby from the house at birth unless there is reason to believe that the baby is in immediate danger. It is incorrect that infants are likely to be protected by the abusive parent after birth.

The nurse is teaching a class about caring for victims of suspected abuse. Which participant statement indicates a need for further teaching? "Always make sure to convey belief in what the child is saying." "It is important to have children tell their story a few times to make sure that it matches." "Make sure to avoid talking negatively about the abuser." "When taking care of a child who is being abused, the priority is to make sure that the child is safe."

"It is important to have children tell their story a few times to make sure that it matches." When caring for a child who is suspected of being a victim of abuse, it is important to avoid having the child retell the story multiple times to avoid retraumatizing the child. The nurse must convey belief in the child and should not speak poorly about the abuser. The priority is always to make sure that the child is safe.

A client mentions that having so many nurses in the unit must be increasing the cost of care because nurses get paid more. The client's nurse appropriately responds:" You are right. Care does cost more with RNs." "Costs rise because nurses waste supplies." "The cost of care is caused by decreased technology, not increased nurses." "Studies show that costs are decreased with an RN staff."

"Studies show that costs are decreased with an RN staff."

A client mentions that having so many nurses in the unit must be increasing the cost of care because nurses get paid more. The client's nurse appropriately responds: "You are right. Care does cost more with RNs." "Costs rise because nurses waste supplies." "The cost of care is caused by decreased technology, not increased nurses." "Studies show that costs are decreased with an RN staff."

"Studies show that costs are decreased with an RN staff." Rationale: Studies show that lengths of stay decrease, which decreases overall costs, when more RNs are used for client care. The client is incorrect about RNs increasing the cost of care, and the nurse would provide appropriate information in a professional manner. Technology is on the rise and, in some cases, reduces cost by utilizing more efficient ways to deliver care, such as computer charting. Costs would rise if nurses waste supplies; however, many initiatives have been instituted in that area to contain costs. Nursing Process: Implementation Client Need: Safe, Effective Care Environment Cognitive Level: Applying

A patient in a support group for rape survivors states, "I do not understand why I need to come to this group." Which response by the nurse is most appropriate? "Medication is not as helpful for recovery, so you are encouraged to attend a support group." "I can help you find another group if you do not feel this is working out for you." "The group often takes charge of the victim's recovery process." "The group provides a safe place to discuss your own individual experience."

"The group provides a safe place to discuss your own individual experience." Rape victims attending group meetings are able to share coping mechanisms and support each other so that a participant can feel less alone. Furthermore, meeting with other survivors allows the victim to discuss the rape experience without feelings of being judged and shamed. Medication is often used in addition to counseling. Offering to assist the patient to find another group does not address the patient's concern. With an increased awareness and understanding of their experience and feelings, patients are in charge of their own recovery.

The nurse is caring for a rape victim who refuses the prescribed antibiotics. Which response by the nurse is correct? "It is not necessary for you to take medication." "The medication will help treat possible sexually transmitted infections." "The medication will help you forget the trauma." "The medication will prevent pregnancy."

"The medication will help treat possible sexually transmitted infections." Numerous sexually transmitted diseases and infections can be contracted during a rape regardless of whether the attacker used a condom or not. Therefore, it is important to explain this to the patient. It is not appropriate to tell the patient that it is not necessary to take the antibiotics. The patient needs the correct information to make an informed decision. Antibiotics are not used to help the patient forget the trauma or prevent pregnancy.

7. Three weeks after a client was raped she tells the nurse "I am going crazy. I have nightmares and wake up screaming. Then during the day all sorts of thoughts about the rape intrude into whatever I am concentrating on. I can't get anything done at work." The nurse should reply "Becoming mentally ill is a frightening thought for you?" "These are a normal response to stress and will decrease with time and therapy." "You are right to be concerned. I can give you a referral for treatment." "Would it help if you took some time off from work and stayed home?"

"These are a normal response to stress and will decrease with time and therapy." Correct These symptoms are part of the response to rape trauma and parallel symptoms experienced by other victims of PTSD

The nurse is reviewing the prescribed treatment for a male victim of rape. The patient asks, "Why is an anal swab required?" Which statement by the nurse is most appropriate? "The test is part of the rape kit that is used." "To collect DNA and to check for sexually transmitted infections." "The police require the evidence." "It is used to check for injury."

"To collect DNA and to check for sexually transmitted infections." DNA evidence may help identify the perpetrator; the swab will also test for sexually transmitted infections. The response referring to the rape kit does not answer the patient's question. The evidence is collected and saved in a rape kit with a special serial number. The evidence is not given to the police unless the victim chooses to report it to the police. A swab is not used to check for injury.

A client is being discharged to a rehabilitation facility and asks if nurses evaluate the quality of care that clients receive. The nurse responds that: "We each contribute by collecting data for evaluation." "The hospital administration is responsible for determining quality." "We have a quality management program here." "Nurses are responsible for monitoring nonprofessionals."

"We each contribute by collecting data for evaluation." Rationale: One role of nursing is collecting the data that is evaluated by the quality management team. Quality improvement is the responsibility of every employee of the agency, not just administration. Stating that there is a quality program does not answer the client's question. Nurses are responsible for monitoring nonprofessional caregivers but not other occupations of nonprofessionals such as engineers or housekeepers. Nursing Process: Implementation Client Need: Safe, Effective Care Environment Cognitive Level: Applying

The nurse recognized making a medication error and immediately reported it to the unit supervisor. Which response from the supervisor should the nurse expect in an environment that promotes quality? "Why are you reporting that to me without completing an incident report?" "You need to report directly to the Chief Nursing Officer." "You have reported this to me, so you do not need to file an incident report." "We have a blame-free environment so you can report errors without fearing punishment."

"We have a blame-free environment so you can report errors without fearing punishment." Most errors in health care are a result of the healthcare system and not the fault of a single individual. If a clinic is afraid to report errors for fear of punishment or because reporting does not result in positive change, then problems within the system cannot be identified or addressed. A key component in quality improvement is establishing a blame-free environment in which healthcare providers can report errors or near misses without the fear of punishment. This helps identify problems, so that corrections can be made, and future events can be prevented. An incident report will be completed as a part of the investigation.

6. What verbal nursing intervention in the immediate post-rape period would be designed to lower client anxiety and increase feelings of safety? "You are safe here. I will stay with you while you have your examination." "I know you feel confused. We will make all the necessary decisions for you." "Please tell me as much about the details of the rape as you can remember." "When you leave you will be given follow-up appointments for pregnancy and sexually transmitted disease screening."

"You are safe here. I will stay with you while you have your examination." Correct The presence of the nurse is reassuring, especially when the client is experiencing disorganization and the environment is confusing.

A patient with a diagnosis of major depression who has attenpted suicide says to the nurse, "I should have died. I've always been a failure. Nothing ever goes right for me." Which response demonstrates therapeutic communication? a. "You have everything to live for" b. "Why do you see yourself as a failiure?" c. "Feeling like this is all part of being depressed." d. "You've been feeling like a failure for a while?"

(D) "You've been feeling like a failure for a while?" RATIONALE: Responding to the feelings expressed by a patient is an effective therapeutic communication technique. The correct option is an example of the use of restating. The remaining options block communication because they minimize the patient's experience and do not facilitate exploration of the patient's expressed feelings. In additions, use of the word "why" is nontherapeutic.

A psychiatric nurse is providing an educational session to the emergency room staff to raise awareness on the topic of elder abuse. Which client is most at risk for elder abuse? 1. An 82-year-old woman with middle-stage dementia 2. A 73-year-old woman living in a poor neighborhood 3. A 70-year-old man with the recent diagnosis of heart disease 4. An 89-year-old man living with a mentally ill family member

1 Rationale: The typical elder abuse victim is a woman of advanced age with physical and/or mental impairment who usually depends on the abuser for care. The client with dementia is the most defenseless as the result of the disease process and requires significant hands-on assistance and care. Socio-economic factors are not relevant. Elders with health-related problems are often still capable of independent living and of attending to their needs.

A nursing instructor is teaching about intimate partner violence. Which of the following student statements indicate that learning has occurred? (SATA) 1. Intimate partner violence is a pattern of abusive behavior that is used by an intimate partner. 2. Intimate partner violence is used to gain power and control over the other intimate partner. 3. Fifty-one percent of victims of intimate violence are women. 4. Women ages 25 to 34 experience the highest per capita rates of intimate violence. 5. Victims are typically young married women who are dependent housewives.

1, 2, 4 ~ Intimate partner violence is a pattern of abusive behavior that is used by an intimate partner. It is used to gain power and control over the other intimate partner. Women ages 25 to 34 experience the highest per capita rates of intimate violence. Eighty-five percent of victims of intimate violence are women. Battered women represent all age, racial, religious, cultural, educational, and socioeconomic groups. They may be married or single, housewives or business executives.

A nurse is discussing the possible existence of abuse related to a 4-year-old currently being treated in the emergency department. Which statement by the nurse requires immediate intervention? 1. "A 4-year-old can be an unreliable source since they have such wonderful imaginations." 2. "It's up to the state's child protection agency to determine if our fears are valid." 3. "I'm absolutely sure every state requires that we report our concerns." 4. "We don't need physical proof of injury to report this situation."

1. When child abuse is suspected persons in authority including nurses, teachers, spiritual leaders, coaches, counselors, and child care providers are legally responsible for reporting to the appropriate child protective agency. Each state mandates that a report must be filed when suspected abuse or neglect is encountered. It is not necessary to have proof of the abuse. If there is a suspicion or the child says something is happening, that is enough grounds to report. It is then up to the CPS agency to investigate and make a determination.

A client is brought to an emergency department after being violently raped. Which nursing action is appropriate? 1. Discourage the client from discussing the rape, because this may lead to further emotional trauma. 2. Remain nonjudgmental while actively listening to the client's description of the violent rape event. 3. Meet the client's self-care needs by assisting with showering and perineal care. 4. Probe for further, detailed description of the rape event.

2 ~ The most appropriate nursing action is to remain nonjudgmental and actively listen to the clients description of the event. It is important to also communicate to the victim that he/she is safe and that it is not his/her fault. Nonjudgmental listening provides an avenue for catharsis, which contributes to the healing process.

After the admission interview and assessment the emergency department nurse has reason to believe that a child is being abused physically. Which intervention will the nurse implement to best determine if the child has been abused? 1. Provide the child with suggestions of other possible examples of abuse 2. Insist that the child be further assessed without the parents being present 3. Allow the child to pick one parent to be present during the remaining examination 4. Delay the assessment until the appropriate child protection authorities are present

2. In the case of suspected child abuse, after the initial interview with the parents, the child should be seen alone giving him or her a chance to disclose mistreatment. The child should not be prompted about possible abuse nor should the examination be delayed since these actions can affect the outcome of the assessment.

A nurse is conducting a family assessment to identify possible triggers for abusive behaviors. Which family characteristic will the nurse identify as such a trigger? 1. The father is the "stay-at-home parent" 2. The parents were teenagers when the children were born 3. The family only socializes with other immigrant families 4. The parents are of different ethnic and religious backgrounds

2. The classic frustration-aggression hypothesis proposes that when frustration is high in response to negative societal situations, frustration may lead to aggression. Early parenthood is considered such a stressor. None of the other options are recognized as triggers for possible family-centered abuse.

Which type of rape often involves the use of date rape drugs? A) Acquaintance rape B) Marital rape C) Anal rape D) Gang rape

A

A physically or mentally impaired older female who is living with a relative and has a history of unexplained bruises or injuries, burns in unusual places, or poor personal hygiene is likely a victim of 1. neglect. 2. child abuse. 3. elder abuse. 4. adolescent abuse.

3 Characteristics of elder abuse

Which question demonstrates the nurse's understanding of the need to assess a client who has been physically abused for additional forms of trauma? 1. "What types of injuries have you received as a result of the physical abuse?" 2. "Did your abuser ever intimidate or threaten you with physical harm?" 3. "Can you tell me when the physical abuse began?" 4. "Do you know what triggers the physical abuse?"

3. The physical damage caused by physical abuse is usually accompanied by emotional abuse. Emotional abuse includes threats and intimidation. The remaining options focus on the physical abuse/trauma.

The nurse is providing care to a toddler-age child. Which assessment finding is indicative of abuse? 1. Parents indicating that they did not see the event occur 2. Inconsistency of stories between caregivers 3. Bruising noted on the knees and shins 4. Acting out behavior of the child

Correct Answer: 2 Inconsistency of stories is a red flag for abuse. All other answers are logical explanations for this age group.

An older adult has experienced both physical and emotional abuse while living with a family member. The family member has been adherent with required therapy and at the client's request the two will again be living together. Which intervention will best assure that both the client and the family member's needs are being met? 1. Initially, 7 days a week, 24-hour home aides are provided 2. The client agrees to report any incidences of abuse by the family member immediately 3. The family member is informed that criminal charges will be filed if any abuse occurs 4. The home will have regular but unscheduled visits by adult protective services agents

4. Follow-up is crucial in ensuring ongoing safety of the elderly patient and support of the caregiving system. None of the other options provide long-term support and supervision.

Which information should the nurse in an employee assistance program provide to an employee who exhibits symptoms of domestic physical abuse? 1. Have ready access to a gun and learn how to use it. 2. Research lawyers that can aid in divorce proceedings. 3. File charges of assault and battery. 4. Have ready access to the number of a safe house for battered women.

4 ~ The nurse should provide information about the accessibility of safe houses for battered women when working with a client who has symptoms of domestic physical abuse. Many women feel powerless within the abusive relationship and may be staying in the abusive relationship out of fear.

A rape victim says to the nurse, "I always try to be so careful. I know I should not have walked to my car alone. Was this attack my fault?" Which communication by the nurse is most therapeutic? a. Support the victim to separate issues of vulnerability from blame. b. Emphasize the importance of using a buddy system in public places. c. Reassure the victim that the outcome of the situation will be positive. d. Pose questions about the rape and help the patient explore why it happened.

: A Although the victim may have made choices that made her vulnerable, she is not to blame for the rape. Correcting this distortion in thinking allows the victim to begin to restore a sense of control. This is a positive response to victimization. The distracters do not permit the victim to begin to restore a sense of control or offer use of non-therapeutic communication techniques. In this interaction, the victim needs to talk about feelings rather than prevention.

A nurse interviews a 17-year-old male victim of sexual assault. The victim is reluctant to talk about the experience. Which comment should the nurse offer to this victim? a. "Male victims of sexual assault are usually better equipped than women to deal with the emotional pain that occurs." b. "Male victims of sexual assault often experience physical injuries and are assaulted by more than one person." c. "Do you have any male friends who have also been victims of sexual assault?" d. "Why do you think you became a victim of sexual assault?

: B Few rape survivors seek help, even with serious injury; so, it is important for the nurse to help the victim discuss the experience. The correct response therapeutically gives information to this victim. A male rape victim is more likely to experience physical trauma and to have been victimized by several assailants. Males experience the same devastation, physical injury, and emotional consequences as females. Although they may cover their responses, they too benefit from care and treatment. "Why" questions represent probing, which is a non-therapeutic communication technique. The victim may or may not have friends who have had this experience, but it's important to talk about his feelings rather than theirs.

Which situation describes consensual sex rather than rape? a. A husband forces vaginal sex when he comes home intoxicated from a party. The wife objects. b. A woman's lover pleads with her to have oral sex. She gives in but later regrets the decision. c. A person is beaten, robbed, and forcibly subjected to anal penetration by an assailant. d. A dentist gives anesthesia for a procedure and then has intercourse with the unconscious patient.

: B Only the key describes a scenario in which the sexual contact is consensual. Consensual sex is not considered rape if the participants are of legal age.

An emergency department nurse prepares to assist with evidence collection for a sexual assault victim. Prior to photographs and pelvic examination, what documentation is important? a. The patient's vital signs b. Consent signed by the patient c. Supervision and credentials of the examiner d. Storage location of the patient's personal effects

: B Patients have the right to refuse legal and medical examination. Consent forms are required to proceed with these steps.

A client with a long history of experiencing domestic violence tells the nurse, "There is no way out for me; this situation will never change." What nursing diagnosis would be most appropriate? A) Powerlessness B) Risk for Other-Directed Violence C) Ineffective Health Maintenance D) Chronic Low Self-Esteem

A

A rape victim is being seen in the clinic. Upon assessment it is discovered the client has contracted syphilis. Which prescription does the nurse anticipate for this client? A) Penicillin B) Ceftriaxone and azithromycin C) Tinidazole D) Doxycycline

A

The nurse is providing care for a client who experienced several fractures as a result of intimate partner violence. Which intervention is the most appropriate to include when planning care for the client? A) Assist the client to devise a safety or escape plan. B) Encourage the client to take charge of the situation. C) Offer to contact outpatient services if the client promises not to return home after discharge. D) Make it clear to the spouse that the couple needs to see a therapist.

A

Which diagnostic test might the healthcare team use to determine the full extent of an abuse victim's injuries if the victim complains of abdominal pain? A) Ultrasound B) X-ray C) MRI D) Blood test

A

Which theory states that individuals learn violent tendencies through association with others and a reinforcement of abusive behaviors? A) Social learning theory B) Psychopathology theory C) Neurobiology theory D) Environmental theory

A

A victim of a violent rape was treated in the emergency department. As discharge preparation begins, the victim says softly, "I will never be the same again. I can't face my friends. There is no reason to go on." Select the nurse's most appropriate response. a. "Are you thinking of harming yourself?" b. "It will take time, but you will feel the same as before the attack." c. "Your friends will understand when you explain it was not your fault." d. "You will be able to find meaning from this experience as time goes on."

A The patient's words suggest hopelessness. Whenever hopelessness is present, so is suicide risk. The nurse should directly address the possibility of suicidal ideation with the patient. The other options attempt to offer reassurance before making an assessment.

A nurse works a rape telephone hotline. Communication with potential victims should focus on: a. explaining immediate steps victims should take. b. providing callers with a sympathetic listener. c. obtaining information for law enforcement. d. arranging counseling.

A The telephone counselor establishes where the victim is and what has happened and provides the necessary information to enable the victim to decide what steps to take immediately. Counseling is not the focus until immediate problems are resolved. The victim remains anonymous. The other distracters are inappropriate or incorrect because counselors are trained to be empathetic rather than sympathetic.

A victim of a sexual assault who sits in the emergency department is rocking back and forth and repeatedly saying, "I can't believe I've been raped." This behavior is characteristic of which stage of rape-trauma syndrome? a. The acute phase reaction c. A delayed reaction b. The long-term phase d. The angry stage

A The victim's response is typical of the acute phase and shows cognitive, affective, and behavioral disruptions. This response is immediate and does not include a display of behaviors suggestive of the long-term (reorganization) phase, anger, or a delayed reaction.

A nurse working in a shelter for abused women would recognize that which of the following is a significant risk factor for intimate partner violence (IPV)? a. pregnancy b. depression c. asthma d. schizophrenia

A Pregnancy poses a significant risk for physical abuse. A pregnant woman may not have the physical ability to protect herself from the physical trauma to herself or her unborn fetus. Abuse during pregnancy can produce adverse reproductive outcomes such as prematurity and pregnancy loss.

An adolescent claims to have been physically abused by a parent. The adolescent's other parent angrily tells the nurse, "It's ridiculous for our child to accuse my spouse, who is a prominent doctor respected by the community.". The nurse responds: a. "Do you believe that abuse does not exist in well-respected, professional families?" b. "I know that it is difficult to believe what your child is saying about your spouse, but abuse has occurred.". c. "I know your spouse and I have never seen him be unkind or abusive to patients, but that is no proof of innocence.". d. "Your spouse seems to have a very stressful, demanding practice. That can be a risk factor for losing one's temper when angry.".

A The correct option effectively uses the therapeutic nursing communication of reflection. By reflecting back to the patient what she has said, the nurse assists the patient to view the statement in perspective.

A 16-year-old adolescent who was sexually abused as a child tells the nurse in the clinic that she is having nightmares about the boys in her class. Which outcome is a realistic short-term goal for her diagnosis of Sleep Pattern Disturbance? The client will: a. verbalize her anxiety and fear about sexual abuse b. identify goals for relationships with boys c. identify two ways to discuss her feelings with her mother d. state that she enjoys school

A The most appropriate outcome for the 16-year-old adolescent who was sexually abused as a child and is now having nightmares about the boys in her class would be to have her verbalize her anxiety and fear about sexual abuse. Verbalizing and acknowledging her feelings would be the first step in addressing the issue that is influencing her nightmares.

Which should the nurse recognize as being the best resource to keep abreast to the changes of the insurance and healthcare​ laws? A.U.S. Department of Health and Human Services B.American Nurses Association C.American Medical Association D.​Physicians' groups

A ​Rationale: Keep abreast of the changes in healthcare and insurance laws by visiting the U.S. Department of Health and Human Services.​ Physicians' groups, the American Nurses Association​ (ANA), and the American Medical Association​ (AMA) are not the best place to keep oneself​ up-to-date about the changes in insurance and healthcare laws.

The nurse manager calls for a meeting to identify and discuss the cause of a recent problem in the facility so that the incident does not happen again. Which term should the nurse use to describe this​ process? A.Root cause analysis B.Reducing medical errors C.Resource utilization D.​Blame-free environment

A ​Rationale: Root cause analysis is the correct answer. The goals of the root cause analysis are to identify the reasons for failures or problems and to develop an action plan for improvement to decrease the likelihood of future adverse events. Reducing medication errors involves interventions specifically help nurses prevent medication errors. Resource utilization is increasing the value of healthcare by reducing costs. A​ blame-free environment is established to maintain or improve the quality of care in which healthcare providers can report errors or near misses without the fear of punishment.

Governmental agencies and the healthcare industry have partnered to improve the quality of care. Which action should the nurse recognize is aimed at providing better​ care? A.Making healthcare more​ client-centered, reliable,​ accessible, and safe B.Reducing the cost of quality healthcare to all consumers C.Addressing​ behavioral, social, and environmental determinants of health D.Delivering care to underserved clients

A ​Rationale: To improve the health of the​ population, the U.S. Department of Health and Human Services​ (HHS) has developed the National Quality​ Strategy, which contains three broad aims. One of the aims is Better Care to improve the overall quality by making healthcare more client​ centered, reliable,​ accessible, and safe. The other two aims are Healthy​ People/Healthy Communities and Affordable Care.

The nurse is providing education about sexual abuse and rape to the parent of a young child. Which statement describes the reason the nurse will discuss the subject matter with the parent? A large percentage of survivors report having been raped prior to 18 years of age. Children have the highest risk of being raped. The majority of perpetrators who rape children are strangers. Environmental factors predispose a child to rape.

A large percentage of survivors report having been raped prior to 18 years of age. The nurse should discuss childhood sexual abuse and rape with a parent because a large percentage of survivors report having been raped prior to 18 years of age. Children do not have the highest risk factor for rape. The majority of perpetrators are people the family trusts, not strangers. Environmental factors can predispose a child to rape; however, this can be included in the teaching after the topic has been presented to the parent.

A nursing instructor is explaining quantitative systems in quality improvement. The students have understood the lecture when a student states that Six Sigma is: A process that uses quantitative data to monitor progress A process that determines waste in the agency An overall philosophy regarding quality A team designed to evaluate processes.

A process that uses quantitative data to monitor progress Rationale: Six Sigma is a process that uses quantitative data to monitor the progress of quality management. Lean Six Sigma is a process aimed at reducing a waste of resources. The team designated to evaluate the processes is the Continuous Quality Improvement team. TQM is the overall philosophy regarding quality management of an agency. Nursing Process: Evaluation Client Need: Safe, Effective Care Environment Cognitive Level: Remembering

An operating room nurse is present when a client is injured permanently during a procedure. The nurse expects to participate in: A root cause analysis The quality management program An increased number of nursing audits A criminal investigation

A root cause analysis Rationale: When a client experiences a permanent unexpected negative reaction due to an error, the Joint Commission requires that the healthcare agency perform a root cause analysis with a focus on the prevention of future such events. The nurse would expect to participate in the analysis because the nurse was present during the procedure. A quality management program is ongoing and is not the same as a root cause analysis. Nursing audits will not necessarily reveal the sentinel event error or prevent future incidents. A criminal investigation may or may not result from a root cause analysis. Nursing Process: Assessment Client Need: Safe, Effective Care Environment Cognitive Level: Understanding

Which behavior best demonstrates aggression? a. Stomping away from the nurses station, going to another room, and grabbing a snack from another patient. b. Bursting into tears, leaving the community meeting, and sitting on a bed hugging a pillow and sobbing. c. Telling the primary nurse, I felt angry when you said I could not have a second helping at lunch. d. Telling the medication nurse, I am not going to take that or any other medication you try to give me.

A ~ Aggression is harsh physical or verbal action that reflects rage, hostility, and the potential for physical or verbal destructiveness. Aggressive behavior violates the rights of others. The incorrect options do not feature violation of anothers rights.

A patient tells the nurse, "My husband is abusive most often when he drinks too much. His family was like that when he was growing up. He always apologizes and regrets hurting me."" What risk factor was most predictive for the husband to become abusive? a. History of family violence b. Loss of employment c. Abuse of alcohol d. Poverty

A ~ An abuse-prone individual is an individual who has experienced family violence and was often abused as a child. This phenomenon is part of the cycle of violence. The other options may be present but are not as predictive.

An older adult diagnosed with Alzheimer disease lives with family. During the week, the person attends a day care center while the family is at work. In the evenings, members of the family provide care. Which factor makes this patient most vulnerable to abuse? a. Dementia b. Living in a rural area c. Being part of a busy family d. Being home only in the evening

A ~ Older adults, particularly those with cognitive impairments, are at high risk for abuse. The other characteristics are not identified as placing an individual at high risk for abuse.

An 11-year-old child says, "My parents don't like me. They call me stupid and say I never do anything right, but it doesn't matter. I'm too dumb to learn." Which nursing diagnosis applies to this child? a. Chronic low self-esteem, related to negative feedback from parents b. Deficient knowledge, related to interpersonal skills with parents c. Disturbed personal identity, related to negative self-evaluation d. Complicated grieving, related to poor academic performance

A ~ The child has indicated a belief in being too dumb to learn. The child receives frequent negative and demeaning feedback from the parents. Deficient knowledge is a nursing diagnosis that refers to knowledge of health care measures. Disturbed personal identity refers to an alteration in the ability to distinguish between self and nonself. Grieving may apply, but a specific loss is not evident in this scenario. Low self-esteem is more relevant to the child's statements.

A patient at the emergency department is diagnosed with a concussion. The patient is accompanied by a spouse who insists on staying in the room and answering all questions. The patient avoids eye contact and has a sad affect and slumped shoulders. Assessment of which additional problem has priority? a. Risk of intimate partner violence b. Phobia of crowded places c. Migraine headaches d. Major depression

A ~ The diagnosis of a concussion suggests violence as a cause. The patient is exhibiting indicators of abuse including fearfulness, depressed affect, poor eye contact, and a possessive spouse. The patient may be also experiencing depression, anxiety, and migraine headaches, but the nurses advocacy role necessitates an assessment for intimate partner violence.

An older adult diagnosed with Alzheimer disease lives with family. After observing multiple bruises, the home health nurse talks with the older adult's daughter, who becomes defensive and says, "My mother often wanders at night. Last night she fell down the stairs." Which nursing diagnosis has priority? a. Risk for injury, related to poor judgment, cognitive impairment, and lack of caregiver supervision b. Noncompliance, related to confusion and disorientation as evidenced by lack of cooperation c. Impaired verbal communication, related to brain impairment as evidenced by the confusion d. Insomnia, related to cognitive impairment as evidenced by wandering at night

A ~ The patient is at high risk for injury because of her confusion. The risk increases when caregivers are unable to provide constant supervision. No assessment data support the diagnoses of Impaired verbal communication or Noncompliance. Sleep pattern disturbance certainly applies to this patient; however, the diagnosis Risk for injury is a higher priority.

*Possible exam question* The nurse is caring for a client who is in the acute phase of rape-trauma syndrome. Which statement from the client reflects a clinical manifestation of the acute phase? A) "I'm doing fine. There's really nothing for me to talk about." B) "It's been months since I was raped, and I'm still having flashbacks." C) "I'm ready to talk about how I'm feeling about what happened to me." D) "I'm so angry at the person who raped me, and I doubt he's going to get charged with anything."

A) "I'm doing fine. There's really nothing for me to talk about." Rationale: Expressive styles of the acute phase of​ rape-trauma syndrome vary. Some clients openly express their​ feelings, while others may have an outward appearance of adjustment as indicated by the client in this scenario who​ states, "I'm doing​ fine." Anger at the assailant and the judicial system and the need to talk to resolve feelings are characteristics of the reorganization phase of​ rape-trauma system. Flashbacks occurring months after the event are characteristics of PTSD.

The nurse is caring for a teen female who has experienced a sexual assault. Which should the nurse initially include in the client's plan of care? A) Offering emergency contraception B) Antidepressant therapy C) Info about a support group D) Antianxiety medication

A) Offering emergency contraception Rationale: The nurse caring for the adolescent who has experienced a sexual assault will initially offer emergency contraception. Antidepressant​ therapy, antianxiety​ medication, and information about a support group may be appropriate for this​ client, but offering emergency contraception is the highest priority. Next Question

A rape victim is being seen in the clinic. Upon assessment it is discovered the client has contracted syphilis. Which prescription does the nurse anticipate for this client? A) Penicillin B) Ceftriaxone and azithromycin C) Tinidazole D) Doxycycline

A) Penicillin Rationale: Syphilis is treated with penicillin. Gonorrhea is treated with a combination of ceftriaxone and either azithromycin or doxycycline. Trichomoniasis is treated with tinidazole or metronidazole. Chlamydia is treated with doxycycline.

*Possible Exam Question* The nurse is preparing to speak with a client who is in the reorganization phase of rape-trauma syndrome. Which clinical manifestation should the nurse anticipate? A) The need to talk to resolve feelings B) Anxiety C) Somatic reactions D) An outward period of adjustment

A) The need to talk to resolve feelings Rationale: The nurse can anticipate the client in the reorganization phase of​ rape-trauma syndrome will express a need to talk to resolve feelings. Anxiety is a characteristic of posttraumatic stress disorder​ (PTSD). Somatic reactions and an outward period of adjustment are clinical manifestations of the acute phase of the​ rape-trauma syndrome.

The nurse working in the emergency department is aware that rape victims initially exhibit which emotions? Select all that apply. A) Shock B) Disbelief C) Anger D) Self-blame E) Humiliation

A, B

*Possible exam question* The nurse working in the ER is aware that rape victims initially exhibit which emotions? SATA A) Shock B) Disbelief C) Anger D) Self-blame E) Humiliation

A, B -Shock -Disbelief Rationale: Initial responses to rape generally include feelings of shock and disbelief. Anger, humiliation, and self-blame are early responses but not typically the initial response.

An emergency department nurse prepares to assist with examination of a sexual assault victim. What equipment will be needed to collect and document forensic evidence? Select all that apply. a. Camera b. Body map c. DNA swabs d. Pulse oximeter e. Sphygmomanometer

A, B, C Body maps, DNA swabs, and photographs are used to collect and preserve body fluids and other forensic evidence.

A patient was abducted and raped at gunpoint by an unknown assailant. Which nursing interventions are appropriate while caring for the patient in the emergency department? Select all that apply. a. Allow the patient to talk at a comfortable pace. b. Place the patient in a private room with a caregiver. c. Pose questions in nonjudgmental, empathetic ways. d. Invite the patient's family members to the examination room. e. Put an arm around the patient to demonstrate support and compassion.

A, B, C Neutral, nonjudgmental care and emotional support are critical to crisis management for the rape victim. The rape victim should have privacy but not be left alone. The rape victim's anxiety may escalate when touched by a stranger, even when the stranger is a nurse. Some rape victims prefer not to have family involved. The patient's privacy may be compromised by family presence.

*Possible Exam Question* The nurse is providing care to a client who experienced a rape 1 year ago. Which assessment finding should the nurse expect? SATA A) Sexual dysfunction B) Eating disorders C) Anxiety D) Anger E) Confusion

A, B, C, D -Sexual dysfunction -Eating disorders -Anxiety -Anger Rationale: Anger,​ anxiety, eating​ disorders, and sexual dysfunction are all​ long-term effects of rape. Confusion is an immediate response to rape.

When an emergency department nurse teaches a victim of the rape about reactions that may occur during the long-term reorganization phase, which symptoms should be included? Select all that apply. a. Development of fears and phobias b. Decreased motor activity c. Feelings of numbness d. Flashbacks, dreams e. Syncopal episodes

ANS: A, C, D These reactions are common to the long-term reorganization phase. Victims of rape frequently have a period of increased motor activity rather than decreased motor activity during the long-term reorganization phase. Syncopal episodes are not expected.

The nurse is providing care to a client who is the victim of rape. Which action by the nurse offers the client emotional support during the assessment process? SATA A) Offering counseling services B) Calling a friend or family member C) Inquiring about current STIs D) Providing access to a rape advocate E) Assuming that pregnancy prevention medication is wanted

A, B, D Rationale: Nursing actions that provide the client with emotional support during the assessment process include offering counseling​ services, calling a friend or family​ member, and providing access to a rape advocate. Inquiring about current sexually transmitted infections and assuming that pregnancy prevention is wanted are not supportive nursing behaviors.

An older adult client is brought into the emergency room after experiencing a fall. The nurse suspects elder abuse. Which assessment findings support the nurse's suspicions? Select all that apply. A) Poor hygiene B) Dehydration C) Intracranial trauma D) Fecal impaction E) Dislocations

A, B, D, E

The nurse is creating a plan of care for a client who is the victim of a rape. Which nursing diagnosis addresses the client's psychosocial needs? SATA A) Powerlessness B) Coping, Ineffective C) Infection, Risk for D) Pain, Acute E) Self-esteem, Situational Low

A, B, E Rationale: Powerlessness​, Coping​, Ineffective​, and ​Self-esteem​, Situational Low are all diagnoses that address the​client's psychosocial needs. Physical pain and risk for infection are biophysical diagnoses.​(NANDA-I ©2014)

The nurse is assisting in the physical examination of a client who is the victim of rape. Which action by the nurse involves collecting evidence that can be used in a criminal case to convict the attacker? SATA A) Gathering a swab from the throat B) Drawing blood for a CBC C) Collecting semen from the vagina D) Combing the pubic area for stray hairs E) Administering a prophylactic antibiotic

A, C, D Rationale: Semen, a swab of the​ throat, and stray hairs may contain DNA that can be used to identify the attacker. A CBC is a diagnostic​ test; is not used to identify the attacker. Administering a prophylactic antibiotic is an action to help prevent a sexually transmitted infection

When an emergency department nurse teaches a victim of rape-trauma syndrome about reactions that may occur during the long-term phase of reorganization, which symptoms should be included? Select all that apply. a. Development of fears and phobias b. Decreased motor activity c. Feelings of numbness d. Flashbacks, dreams e. Syncopal episodes

A, C, D These reactions are common to the long-term phase. Victims of rape frequently have a period of increased motor activity rather than decreased motor activity during the long-term reorganization phase. Syncopal episodes would not be expected.

Which aspects of assessment have priority when a nurse interviews a rape victim in an acute setting? Select all that apply. a. Coping mechanisms the patient is using b. The patient's previous sexual experiences c. The patient's history of sexually transmitted diseases d. Signs and symptoms of emotional and physical trauma e. Adequacy and availability of the patient's support system

A, D, E The nurse assesses the victim's level of anxiety, coping mechanisms, available support systems, signs and symptoms of emotional trauma, and signs and symptoms of physical trauma. The history of STDs or previous sexual experiences has little relevance.

*Probable Exam Question* The nurse is caring for a client who has been raped. Which emotions should the nurse expect the client to experience initially? SATA A) Denial B) PTSD C) Suicidal Ideation D) Shock E) Disbelief

A, D, E -Denial -Shock -Disbelief Rationale: Immediate responses to rape generally include feelings of​ denial, shock, and disbelief. Suicidal ideation and posttraumatic stress disorder may appear later in​ rape-trauma syndrome.

The nurse is providing care for a client who was the victim of sexual abuse 8 months ago. Which ongoing, long-term treatment goals are appropriate? Select all that apply. A) The client's symptoms of anxiety and fear will decrease. B) The client will involve significant others in the treatment plan. C) The client will be able to verbalize legal rights. D) The client will establish rapport and build a trusting nurse—client relationship. E) The client will learn how to reconnect with others.

A, E

The nurse is providing care for a client who was the victim of sexual abuse 8 mos ago. Which ongoing, long-term treatment goals are appropriate? SATA A) The client's symptoms of anxiety and fear will decrease B) The client will involve significant others in the treatment plan C) The client will be able to verbalize legal rights D) The client will establish rapport and build a trusting nurse-client relationship E) The client will learn how to reconnect with others

A, E Rationale: Decreasing symptoms of anxiety and fear and learning how to reconnect with others may take months or years, whereas the other treatment goals can be met in the short term (hours to days). The nurse should have involved significant others in the treatment plan, established rapport, and made the client aware of legal rights immediately after the sexual abuse occurred.

As head of continuous quality improvement at a​ hospital, the nurse wants to interview external customers. Which customer should the nurse​ include? (Select all that​ apply.) A.Durable medical equipment suppliers B.Insurance companies C.Clients who seek healthcare D.Billing specialist E.Hospital volunteers

A,B,C,E ​Rationale: External customers include the individuals who seek healthcare as well as their family members and significant others. External customers also include other individuals and entities with which internal clients​ interact, such as insurance​ companies, managed care​ organizations, equipment or material​ suppliers, social service​ agencies, and law enforcement officials. Internal customers include employees of a healthcare​ organization, such as​ nurses, healthcare​ providers, therapists, medical records​ staff, billing​ specialists, and other employees.

Several medication errors occurred at a facility. Which method should the nurse anticipate being suggested to avoid future​ errors? (Select all that​ apply.) A.​Double-check the​ "seven rights" every time medication is administered. B.Use smart infusion pumps for intravenous medications. C.Conduct medication reconciliation at every transition in care. D.Combine medications with the same active ingredient. E.Have a second nurse check the medication order.

A,B,C,E ​Rationale: The correct answers to avoid such errors are​ (1) double-check the​ "seven rights" every time medication is​ administered, (2) conduct medication reconciliation at every transition in​ care, (3) use smart infusion pumps for intravenous​ medications, and​ (4) have a second nurse check the medication order. Combining medications with the same active ingredient is incorrect and is not a method in reducing medication errors.

An organization is using Six Sigma to determine why discharge instructions given to a group of clients were below national standards. Which step should the nurse understand applies to this quality management​ process? A.Improving the knowledge level of the staff with​ one-on-one training B.Standardizing the discharge process with the healthcare providers C.Standardizing and simplifying the discharge instruction process D.Improving the knowledge level of the staff​ unit-by-unit E.Meeting with the discharge planners

A,C,D ​Rationale: Six Sigma is a quality improvement program that aims to produce a​ near-perfect product. Sigma is used to measure deviation from a standard. In this​ system, a defect is defined as anything that could lead to client dissatisfaction. Defects in healthcare could range from relatively minor problems to major problems. Six Sigma primarily uses the​ Define, Measure,​ Analyze, Design, and Verify system to improve outcomes. For this​ instance, the organization is aiming to increase the percentage of heart failure clients for compliance.

A 17-year-old high school student who was recently raped is reluctant to discuss the event. She can no longer use tampons during her period because she becomes dizzy and nauseated when trying to insert them. She states that she will never have another boyfriend because "I'm ruined." Which of the following nursing diagnoses is most appropriate for this client? a Rape-trauma Syndrome: silent reaction b Post-trauma Syndrome c Rape-trauma Syndrome: compound reaction d Sexual Dysfunction

A. The client is unable to talk about the trauma, has developed a phobic reaction to tampons, and is renouncing future relationships with men. Rape-trauma syndrome: compound reaction indicates reactivation of a physical or mental illness or use of addictive substances to cope with the trauma. The client is not displaying symptoms such as nightmares, hypervigilance, insomnia, panic attacks, flashbacks, or intrusive memories that are associated with a diagnosis of post-traumatic stress disorder (PTSD). There are no indications of a physical inability that would limit sexual activity.

The care plan formulated with a client includes the goal: client describes self as a rape survivor. For which client would this goal be inappropriate? a. Client in the emergency department immediately after the rape b. Client in individual therapy 1 month after a rape c. Client in the emergency department with a panic attack that the client relates with a rape 6 months ago d. Client in primary care setting 3 months after a rape

A. Immediately after the rape is too soon to expect the client to see herself as a survivor. The goals for this client might be to have the client make choices about treatment or to identify current feelings. Clients who are 1, 3, and 6 months after the rape might consider themselves as survivors. However, this does not mean they are free of the fears and feelings related to the rape.

A nurse is discussing silent rape reaction with a newly licensed nurse. Which of the following should the nurse identify as a characteristic of this type of reaction? (Select all that apply.) A. Sudden development of phobias B. Development of substance use disorder C. Increased level of anxiety during interview D. Reactivation of a prior physical disorder E. Unwillingness to discuss the sexual assault

A. CORRECT: Sudden onset of phobic reactions is a characteristic of a silent rape reaction. B. INCORRECT: Development of substance use disorder is a characteristic of a compound rape reaction. C. CORRECT: Increased anxiety during interview is a characteristic of a silent rape reaction. D. INCORRECT: Reactivation of a prior physical disorder is a characteristic of a compound rape reaction. E. CORRECT: No verbalization of the sexual assault is a characteristic of a silent rape reaction.

A nurse is assessing a client who is the victim of sexual assault. Which of the following findings indicate the client is experiencing an initial impact reaction of rape-trauma syndrome? (Select all that apply.) A. Genitourinary soreness from the assault B. Difficulties with low self-esteem C. Sleep disturbances D. Emotional outbursts E. Difficulty making decisions

A. INCORRECT: Soreness from the attack indicates a somatic, rather than initial impact, reaction. B. INCORRECT: Difficulties with low self-esteem are an indication of the long-term reorganization phase rather than an initial impact reaction. C. INCORRECT: Sleep disturbances indicates a somatic, rather than initial impact, reaction. D. CORRECT: Emotional outbursts indicate an expressed initial impact reaction during the acute phase of rape-trauma syndrome. E. CORRECT: Difficulty making decisions indicates a controlled initial impact reaction during the acute phase of rape-trauma syndrome.

A nurse is caring for a client who was recently raped. The client states, "I never should have been out on the street alone at night." Which of the following is an appropriate response by the nurse? A. "Your actions had nothing to do with what happened." B. "You should focus on recovery rather than blaming yourself for what happened." C. "You believe this wouldn't have happened if you hadn't been out alone?" D. "Why do feel that you should not have been alone on the street at night?"

A. INCORRECT: This responses offers the nurse's opinion, which is a nontherapeutic communication technique. B. INCORRECT: This responses indicates disapproval, which is a nontherapeutic communication technique. C. CORRECT: This response uses the therapeutic communication technique of restating, which promotes reflection and verbalization of feelings. D. INCORRECT: This responses asks a "why" question, which is a nontherapeutic communication technique

A community health nurse is leading a discussion about rape with a neighborhood task force. Which of the following statements by a neighborhood citizen indicates the need for further teaching? A. "Rape is a crime of aggression." B. "Acquaintance rape often involves alcohol." C. "Both men and women can be victims of rape." D. "The majority of rapists are unknown to the victims."

A. INCORRECT: This statement does not require further teaching. Rape is a crime of violence, aggression, anger, and power. B. INCORRECT: This statement does not require further teaching. Drugs and alcohol are often associated with date or acquaintance rape. C. INCORRECT: This statement does not require further teaching. Both men and women can be victims of rape. D.CORRECT: This statement requires further teaching. The majority of rapists are known to the victims.

A nurse is discussing the care of a client following a sexual assault with a newly licensed nurse. Which of the following statements indicates the need for further teaching? A. "I will administer prophylactic treatment for sexually transmitted infections like chlamydia." B. "I need to obtain informed consent before the sexual assault nurse examiner obtains forensic evidence." C. "I can expect manifestations of rape-trauma syndrome to be similar to bipolar disorder." D. "I should perform a self-assessment before caring for a client who has been raped."

A. INCORRECT: This statement does not require further teaching. The nurse should administer prophylactic treatment for infections such as chlamydia according to the Centers for Disease Control and Prevention. B. INCORRECT: This statement does not require further teaching. The nurse must obtain informed consent to collect data that can be used as legal evidence. C. CORRECT: This statement requires further teaching. Manifestations of rape-trauma syndrome are similar to posttraumatic stress disorder rather than bipolar disorder. D. INCORRECT: This statement does not require further teaching. The nurse should perform a self-assessment prior to client care to ensure he is able to provide empathetic, objective, and nonjudgmental care.

3. A patient who has been raped has chosen to accept pregnancy prophylaxis medication. If the nurse does not believe in abortion, what is the appropriate nursing action? 1. Examine own feelings about abortion before entering the patient's room. 2. Encourage patient to take more time to consider her options. 3. Provide the patient with the number to Planned Parenthood. 4. Administer the pregnancy prophylaxis medication as ordered.

ANS: 1 Rationale: Nurses must continually be aware of their own feelings about issues such as abortion. Nurses who examine their personal feelings and reactions before encountering a rape survivor are better prepared to give empathetic and effective care.

1. The nurse is caring for a patient in the emergency department who has been raped just hours earlier. Which behaviors should the nurse expect if the patient were exhibiting controlled-style reactions? 1. Shock, numbness 2. Volatility, anger 3. Crying, sobbing 4. Smiling, laughing

ANS: 1 Rationale: Patients who exhibit controlled -style reactions may present with ambiguous behaviors such as calmness, a subdued appearance, shock, numbness, and distractibility. Volatility, anger, crying, sobbing, smiling, and laughter are associated with expressed styles of behavior.

5. The nurse is caring for a patient who is in the long-term reorganization phase of rape-trauma syndrome. Which symptom(s) should the nurse anticipate? Select all that apply. 1. Development of fear of locations that resemble the rape location 2. Emergence of acceptance of the rape 3. Dreams with violent content 4. A shift from anxiety to calm 5. Onset of phobia of being alone

ANS: 1, 3, 5 Rationale: Patients in the long-term reorganization phase of rape-trauma syndrome are likely to experience emotions such as intrusive thoughts, increased activity, increased emotional liability, and development of fears and phobias. Acceptance of the rape and an air of calmness are not noted within this phase.

4. The nurse is working at a telephone hotline center when a rape victim calls. If the rape victim states she is fearful of going to the hospital, what is the appropriate nursing response? 1. "You don't need to go to the hospital if you don't want to." 2. "I'm here to listen to you, and we can talk about your feelings." 3. "Did you do something to make the other person attack you?" 4. "Why are you afraid to seek medical attention?"

ANS: 2 Rationale: When a nurse speaks with a rape victim, the most helpful thing the nurse can do is to listen and let the survivor talk. A victim who feels understood is no longer alone and feels more in control of the situation. It is critical to avoid placing blame on the victim. Once the nurse has established a rapport with the victim and established trust by listening non-judgmentally, the nurse will be better poised to explain the importance of medical attention.

2. The nurse is caring for a patient who has just been raped. Which is the appropriate initial nursing response? 1. "I will get you the number for the crisis intervention specialist." 2. "May I get your consent to test you for pregnancy and HIV?" 3. "You are safe here." 4. "I need to look at your bruises and cuts."

ANS: 3 Rationale: The initial message that the rape victim needs to hear is that he or she is safe. This provides a nonjudgmental and empathetic approach and establishes trust between the patient and nurse. Although the nurse will eventually assist with obtaining laboratory tests, assessment of physical appearance, and education regarding crisis intervention, the first message should indicate to the patient that they are now in a safe environment.

An elderly client who lives with her daughter and son-in-law and their three children reveals that her daughter sometimes slaps her when she does not move fast enough or spills things. The daughter is a midlevel business executive who is under considerable stress at work. The chil-dren have many school activities to which they must be transported. The husband is often out of town on business trips. The daughter states, "I have so much to do that I become frustrated when my mother can't move fast enough or causes me extra work." The nurse caring for the mother could appropriately suggest: 1. Moving the mother to an adult ambulatory care facility 2. Employing an aide to provide care and stimulation for the mother 3. Enrolling in a therapeutic group that addresses stress management 4. Reading the elder law of the state to learn the penalties for elder abuse

ANS: 3 The daughter has many stressors and has few external supports. Enrolling in a stress management group would provide support as well as teach more new adaptive coping strategies. Options 1 and 2 are probably not necessary. Option 4 is threatening.

An unconscious person is brought to the emergency department by a friend. The friend found the person in a bedroom at a college fraternity party. Semen is observed on the persons underclothes. The priority actions of staff members should focus on: a. maintaining the airway. b. preserving rape evidence. c. obtaining a description of the rape. d. determining what drug was ingested.

ANS: A Because the patient is unconscious, the risk for airway obstruction is present. The incorrect options are of lower priority than preserving physiologic functioning.

A child was abducted and raped. Which personal reaction by the nurse could interfere with the childs care? a. Anger b. Concern c. Empathy d. Compassion

ANS: A Feelings of empathy, concern, and compassion are helpful. Anger, on the other hand, may make objectivity impossible.

A college student was sexually assaulted when out on a date. After several weeks of crisis intervention therapy, which client statement should indicate to a nurse that the student is handling this situation in a healthy manner? A. "I know that it was not my fault." B. "My boyfriend has trouble controlling his sexual urges." C. "If I don't put myself in a dating situation, I won't be at risk." D. "Next time I will think twice about wearing a sexy dress."

ANS: A The client who realizes that sexual assault was not her fault is handling the situation in a healthy manner. The nurse should provide nonjudgmental listening and communicate statements that instill trust and validate self-worth.

Which statement made by an emergency department nurse indicates accurate knowledge of domestic violence? A. "Power and control are central to the dynamic of domestic violence." B. "Poor communication and social isolation are central to the dynamic of domestic violence." C. "Erratic relationships and vulnerability are central to the dynamic of domestic violence." D. "Emotional injury and learned helplessness are central to the dynamic of domestic violence."

ANS: A The nurse accurately states that power and control are central to the dynamic of domestic violence. Battering is defined as a pattern of coercive control founded on physical and/or sexual violence or threat of violence. The typical abuser is very possessive and perceives the victim as a possession.

A kindergarten student is frequently violent toward other children. A school nurse notices bruises and burns on the child's face and arms. What other symptom should indicate to the nurse that the child might have been physically abused? A. The child shrinks at the approach of adults. B. The child begs or steals food or money. C. The child is frequently absent from school. D. The child is delayed in physical and emotional development.

ANS: A The nurse should determine that a child who shrinks at the approach of adults in addition to having bruises and burns might be a victim of abuse. Whether or not the adult intended to harm the child, maltreatment should be considered.

Which assessment data should a school nurse recognize as signs of physical neglect? A. The child is often absent from school and seems apathetic and tired. B. The child is very insecure and has poor self-esteem. C. The child has multiple bruises on various body parts. D. The child has sophisticated knowledge of sexual behaviors.

ANS: A The nurse should recognize that a child who is often absent from school and seems apathetic and tired might be a victim of neglect. Other indicators of neglect are stealing food or money, lacking medical or dental care, being consistently dirty, lacking sufficient clothing, or stating that there is no one home to provide care.

The nurse cares for a victim of a violent sexual assault. What is the most therapeutic intervention? a. Use accepting, nurturing, and empathetic communication techniques. b. Educate the victim about strategies to avoid attacks in the future. c. Discourage the expression of feelings until the victim stabilizes. d. Maintain a matter-of-fact manner and objectivity.

ANS: A Victims require the nurse to provide unconditional acceptance of them as individuals, because they often feel guilty and engage in self-blame. The nurse must be nurturing if the victims needs are to be met and must be empathetic to convey understanding and to promote an establishment of trust.

Which of the following nursing diagnoses could be appropriate for an adult survivor of incest? (Select all that apply.) A. Low self-esteem B. Powerlessness C. Disturbed personal identity D. Knowledge deficit E. Noncompliance

ANS: A, B An adult survivor of incest would most likely have low self-esteem and a sense of powerlessness. Adult survivors of incest are at risk for developing post-traumatic stress disorder, sexual dysfunction, somatization disorders, compulsive sexual behavior disorders, depression, anxiety, eating disorders, and substance abuse disorders. Disturbed personal identity refers to an inability to distinguish between self and nonself and is seen in disorders such as autistic disorders, borderline personality disorders, dissociative disorders, and gender identity disorders.

A person was abducted and raped at gunpoint by an unknown assailant. Which interventions should the nurse use while caring for this person in the emergency department? Select all that apply. a. Allow the person to talk at a comfortable pace. b. Pose questions in nonjudgmental, empathic ways. c. Place the person in a private room with a caregiver. d. Reassure the person that a family member will arrive as soon as possible. e. Invite family members to the examination room and involve them in taking the history. f. Put an arm around the person to offer reassurance that the nurse is caring and compassionate.

ANS: A, B, C Neutral, nonjudgmental care and emotional support are critical to crisis management for the victim of rape. The rape victim should have privacy but not be left alone. Some rape victims prefer not to have family members involved. The patients privacy may be compromised by the presence of family. The rape victims anxiety may escalate when he or she is touched by a stranger, even when the stranger is a nurse.

When planning care for women in abusive relationships, which of the following information is important for the nurse to consider? (Select all that apply.) A. It often takes several attempts before a woman leaves an abusive situation. B. Substance abuse is a common factor in abusive relationships. C. Until children reach school age, they are usually not affected by parental discord. D. Women in abusive relationships usually feel isolated and unsupported. E. Economic factors rarely play a role in the decision to stay in abusive relationships.

ANS: A, B, D When planning care for women who have been victims of domestic abuse, the nurse should be aware that it often takes several attempts before a woman leaves an abusive situation, that substance abuse is a common factor in abusive relationships, and that women in abusive relationships usually feel isolated and unsupported. Children can be affected by domestic violence from infancy, and economic factors often play a role in the victim's decision to stay.

A nurse working in the county jail interviews a man who recently committed a violent sexual assault against a woman. Which comment from this perpetrator is most likely? a. She was very beautiful. b. I gave her what she wanted. c. I have issues with my mother. d. Ive been depressed for a long time.

ANS: B Rape involves a need for control, power, degradation, and dominance over others. The correct response shows a lack of remorse or guilt, which is a common characteristic of an antisocial personality. The incorrect responses show an appreciation for women, psychological conflict, and self-disclosure, which are not expected from a perpetrator of sexual assault.

A survivor in the long-term reorganization phase of the rape trauma syndrome has experienced intrusive thoughts of the rape and developed a fear of being alone. Which finding demonstrates this survivor has made improvement? The survivor: a. temporarily withdraws from social situations. b. plans coping strategies for fearful situations. c. uses increased activity to reduce fear. d. expresses a desire to be with others.

ANS: B The correct response shows a willingness and ability to take personal action to reduce the disabling fear. The incorrect responses demonstrate continued ineffective coping.

A client is brought to an emergency department after being violently raped. Which nursing action is appropriate? A. Discourage the client from discussing the event as this may lead to further emotional trauma. B. Remain nonjudgmental and actively listen to the client's description of the event. C. Meet the client's self-care needs by assisting with showering and perineal care. D. Provide cues, based on police information, to encourage further description of the event.

ANS: B The most appropriate nursing action is to remain nonjudgmental and actively listen to the client's description of the event. It is important to also communicate to the victim that he or she is safe and that it is not his or her fault. Nonjudgmental listening provides an avenue for client catharsis needed in order to begin the process of healing.

An anorexic client states to a nurse, "My father has recently moved back to town." Since that time the client has experienced insomnia, nightmares, and panic attacks that occur nightly. She has never married or dated and lives alone. What should the nurse suspect? A. Possible major depressive disorder B. Possible history of childhood incest C. Possible histrionic personality disorder D. Possible history of childhood physical abuse

ANS: B The nurse should suspect that this client might have a history of childhood incest. Adult survivors of incest are at risk for developing posttraumatic stress disorder, sexual dysfunction, somatization disorders, compulsive sexual behavior disorders, depression, anxiety, eating disorders, and substance abuse disorders.

An older adult diagnosed with dementia lives with family and attends daycare. After observing poor hygiene, the nurse at the center talks with the patient's adult child. This caregiver becomes defensive and says, "It takes all my time and energy to care for my mother. She's awake all night. I never get any sleep." Which nursing intervention has priority? a. Teach the caregiver more about the effects of dementia. b. Secure additional resources for the mother's evening and night care. c. Support the caregiver to grieve the loss of the mother's ability to function. d. Teach the family how to give physical care more effectively and efficiently.

ANS: B The patient's child and family were coping with care until the patient began to stay awake at night. The family needs assistance with evening and night care to resume their precrisis state of functioning. Secondary prevention calls for the nurse to mobilize community resources to relieve overwhelming stress. The other interventions may then be accomplished.

After assessing a victim of sexual assault, which terms could the nurse use in the documentation? Select all that apply. a. Alleged b. Reported c. Penetration d. Intercourse e. Refused f. Declined

ANS: B, C, F The nurse should refrain from using pejorative language when documenting assessments of victims of sexual assault. Reported should be used instead of alleged. Penetration should be used instead of intercourse. Declined should be used instead of refused.

Which activities are in the scope of practice of a sexual assault nurse examiner? Select all that apply. a. Requiring HIV testing of a victim b. Collecting and preserving evidence c. Providing long-term counseling for rape victims d. Obtaining signed consents for photographs and examinations e. Providing pregnancy and sexually transmitted disease prophylaxis

ANS: B, D, E HIV testing is not mandatory for a victim of sexual assault. Long-term counseling would be provided by other members of the team. The other activities would be included within this practice role.

When working with rape victims, immediate care focuses first on: a. collecting evidence. b. notifying law enforcement. c. helping the victim feel safe. d. documenting the victims comments.

ANS: C The first focus of care is helping the victim feel safe. An already vulnerable individual may view assessment questions and the physical procedures as intrusive violations of privacy and even physically threatening. The patient might decline to have evidence collected or to involve law enforcement.

A woman comes to an emergency department with a broken nose and multiple bruises after being beaten by her husband. She states, "The beatings have been getting worse, and I'm afraid that next time he might kill me." Which is the appropriate nursing reply? A. "Leopards don't change their spots, and neither will he." B. "There are things you can do to prevent him from losing control." C. "Let's talk about your options so that you don't have to go home." D. "Why don't we call the police so that they can confront your husband with his behavior?"

ANS: C The most appropriate reply by the nurse is to talk with the client about options so that the client does not have to return to the abusive environment. It is essential that clients make decisions independently without the nurse being the "rescuer." Imposing judgments and giving advice is nontherapeutic.

A nursing student asks an emergency department nurse, "Why does a rapist use a weapon during the act of rape?" Which nursing reply is most accurate? A. "A weapon is used to increase the victimizer's security." B. "A weapon is used to inflict physical harm." C. "A weapon is used to terrorize and subdue the victim." D. "A weapon is used to mirror learned family behavior patterns."

ANS: C The nurse should explain that a rapist uses weapons to terrorize and subdue the victim. Rape is the expression of power and dominance by means of sexual violence. Rape can occur over a broad spectrum of experience from violent attack to insistence on sexual intercourse by an acquaintance or spouse.

In the emergency department, a raped client appears calm and exhibits a blunt affect. The client answers a nurse's questions in a monotone using single words. How should the nurse interpret this client's responses? A. The client may be lying about the incident. B. The client may be experiencing a silent rape reaction. C. The client may be demonstrating a controlled response pattern. D. The client may be having a compounded rape reaction.

ANS: C This client is most likely demonstrating a controlled response pattern. In a controlled response pattern, the client's feelings are masked or hidden, and a calm, composed, or subdued affect is seen. In the expressed response pattern, feelings of fear, anger, and anxiety are expressed through crying, sobbing, smiling, restlessness, and tension.

The nursing diagnosis rape trauma syndrome applies to a rape victim in the emergency department. Which outcome should occur before the patients discharge? a. Patient states, I feel safe and entirely relaxed. b. Memory of the rape is less vivid and frightening. c. Physical symptoms of pain and discomfort are no longer present. d. Patient agrees to keep a follow-up appointment with the rape crisis center.

ANS: D Agreeing to keep a follow-up appointment is a realistic short-term outcome. The incorrect options are unlikely to occur during the limited time the victim is in the emergency department.

A rape victim asks an emergency department nurse, Maybe I did something to cause this attack. Was it my fault? Which response by the nurse is the most therapeutic? a. Pose questions about the rape, helping the patient explore why it happened. b. Reassure the victim that the outcome of the situation will be positive. c. Make decisions for the victim because of the temporary confusion. d. Support the victim to separate issues of vulnerability from blame.

ANS: D Although the victim may have made choices that increased vulnerability, the victim is not to blame for the rape. The incorrect options either suggest the use of a nontherapeutic communication technique or do not permit the victim to restore control. No confusion is evident.

A nurse interviews a person abducted and raped at gunpoint by an unknown assailant. The person says, I cant talk about it. Nothing happened. I have to forget! What is the persons present coping strategy? a. Somatic reaction b. Repression c. Projection d. Denial

ANS: D Disbelief is a common finding during the acute stage following sexual assault. Denial is evidence of the disbelief. This mechanism may be unconsciously used to protect the person from the emotionally overwhelming reality of rape. The patients statements do not reflect somatic symptoms, repression, or projection.

What is the primary motivator for most rapists? a. Anxiety b. Need for humiliation c. Overwhelming sexual desires d. Desire to humiliate or control others

ANS: D Rape is not a crime of sex; rather, it is a crime of power, control, and humiliation. The perpetrator wishes to subjugate the victim. The dynamics listed in the other options are not the major motivating factors for rape.

A patient is hospitalized after an arrest for breaking windows in the home of a former domesticpartner. The history reveals childhood abuse by a punitive parent, torturing family pets and an arrest for disorderly conduct. Which nursing diagnosis has priority? a. Risk for injury b. Post-trauma response c. Disturbed thought processes d. Risk for other-directed violence

ANS: D The defining characteristics for Risk for other-directed violence include a history of being abused as a child, having committed other violent acts, and demonstrating poor impulse control. The defining characteristics for the other diagnoses are not present in this scenario.

Which teaching should the nurse in an employee assistance program provide to an employee who exhibits symptoms of domestic physical abuse? A. Have ready access to a gun and learn how to use it B. Research lawyers who can aid in divorce proceedings C. File charges of assault and battery D. Have ready access to the number of a safe house for battered women

ANS: D The nurse should provide information about safe houses for battered women when working with a client who has symptoms of domestic physical abuse. Many women feel powerless within the abusive relationship and may be staying in the abusive relationship out of fear for their lives.

A woman describes a history of physical and emotional abuse in intimate relationships. Which additional factor should a nurse suspect? A. The woman may be exhibiting a controlled response pattern. B. The woman may have a history of childhood neglect. C. The woman may be exhibiting codependent characteristics. D. The woman might be a victim of incest.

ANS: D The nurse should suspect that this client might be a victim of incest. Women in abusive relationships often grew up in abusive homes.

A client who is in a severely abusive relationship is admitted to a psychiatric inpatient unit. The client fears for her life. A staff nurse asks, "Why doesn't she just leave him?" Which is the nursing supervisor's most appropriate reply? A. "These clients don't know life any other way, and change is not an option until they have improved insight." B. "These clients have limited KEY: Cognitive skills and few vocational abilities to be able to make it on their own." C. "These clients often have a lack of financial independence to support themselves and their children, and most have religious beliefs prohibiting divorce and separation." D. "These clients are paralyzed into inaction by a combination of physical threats and a sense of powerlessness."

ANS: D The nursing supervisor is accurate when stating that clients in severely abusive relationships are paralyzed into inaction by a combination of physical threats and a sense of powerlessness. Women often choose to stay with an abusive partner for some of the following reasons: for the children, for financial reasons, fear of retaliation, lack of a support network, religious reasons, and/or hopelessness.

A nurse working a rape telephone hotline should focus communication with callers to: a. arrange long-term counseling. b. serve as a sympathetic listener. c. obtain information to relay to the local police. d. explain immediate steps that a victim of rape should take.

ANS: D The telephone counselor establishes where the victim is and what has happened and provides the necessary information to enable the victim to decide what steps to take immediately. Long-term aftercare is not the focus until immediate problems are resolved. The victim remains anonymous. The incorrect options are inappropriate or incorrect because counselors should be empathic rather than sympathetic.

The nurse is counseling a young man who was scheduled for anger management classes after a road rage incident. The young man confides that his father used to yell at and hit him when he was a child. Which statement describes why it is important for this man to seek anger management​ counseling? Abuse by a parent is a vulnerability factor for abusing his own children. Abuse by a parent is a protective factor for abusing his own children. Abuse by a parent is a risk factor for abusing his own children. Abuse by a parent is a precipitating factor to road rage.

Abuse by a parent is a risk factor for abusing his own children. Risk factors are those that increase the potential that someone will be a perpetrator of​ abuse, such as having a parent who was also an abuser. Protective factors decrease the risk of victimization and perpetration. Vulnerability factors increase the risk of being a victim. Precipitating factors are factors that trigger a specific incident.

Which National Quality Strategy should the nurse understand focuses on the​ community? (Select all that​ apply) Effective prevention and treatment Care coordination Client safety Affordability Healthy living

Affordability Healthy living Affordability covers the community as the healthcare industry works to make healthcare more affordable to​ individuals, families,​ employers, and governments. Healthy living also covers the community because this​ strategy's main aim is to work with communities to promote wide use of best practices to promote healthy living. Client​ safety, care​ coordination, and effective prevention and treatment are all more focused on the individual client.

A client is brought into the emergency room after being found unconscious as a result of an assault. Which is the priority assessment by the​ nurse? Bleeding Airway Neurologic status Urinary output

Airway When assessing a client after​ trauma, the nurse must follow the​ ABCs: airway,​ breathing, and circulation. These must be stabilized immediately to prevent death.​ Bleeding, urinary​ output, and neurologic status are​ important, but they are not the priority assessments immediately after trauma.

The nurse is studying the National Patient Safety Goals to ensure that the nurse delivers safe care to assigned clients and is aware that these goals are revised: Every two years Once a month Annually Every five years

Annually Feedback Rationale: The Joint Commission is responsible for assessing and revising goals for client safety on an annual basis. Nursing Process: Assessment Client Need: Safe, Effective Care Environment Cognitive Level: Remembering

The nurse is working with a rape survivor. Which eating disorder should the nurse monitor in the patient? Anorexia Purging Obesity Cachexia

Anorexia Rape survivors are at a high risk for developing an eating disorder, including anorexia, bulimia, or a crossover between the two. One of the main components of both anorexia and bulimia is control over what the individual is consuming and over the nutrients that stay in the body or are forcefully discarded. Purging is a behavior in some eating disorders and is characterized by recurrent self-induced vomiting or abuse of laxatives, diuretics, or enemas to lose weight; there is not a purging disorder. Obesity is not associated with rape trauma. Cachexia is body wasting associated with a severe chronic illness.

After a series of admissions to the emergency department over the past several months, an 80-year-old woman's malnutrition, vague history, and pattern of physical injuries lead the nurse to suspect elder abuse. Which of the following aspects of the woman's situation may contribute to elder abuse? (Select all that apply.) A) The woman is physically dependent on her son since she lost her mobility. B) The woman has no income or savings of her own. C) The woman's son describes her as "needy, helpless, and pathetic." D) The woman and her son are recent immigrants to the United States. E) The woman describes herself and her son as "not well-off, but not terribly poor either."

Ans: A, B, C Physical and financial dependence and personality conflicts with caregivers and children are known to contribute to elder abuse. Low socioeconomic status and recent immigration are not identified as causative factors.

The nurse is caring for a group of older adults. Which patients would the nurse recognize as being at greater risk for elder abuse? Select all that apply. 1. The patient with dementia who is cared for by family members. 2. The patient with dementia who is cared for by a paid caregiver. 3. The patient with depression who is cared for by family members. 4. The patient who is experiencing chronic anxiety and is cared for family members. 5. The patient who is grieving the loss of a spouse and is cared for by a paid caregiver.

Answer: 1, 2, 3, 4 Explanation: Older adults most at risk for elder abuse are those individuals with dementia and mental illness, regardless of who is caring for them. The patient who is grieving the loss of a spouse is not described as having a mental illness and is not at greater risk for elder abuse.

The nurse is caring for a patient whom the nurse suspects is a victim of intimate partner violence (IPV). What screening question made by the nurse is most appropriate? 1. "Can you tell me how you got your injuries?" 2. "Can you tell me if it is safe for you to go home?" 3. "Can you tell me what you know about intimate partner violence?" 4. "Can you tell me what your spouse was doing when you sustained your injuries?"

Answer: 2 Explanation: Screening is one way that nurses can help to provide information and resources to a person who may be suffering IPV. The most appropriate way to screen for IPV is the use of direct questions about the violence. The most appropriate question is, "Is it safe for you to go home?" All the other questions are not as direct, and they do not get at the priority nursing action, which is to assess the safety of the patient.

The nurse manager is reviewing a quality improvement study conducted on a client care issue. List the order in which the steps should be evaluated to determine that the study was completed correctly. 1. Research factors that contribute to better outcomes. 2. Compare outcomes to benchmarks. 3. Identify areas for improvement. 4. Analyzing current protocols of care and associated outcomes. 5. Implement changes to improve outcomes. 6. Analyze client outcomes to determine effectiveness of changes.

Answer: 4, 2, 3, 1, 5, 6 Explanation: Quality improvement involves analyzing current protocols of care and their associated outcomes, comparing those outcomes to leaders in high-quality care through benchmarking, identifying areas for improvement, researching factors that contribute to better outcomes, and implementing changes to improve outcomes. Client outcomes must then be analyzed to determine the effectiveness of the changes and identify areas for further improvement.

The nurse on a medical-surgical unit is asked to participate in data collection on skin care for the unit. What purpose will it serve for the nurse to cooperate with this request? A) Participate in the quality improvement process B) Advance the nurse's practice C) Prevent problems from arising in the unit D) Fulfill legal requirements

Answer: A Explanation: A) Quality improvement is the name for the processes used by an agency to measure and improve aspects of client care. The nurse may advance practice, but that is usually accomplished by returning to school for a higher degree. Preventing problems from arising is only one benefit of quality management. Nurses are encouraged to participate in quality improvement programs but are not legally required to do so.

The nurse conducting nursing audits to help increase efficiency and reduce costs wants to suggest a better contribution to quality care. What should the nurse suggest be performed instead? A) Conduct a wound care study to enhance client outcomes. B) Install cameras to detect abuse of the clients. C) Acquire new client care equipment. D) Decrease staffing on the unit.

Answer: A Explanation: A) The top goal of any quality improvement program is to improve client outcomes of care. Increasing the RN staff, purchasing new equipment, and installing cameras may be found to be means to reach that goal, but studies must first be conducted to identify those means.

The nurse manager at an acute care facility is educating her staff nurses on the definition of a sentinel event and providing examples. Which would be appropriate for the nurse manager to present to the staff nurses as examples of a sentinel event? Select all that apply. A) Delivery of radiation to the wrong body region B) Invasive surgical procedure at the wrong site C) Homicide of a staff member while at the facility D) Homicide of a patient while at the facility E) Administration of a compatible blood transfusion

Answer: A, B, C, D Explanation: A) A sentinel event is an unexpected occurrence causing serious injury or death. According to the Joint Commission, the following are sentinel events: delivery of radiation to the wrong body region, invasive surgery at the wrong site, homicide of a staff member or patient while at the facility. Administration of a compatible blood transfusion would be desired. Administration of an incompatible blood transfusion would be a sentinel event.

The quality assurance officer notes that one particular nursing unit has received a higher-than-usual number of negative client responses about aspects of the nursing care during the previous quarter. To which component of care should the quality assurance officer pay particular attention when benchmarking this issue? A) Structure B) Process C) Outcome D) Competency

Answer: B Explanation: B) Process evaluation focuses on how the care was given in regard to relevance, appropriateness, completeness, and timeliness. Process standards focus on the manner in which the nurse uses the nursing process. Competency is not one of the components of quality assurance evaluation. Structure evaluation focuses on the setting in which the care is given. Outcome evaluation focuses on demonstrable changes in the client's health status as a result of nursing care.

The nurse instructor is preparing a teaching session for staff nurses on intradisciplinary assessments. Which information should the instructor consider when preparing this presentation? Select all that apply. A) Utilization reviews B) Peer review C) Audits D) Performance appraisals E) Outcomes management

Answer: B, C, E Explanation: B) Intradisciplinary assessment occurs within a group of individuals with a similar position in the healthcare system, such as a group of nurses. An intradisciplinary assessment is important for identifying areas of improvement at each level of care and includes peer review, audits, and outcomes management. Utilization reviews are completed when conducting an interdisciplinary assessment. Performance appraisals are not a part of either intra- or interdisciplinary assessments.

The nursing instructor is speaking to a group of nursing students about standards of care. Which comment made by the nursing student indicates the need for further education about the standards of care? A) "Standards of care are based on models of high-quality performance." B) "Process standards focus on the steps used to lead to a particular outcome." C) "Process standards focus on human resources, and general organizational structure." D) "Outcome standards focus on the performance of a process."

Answer: C Explanation: C) "Process standards focus on human resources and general organizational structure" is incorrect, and indicates that the student needs further education. The rest of the statements are correct.

A newly licensed nurse is passing medications with a nurse preceptor. Which action taken by the newly licensed nurse would be inappropriate and require the nurse preceptor to intervene? A) The newly licensed nurse verifies tube placement prior to administering medications. B) The newly licensed nurse checks for known allergies prior to administering medication. C) The newly licensed nurse combines medications with the same active ingredient. D) The newly licensed nurse has a second nurse check the medication order.

Answer: C Explanation: C) It is not an appropriate action to combine medications with the same active ingredient. Combining medications with the same active ingredient is not considered a method to reduce medication errors. Verifying tube placement prior to administering medications is an appropriate action and is considered a method to reduce medication errors. Checking for known allergies prior to administering medications is an appropriate action and is considered a method to reduce medication errors. Having a second nurse check the medication order is an appropriate action and is considered a method to reduce medication errors.

A client who has read several articles about the need to contain healthcare costs asks how a quality improvement program can contain cost of care. What should the nurse respond to this client's question? Select all that apply. A) "Promoting safety increases the cost of care." B) "Medication errors decrease the cost of care." C) "High nurse-to-client ratios result in decreased length of stay." D) "Increased nursing staff has been linked to decreased infection rates." E) "Use of computers increases the number of lawsuits."

Answer: C, D Explanation: C) Studies have shown that increasing the nurse-to-client ratio can decrease overall cost because the length of stay, as well as mortality rate, is reduced with RN care. Other studies have shown that increased nursing staff has been linked to a decrease in client infection rates. Medication errors increase cost due to harm to the client and increased length of stay. Promoting safety is a cost-containment measure because it decreases injury to the client and the consequent risk of lawsuits. Computers increase efficiency and reduce cost as a result. Lawsuits do not increase because of computer use; they increase when computers are used improperly.

What is a nurse's legal responsibility if child abuse or neglect is suspected? a. Discuss the findings with the child's teacher, principal, and school psychologist. b. Report the suspected abuse or neglect according to state regulations. c. Document the observations and speculations in the medical record. d. Continue the assessment.

B ~ Each state has specific regulations for reporting child abuse that must be observed. The nurse is usually a mandated reporter. The reporter does not need to be sure that abuse or neglect has occurred but only that it is suspected. Speculation should not be documented; only the facts are recorded.

While preparing a client for surgery, the nurse marks the arm that is to be amputated and participates in a "time out" procedure before the surgery begins. What sentinel event should the "time out" procedure prevent? A) Ineffective control of the client's pain B) The lack of healing of the stump C) The client being mildly over-sedated D) The removal of the wrong arm

Answer: D Explanation: D) A sentinel event is an unexpected event that causes death or severe physical or psychological injury. The removal of the client's incorrect arm would be a sentinel event. Mild over-sedation is not a sentinel event as the client is most likely on a ventilator during surgery. The inability to heal properly is an expected event in a diabetic client. Pain control is individual and is not a sentinel event.

The nurse manager is planning to implement the Lean Six Sigma system on the care area to improve the quality of care. When following this model, what should the manager implement? A) Shortening break time B) Ordering more supplies than needed on the unit to ensure they never run out C) Replacing a licensed staff member with unlicensed assistive personnel D) Decreasing staff when the census is low

Answer: D Explanation: D) Lean Six Sigma focuses on eliminating waste and improving process flow. When the census decreases, the nurse manager should also decrease the number of staff. Replacing licensed staff members with unlicensed assistive personnel may not be safe. The nurse manager would cut back on ordering supplies that are not needed when following this model. A shortened break time would not be considered as reducing waste.

The nurse manager is considering increasing the number of RN staff because studies have shown that it decreases infection rates. What purpose will decreasing infection rates serve? A) An increased use of overtime B) A decrease in client satisfaction C) An increase in client care supplies D) A decreased cost of care

Answer: D Explanation: D) Research has shown that an increase in RN staff decreases a unit's infection rate. Because infection is reduced, cost of care is also reduced. Overtime is not necessarily reduced by an increase in staff, depending on the number of nurses available at any given time. Studies show that client satisfaction increases with an increase of RN staff. There is no research that suggests that decreased infection rates will increase the need for client care supplies.

The nurse provides medication to a client at the wrong time. No harm came to the client as a result of the nurse's error and the nurse files a report about the medication error. What should the risk management team do? A) Discipline the nurse appropriately. B) Report the nurse to the board of nursing. C) Monitor all nurses on the unit to ensure this does not occur again. D) Attempt to implement policy changes to prevent future errors.

Answer: D Explanation: D) When a nurse makes an error and reports it, the risk management team will investigate to discover causes for the error and effect policy changes that can prevent future errors, improving the level of client care. The situation does not warrant reporting the nurse to the board of nursing. The risk management team would not be responsible for implementing any disciplinary actions. It is not prudent for the risk management team to monitor all nurses who administer medications on the unit.

The emergency department nurse is obtaining a history from a patient following a date rape. Which prescription should the nurse anticipate for the patient? Selective serotonin reuptake inhibitor (SSRI) Antibiotic Narcotic Nonsteroidal anti-inflammatory drug (NSAID)

Antibiotic The nurse can anticipate a prescription for antibiotics to prophylactically treat any potential sexually transmitted infection (STI). SSRIs, narcotics, and NSAIDs are not indicated at this time.

The nurse is a member of the utilization review committee that is composed of members from various disciplines within the hospital. Which patient situation should the nurse understand will be of interest to the utilization review committee? Each inpatient provided with an admission kit Routine use of sterile packs in surgery Application of adult diapers on every older adult patient Routine maintenance of medical equipment

Application of adult diapers on every older adult patient A utilization review analyzes the use of resources to identify overuse, misuse, and underuse. The application of adult diapers on each older adult patient in the event of incontinence is a red flag because not all older adult patients will be incontinent. This is a possible overuse of supplies. It would be expected for surgery to routinely use sterile packs, for each inpatient to be provided with an admission kit, and for routine maintenance to be scheduled for medical equipment. This utilization review committee uses interprofessional assessment to review situations and cases. An interprofessional assessment involves the input of more than one discipline, such as nursing or physical therapy.

The nurse is presenting an​ in-service to colleagues regarding the impact of violence on clients and healthcare workers. Which factor should the nurse include in the​ presentation? (Select all that​ apply.) Assault and murder typically leave the individual feeling powerless and angry. Strong connections between​ aggression, fear, and stress are biologically based. Chronic physiological activation in response to stress can cause an aggressive personality. Victims and perpetrators of violence being treated in healthcare agencies act out their frustrations. Healthcare workers will care for perpetrators and victims when they are most vulnerable.

Assault and murder typically leave the individual feeling powerless and angry. Strong connections between​ aggression, fear, and stress are biologically based. Victims and perpetrators of violence being treated in healthcare agencies act out their frustrations. Healthcare workers will care for perpetrators and victims when they are most vulnerable.

The nurse is talking with a patient who just had a beautiful potted flower delivered. Suddenly, the patient starts to cry and stares out the window. The patient has a prior history of abuse by an ex-spouse. Which intervention should the nurse include in the plan of care for this patient? Give the patient some time and return later. Tell the patient to enjoy the flowers and that the patient will feel better in a little while. Assess if the patient is having a flashback of previous abuse. Tell the patient that the abuse was in the past.

Assess if the patient is having a flashback of previous abuse. Patients who have experienced trauma such as interpersonal or intimate partner violence may experience flashbacks. The flowers may trigger flashbacks for this patient. The nurse needs to assess if the patient is having a flashback and stay with the patient to help the patient cope during the flashback. Leaving the patient alone while having a flashback of previous events is not therapeutic because the patient may be experiencing a feeling of being in danger. Telling the patient that the abuse was in the past does not acknowledge the patient's past experience with abuse. It also does not allow the patient to express feelings about the past events that have occurred.

A middle-aged woman who has been physically and financially abused by her son tells the nurse, "I am not pressing charges against my son because I am afraid that he will put me out on the street, and I will have no place to go." Which should be the priority nursing intervention for this patient? Assess the patient's safety and help her develop a safety plan. Support the patient's wishes to not press charges due to fear. Encourage the patient to move out of her son's home to avoid future encounters with him. Instruct the patient not to worry about her son because she is in the hospital, so her son will not do it again.

Assess the patient's safety and help her develop a safety plan. The patient may be at risk for future attacks because she is being abused by someone with whom she lives. The nurse needs to make a thorough assessment of the patient's safety and assist the patient in developing a safety plan in the event the son abuses the patient again. Having the patient move out may not be an option because the patient may have nowhere else to live. Even though the patient is in the hospital, the patient is still in danger. Supporting the patient's wishes to not press charges due to fear is not a therapeutic intervention.

The nurse is caring for a rape victim who is scheduled for a session with a therapist. Which statement describes the specific benefit of a therapist during the initial stages of therapy? Helps the patient develop coping mechanisms Assists the patient in processing the trauma Identifies medications for treatment Improves the self-esteem of the patient

Assists the patient in processing the trauma Initially after the trauma, a therapist can help an individual process the trauma. The therapist can later assist the patient with the identification of coping mechanisms and improving self-esteem through group therapy, cognitive-behavioral therapy (CBT), or individually working with the patient. The primary role of the therapist is not to identify medications for treatment.

The nurse is performing an assessment on a woman who was brought into the emergency department after a domestic violence incident at her home. The nurse notes small red dots around the​ client's eyes. Which injury should the nurse​ suspect? Orbital trauma Skull fracture Facial hematoma Attempted strangulation

Attempted strangulation Petechiae are small red dots caused by the rupture of the microvasculature. When found around the​ eyes, the presence of petechiae can indicate attempted strangulation. Petechiae are not found with orbital​ trauma, facial​ hematoma, or skull fracture.

The nurse is discussing social determinants addressed by Healthy​ People/Healthy Communities. Which factor should the nurse​ include? (Select all that​ apply.) Availability of resources to meet daily needs Social norms and​ attitudes, such as discrimination Physical​ barriers, especially for people with disabilities Public safety Exposure to toxic substances and other physical hazards

Availability of resources to meet daily needs Social norms and​ attitudes, such as discrimination Public safety Healthy​ People/Healthy Communities is another aim the U.S. Department of Health and Human Services​ (HHS) has developed to improve the health of the population. The​ aim's focus is to health. Examples of social determinants​ include, but, are not limited​ to: (1) availability of resources to meet daily​ needs, such as educational and job​ opportunities, living​ wages, or healthful​ foods; (2) social norms and​ attitudes, such as​ discrimination; (3) social support and social​ interactions; (4) socioeconomic​ conditions, such as concentrated​ poverty; (5) quality​ schools; (6) transportation​ options; and​ (7) public safety.

The nurse is counseling a man who confesses to pushing his wife when he gets really mad. The patient asks the nurse what he can do to help control his temper. Which is the best advice by the nurse? Avoid using drugs or alcohol. Switch to a low-carbohydrate diet. Begin an intense weight-training regimen. Reconnect with his estranged father, who was also abusive.

Avoid using drugs or alcohol. Although alcohol and drug use don't cause violent behavior, their use can increase the risk of it occurring. It can also contribute to aggressive behavior, which can lead to abuse. A low-carbohydrate diet is not associated with decreased aggression. Intense exercise can increase testosterone levels, which can increase aggression. Reconnecting with an estranged abusive parent is not likely to reduce anger or aggression.

A 72-year-old male client has been admitted to the emergency department after a nurse at the long-term care facility where the client lives found the client bleeding from his rectum. The client told the emergency department nurse that one of the caregivers at the facility raped him. What intervention will the nurse need to include in this client's plan of care before discharge? A) Help the client find a new long-term care facility. B) Help the client create a post-discharge safety plan. C) Help the client find a lawyer to sue the long-term care facility. D) Help the client understand the warning signs of suicide.

B

A client who has experienced domestic violence in the past has decided to stop participating in counseling. Which client statement would indicate that therapy has been effective? A) "Everyone knows what my problems are, and there is nothing I can do about it." B) "I am functioning fine now but I know that when problems come up again, I will ask for help." C) "My friends tell me that I have improved so this is a good time to stop." D) "It is so draining to deal with the same painful issues all of the time."

B

The nurse is caring for a client who has a history of being physically and sexually abused as a child, and his father abandoned the family when he was 7 years old. The nurse recognizes that this increases the client's risk of becoming a perpetrator of rape because of which type of risk factors? A) Individual B) Relationship C) Community D) Societal

B

Which activity should the nurse recognize as a way for state and local entities to make healthcare more​ affordable? A.Require hospitals to track readmission rates for​ low-income clients B.Offer basic health coverage for all citizens living in their state C.Develop new healthcare delivery models D.Coordinate care through the use of effective communication

B

A victim of a sexual assault comes to the hospital for treatment but abruptly decides to decline treatment and leaves the facility. While respecting the person's rights, the nurse should: a. say, "You may not leave until you receive prophylactic treatment for sexually transmitted diseases." b. provide written information about physical and emotional reactions the person may experience. c. explain the need and importance of infectious disease and pregnancy tests. d. give verbal information about legal resources in the community.

B All information given to a patient before he or she leaves the emergency department should be in writing. Patients who are anxious are unable to concentrate and therefore cannot retain much of what is verbally imparted. Written information can be read and referred to later. Patients may not be kept against their will or coerced into treatment. This constitutes false imprisonment.

An unconscious teenager is treated in the emergency department. The teenager's friends suspect a rape occurred at a party. Priority action by the nurse should focus on: a. preserving rape evidence. b. maintaining physiologic stability. c. determining what drugs were ingested. d. obtaining a description of the rape from a friend

B Because the patient is unconscious, the risk for airway obstruction is present. The nurse's priority will focus on maintaining physiologic stability. The distracters are of lower priority than preserving physiological functioning.

After an abduction and rape at gunpoint by an unknown assailant, which assessment finding best indicates that a patient is in the acute phase of the rape-trauma syndrome? a. Decreased motor activity c. Flashbacks and dreams b. Confusion and disbelief d. Fears and phobias

B Reactions of the acute phase of the rape-trauma syndrome are shock, emotional numbness, confusion, disbelief, restlessness, and agitated motor activity. Flashbacks, dreams, fears, and phobias are seen in the long-term reorganization phase of the rape-trauma syndrome. Decreased motor activity by itself is not indicative of any particular phase.

A nurse in the emergency department assesses an unresponsive victim of rape. The victim's friend reports, "That guy gave her salty water before he raped her." Which question is most important for the nurse to ask of the victim's friend? a. "Does the victim have any kidney disease?" b. "Has the victim consumed any alcohol?" c. "What time was she given salty water?" d. "Did you witness the rape?"

B Salty water is a slang/street name for GHB (g-hydroxy-butyric acid), a Schedule III central nervous system depressant associated with rape. Use of alcohol would produce an increased risk for respiratory depression. GHB has a duration of 1-12 hours, but the duration is less important that the potential for respiratory depression. Seeking evidence is less important than the victim's physiologic stability.

A family arrives at the emergency room with their injured child. After discrepant stories are given by the parents about the cause of the child's injuries, child abuse is suspected. Which diagnosis would be most appropriate for this family? a. Altered Family Processes b. Altered Family Coping c. Opportunity to Enhance Family Processes d. Risk for Altered Family Processes

B The most appropriate diagnosis for this family would be Altered Family Coping. Family coping refers to the family's patterns of interactions that have to do with its ability to provide sufficient and effective support, encouragement, or assistance to its members. When children are abused, it is related to a parent's inability to cope with the stressors he or she faces and consequently lashes out at the child.

The nurse caring for a client who was the victim of Intimate Partner Abuse (IPV) has identified the nursing diagnosis of "Ineffective Coping, related to a situational crisis secondary to ongoing cycle of violence, as evidenced by inability to ask for help." A possible outcome objective for this diagnosis would be which of the following? a. The client will state reasons her husband needed to hurt her. b. The client will verbalize her feelings, strengths, and needs. c. The client will state that she deserved to be battered. d. The client will not press charges against her husband.

B The most appropriate outcome for a nursing diagnosis of "Ineffective Coping, related to a situational crisis secondary to ongoing cycle of violence, as evidenced by inability to ask for help," is for the client to verbalize her feelings, strengths, and needs. The other outcomes do not demonstrate improvement in the client's thinking.

An inpatient client with a known history of violence suddenly begins to pace. Which client behavior should alert a nurse to escalating anger and aggression? A. The client requests prn medications. B. The client has a tense facial expression and body language. C. The client refuses to eat lunch. D. The client sits in group therapy with back to peers.

B The nurse should assess that tense facial expressions and body language may indicate that a client's anger is escalating. The nurse should conduct a thorough assessment of the client's past and current violent behaviors and develop interventions for de-escalation.

The nurse organized a staff meeting to address morale issues and improve the level of care on the unit. Which assessment practice is the nurse​ demonstrating? A.Interprofessional B.Intraprofessional C.Utilization review D.Benchmarking

B ​Rationale: Intraprofessional assessment occurs within a group of individuals who have similar positions within a healthcare​ system, such as a group of nurses or a group of surgeons. Such an assessment is important for identifying areas of improvement at each level of care. Interprofessional assessment would take place if a different units provided feedback. Benchmarking is comparing outcomes of two different departments. A utilization review looks at areas of​ misuse, overuse, or underuse of​ resource, not a moral issue.

To address client complaints of disrupted sleep due to noise on the​ floor, the nurse manager formed three teams who implemented various processes to reduce the noise. Another team is collecting sleep data from the clients and analyzing the effectiveness of the​ solution, based on which they intend to develop better methods and improve the facility. Which quality improvement process is the manager​ implementing? A.Performance improvement B.Six Sigma C.Benchmarking D.Continuous quality improvement

B ​Rationale: Six Sigma considers factors leading to client dissatisfaction as​ "defects." Disrupted sleep qualifies as a defect. Defect is not a concept used in continuous quality improvement or performance improvement. Benchmarking uses industry​ standards, which do not exist for disrupted sleep.

A clinic nurse interviews an adult patient who reports fatigue, back pain, headaches, and sleep disturbances. The patient seems tense and then becomes reluctant to provide more information and hurries to leave. How can the nurse best serve the patient? a. Explore the possibility of patient social isolation. b. Have the patient complete an abuse assessment screen. c. Ask whether the patient has ever had psychiatric counseling. d. Ask the patient to disrobe; then assess for signs of physical abuse.

B ~ In this situation, the nurse should consider the possibility that the patient is a victim of intimate partner violence. Although the patient is reluctant to discuss issues, she may be willing to fill out an abuse assessment screen, which would then open the door to discussion.

What feelings are most commonly experienced by nurses working with abusive families? a. Outrage toward the victim and sympathy for the abuser b. Sympathy for the victim and anger toward the abuser c. Unconcern for the victim and dislike for the abuser d. Vulnerability for self and empathy with the abuser

B ~ Intense protective feelings, sympathy for the victim, and anger and outrage toward the abuser are common emotions of a nurse working with an abusive family.

After treatment for a detached retina, a victim of intimate partner violence says, "My partner only abuses me when intoxicated. I've considered leaving, but I was brought up to believe you stay together, no matter what happens. I always get an apology, and I can tell my partner feels bad after hitting me." Which nursing diagnosis applies? a. Social isolation, related to lack of community support system b. Risk for injury, related to partners physical abuse when intoxicated c. Deficient knowledge, related to resources for escape from the abusive relationship d. Disabled family coping, related to uneven distribution of power within a relationship

B ~ Risk for injury is the priority diagnosis because the partner has already inflicted physical injury during violent episodes. The episodes are likely to become increasingly violent. Data are not present that show social isolation or disabled family coping, although both are common among victims of violence. Deficient knowledge does not apply to this patient's use of defense mechanisms.

Which rationale best explains why a nurse should be aware of personal feelings while working with a family experiencing family violence? a. Self-awareness protects one's own mental health. b. Strong negative feelings interfere with assessment and judgment. c. Strong positive feelings lead to underinvolvement with the victim. d. Positive feelings promote the development of sympathy for patients.

B ~ Strong negative feelings cloud the nurse's judgment and interfere with assessment and intervention, no matter how well the nurse tries to cover or deny personal feelings. Strong positive feelings lead to over-involvement with the victim.

A victim of physical abuse by an intimate partner is treated for a broken wrist. The patient has considered leaving but says, "You stay together, no matter what happens." Which outcome should be met before the patient leaves the emergency department? The patient will: a. limit contact with the abuser by obtaining a restraining order. b. name two community resources that can be contacted. c. demonstrate insight into the abusive relationship. d. facilitate counseling for the abuser.

B ~ The only outcome indicator clearly attainable within this time is for a staff member to provide the victim with information about community resources that can be contacted. The development of insight into the abusive relationship requires time. Securing a restraining order can be quickly accomplished but not while the patient is in the emergency department. Facilitating the abuser's counseling may require weeks or months.

The nurse is caring for a victim of rape who is indecisive about taking emergency contraception. The nurse understands that emergency contraception is more likely to be successful in which time frame following the attack? A) 1 month B) 3 days C) 10 days D) 7 days

B) 3 days Rationale: Emergency contraception is more likely to be successful within 3 days after the attack. After 3​ days, emergency contraception is not effective.

*Possible Exam Question* The nurse is preparing to provide instructions for a client who is prescribed treatment for the prevention of chlamydia following a sexual assault. Which prescription should the nurse anticipate? A) Penicillin B) Azithromycin C) Ceftriaxone D) Metronidazole

B) Azithromycin Rationale: Chlamydia can be treated with a single dose of azithromycin or a week of doxycycline. Penicillin is used to treat syphilis. Ceftriaxone is used for the treatment of gonorrhea. Metronidazole is used to treat trichomoniasis.

The nurse is teaching colleagues about the risk factors for sexual violence. Which community risk factor should the nurse include? A) Emotionally unsupportive family B) Lack of employment opportunities C) High levels of crime and other forms of violence D) Alcohol and drug abuse

B) Lack of employment opportunities Rationale: Lack of employment opportunities is a community risk factor for sexual violence. Alcohol and drug abuse is a personal risk factor. An emotionally unsupportive family is a relationship factor that increases the risk of sexual violence. High levels of crime and other forms of violence are societal risk factors.

*Possible exam question* The nurse is caring for a client who has a history of being physically and sexually abused as a child, and his father abandoned the family when he was 7. The nurse recognizes that this increases the client's risk of becoming a perpetrator of rape because of which type of risk factors? A) Individual B) Relationship C) Community D) Societal

B) Relationship Rationale: Relationship risk factors for perpetration include a family environment characterized by physical violence and conflict; a childhood history of physical, sexual, or emotional abuse; and poor parent-child relationships, particularly with fathers. Although the client may also have individual, community, or societal risk factors as well, the factors the nurse has identified here are relationship risk factors.

The nurse is teaching coping skills to clients who have experienced sexual trauma. Which of the following demonstrates that the teaching has been successful? (Select all that apply.) a. The client talks of the past more than the present. b. The client enjoys an intimate relationship with a significant other. c. The client restructures negative thoughts and makes positive self-statements. d. The client verbalizes feelings of anger and despair from past sexual abuse. e. The client practices deep breathing techniques when intrusive memories occur.

B, C, D, E The client who is able to enjoy an intimate relationship with a significant other is demonstrating the ability to relate to another; this is a barrier for those who have experienced sexual trauma.Verbalizing feelings of anger and despair from past sexual abuse allows the client explore these feelings before moving on to self-forgiveness and more complete healing. Practicing deep breathing techniques when intrusive memories occur is an effective stress management technique to self-soothe one's anxiety. Ability to restructure negative thoughts and make positive self-statements demonstrates a cognitive ability to monitor irrational thoughts and replace them with rational ones. Talking of the past more than the present indicates that the client is dwelling on past sexual abuse and is not able to move forward with life.

A client recovering from a rape tells the nurse that flashbacks do occur but can be managed. Which techniques should the nurse suggest to the client for managing flashbacks about the event? Select all that apply. A) Restoring personal choice B) Deep breathing C) Muscle relaxation D) Problem solving E) Guided imagery

B, C, E

A client recovering from a rape tells the nurse that flashbacks do occur but can be managed. Which techniques should the nurse suggest to the client for managing flashbacks about the event? SATA A) Restoring personal choice B) Deep breathing C) Muscle relaxation D) Problem solving E) Guided imagery

B, C, E Rationale: Techniques that the client can use to control flashbacks include muscle relaxation, deep breathing, and guided imagery. Problem solving and restoring personal choice are techniques to support coping behaviors.

A rape victim tells the emergency nurse, "I feel so dirty. Help me take a shower before I get examined." The nurse should: (select all that apply) a. arrange for the victim to shower. b. explain that bathing destroys evidence. c. give the victim a basin of water and towels. d. offer the victim a shower after evidence is collected. e. explain that bathing facilities are not available in the emergency department.

B, D As uncomfortable as the victim may be, she should not bathe until the examination is completed. Collection of evidence is critical for prosecution of the attacker. Showering after the examination will provide comfort to the victim. The distracters will result in destruction of evidence or are untrue.

The nurse is caring for a victim of rape. Which interventions should the nurse include in the client's plan of care? Select all that apply. A) Notifying an attorney for the client B) Supporting the victim during the examination C) Identifying the individual who committed the rape D) Treating acute injuries E) Providing referrals for follow-up care

B, D, E

*Possible Exam question* The nurse is preparing to perform a physical exam on a client who is the victim of rape. Which injury should the nurse identify as an indication of the client being restrained? SATA A) Broken fingers B) Bruising on ankles C) Internal injuries D) Bruising around the neck E) Burns on the wrist

B, D, E Rationale: Burns on the wrists and bruising around the ankles and neck are all indications that the client was restrained. Broken fingers and internal injuries may be defensive wounds or the result of physical attack.

The nurse is caring for a victim of rape. Which interventions should the nurse include in the client's plan of care? SATA A) Notifying an attorney for the client B) Supporting the victim during the examination C) Identifying the individual who committed the rape D) Treating acute injuries E) Providing referrals for follow-up care

B, D, E Rationale: Priorities of nursing care include treating any acute injuries, supporting the victim during the examination, and providing referrals for follow-up care. Nursing priorities do not include identifying the individual who committed the rape or notifying an attorney for the client.

The rehabilitation department is conducting an audit on the efficacy of a new treatment protocol by examining the client report and status upon discharge. Which type of audit is the department​ conducting? (Select all that​ apply.) A.Interprofessional assessment B.Concurrent audit C.Intraprofessional assessment D.Retrospective audit E.Utilization review

B,C ​Rationale: An audit is an examination of records to verify accuracy and proper use. If the audit is focused on one​ discipline, it is an intraprofessional assessment. If the audit is focused on multiple​ disciplines, it becomes an interprofessional assessment. A concurrent audit is performed while the client is still undergoing care at the healthcare facility. A retrospective audit is performed after a​ client's discharge. A utilization review analyzes the use of resources to identify areas of​ overuse, misuse, and underuse.

The nurse is responsible for continuous quality improvement at a rehabilitation hospital. Which internal client should the nurse interview for​ suggestions? (Select all that​ apply.) A.Parents of a child with spina bifida B.Clinical nurse specialist C.Head of Management of Information Systems D.Physical therapist E.Client after hip replacement

B,C,D Rationale: Internal clients are employees of the rehabilitation facility. They could be a physical​ therapist, the head of the MIS​ department, and a clinical nurse specialist. External clients include a client after hip replacement and parents of a child with spina bifida.

The nurse is discussing social determinants addressed by Healthy​ People/Healthy Communities. Which factor should the nurse​ include? (Select all that​ apply.) A.Exposure to toxic substances and other physical hazards B.Social norms and​ attitudes, such as discrimination C.Physical​ barriers, especially for people with disabilities D.Public safety E.Availability of resources to meet daily needs

B,D,E Rationale: Healthy​ People/Healthy Communities is another aim the U.S. Department of Health and Human Services​ (HHS) has developed to improve the health of the population. The​ aim's focus is to health. Examples of social determinants​ include, but, are not limited​ to: (1) availability of resources to meet daily​ needs, such as educational and job​ opportunities, living​ wages, or healthful​ foods; (2) social norms and​ attitudes, such as​ discrimination; (3) social support and social​ interactions; (4) socioeconomic​ conditions, such as concentrated​ poverty; (5) quality​ schools; (6) transportation​ options; and​ (7) public safety.

A female was sexually assaulted in the parking lot of a mall and was brought to the emergency department by a friend. Which of the following is improper procedure for conducting a sexual assault assessment? a. At the victim's request, the friend is present during the examination. b. The victim uses the bathroom and washes her hands before the examination begins. c. After obtaining permission, the nurse takes photographs of the victim's injuries. d. The nurse documents the victim's verbal and nonverbal behavior.

B. It is improper procedure for the victim to use the bathroom and wash her hands before the examination begins because valuable forensic evidence may be destroyed. The victim has the right to have friends or family present during the assessment. The victim must give permission before any photographs or other evidence is collected. Careful documentation of the victim's statements and behavior must be done to assist with possible prosecution of the perpetrator.

There are several biopsychosocial theories associated with the causation of rape and intrafamily abuse. However, the nurse knows that: a. The greatest predictor for family rape is the perpetrator's history of abuse as a child. b. None of the contributing factors consistently results in or is predictive of rape. c. Inability to control impulses is a consistent finding. d. Stranger rape has a sexual connotation, while the dynamics associated with family rape relate to power and control.

B. There is no consistent predictor of rape behaviors. Although genetic predisposition may make certain behaviors more likely, it does not make them inevitable. Controlling impulses is not a consistent finding. All rape is about power and control. Although some abused children grow up to become abusers, this factor is not the greatest predictor for family rape.

The nurse is conducting a teaching session at a community center for women about rape. The nurse would include that which individual is at highest risk for experiencing rape? a A 30-year-old married female who works out of the home b A student c A 50-year-old woman living alone who rides a bus to work d An older client in a long-term care facility

B. Studies show that the young, women who are unmarried, women who are unemployed or are from low income groups, and students have the highest incidence of sexual assault. Older women and women who work do not fit into this category.

The nurse is discussing the purpose of a just culture. Which information should the nurse include? Balancing quality with justice Balancing the blame-free environment with appropriate accountability Balancing discipline with accountability Balancing the blame-free environment with discipline

Balancing the blame-free environment with appropriate accountability A just culture attempts to balance a blame-free environment with appropriate accountability by focusing on correcting problems that lead individuals to engage in unsafe behavior while maintaining individual accountability by establishing zero tolerance for reckless behavior. A just culture differentiates among human error, at risk behavior, and reckless behavior in contrast to the no-blame approach of the no-blame environment.

A client who was raped tells the nurse that she must not get pregnant. Which response by the nurse is appropriate? A) "The baby could always be given up for adoption." B) "You will not know for sure for at least a few more days." C) "Emergency contraception is available to prevent pregnancy." D) "Are you sure the rapist did not use a condom?"

C

The nurse is caring for a rape victim in the emergency department. Which term describes a psychologic element of rape? Anxiety Perceived danger Berating Distress

Berating The psychologic elements of rape include berating the victim. Anxiety, perceived danger, and distress are consequences of the psychologic element of rape.

A newly hired nurse made a medication error in her first week on the job. The nurse soon learned that her facility had a strong policy in which errors or near misses could be reported without the fear of punishment. Which concept supports this attitude toward​ mistakes? Responsibility ​Blame-free environment Just culture Accountability

Blame-free environment Learning Objective Describe the process of quality improvement. Rationale In a​ blame-free environment, errors or near misses can be reported without fear of punishment. Just culture balances accountability with correcting system problems. Responsibility and accountability both call for admitting​ mistakes, but without guarantees of how they will be handled.

The nurse is part of a Continuous Quality Improvement (CQI) team measuring the number of times a patient's blood pressure is incorrect due to a defect. Which defect should the nurse and team define in such a situation? Blood pressure is taken on the nondominant arm. Blood pressure is taken with the wrong size cuff. Blood pressure is taken when the patient is seated. Blood pressure is taken with the patient's legs uncrossed.

Blood pressure is taken with the wrong size cuff. A defect is defined as anything that could lead to patient dissatisfaction. Defects in health care can range from the wrong-size gown to a major problem such as an amputation performed on the wrong limb. In the case outlined, only using a too large or small cuff would cause an incorrect blood pressure reading. Blood pressure defects are not related to dominant or nondominant arm. Being seated with the patient's arm at their side gives the most accurate reading. Patients should not have their legs crossed.

The nurse at a prenatal clinic listens as a 17-year-old pregnant patient talks about her boyfriend. The patient states, "He beat up his ex-wife a lot of times, but so far, he hasn't done more than yell at me." Which feature of the situation is evidence that the young woman is at high risk of violence? Boyfriend's previous behavior Patient's conversation with the nurse Patient's age Boyfriend's divorce

Boyfriend's previous behavior The boyfriend's previous behavior makes this a high-risk situation for violence. Neither the patient's disclosure or age nor the boyfriend's marital status increases the risk for domestic violence.

A client, who was raped and refuses to see any male healthcare providers, tells the nurse that she had an "incident" that she does not want to talk about, and wants a bed by the door. Which nursing diagnosis is appropriate for the client? A) Relocation Stress Syndrome B) Readiness for Enhanced Power C) Rape-Trauma Syndrome D) Acute Confusion

C

The nurse failed to give a medication to a patient at the right time. Which type of scenario should the nurse understand this demonstrate? Standards of care Risk management Breach of care Sentinel event

Breach of care A breach of care occurs when a nurse deviates from the standard of care. This occurs when the nurse does something that should not have been done or does not do something that should have been done. Standard of care can be defined as the amount of care that a reasonable person would have exercised in the same circumstances. Risk management is the process in which vulnerabilities are identified and changes are made to minimize the consequences of adverse patient outcomes and liabilities. A sentinel event is an unexpected occurrence involving death or physical or psychologic injury, or risk thereof.

The nurse is assessing a pediatric patient in the clinic during a well-child visit. Which manifestation should prompt the nurse to ensure the child's safety at home? Bruises in different stages of healing Cupping Coining A soft-spoken and shy demeanor

Bruises in different stages of healing The first priority for a nurse dealing with a child victim of violence is to ensure the safety of the child. The nurse should follow institution policy about reporting suspected abuse. Cupping is the act of placing a glass cup on the skin and then using heat to create suction; often this is performed to promote blood flow and overall healing. Coin rubbing is used to treat a multitude of ailments, from headaches and fevers to minor illnesses, but it also leaves marks on the skin. Neither of these treatments is abusive in nature; they are considered a form of healing. Being soft-spoken and shy alone does not indicate abuse because this may be the child's natural personality. The accompanying image shows bruises in multiple stages of healing, a finding that prompts the nurse to ensure the child's safety at home.

The nurse is providing care for a 2-year-old client. When assessing the client's risk for abuse, which factors increase this client's risk? Select all that apply. A) The child has bruises on the knees and shins. B) The child's parents are married. C) The child is less than 3 years old. D) The child is deaf. E) The child's parents are unemployed and receive medical assistance.

C, D, E

A nurse is assessing a survivor of intimate partner violence. During the interview, the nurse determines that the survivor's partner is using power and control over the client through coercion and threats. Which client statement would lead the nurse to suspect this? A) "He always tells me that the abuse never happened." B) "He tells me who I can and cannot see." C) "He tells me that he'll tell child services I'm a bad mother." D) "He acts like he's the master of his castle and I'm his servant."

C

A pediatric nurse is caring for an 8-month-old client. While making rounds, the nurse enters the room and finds the infant's father violently shaking the infant. The father attempts to make it appear as though the infant was choking. Upon further assessment, the nurse notes bruised areas on the infant's arms and legs. What is a priority action for the nurse to take? A) Discuss what the nurse witnessed with the infant's mother. B) Discuss what the nurse witnessed with the other nurses. C) Report what the nurse witnessed and assessed to the authorities. D) Call security to remove the father from the room.

C

A rape victim is being seen in the clinic. Upon assessment it is discovered the client has contracted trichomoniasis. Which prescription does the nurse anticipate for this client? A) Penicillin B) Ceftriaxone and azithromycin C) Metronidazole D) Doxycycline

C

The nurse is completing a morning assessment on an older adult Asian client. Assessment findings reveal circular red welts over the client's upper back with several bruised areas. Which nursing action is the most appropriate? A) Contact adult protective services. B) Call the healthcare provider immediately. C) Assess the client's cultural traditions. D) Contact the client's family.

C

The nurse is preparing to teach a class about date rape to a group of college-age students. When discussing date rape drugs, which method of prevention should the nurse include in her presentation? A) Never leave a location with a friend. B) Only accept premade drinks from someone you know. C) Never leave your drink unattended. D) Only consume drinks handed to you directly by the bartender or a waitress.

C

Which of the following is a common element of abuse experienced by the victim? A) Accidental injury B) Feelings of control C) Humiliation D) Manipulation

C

A rape victim visited a rape crisis counselor weekly for 8 weeks. At the end of this counseling period, which comment by the victim best demonstrates that reorganization was successful? a. "I have a rash on my buttocks. It itches all the time." b. "Now I know what I did that triggered the attack on me." c. "I'm sleeping better although I still have an occasional nightmare." d. "I have lost 8 pounds since the attack, but I needed to lose some weight."

C Rape-trauma syndrome is a variant of posttraumatic stress disorder. The absence of signs and symptoms of posttraumatic stress disorder suggest that the long-term reorganization phase was successfully completed. The victim's sleep has stabilized; occasional nightmares occur, even in reorganization. The distracters suggest somatic symptoms, appetite disturbances, and self-blame, all of which are indicators that the process is ongoing.

Which nursing diagnosis is the child likely to experience if the child is not successfully treated for psychological problems after physical or sexual abuse or neglect? a. Agitation, related to anxiety b. Depression, related to fear c. Post-trauma Response d. Post-traumatic Stress Disorder

C A child who has not been successfully treated for psychological problems after physical or sexual abuse or neglect will most likely be given a diagnosis of post-trauma response.

Which of the following behaviors would first alert the school nurse or teacher to suspect sexual abuse in a 7-year-old child? A) Extreme friendliness to peers B) Learning problems and shyness C) Telling sexually explicit stories to peers D) Withdrawn behavior and enuresis

C Feedback: Children who have sexual knowledge not expected at their age have often been sexually abused.

While making a home visit, a community health nurse sees evidence that the child of a patient has been abused. What rationale should be the basis for the nurse's nursing action? a. Privileged patient communication prevents the nurse from reporting the abuse. b. Documenting the evidence in the medical record supports the observation. c. A federal ruling requires that the nurse report the suspected abuse. d. A signed patient release is needed before action can be taken.

C Nurses are mandated reporters of suspected child abuse. To report or not is not discretionary.

The nurse uses a checklist to look at the completeness of documentation of postsurgical pain relief for clients discharged after a specific surgical procedure. Which term best describes the​ nurse's activity of this review​ process? A.Root cause analysis B.Utilization review C.Retrospective audit D.Concurrent audit

C Rationale: The nurse is conducting a retrospective audit by looking back in time. A retrospective audit compares care provided to clients with similar​ conditions, and recommendations are made to change procedures if needed. A concurrent audit takes place when clients are still hospitalized. Utilization review looks at the use of​ resources, not documentation. A root cause analysis is triggered by a sentinel​ event, rather than by routine client care documentation.

A nurse is examining a 75-year-old woman and finds evidence of ongoing physical abuse. Upon asking, the woman reveals that her 75-year-old husband hits her on occasion. The woman asks the nurse not to disclose this information to the police. The nurse understands that: a. in any case of abuse, the nurse is required to disclose the information to the police, regardless of the client's wishes b. the nurse is free to use her own judgment as to whether or not she should inform the police c. because this is a case of elderly abuse, the nurse is required to disclose the information to the police regardless of the client's wishes d. because the abuser is the client's husband, it is not considered a case of elderly abuse; therefore the nurse cannot disclose the information to the police against the client's wishes

C The nurse is required by law to report all cases of suspected elder abuse to the proper authorities. The nurse is also obligated to report cases of child abuse.

A visiting nurse notices bruises on an elderly client's face and legs. When she questions the client about the bruises, the client is very evasive. The nurse suspects that the client has been a victim of elder abuse. What should the nurse do next? a. Call protective services to report the suspected elder abuse. b. Confront the client's caregiver and threaten to notify the police. c. Continue questioning the client to assess the degree of abuse. d. Return in 2 weeks to reassess the client's condition.

C The nurse should continue to question the client to further assess the situation. If elder abuse is confirmed, the nurse should then contact the protective services.

The client satisfaction rate is at​ 60% for two consecutive​ months, and staff morale is at its lowest. The nurse manager decides to plan changes that will improve conditions on the unit. Which should be the priority​ action? A.Ignoring the issues since these will be resolved naturally B.Seeking help from another manager C.Calling for a staff meeting placing this issue on the agenda D.Developing a strategic action on how to deal with these concerns

C ​Rationale: Calling for a staff meeting to address the issue will allow for the participation of every staff member in the unit. If they contribute to the solutions of the​ problem, they will own the​ solutions; hence the chance for compliance would be greater. Ignoring the issue with a perception that these will be naturally resolved is not a correct approach. Developing strategic action on dealing with these concerns and seeking help from his manager will be the next​ steps, or can wait for some time at this juncture.

The nurse manager is proactive when conducting risk management for a unit. Which key factor of risk management should be the​ nurse's primary​ concern? A.Client communication B.Affordable care C.Client satisfaction D.Proper care and treatments

C ​Rationale: Client satisfaction is a key factor in risk management because a dissatisfied client presents a higher risk for liability than a satisfied​ client, which should be the concern for a manager. A nurse who becomes aware of client dissatisfaction should take steps to communicate with the client to clarify​ misunderstandings, advocate for the client to receive better​ care, and notify a supervisor about potential problems. Client​ communication, proper care and​ treatment, and affordable care are the concerns of the healthcare providers and respective departments.

The nurse is reviewing yearly national patient safety goals. For which organization is the nurse retrieving this​ information? A.The Food and Drug Association B.The American Medical Association C.The Joint Commission D.Institute for Safe Medical Practices

C ​Rationale: The Joint Commission is the organization that identifies client safety goals every year for medical facilities to focus on. The goals​ include, but are not limited​ to, ensuring clients are identified​ safely, improving staff​ communication, using alarms​ safely, and preventing infections. The American Medical Association​ (AMA) promotes the betterment of public health by enhancing the delivery of care and enabling physicians and healthcare teams to partner with clients to achieve better health. The Institute for Safe Medication Practice​ (ISMP) maintains a list of high alert medications such as​ look-alike, sound-alike medications to assist clinicians with identifying medications that can either look similar or have similar​ names, but that have very different chemical properties that can cause harm to the client if the medications are mixed up. The Food and Drug Administration​ (FDA) is responsible for advancing the public health by helping to speed innovations that make medical products more​ effective, safer, and more affordable and by helping the public get the​ accurate, science-based information they need to use medical products and foods to maintain and improve their health.

An 11-year-old child is absent from school to care for siblings while the parents work. The family cannot afford a babysitter. When asked about the parents, the child reluctantly says, "My parents don't like me. They call me stupid and say I never do anything right." Which type of abuse is likely? a. Sexual b. Physical c. Emotional d. Economic

C ~ Examples of emotional abuse include having an adult demean a child's worth or frequently criticize or belittle a child. No data support physical battering or endangerment, sexual abuse, or economic abuse.

Several children are seen in the emergency department for treatment of illnesses and injuries. Which finding would create a high index of suspicion for child abuse? The child who has: a. repeated middle ear infections. b. severe colic. c. bite marks. d. croup.

C ~ Injuries such as immersion or cigarette burns, facial fractures, whiplash, bite marks, traumatic injuries, bruises, and fractures in various stages of healing suggest the possibility of abuse. In older children, vague complaints such as back pain may also be suspicious. Ear infections, colic, and croup are not problems induced by violence.

An adult has recently been absent from work for 3-day periods on several occasions. Each time, this person returns to work wearing dark glasses. Facial and body bruises are apparent. What is the occupational health nurse's priority question? a. Do you drink excessively? b. Did your partner beat you? c. How did this happen to you? d. What did you do to deserve this?

C ~ Obtaining the person's explanation is necessary. If the explanation does not match the injuries or if the victim minimizes the injuries, abuse should be suspected.

An older adult diagnosed with dementia lives with family and attends a day care center. A nurse at the day care center notices the adult has a disheveled appearance, a strong odor of urine, and bruises on the limbs and back. What type of abuse might be occurring? a. Psychological b. Financial c. Physical d. Sexual

C ~ The assessment of physical abuse is supported by the nurse's observation of bruises. Physical abuse includes evidence of improper care, as well as physical endangerment behaviors such as reckless behavior toward a vulnerable person that could lead to serious injury. No data substantiate the other options.

The nurse is discussing protective risk factors for the perpetration of sexual violence with colleagues. Which statement by a colleague indicates an understanding of this information? A) "Optimal physical health decreases the risk of sexual violence." B) "Participation in community crime watch is a protective factor from sexual violence." C) "An individual's empathy and concern for others is a protective factor for perpetration." D) "Exposure to sexually explicit material creates an awareness of sexual predators."

C) "An individual's empathy and concern for others is a protective factor for perpetration." Rationale: Having empathetic deficits is a characteristic of a sexual perpetrator.​ Therefore, an​ individual's empathy and concern for others is a protective factor for perpetration. Optimal physical health and participation in community crime watch are not protective factors for perpetration. Exposure to sexually explicit material is a risk factor for perpetration.

A client who was raped tells the nurse that she must not get pregnant. Which response by the nurse is appropriate? A) "The baby could always be given up for adoption." B) "You will not know for sure for at least a few more days." C) "Emergency contraception is available to prevent pregnancy." D) "Are you sure the rapist didn't use a condom?"

C) "Emergency contraception is available to prevent pregnancy." Rationale: Female rape victims may request information about emergency contraception if the attacker did not use a condom. The nurse should not tell the client that it will be a few more days to know for sure if she is pregnant. The nurse should not question whether the rapist used a condom. The client does not want to get pregnant. The nurse should not talk about giving a baby up for adoption at this time.

The ER nurse is preparing to discharge a client who was raped. Which client statement indicates a need for additional teaching prior to discharge? A) "My mom is coming to stay with me for a few weeks." B) "I have an appointment to get my stitches removed in 1 week." C) "I don't need to go to the counselor-I feel fine." D) "I live alone and will get my locks changed before I return."

C) "I don't need to go to the counselor-I feel fine." Rationale: Denial of the possibility of needing to speak with a counselor indicates the client requires additional teaching. Staying with family or​ friends, changing the​ locks, and getting​ follow-up care indicate that the client understands the teaching that was presented.

A rape victim is being seen in the clinic. Upon assessment it's discovered the client has contracted trichomoniasis. Which prescription does the nurse anticipate for this client? A) Penicillin B) Ceftriaxone and azithromycin C) Metronidazole D) Doxycycline

C) Metronidazole Rationale: Trichomoniasis is treated with metronidazole or tinidazole. Syphilis is treated with penicillin. Gonorrhea is treated with a combination of ceftriaxone and azithromycin. Chlamydia is treated with doxycycline.

A client who was raped and refuses to see any male HCPs tells the nurse that she had an "incident" that she doesn't want to talk about, and wants a bed by the door. Which nursing diagnosis is appropriate for the client? A) Relocation Stress Syndrome B) Readiness for Enhanced Power C) Rape-Trauma Syndrome D) Acute Confusion

C) Rape-Trauma Syndrome Rationale: Rape-Trauma Syndrome can manifest itself in many ways depending on the client. Some clients, such as this one, exhibit fear, especially of individuals of the same gender as the attacker. Clients may also exhibit humiliation, shame, and distrust in others. This client is not displaying evidence of readiness for enhanced power. There is no evidence that the client is experiencing relocation stress syndrome or acute confusion.

The nurse is assisting with the initial exam for a vicitim of rape. Which action should the nurse perform when assisting with the collection of evidence during the exam? SATA A) Drawing blood for an electrolyte panel B) Drawing blood for a CBC C) Examining the client's vagina, anus, and throat D) Collecting skin scrapings from fingernails E) Collecting the client's clothing

C, D, E Rationale: During the initial physical examination for a client who is the victim of a​ rape, the nurse assists in collecting the clothes the client was wearing when the attack occurred and skin scrapings from the​ fingernails, as well as examining and swabbing the​ vagina, anus, and throat. An electrolyte panel and CBC are diagnostic tools but are not used for collecting evidence during the initial examination.

According to systems theory, families in which sexual abuse occurs, are characterized by: a. Consistent equality within their structure and roles. b. High expressed emotion. c. Fluid boundaries. d. Openness with nonfamily members.

C. In a family with fluid boundaries, an adult may move down in the structure or the child may move up in terms of roles and influence (boundaries). If the father moves downward, he assumes a childlike role and is cared for and nurtured like a child in the family. In this position, the father assumes little parental responsibility. He may then turn to a child as a peer for sexual gratification. Openness with nonfamily members does not affect this process. Consistent equality within their structure and roles is a healthy response. This phenomenon has little to do with expressed emotion.

The client satisfaction rate is at​ 60% for two consecutive​ months, and staff morale is at its lowest. The nurse manager decides to plan changes that will improve conditions on the unit. Which should be the priority​ action? Ignoring the issues since these will be resolved naturally Calling for a staff meeting placing this issue on the agenda Developing a strategic action on how to deal with these concerns Seeking help from another manager

Calling for a staff meeting placing this issue on the agenda Calling for a staff meeting to address the issue will allow for the participation of every staff member in the unit. If they contribute to the solutions of the​ problem, they will own the​ solutions; hence the chance for compliance would be greater. Ignoring the issue with a perception that these will be naturally resolved is not a correct approach. Developing strategic action on dealing with these concerns and seeking help from his manager will be the next​ steps, or can wait for some time at this juncture.

The nurse is caring for a victim of rape in the emergency department. Which action should not be included in the nursing plan of care? Calling the police Providing safety for the patient Assessing for wounds Offering counseling services

Calling the police The police are not called unless requested by the victim. Providing safety for the patient prior to the assessment, assessing the wounds, and offering counseling services are part of the nursing care of the patient.

A nurse on the quality improvement committee understands that the step of quality improvement which analyzes current protocols of care and their associated outcomes includes all except: An individual, unit, or facility must understand their baseline performance records. Can be used to discover areas for improvement and to analyze areas of excellence. Performance can be assessed on an intradisciplinary level or an interdisciplinary level. Peer review

Can be used to discover areas for improvement and to analyze areas of excellence.

A nurse on the quality improvement committee understands that the step of quality improvement which analyzes current protocols of care and their associated outcomes includes all except: An individual, unit, or facility must understand their baseline performance records. Can be used to discover areas for improvement and to analyze areas of excellence. Performance can be assessed on an intradisciplinary level or an interdisciplinary level. Peer review

Can be used to discover areas for improvement and to analyze areas of excellence. Rationale: Quality improvement is a continuous multi-step, multi-level process that identifies areas for improvement based on performance and industry standards. One step in quality improvement involves analyzing current protocols of care and their associated outcomes. This includes: an individual, unit, or facility must understand their baseline performance records; performance can be assessed on an intradisciplinary level or an interdisciplinary level; this includes peer review. Outcomes management, another step of quality improvement, can be used to discover areas for improvement and to analyze areas of excellence. Nursing Process: Evaluation Client Need: Safe, Effective Care Environment Cognitive Level: Applying

The nurse is explaining the meaning of equitable care. Which explanation should the nurse include? Care that does not vary in quality because of personal characteristics Care that is respectful of and responsive to individual patient preferences, needs, and values Reducing wait times that may result in harmful delays for those who receive and give care Avoiding injuries to patients from the care that is intended to help them

Care that does not vary in quality because of personal characteristics Equitable care is defined as providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, or geographic location. Patient-centered care is described as providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring patient values guide all clinical decisions. Efficient care involves decreasing wait times and avoiding waste, including waste of equipment, supplies, ideas, and energy. Safety is guided by avoiding injuries to the patients in the nurse's care.

The nurse manager is proactive when conducting risk management for a unit. Which key factor of risk management should be the​ nurse's primary​ concern? Client satisfaction Proper care and treatments Affordable care Client communication

Client satisfaction Client satisfaction is a key factor in risk management because a dissatisfied client presents a higher risk for liability than a satisfied​ client, which should be the concern for a manager. A nurse who becomes aware of client dissatisfaction should take steps to communicate with the client to clarify​ misunderstandings, advocate for the client to receive better​ care, and notify a supervisor about potential problems. Client​ communication, proper care and​ treatment, and affordable care are the concerns of the healthcare providers and respective departments.

The nurse is discharging a client who has had an organ transplant. To accurately summarize the client​'s complex​ treatments, the nurse is carefully entering data into an electronic health record​ (EHR). How does that activity affect continuity of​ care? The EHR documents actions at the point of care. Clinical information is available to collaborating healthcare providers. The software will scan for grammatical errors. The nurse follows guidelines encouraging use of EHRs.

Clinical information is available to collaborating healthcare providers. Learning Objective Discuss the role of quality improvement initiatives in health care. Rationale Entering data into an EHR makes clinical information available to collaborators. It is not important that the software corrects grammatical errors. The EHR documents actions at the point of care.​ However, it is the availability of that information to others that affects the continuity of​ care, not its being recorded. Support for continuity of care is one​ reason, but not the only​ one, for encouraging the use of EHRs.

Continuous Quality Improvement​ (CQI) is a​ client-driven process. In a rehabilitation​ facility, which individuals are examples of internal clients who drive the CQI​ process? ​(Select all that​ apply.) Clinical nurse specialist Client after hip replacement Head of Management of Information Systems​ (MIS) department Physical therapist Parents of a child with spina bifida

Clinical nurse specialist Client after hip replacement Physical therapist Learning Objective Compare the components of various quality management programs. Rationale Internal clients are employees of the rehabilitation facility. They could be a physical​ therapist, the head of the MIS​ department, and a clinical nurse specialist. External clients include a client after hip​ replacement, and parents of a child with spina bifida.

The nurse is caring for an older patient who is experiencing posttraumatic stress disorder (PTSD) after being raped. Which collaborative intervention should the nurse include in the plan of care? Follow-up care for physical trauma Cognitive-behavioral therapy Collection of specimens to use as evidence Medications for headaches and nausea

Cognitive-behavioral therapy Cognitive-behavioral therapy is a clinical therapy used to treat patients experiencing PTSD. Follow-up care for physical trauma, collection of specimens to use for evidence, and medications for treatment of somatic symptoms such as headaches and nausea are clinical therapies for the acute phase of rape-trauma syndrome.

The nurse chairs a committee tasked with improving the number of hospital-acquired infections and is asked for a definition of "benchmarking." Which response should the nurse give? Minimum starting point used for comparisons Comparison of the performance of an individual or organization to industry standards Process to identify vulnerabilities within an organization Analysis used to prevent certain events from repeating

Comparison of the performance of an individual or organization to industry standards Benchmarking is a process used to compare the performance of an individual or organization to industry standards. It uses indicators, or statistics, of an organization's performance in a specific area, to use in a comparison to industry standards. The indicators or statistics are a baseline or a starting point for improvement. Risk management is the process by which an organization looks into vulnerable areas and makes changes to improve outcomes and avoid making repeated mistakes.

The mental health nurse enjoys working at a community health center​ (CHC). Part of the nurse​'s satisfaction comes from helping provide the required services for CHC facilities. Which services are​ required? ​On-site pharmacy Comprehensive primary care Emergency Department​ (ED) Chemotherapy

Comprehensive primary care Learning Objective Discuss the role of quality improvement initiatives in health care. Rationale The regulations for CHCs require that they provide comprehensive primary care. They are not required to have an​ ED, offer​ chemotherapy, or stock an​ on-site pharmacy.

The rehabilitation department is conducting an audit on the efficacy of a new treatment protocol by examining the client report and status upon discharge. Which type of audit is the department​ conducting? (Select all that​ apply.) Interprofessional assessment Concurrent audit Intraprofessional assessment Utilization review Retrospective audit

Concurrent audit Intraprofessional assessment An audit is an examination of records to verify accuracy and proper use. If the audit is focused on one​ discipline, it is an intraprofessional assessment. If the audit is focused on multiple​ disciplines, it becomes an interprofessional assessment. A concurrent audit is performed while the client is still undergoing care at the healthcare facility. A retrospective audit is performed after a​ client's discharge. A utilization review analyzes the use of resources to identify areas of​ overuse, misuse, and underuse.

A child is admitted to the hospital unit with physical injuries. The nurse is taking the child's history. Which statement by the parent would arouse suspicion of abuse? 1. "I did not realize that my baby was able to roll over yet, and I was just gone a minute to check on dinner when the baby rolled off of the couch and onto our tile floor." 2. "The baby's 18-month-old brother was trying to pull the baby out of the crib and dropped the baby on the floor." 3. "I placed the baby in the infant swing. His 6-year-old brother was running through the house and tripped over the swing, causing it to fall." 4. "I was walking up the steps and slipped on the ice, falling while carrying my baby."

Correct Answer: 2 All of the statements made by the parent are plausible from a developmental perspective except the statement "The baby's 18-month-old brother was trying to pull the baby out of the crib and dropped the baby on the floor." Developmentally, it would be very difficult for an 18-month-old child to pull an infant out of a crib.

The nurse is answering questions at the community center about childhood sexual abuse. When asked which child is at greater risk for violence, the nurse responds: A) The male child. B) The firstborn child. C) The child who has a stepfather. D) The child with a physical disability.

D

A rape victim tells the nurse, "I should not have been out on the street alone." Select the nurse's most therapeutic response. a. "Rape can happen anywhere." b. "Blaming yourself increases your anxiety and discomfort." c. "You are right. You should not have been alone on the street at night." d. "You feel as though this would not have happened if you had not been alone."

D A reflective communication technique is most helpful. Looking at one's role in the event serves to explain events that the victim would otherwise find incomprehensible. The distracters discount the victim's perceived role and interfere with further discussion.

A woman was found confused and disoriented after being abducted and raped at gunpoint by an unknown assailant. The emergency department nurse makes these observations about the woman: talking rapidly in disjointed phrases, unable to concentrate, indecisive when asked to make simple decisions. What is the woman's level of anxiety? a. Weak c. Moderate b. Mild d. Severe

D Acute anxiety results from the personal threat to the victim's safety and security. In this case, the patient's symptoms of rapid, dissociated speech, inability to concentrate, and indecisiveness indicate severe anxiety. Weak is not a level of anxiety. Mild and moderate levels of anxiety would allow the patient to function at a higher level.

The nursing diagnosis Rape-trauma syndrome applies to a rape victim in the emergency department. Select the most appropriate outcome to achieve before discharging the patient. a. The memory of the rape will be less vivid and less frightening. b. The patient is able to describe feelings of safety and relaxation. c. Symptoms of pain, discomfort, and anxiety are no longer present. d. The patient agrees to a follow-up appointment with a rape victim advocate.

D Agreeing to keep a follow-up appointment is a realistic short-term outcome. The victim is in the acute phase; the distracters are unlikely to be achieved during the limited time the victim is in an emergency department.

The nurse at a university health center leads a dialogue with female freshmen about rape and sexual assault. One student says, "If I avoid strangers or situations where I am alone outside at night, I'll be safe from sexual attacks." Choose the nurse's best response. a. "Your plan is not adequate. You could still be raped or sexually assaulted." b. "I am glad you have this excellent safety plan. Would others like to comment?" c. "It's better to walk with someone or call security when you enter or leave a building." d. "Sexual assaults are more often perpetrated by acquaintances. Let's discuss ways to prevent that."

D Females know their offenders in almost 70% of all violent crimes committed against them, including rape. The nurse should share this information along with encouraging discussion of safety measures. The distracters fail to provide adequate information or encourage discussion.

Before a victim of sexual assault is discharged from the emergency department, the nurse should: a. notify the victim's family to provide emotional support. b. offer to stay with the patient until stability is regained. c. advise the patient to try not to think about the assault. d. provide referral information verbally and in writing.

D Immediately after the assault, rape victims are often disorganized and unable to think well or remember instructions. Written information acknowledges this fact and provides a solution. The distracters violate the patient's right to privacy, evidence a rescue fantasy, and offer a platitude that is neither therapeutic nor effective.

A nurse cares for a rape victim who was given a drink that contained flunitrazepam (Rohypnol) by an assailant. Which intervention has priority? Monitoring for: a. coma. c. hypotonia. b. seizures. d. respiratory depression.

D Monitoring for respiratory depression takes priority over hypotonia, seizures, or coma.

. A nurse interviews a patient abducted and raped at gunpoint by an unknown assailant. The patient says, "I can't talk about it. Nothing happened. I have to forget." What is the patient's present coping strategy? a. Compensation c. Projection b. Somatization d. Denial

D The patient's statements reflect use of denial, an ego defense mechanism. This mechanism may be used unconsciously to protect the person from the emotionally overwhelming reality of the rape. The patient's statements do not reflect somatization, compensation, or projection.

An older adult patient exhibits bilateral bruising for the second time on both upper outer arms. When the nurse questions the patient about the bruising, the patient starts to cry and pleads, "Please don't say anything. It's not my daughter's fault. I just bruise easily.". Which intervention reflects the best management of this situation? a. Calling the daughter to discuss both the bruising and her parent's reaction b. Reporting the elder abuse and informing the patient and the daughter of the action c. Notifying the patient's social worker of the bruising after a complete assessment has been completed d. Informing the patient and the daughter of the nurse's obligation to document the bruising and report the findings to protective services

D Although it is often difficult to differentiate elder abuse, bilateral bruising on the upper outer arms is a definitive sign. The nurse is responsible for reporting such findings and continuing vigilant observation for further signs of elder abuse and neglect. It is usually best to inform the family of your intention to report elder abuse with the expressed purpose of obtaining help for both; this makes protective services less threatening and preserves the nurse's therapeutic alliance.

The family of a suicidal client is very supportive and requests more facts related to caring for their family member after discharge. Which information should the nurse provide? A. Address only serious suicide threats to avoid the possibility of secondary gain. B. Promote trust by verbalizing a promise to keep suicide attempt information within the family. C. Offer a private environment to provide needed time alone at least once a day. D. Be available to actively listen, support, and accept feelings.

D Being available to actively listen, support, and accept feelings increases the potential that a client would confide suicidal ideations to family members.

A nurse working in an home health agency, which provides services to elderly client, would understand that which client is MOST at risk for possible elder abuse? a. a 66-year-old woman who lives with her son and experiences poor mobility b. a 72-year-old woman who lives alone and has no income except for Social Security c. a 75-year-old man who lives alone and has a good income from investments in the stock market d. an 83-year-old woman who livers with her daughter and has no income except for Social Security

D Research has shown that individuals over 80 years old are at greatest risk for elder abuse. This situation compounded with the fact that her only income is Social Security places her in a dependent position.

A suicidal client says to a nurse, "There's nothing to live for anymore." Which is the most appropriate nursing reply? A. "Why don't you consider doing volunteer work in a homeless shelter?" B. "Let's discuss the negative aspects of your life." C. "Things will look better in the morning." D. "It sounds like you are feeling pretty hopeless."

D This statement verbalizes the client's implied feelings and allows him or her to validate and explore them.

A patient who was abused as a child tells a nurse of the abuse in a stilted, unemotional manner. Which intervention would encourage the patient to examine feelings associated with childhood abuse? a. "You poor thing! I feel deeply sorry for what you endured.". b. "When you described this relationship, you didn't tell me how you felt.". c. "You must be feeling so angry with your parents that you'd like to harm them.". d. "If I experienced that as a child, I would feel betrayed, confused, and frightened.".

D When patients have difficulty describing feelings, the nurse can use the technique of verbalizing how he or she might have felt in the same situation. This demonstrates the nurse's empathy for the patient.

The nruse is preparing to swab a client for a DNA analysis after a sexual assault. Which is a priority in nursing action? A) Ensure all evidence obtained is placed in a single designated envelope B) Obtain cultures for STIs and administer emergency contraception C) Initiate prophylactic treatment for STIs D) Inquire about any consensual sexual relations over the past 5 days

D) Inquire about any consensual sexual relations over the past 5 days Rationale: The priority nursing action when preparing to swab a client for DNA analysis after a sexual assault is to inquire about any consensual sexual relations over the past 5 days. It is important to be able to differentiate the perpetrator from a consensual partner. Cultures for sexually transmitted infections will be obtained prior to prophylactic treatment. Emergency contraception can be administered within 3 days of the attack. Each piece of evidence obtained is placed in its own special envelope with the same rape kit number.

The nurse is discussing the purpose of utilization review with colleagues. Which statement should the nurse​ include? A.Contacting the insurance company to facilitate payment for services B.Working with a social worker to make sure the​ client's family has resources for care C.Working with members of the interdisciplinary team to provide comprehensive care for the client D.Ensuring that the​ client's medications and treatments are appropriate for his or her diagnosis

D ​Rationale: The utilization review​ nurse's role is designed to ensure that a client is receiving the necessary treatments and procedures for his or her condition without undergoing any unnecessary therapies. By reviewing these​ terms, the utilization review nurse saves the healthcare center money by avoiding payments on expensive treatments that are unwarranted. The​ nurse's role also saves the client from undergoing possibly painful and expensive tests and procedures that are not needed. All the other options are not a part of the utilization review process.

A hospital administrator wants to improve quality care and workflow process within the organization by involving the whole​ organization, suppliers, and customers in the process. Which quality management program should the nurse understand the manager is​ using? A.Lean Six Sigma B.Six Sigma C.Continuous quality improvement D.Total quality management

D ​Rationale: Total quality management​ (TQM) is a comprehensive management philosophy that is used to improve quality and productivity by using data and statistics to improve systems processes. TQM involves teamwork throughout the​ organization, involving all departments and employees and including both suppliers and customers. Its essential elements include​ communication, feedback,​ fact-based decision​ making, and a focus on continual improvement.

In which order should the steps of the quality improvement process be reviewed to determine whether it was completed correctly? A) Research factors that contribute to better outcomes. B) Compare outcomes to benchmarks. C) Identify areas for improvement. D) Analyze current protocols of care and associated outcomes. E) Implement changes to improve outcomes F) Analyze client outcomes to determine effectiveness of changes.

D B C A E F

An employee has recently been absent from work on several occasions. Each time, this employee returns to work wearing dark glasses. Facial and body bruises are apparent. During the occupational health nurses interview, the employee says, "My partner beat me, but it was because there are problems at work." What should the nurses next action be? a. Call the police. b. Arrange for hospitalization. c. Call the adult protective agency. d. Document injuries with a body map.

D ~ Documentation of the injuries provides a basis for possible legal intervention. The abused adult will need to make the decision to involve the police. Because the worker is not an older adult and is competent, the adult protective agency is unable to assist. Admission to the hospital is not necessary.

An adult has recently been absent from work for 3-day periods on several occasions. Each time, the individual returns to work wearing dark glasses. Facial and body bruises are apparent. What is the occupational health nurse's priority assessment? a. Interpersonal relationships b. Work responsibilities c. Socialization skills d. Physical injuries

D ~ The individual should be assessed for possible battering. Physical injuries are abuse indicators and are the primary focus for assessment. No data support the other options.

*Possible Exam Question* The nurse is discussing the use of a victims advocate with a client who has been raped. Which client statement indicates an understanding of the role of the advocate? A) "I can call my advocate anytime that I feel the need to talk about what happened." B) "The advocate assigned to me will accompany me to the court proceedings." C) "I understand the advocate assigned to me will be able to provide legal advice." D) "My advocate will help guide me through the process of prosecution."

D) "My advocate will help guide me through the process of prosecution." Rationale: The primary purpose of a​ victims' advocate is to help guide the victim through the process of prosecuting the attacker. The primary purpose of the advocate is not to accompany the victim to the court​ proceedings, provide legal​ advice, or be available to speak to the victim anytime that the individual feels the need to talk about what has happened.

The nurse is caring for a client who has been raped. Which prescribed intervention should the nurse anticipate being incorporated into the plan of care? A) Pregnancy testing B) Prophylactic treatment for HIV C) Administration of emergency contraception D) Collection of specimens for legal purposes

D) Collection of specimens for legal purposes Rationale: The prescribed intervention the nurse anticipates is the collection of specimens for legal purposes. The specimens collected are assigned a special rape kit number that will only be processed if the victim chooses to make a report to the police. Pregnancy testing related to the rape cannot be accurately performed until the woman has missed her first period. HIV testing is​ offered, but prophylactic treatment is not administered. Emergency contraception is only provided with the​ client's permission.

The nurse is caring for an older adult who was sexually assaulted by a caregiver. Which intervention should the nurse implement into the plan of care? A) Address the caregiver B) Obtain a consult for a therapist C) Contact a family member D) Create a post-discharge safety plan

D) Create a post-discharge safety plan Rationale: The nurse caring for an older adult who was sexually assaulted by a caregiver will create a postdischarge safety plan. It may be unsafe for the client to return home. Addressing the caregiver is inappropriate and may result in violence. Contacting a family member is a HIPAA violation. Obtaining a consult for a therapist without discussing it with the client first is inappropriate.

*Shit question alert* The community health nurse is conducting a presentation for the prevention of rape. Which info should the nurse include? A) Avoid going out at night B) When going out alone carry pepper spray. C) Avoid crowded places D) Enroll in self-defense classes

D) Enroll in self-defense classes Rationale: The information the nurse will include about the prevention of rape is to enroll in​ self-defense classes.​ Self-defense classes and training aid in fighting off an individual attempting to commit a sexual assault. It is not necessary to avoid crowded places or going out at night. Knowledge and​ awareness, as well as traveling with​ another, are important in the prevention of sexual assault. It is not advised to go out alone. Pepper spray may not be immediately accessible if attacked.

What medication is used to treat syphilis? A) Metronidazole B) Azithromycin C) Ceftriaxone D) Penicillin

D) Penicillin

Which National Quality Strategy should the nurse understand focuses on the​ community? (Select all that​ apply) A.Care coordination B.Effective prevention and treatment C.Client safety D.Healthy living E.Affordability

D,E Rationale: Affordability covers the community as the healthcare industry works to make healthcare more affordable to​ individuals, families,​ employers, and governments. Healthy living also covers the community because this​ strategy's main aim is to work with communities to promote wide use of best practices to promote healthy living. Client​ safety, care​ coordination, and effective prevention and treatment are all more focused on the individual client.

The nurse is preparing to present the goals of risk management. Which should the nurse​ include? (Select all that​ apply.) A.Prevent breach of care B.Conduct root cause analysis C.Occurs on a monthly basis D.Minimize damage from adverse events E.Prevent adverse events

D,E ​Rationale: Risk management is the process of identifying vulnerabilities to minimize the consequences of adverse client outcomes. Risk management includes both proactive components to prevent adverse events and reactive components to minimize damage from adverse events. Risk assessment must occur​ daily, and all individuals must be dedicated to keeping clients safe from harm.

Which of the following statements would hinder the therapeutic relationship between the nurse and an adult victim of a recent sexual assault? a. "You handled the attack as well as you could; you survived." b. "You may feel anger, guilt, fear or resentment, but these are very normal reactions." c. "You didn't do anything to cause the attack, and it's not your fault you were raped." d. "You may want to have an abortion if you find out you are pregnant."

D. Mentioning abortion hinders the therapeutic relationship because it advises the client to make a personal choice that may be against her values and beliefs. This statement would block further communication about the options that are available to the client. The therapeutic relationship is facilitated by reassuring the client that she acted as rationally and appropriately as anyone could in a life-threatening situation, by letting the client know that the nurse understands the emotions one commonly feels following a violent attack, and by reminding the client of her innocence. Many victims think they could have avoided the rape if they had acted differently.

A young woman presents to the emergency department and informs the nurse of being raped by her date this evening. Which test should the nurse anticipate the healthcare provider to order? Computerized tomography (CT) scan DNA swabs Pregnancy test Chest x-ray

DNA swabs DNA swabs are essential whenever someone is sexually assaulted because they can help to identify the attacker. It is too early to take a pregnancy test; a woman will not test positive if she conceived as a result of this rape. A CT scan or chest x-ray is not relevant after a sexual assault unless there are internal injuries resulting from the attack.

The nurse is caring for a patient who has been raped. Which is the most important nursing consideration when providing care for the patient? Cultural practice Developmental age Emotional injury Physical disability

Developmental age The most important nursing consideration when caring for a patient who has been raped is the developmental age of the patient. The approach to nursing care, interventions, and communication will be based on the patient's developmental age. Cultural practices, emotional injury, and physical disability are all important considerations when caring for a patient who is a victim of rape, but they can only be effectively addressed based on the nurse's understanding of the developmental age of the patient.

The nurse is caring for a patient who experienced a rape several months prior. Which collaborative team member may need to be included in the plan of care for the patient? Dietitian Physical therapist Occupational therapist Pharmacist

Dietitian Rape survivors are at a high risk for developing an eating disorder, including anorexia, bulimia, or a crossover between the two. The patient may require a dietitian to assist with nutritional needs. Dietary interventions include assessing nutritional intake to maintain adequate body mass index (BMI). There is no indication the patient may require a physical therapist, occupational therapist, or pharmacist.

5. What reaction is most commonly displayed by rape victims in the immediate aftermath of the rape? Disorganization Philosophical acceptance Total withdrawal from reality Display of seductive actions

Disorganization Correct The acute phase of the rape trauma syndrome occurs immediately after the assault and may last for a few weeks. This stage is seen by ED personnel. Nurses are the ones most involved in dealing with these initial reactions. During this phase a great deal of disorganization in the person's lifestyle and somatic symptoms are common. Awarded 0.0 points out of 1.0 possible points.

The nurse caring for a patient who has experienced rape is focusing on therapeutic communication. Which communication technique should the nurse utilize? Provide reassurance. Provide warm blankets. Encourage the patient to ask questions. Reassure that the patient is safe.

Encourage the patient to ask questions. The nurse will facilitate communication with the patient by encouraging the patient to ask questions. Providing reassurance addresses the concept of development. The provision of warm blankets and reassuring that the patient is safe promote comfort.

A 5-year-old girl who has been physically abused is having difficulty putting her feelings into words. Which nursing intervention would best enable the child to express her feelings? Engaging in play therapy Giving the child's drawings to the abuser Role playing Reporting the abuse to a prosecutor

Engaging in play therapy The toys and dolls in a play therapy room are useful props to help the child remember situations and reexperience the feelings; acting out the experiences with toys rather than putting them into words is sometimes easier for the child. Role playing for a younger child is difficult, especially without the use of toys or dolls. Giving the drawing to the abuser can put the child in danger. It is the nurse's responsibility to report suspected child abuse to the proper agency, but the reporting does not help the child express her feelings.

Which action should the nurse take to secure the safety of a trauma team and a client who is being treated for injuries sustained in an attempted​ homicide? (Select all that​ apply.) Use chain of custody procedures for specimens. Ensure that the client is free of weapons. Ask law enforcement or security personnel to be present during treatment. Do not clean the​ victim's hands. Cooperate with law enforcement and security personnel.

Ensure that the client is free of weapons. Ask law enforcement or security personnel to be present during treatment. Cooperate with law enforcement and security personnel. There are situations where clients have the potential to direct violence toward the healthcare team. Hospital staff and law enforcement personnel must cooperate to ensure the safety of the trauma team. Law enforcement or the trauma team must determine that the client is free of weapons before treatment is initiated. In the clinical​ setting, police officers or security personnel may be needed during treatment. Not cleaning the​ victim's hands or the area around the​ victim's wounds and following legal chain of custody procedures are aspects of the preservation of evidence that may be needed to prosecute a​ crime, not actions taken to ensure safety of the trauma team and client.

The telephone hotline nurse is fielding a complex question about possible intimate partner abuse. From the description that the caller is giving, abuse seems likely. Which is the first priority of the advice nurse? Emphasizing that the caller is not to blame for the abuse Exploring the need for resources Ensuring safety from the partner's abuse Giving information about helpful services

Ensuring safety from the partner's abuse The first priority is ensuring safety from the partner's abuse. The other approaches come next: The lack of blame, the need for resources, and giving information.

The nurse is discussing the purpose of utilization review with colleagues. Which statement should the nurse​ include? Working with a social worker to make sure the​ client's family has resources for care Ensuring that the​ client's medications and treatments are appropriate for his or her diagnosis Working with members of the interdisciplinary team to provide comprehensive care for the client Contacting the insurance company to facilitate payment for services

Ensuring that the​ client's medications and treatments are appropriate for his or her diagnosis The utilization review​ nurse's role is designed to ensure that a client is receiving the necessary treatments and procedures for his or her condition without undergoing any unnecessary therapies. By reviewing these​ terms, the utilization review nurse saves the healthcare center money by avoiding payments on expensive treatments that are unwarranted. The​ nurse's role also saves the client from undergoing possibly painful and expensive tests and procedures that are not needed. All the other options are not a part of the utilization review process.

9. The emergency department nurse planning care for a rape victim must realize that the emotional reaction displayed by many rape victims during assessment and treatment while in the emergency department is fear. eagerness. suspicion. disinterest.

Fear Rape is an act of violence, and sex is the weapon used by the perpetrator. Rape engulfs its victims in fear and anxiety, resulting in withdrawal for some and causing severe panic reactions in others. After being traumatized, the person raped often carries an additional burden of shame, guilt, fear, anger, distrust, and embarrassment. Awarded 1.0 points out of 1.0 possible points.

1. A client tells the college health nurse she was raped by her date several weeks ago. Which reason is the client most likely to give for waiting to tell someone? Feeling embarrassed about having a physical examination Feeling guilty for somehow having caused it Fear that no one would believe her Fear of contracting a sexually transmitted disease

Feeling guilty for somehow having caused it Correct Many rape victims feel that they are somehow at fault for the rape and harbor feelings of guilt. This guilt stands in the way of reporting the rape to the authorities. Text page: 618

The nurse is caring for the parents of a young child who was beaten up at school by another student. The healthcare provider orders the focused assessment by sonography in trauma (FAST) test. Which purpose should the nurse expect this test to fulfill? Assessing level of consciousness Measuring response to pain Finding blood in body cavities Screening for antibodies

Finding blood in body cavities The purpose of a FAST test is to find blood in body cavities. It is not concerned with level of consciousness, pain, or antibodies.

The nurse in the emergency department is bandaging the forearm of a​ 26-year-old woman who was mugged. In addition to the physical​ injury, which manifestation should the nurse assess for at the time of treatment related to an exaggerated stress​ response? (Select all that​ apply.) Loss of senses Resiliency Flashbacks Disbelief and despair Confusion or disorientation

Flashbacks Disbelief and despair Confusion or disorientation Flashbacks, disbelief and​ despair, and confusion or disorientation are all manifestations of an exaggerated stress response that may be present in an individual who has also experienced a physical trauma. Most clients will display​ resiliency, which is a positive coping​ mechanism, after experiencing a traumatic event. Loss of senses would be a physical​ manifestation, not a manifestation of an emotional injury.

The nurse is reviewing the chart for a patient who is exhibiting signs of the inability to recover from a rape. Which assessment finding should the nurse anticipate? Periods of shame Hostility Increased startle reaction Flashbacks

Flashbacks The assessment finding the nurse anticipates for the patient exhibiting signs of inability to recover from a rape is flashbacks. Flashbacks are a clinical manifestation of posttraumatic stress disorder (PTSD). Periods of shame, hostility, and an increased startle reaction occur during the acute phase of rape-trauma syndrome.

During a routine​ well-child visit, a child confides that their dad beats them whenever their dad drinks alcohol. Which is the correct action by the​ nurse? Notify social services to take custody of the child. Follow the​ clinic's protocols for reporting abuse in a child. Immediately contact the police. Call the​ child's mother to discuss the situation

Follow the​ clinic's protocols for reporting abuse in a child Nurses and healthcare providers are mandatory reporters of child abuse and​ neglect, and all healthcare agencies will have protocols on how to deal with this type of situation. It is important for the nurse to follow the established protocols to ensure that the appropriate reports are made.

The hospital management is concerned about feedback regarding long waiting times for treatment in the emergency department and forms a committee to resolve the issue. Which should be the first task by the leader of the committee to solve the problem? Form a Continuous Quality Improvement team to define the desired outcome. Reevaluate emergency room waiting times. Collect baseline data to determine if a problem exists. Ask the director of operations for solutions.

Form a Continuous Quality Improvement team to define the desired outcome. The first step in the Continuous Quality Improvement (CQI) process is to assemble a team of individuals who are stakeholders in the problem to form a CQI team to define the desired outcome. From there, the nurse can measure performance against the desired outcome, analyze the results, provide feedback, implement a solution, and evaluate its effectiveness. If the nurse were to collect baseline information without determining the desired outcome, they might not measure the relevant indicators. CQI is about including the team in the problem-solving process, rather than dictating what needs to be accomplished. By including the team in the problem solving, it is more likely they will buy into the solutions. Asking the operations manager for solutions is not the best way to resolve the issue, and reevaluating the wait time will only help after implementation of the first plan of action to reduce that issue.

The nurse is providing information to a rape victim about the importance of following up with prescribed diagnostic testing. Which prescribed diagnostic test performed initially will be repeated at 3, 6, and 12 months? Gonorrhea HIV Chlamydia Trichomoniasis

HIV Testing for HIV infection is done on arrival to the emergency department and again at 3, 6, and 12 months after the rape. It is not usually necessary to repeat testing for gonorrhea, chlamydia, or trichomoniasis.

The nurse is responsible for continuous quality improvement at a rehabilitation hospital. Which internal client should the nurse interview for​ suggestions? (Select all that​ apply.) Parents of a child with spina bifida Client after hip replacement Head of Management of Information Systems Physical therapist Clinical nurse specialist

Head of Management of Information Systems Physical therapist Clinical nurse specialist Internal clients are employees of the rehabilitation facility. They could be a physical​ therapist, the head of the MIS​ department, and a clinical nurse specialist. External clients include a client after hip replacement and parents of a child with spina bifida.

The school nurse is talking to a​ fifth-grade class about recognizing behavioral and psychologic factors in themselves and their classmates that predispose them to violence. Which characteristic should the nurse​ describe? (Select all that​ apply.) History of being bullied Living in a​ low-income community Depression Having siblings who are heroin addicts History of bullying others

History of being bullied Depression History of bullying others A history of bullying​ (either as victim or​ perpetrator) is a behavioral factor that could predispose an individual to violence. Depression is a psychologic factor that could predispose an individual to violence. Family​ members' involvement in substance abuse is not a behavioral or psychologic factor. Living in a​ low-income community is not a behavioral or psychologic factors

Which statement should the nurse use to describe the purpose of the root cause analysis? Brainstorming preferred outcomes Identifying risks causing financial loss Providing a report to the leader of the committee Identifying the root cause of the problem through problem solving

Identifying the root cause of the problem through problem solving The purpose of a root cause analysis is to determine the root cause of a problem. Brainstorming outcomes and reporting to the leader would be part of the task force to implement quality improvements. Identifying risks of financial loss is part of an audit.

An organization is using Six Sigma to determine why discharge instructions given to a group of clients were below national standards. Which step should the nurse understand applies to this quality management​ process? Meeting with the discharge planners Improving the knowledge level of the staff with​ one-on-one training Standardizing the discharge process with the healthcare providers Standardizing and simplifying the discharge instruction process Improving the knowledge level of the staff​ unit-by-unit

Improving the knowledge level of the staff with​ one-on-one training Standardizing and simplifying the discharge instruction process Improving the knowledge level of the staff​ unit-by-unit Six Sigma is a quality improvement program that aims to produce a​ near-perfect product. Sigma is used to measure deviation from a standard. In this​ system, a defect is defined as anything that could lead to client dissatisfaction. Defects in healthcare could range from relatively minor problems to major problems. Six Sigma primarily uses the​ Define, Measure,​ Analyze, Design, and Verify system to improve outcomes. For this​ instance, the organization is aiming to increase the percentage of heart failure clients for compliance.

The nurse is speaking with a friend who mentions having the problem of being stalked by a previous acquaintance. The nurse should consider this as which type of violence? Cyberbullying Sexual abuse Neglect Intimate partner violence

Intimate partner violence Stalking is a form of intimate partner violence. Stalking is a pattern of repeated, unwanted attention and contact that causes fear or concern for one's own safety or the safety of someone else (e.g., family member or friend). Cyberbullying is pattern of abuse that occurs online and does not include stalking. Stalking is not a form of sexual abuse or neglect.

Which term describes an assessment occurring within a group of individuals with similar positions within a healthcare system? Six Sigma audit Interprofessional Internal audit Intraprofessional

Intraprofessional An intraprofessional assessment is one occurring within a group of individuals with similar positions within a healthcare system. A peer audit is a review used to professionally critique a colleague's work, based on a predetermined set of standards. An audit is an examination of records to verify accuracy and proper use. Outcomes management uses patient experiences to improve all areas of health care.

The nurse organized a staff meeting to address morale issues and improve the level of care on the unit. Which assessment practice is the nurse​ demonstrating? Utilization review Interprofessional Benchmarking Intraprofessional

Intraprofessional Intraprofessional assessment occurs within a group of individuals who have similar positions within a healthcare​ system, such as a group of nurses or a group of surgeons. Such an assessment is important for identifying areas of improvement at each level of care. Interprofessional assessment would take place if different units provided feedback. Benchmarking is comparing outcomes of two different departments. A utilization review looks at areas of​ misuse, overuse, or underuse of​ resource, not a moral issue.

The nurse is teaching a group of teachers about signs of sexual abuse to watch for in students. Which sign should the nurse include? Hyperactivity Isolation from peers Stuttering Impulsive behaviors

Isolation from peers Behavioral symptoms of children who have been sexually abused include a lack of peer friendship or isolation from other peers. Impulsivity, hyperactivity, stuttering, and leadership traits are not manifestations of sexual abuse.

The nurse is teaching about an individual's risk factors for perpetration of sexual violence. Which factor included by a participate indicates the need for further teaching? Empathetic deficits Exposure to sexually explicit material Late sexual initiation Delinquency

Late sexual initiation The risk factors for an individual's perpetration of sexual violence include empathetic deficits, suicidal behavior, delinquency, and exposure to sexually explicit material. Early sexual initiation, not late sexual initiation, is also an identified risk factor.

The nurse in the blood bank is part of a team effort to reduce the cost of collecting and storing blood components. The nurse conducts an inventory check for expired sterile supplies. Which quality improvement method is the team using in seeking to reduce waste? Utilization review Root cause analysis Quality assurance Lean Six Sigma

Lean Six Sigma The objective of Lean Six Sigma, the quality improvement method used by the blood bank team, is to reduce waste. Quality assurance determines whether standards are met. Root cause analysis explores a sentinel event. Utilization review collects data about resource use.

The nurse in the blood bank is part of a team effort to reduce the costs of collecting and storing blood components. The nurse conducts an inventory to check for expired sterile supplies. In seeking to reduce​ waste, which quality improvement​ (QI) method is the team​ using? Quality assurance Lean Six Sigma Root cause analysis Utilization review

Lean six sigma

The nurse in the blood bank is part of a team effort to reduce the costs of collecting and storing blood components. The nurse conducts an inventory to check for expired sterile supplies. In seeking to reduce​ waste, which quality improvement​ (QI) method is the team​ using? Quality assurance Lean Six Sigma Root cause analysis Utilization review

Lean six sigma Learning Objective Compare the components of various quality management programs. Rationale The objective of Lean Six​ Sigma, the QI method used by the blood bank​ team, is to reduce waste. Quality assurance determines whether standards are met. Root cause analysis explores a sentinel event. Utilization review collects data about resource use.

The nurse is caring for a patient who experienced a deep laceration to the arm as the result of an assault. The patient is resting comfortably and is denying any pain but will need sutures to close the wound. Which pharmacologic therapy should the nurse anticipate for this patient prior to suturing? Opioid Nonsteroidal anti-inflammatory drug (NSAID) Antibiotic Local anesthetic

Local anesthetic The nurse would anticipate that the patient would require a local anesthetic, such as lidocaine, prior to the suturing that will be required to close the wound. The patient is not complaining of intense pain; therefore, an opioid would not be anticipated. The patient may be sent home with prescriptions for ibuprofen for pain and/or an antibiotic to prevent infection, but these medications are not required prior to suturing.

Governmental agencies and the healthcare industry have partnered to improve the quality of care. Which action should the nurse recognize is aimed at providing better​ care? Reducing the cost of quality healthcare to all consumers Making healthcare more​ client-centered, reliable,​ accessible, and safe Delivering care to underserved clients Addressing​ behavioral, social, and environmental determinants of health

Making healthcare more​ client-centered, reliable,​ accessible, and safe To improve the health of the​ population, the U.S. Department of Health and Human Services​ (HHS) has developed the National Quality​ Strategy, which contains three broad aims. One of the aims is Better Care to improve the overall quality by making healthcare more client​ centered, reliable,​ accessible, and safe. The other two aims are Healthy​ People/Healthy Communities and Affordable Care.

The nurse is caring for a pregnant woman who has been raped by her spouse. Which statement best describes the nurse's understanding of marital rape? Marital rape is legal. Marital rape can be committed by an acquaintance. Marital rape is not acknowledged in some cultures. Marital rape is characterized by only physical abuse.

Marital rape is not acknowledged in some cultures. Marital rape is not acknowledged in many cultures around the world. Marital rapes often go unreported; however, 9% of all rapes reported are perpetrated by a husband or ex-husband. Marital rape is illegal in all states. Rape committed by an acquaintance is considered acquaintance rape. Marital rape can include both physical and emotional abuse.

The nurse orienting to the emergency department is caring for a patient who presents with a right clavicular fracture. Which nursing intervention by the orienting nurse requires immediate correction from the preceptor? Offering resources and assistance Documenting the description and location of any injuries Initiating a thorough physical and emotional assessment Mediating a discussion between the victim and the abuser

Mediating a discussion between the victim and the abuser Nursing interventions for intimate partner violence include initiating a thorough physical and emotional assessment; offering resources and assistance; and documenting the description and location of any bruising, burns, scars, and other physical injuries or abnormalities. Nursing interventions for intimate partner violence do not include mediating a discussion between the victim and the abuser

2. Which statistic concerning rape is true? Most male rape victims do not report the crime. Male rape is perpetrated by homosexual men. The peak incidence of rape is ages 25 to 29 years. Most rapes occur after abductions.

Most male rape victims do not report the crime. Correct Option 1 is the only true statement. Awarded 1.0 points out of 1.0 possible points.

6. Which statement reflects a truth about rape? Many women want to be raped. Rapists are oversexed. Most rapes are planned. Most women are raped by strangers.

Most rapes are planned. Correct Many myths about rape exist. Most rapes are not impulsive, spur-of-the-moment acts, but are carefully planned and orchestrated. Awarded 0.0 points out of 1.0 possible points.

A new nurse orienting to the emergency department admits a patient who was raped. Which action by the new nurse requires immediate follow-up by the preceptor? Placing the patient in a private room Treating the patient for sexually transmitted infections Administering emergency contraceptive medications with permission Obtaining a history of the incident in the triage area

Obtaining a history of the incident in the triage area Interviewing the patient in the triage area does not provide the patient with privacy. Appropriate nursing interventions for this patient include placing the patient in a private room, providing treatment for potential sexually transmitted infections, and administering emergency contraceptive medications with the permission of the patient.

Which activity should the nurse recognize as a way for state and local entities to make healthcare more​ affordable? Require hospitals to track readmission rates for​ low-income clients Develop new healthcare delivery models Coordinate care through the use of effective communication Offer basic health coverage for all citizens living in their state

Offer basic health coverage for all citizens living in their state Developing new healthcare delivery models is a state and local initiative that can lower healthcare costs. Coordinating care through effective communication would be the responsibility of the healthcare institution. States and local entities are not required to provide affordable healthcare to all their citizens. Local hospitals are not just responsible to track the readmission​ rates, but are encouraged to actively try to reduce readmission rates through broad based teaching and​ follow-up as a way to lower costs.

The nurse is planning to initiate a new type of support group for young children who have been the victims of abuse and neglect. Which type of activity should the nurse plan? Cognitive therapy Playground time Self-defense training Play therapy

Play therapy Play therapy is most appropriate for young children who are recovering from a trauma like abuse. It can also help them process what happened to them. Cognitive therapy and self-defense training aren't age-appropriate, and playground time, although fun, does not help a child to process trauma.

The nurse working in the assisted living facility is reviewing the weekly report of the number of bedridden clients who developed pressure ulcers. The facility uses the Donabedian model of QI. Which standard is the nurse using with this data​ review? Process standard Structure standard Outcome standard Decubiti standard

Outcome standard Learning Objective Describe the process of quality improvement. Rationale The nurse is examining data about an outcome​ standard, pressure​ ulcers, which is a negative result of the care process. A process standard would look at steps to achieve a positive result. A structure standard would look at the organization. There is no decubiti standard.

The emergency department nurse manager is sharing the most recent client satisfaction data and statistics with the evening shift staff. As a​ team, they are using the total quality management​ (TQM) approach. Which process organizes their​ efforts? DMADV DMAIC LEED PDSA

PDSA Learning Objective Compare the components of various quality management programs. Rationale TQM uses the PDSA approach of​ Plan-Do-Study-Act. The DMAIC and the DMADV methods are used in Six Sigma. LEED is not a QI method.

The nurse is caring for a patient with physical injuries resulting from rape. Which nursing diagnosis is the most appropriate for the patient? Powerlessness, Risk for Self-Esteem, Situational Low, Risk for Pain, Acute Self-Concept, Readiness for Enhanced

Pain, Acute Pain, Acute is the most appropriate nursing diagnosis for the physical injuries that occurred as the result of a rape. The potential for powerlessness, decreased self-esteem, and decreased self-concept are diagnoses reflective of the psychosocial effect of rape.

The nursing team is using the Total Quality Management (TQM) approach to improve patient satisfaction on the unit. Which process should the team follow to organize their efforts? Define-Measure-Analyze-Improve-Control Continuous Quality Improvement plan Plan-Do-Study-Act Define-Measure-Analyze-Design-Verify

Plan-Do-Study-Act TQM uses the PDSA approach of Plan-Do-Study-Act. The Define-Measure-Analyze-Improve-Control and the Define-Measure-Analyze-Design-Verify methods are used in Six Sigma.

The nurse is reviewing the risk factors for sexual violence related to personal relationships. Which risk should the nurse associate with perpetrators' personal relationships? Poverty Hostility toward women Poor parent-child relationship Societal norms that support sexual violence

Poor parent-child relationship The risk factor for sexual violence the nurse associates with perpetrators' personal relationships is poor parent-child relationships. This occurs particularly with poor father-child relationships. Poverty is a community factor. Hostility toward women is an individual risk factor. Societal norms that support sexual violence are a societal risk factor.

The public health nurse is visiting the home of an older woman. Looking out the window, the nurse sees graffiti, empty beer cans, and discarded trash items. Which term describes the fact that this woman is more likely to be a victim of violence based on her environment? Precipitating factor Protective factor Predisposing factor Reactive factor

Predisposing factor Graffiti, empty beer cans, and discarded trash items can be signs of a low-income environment. That setting is a predisposing factor for violence. By itself, the setting does not precipitate or cause violence. The setting is neither protective nor reactive.

The nurse is preparing to present the goals of risk management. Which should the nurse​ include? (Select all that​ apply.) Prevent breach of care Occurs on a monthly basis Conduct root cause analysis Prevent adverse events Minimize damage from adverse events

Prevent adverse events Minimize damage from adverse events Risk management is the process of identifying vulnerabilities to minimize the consequences of adverse client outcomes. Risk management includes both proactive components to prevent adverse events and reactive components to minimize damage from adverse events. Risk assessment must occur​ daily, and all individuals must be dedicated to keeping clients safe from harm.

Which statement should the nurse understand describes the primary goal when conducting a root cause analysis? Gaining group consensus Mandating solutions to problems Producing ideas by holding a group discussion Preventing problem recurrence

Preventing problem recurrence The goal of a root cause analysis is entirely preventing problem recurrence. Gaining group consensus will be a tool used during the analysis to agree upon indicators. Ideas will be produced during the root cause analysis by the process of brainstorming. During a collaborative process such as root cause analysis, mandating solutions will not foster a collaborative approach.

The nurse suspects that a patient is being abused by a partner, but the patient denies that anything wrong is happening at home. Which is the best action by the nurse? Report the abuse to the authorities. Confront the abuser and explain the dangers of the individual's behavior. Provide a list of referrals in case the patient decides to leave. Notify social services of what is happening.

Provide a list of referrals in case the patient decides to leave. Ultimately, it is up to the patient whether or not to leave the partner. The nurse can provide information about community resources that can help the patient decide whether to leave, but the nurse cannot report the abuse to the authorities or social services (unless children are involved). The nurse should not confront the abuser because of the potential for escalation of the situation.

The nurse is evaluating the effectiveness of changes made to improve quality of care. Which procedure is the nurse conducting? Quality assurance Total quality management Continuous quality improvement Quality management plan

Quality assurance Implemented changes must be evaluated to assess their impact on patient care, patient outcomes, patient and clinical satisfaction, and resource utilization. Data related to the original problem must be collected and are then analyzed on the basis of benchmark standards to determine whether standards are being met. This is called quality assurance. A quality management plan is used to help healthcare facilities integrate new programs, models, and technologies with the primary care services that are already in place. Total quality management (TQM) is a comprehensive management philosophy used to improve quality and productivity by using data and statistics to improve processes. Continuous quality improvement (CQI) is a structured organizational process for including personnel in planning and executing a continuous flow of improvements to provide quality health care that meets or exceeds expectations.

The graduate nurse understands that the five rights of medication administration are part of: Quality management Environmental safety Anticipatory guidance Care coordination

Quality management Feedback Rationale: Quality management includes the prevention of errors for client safety. Checking the five rights when administering medication has been shown to reduce medication errors. An example of environmental safety might include placing signs around a wet floor. Anticipatory guidance is the nurse working with the client to effect changes in the client's lifestyle. Care coordination is a method of preventing duplication of services, usually accomplished by a case manager. Nursing Process: Evaluation Client Need: Safe, Effective Care Environment Cognitive Level: Understanding

The dialysis nurse manager decides to evaluate the sterility processes the renal unit staff​ follows, compared to accepted standards of care. Which term best describes that​ effort? Performance improvement Quality improvement Process standards Quality management

Quality management Learning Objective Discuss the role of quality improvement initiatives in health care. Rationale Quality management compares specific nursing​ processes, like​ sterilization, to accepted standards of care. Quality improvement is one method of improving the processes of care. Performance improvement matches positive changes with participating staff. Process standards record​ step-by-step client care activities.

The nurse is responsible for the implementation of an electronic system of documentation involving the use of tablets by the nursing staff when seeing patients. Which program should the nurse use? Quality management plan Plan-Do-Study-Act (PDSA) Continuous quality improvement Total quality management

Quality management plan A quality management plan is used to help healthcare facilities integrate new programs, models, and technologies with the primary care services already in place. Total quality management (TQM) is a comprehensive management philosophy used to improve quality and productivity by using data and statistics to improve processes. Continuous quality improvement (CQI) is a structured organizational process for including personnel in planning and executing a continuous flow of improvements to provide quality health care that meets or exceeds expectations. PDSA is a system of quality improvement most often associated with TQM. In the Do phase, the plan is implemented on a small scale to determine whether it will be effective. This is followed by the Study phase, in which the outcomes of the Do phase are analyzed and compared to the expected outcomes. In the Act phase, the team must decide whether the goal was met, plan further changes, and decide whether the original goal is attainable based on the results of the previous interventions.

The nurse manager's review revealed that the increased number of nursing hours was associated with reduced patient mortality. Which nursing-sensitive indicator area, as it relates to quantity or quality, should the nurse understand to be reflected by this review? Quality of structure related to quality of outcome Quantity of structure related to quantity of outcome Quantity of structure related to quality of process Quality of structure related to quantity of process

Quantity of structure related to quantity of outcome The example of increased nursing hours shown to decrease patient mortality is a quantity structure to quantity outcome relationship (number of nursing hours compared to quantity of mortalities). An example of quality structure to quantity process would be more proficient nurses completing more repeat assessments per hour. Quantity structure related to quality structure would be related to reduction in nursing staff leading to less job satisfaction. A quality structure related to quality outcome example could be the good mix of staff that results in better patient outcomes and satisfaction.

The nurse manager conducts nurse evaluations based on standards of care. The manager understands that standards of care are based on established models of high-quality performance and may reflect all except: Recommendations of professional organizations Scientific or clinical research Recommendations of hospital physicians The performance of industry leaders

Recommendations of hospital physicians Rationale: Benchmarking is a method used to compare the performance of an individual or organization to industry standards. Standards of care are based on established models of high-quality performance and may reflect the performance of industry leaders, scientific or clinical research, or recommendations of professional organizations such as the ANA. Recommendations of hospital physicians are not necessarily standards of care. Nursing Process: Evaluation Client Need: Safe, Effective Care Environment Cognitive Level: Understanding

Which statement should the nurse understand as reflecting the aim of affordable care in the United States? Improving health by addressing behavioral, social, and environmental determinants Reducing the cost of quality health care for individuals, families, employers, and government Improving the quality of care by making care more patient centered, reliable, accessible, and safe Reducing wait times that may result in harmful delays for those who provide or receive care

Reducing the cost of quality health care for individuals, families, employers, and government Affordable care is meant to reduce the cost of quality health care for individuals, families, employers, and government. Better care is to improve the quality of care by making care more patient centered, reliable, accessible, and safe. The aim of healthy people/healthy communities is to improve the health of the U.S. population by supporting proven interventions to address behavioral, social, and environmental determinants.

A woman wishes to take the children and leave her abusive husband. The patient has no family nearby and asks the nurse for help in finding somewhere to go. Which is the best referral by the nurse? Referral to a nearby motel Referral to a domestic violence shelter that cares for women and children Referral to the police to have the husband removed from the house Referral to the local community center

Referral to a domestic violence shelter that cares for women and children Domestic violence shelters offer a range of services, not just a safe place to sleep. Many offer referrals to attorneys and education and training services. A nearby motel can be expensive and is likely not sustainable long-term, making it not the best option. The police may not be able to remove the spouse from the home without a court order or as a long-term solution, so this is not the best option for the patient. A local community center does not provide housing options.

An alert and oriented older adult patient is receiving home care services following a cerebrovascular accident that has left the patient with right-sided hemiparesis. The patient lives with a family member. The nurse suspects that the patient is being neglected after observing that the patient's hair and clothes are dirty and that the patient smells of urine. Which intervention would be a priority for this patient? Report the neglect to the appropriate agency. Wait until enough trust has been developed to enable the patient to approach the nurse first. Confront the family member with the suspicions. Interview the family member to gain the family member's perspective on the situation.

Report the neglect to the appropriate agency. Reporting the abuse to the appropriate agency, according to the requirements of state law, is a nonpharmacologic treatment of older adult abuse and takes priority in this case. Developing trust is also important, but it does not take priority in this case. The nurse should not confront the family member but should report the suspected neglect to the proper authorities and allow them to investigate the situation. The nurse caring for a patient who is a victim of abuse needs to focus on interventions that include establishing a therapeutic relationship, encouraging and facilitating communication, and promoting empowerment.

The urology nurse is reviewing medical records of the last five clients discharged after transurethral resection of the prostate​ (TURP). The nurse uses a checklist to look at the completeness of documentation of postsurgical pain relief. Which activity is the nurse participating in with this review​ process?Utilization review Concurrent audit Retrospective audit Root cause analysis

Retrospective audit

The nurse manager complimented the night staff on recent data about reducing noise. The day shift nurses asked each client about obstacles to sleep the previous night. They recorded the clients​' responses as either achieving the goal of sleep or being disrupted by the defect of loud sounds or other obstacles. Which kind of quality improvement activity is taking​ place? Six Sigma Performance improvement Continuous quality improvement Benchmarking

Six Sigma

The urology nurse is reviewing medical records of the last five clients discharged after transurethral resection of the prostate​ (TURP). The nurse uses a checklist to look at the completeness of documentation of postsurgical pain relief. Which activity is the nurse participating in with this review​ process? Utilization review Concurrent audit Retrospective audit Root cause analysis

Retrospective audit Learning Objective Describe the process of quality improvement. Rationale The nurse is conducting a retrospective​ audit, looking back in time. A concurrent audit takes place when clients are still hospitalized. Utilization review looks at use of​ resources, not documentation. A root cause analysis is triggered by a sentinel​ event, rather than by routine client care documentation.

The nurse uses a checklist to look at the completeness of documentation of postsurgical pain relief for clients discharged after a specific surgical procedure. Which term best describes the​ nurse's activity of this review​ process? Utilization review Retrospective audit Root cause analysis Concurrent audit

Retrospective audit The nurse is conducting a retrospective audit by looking back in time. A retrospective audit compares care provided to clients with similar​ conditions, and recommendations are made to change procedures if needed. A concurrent audit takes place when clients are still hospitalized. Utilization review looks at the use of​ resources, not documentation. A root cause analysis is triggered by a sentinel​ event, rather than by routine client care documentation.

A client called Patient Relations after being discharged to report that a skin infection developed around the IV catheter insertion site on the client​'s right arm. Which process would likely prevent a similar recurrence in the​ future? Peer review Utilization review Root cause analysis Risk management

Risk management Learning Objective Describe the process of quality improvement. Rationale Risk management could add this complaint to its data about client​ satisfaction/outcomes, and work with the relevant clinical unit about prevention. A skin infection is not a sentinel​ event, so no root cause analysis needs to be initiated. An isolated event would not prompt peer review. Utilization review looks at resource​ use, not postdischarge outcomes.

While in the hospital, a patient fell in the shower, had an allergic reaction to the hospital gown, and spiked a high temperature. Which type of assessment should the nurse understand will be used to collect data about the three complications the patient experienced? Risk management Blame-free environment Root cause analysis Utilization review

Risk management Risk management, which looks at past adverse events, would most likely be used to collect data. With no evidence of overuse, misuse, or underuse, the data would not be flagged for utilization review. Even with complications, the patient did not have a sentinel event, so no root cause analysis would be initiated. The events might or might not take place in a blame-free environment, but no errors or near misses are part of the known story.

The nurse manager calls for a meeting to identify and discuss the cause of a recent problem in the facility so that the incident does not happen again. Which term should the nurse use to describe this​ process? ​Blame-free environment Reducing medical errors Root cause analysis Resource utilization

Root cause analysis Root cause analysis is the correct answer. The goals of the root cause analysis are to identify the reasons for failures or problems and to develop an action plan for improvement to decrease the likelihood of future adverse events. Reducing medication errors involves interventions specifically help nurses prevent medication errors. Resource utilization is increasing the value of healthcare by reducing costs. A​ blame-free environment is established to maintain or improve the quality of care in which healthcare providers can report errors or near misses without the fear of punishment.

The oncology nurse is reviewing the Department of Health and Human Services​ (HHS) National Strategy for Quality Improvement in Health Care. In evaluating the nurse​'s cancer center​ facility, which descriptions of that healthcare system fit the HHS​ criteria? ​(Select all that​ apply.) Safe Compliant Reliable Sensitive Accessible

Safe Reliable Accessible Learning Objective Discuss the role of quality improvement initiatives in health care. Rationale The HHS criteria expect the healthcare system to be​ client-centered, reliable,​ accessible, and safe. The HHS does not discuss compliance or sensitivity.

The nurse is discussing the six aims of improvement in healthcare systems. Which term should be used to describe the goal of avoiding patient injuries from the care that is intended to help them? Efficient Patient-centered Safety Equitable

Safety According to the six aims of healthcare, safety is described as avoiding injuries to patients from the care that is intended to help them. Equitable care is related to providing care that does not vary in quality. Efficiency is related to avoiding waste. Patient-centered care is care that is tailored to the individual patient needs and preferences.

The nurse manager complimented the night staff on recent data about reducing noise. The day shift nurses asked each client about obstacles to sleep the previous night. They recorded the clients​' responses as either achieving the goal of sleep or being disrupted by the defect of loud sounds or other obstacles. Which kind of quality improvement activity is taking​ place? Six Sigma Performance improvement Continuous quality improvement Benchmarking

Six Sigma Learning Objective Compare the components of various quality management programs. Rationale Six Sigma considers factors leading to client dissatisfaction as open double quote"defects.close double quote" Disrupted sleep qualifies as a defect. Defect is not a concept used in continuous quality improvement or performance improvement. Benchmarking uses industry​ standards, which do not exist for disrupted sleep.

To address client complaints of disrupted sleep due to noise on the​ floor, the nurse manager formed three teams who implemented various processes to reduce the noise. Another team is collecting sleep data from the clients and analyzing the effectiveness of the​ solution, based on which they intend to develop better methods and improve the facility. Which quality improvement process is the manager​ implementing? Benchmarking Continuous quality improvement Six Sigma Performance improvement

Six Sigma Six Sigma considers factors leading to client dissatisfaction as​ "defects." Disrupted sleep qualifies as a defect. Defect is not a concept used in continuous quality improvement or performance improvement. Benchmarking uses industry​ standards, which do not exist for disrupted sleep.

3. When the nurse finishes addressing a group of college women about rape, the following comments are heard during the discussion period. Which comment calls for additional teaching by the nurse? "It makes sense that rape is a crime of violence, not a crime of sex." "Who would have guessed that most rape victims know the rapist?" "So if you dress conservatively, your risk of being raped is small." "I always thought rapes happened at night but now I know that isn't true."

So if you dress conservatively, your risk of being raped is small." Correct Rapes have little to do with whether the victim dresses seductively because rape is a crime of violence rather than a crime of sex. Text page: 616

Which type of agency should the nurse recognize as being responsible for providing health insurance for low-income individuals and families? Centers for Disease Control and Prevention Office of the Surgeon General State agency Office of Medicare

State agency Even with the advent of the Affordable Care Act, state agencies are partially responsible for providing health insurance programs for low-income individuals and families. The Surgeon General reports to the Assistant Secretary for Health (ASH), who may be a four-star admiral in the commissioned corps, and who serves as the principal adviser to the Secretary of Health and Human Services on public health and scientific issues. As the nation's health protection agency, the Centers for Disease Control and Prevention (CDC) saves lives and protects people from health, safety, and security threats. Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with end-stage renal disease.

The nurse is caring for a patient experiencing the acute phase of rape-trauma syndrome (RTS) who is exhibiting a compound reaction. Which clinical manifestation should the nurse recognize as a reactivated condition? Somatic reactions Suicidal behavior Guilt Inappropriate laughter

Suicidal behavior The nurse caring for the patient who is exhibiting a compound reaction in the acute phase of rape-trauma syndrome anticipates the reappearance of symptoms from previous conditions, such as suicidal behavior. Other reactivated symptoms could include psychotic behavior, depression, and substance abuse. During a compound reaction, reactivated symptoms of a previous condition occur in addition to the symptoms characteristic of the acute phase of RTS. Somatic reactions, guilt, and inappropriate laughter are clinical manifestations of the acute phase of rape.

The nurse is giving a presentation to middle school children about cyberbullying and the potential dangers associated with online abuse. Which manifestation should the nurse include as a potential complication? Sexual assault Suicide Financial loss Bullying of younger siblings

Suicide Cyberbullying has been known to cause anxiety, depression, and even suicide. It is not, however, associated with sexual assault, financial loss, or victims bullying their younger siblings.

The nurse is reviewing yearly national patient safety goals. For which organization is the nurse retrieving this​ information? The Food and Drug Association The Joint Commission Institute for Safe Medical Practices The American Medical Association

The Joint Commission The Joint Commission is the organization that identifies client safety goals every year for medical facilities to focus on. The goals​ include, but are not limited​ to, ensuring clients are identified​ safely, improving staff​ communication, using alarms​ safely, and preventing infections. The American Medical Association​ (AMA) promotes the betterment of public health by enhancing the delivery of care and enabling physicians and healthcare teams to partner with clients to achieve better health. The Institute for Safe Medication Practice​ (ISMP) maintains a list of high alert medications such as​ look-alike, sound-alike medications to assist clinicians with identifying medications that can either look similar or have similar​ names, but that have very different chemical properties that can cause harm to the client if the medications are mixed up. The Food and Drug Administration​ (FDA) is responsible for advancing the public health by helping to speed innovations that make medical products more​ effective, safer, and more affordable and by helping the public get the​ accurate, science-based information they need to use medical products and foods to maintain and improve their health.

The nurse is assessing a 9-year-old child whose teacher suspects that the child is a victim of abuse. The physical assessment reveals no unexplained or untreated injuries, and the child does not appear to be malnourished or dehydrated. Which clinical manifestation should indicate to the nurse that this child might be a victim of abuse? The child reports disliking doctor visits. The child still wets the bed on some nights. The child has a bandage over a scrape on the left knee. The child has multiple cavities that have been filled.

The child still wets the bed on some nights. Bedwetting in a 9-year-old is not a normal behavior and can indicate that abuse is present in the home. An aversion to going to the doctor would not be considered an indication of abuse. Young children fall and injure themselves frequently, so the bandage over a scrape on the child's knee is a normal finding and indicates the child is being cared for. Dental fillings that have been treated also indicate that the child is getting appropriate dental and medical care.

The nurse is reviewing the records of a child who is about to be placed into the foster care system after physical neglect by the parents. Which statement by the nurse is​ accurate? The parents intentionally caused physical harm. The parents intentionally caused psychologic harm. The parents intentionally ignored their own physical and healthcare needs. The parents intentionally ignored the​ child's physical needs.

The parents intentionally ignored the​ child's physical needs. Physical neglect occurs when an individual intentionally ignores the physical and healthcare needs of another. Physical abuse is the intentional infliction of physical harm on another individual. Emotional abuse is the intentional infliction of psychologic harm on another. When individuals ignore their own physical and healthcare​ needs, it is​ self-neglect.

A community nurse is caring for a young man who reports having an abusive spouse. The nurse is performing teaching to promote safety for this patient. Which outcome would indicate effective teaching? The patient promises to control his temper to avoid getting into a fight. The patient states that he is no longer afraid of his partner. The patient creates a safety plan. The patient begins to write in a journal.

The patient creates a safety plan. Creating a safety plan indicates that the young man understood the teaching and took the appropriate steps. The patient also needs to understand that the abuse is not his fault (no matter how angry he gets). Not being able to communicate fears about the abuse may mean that the patient is in denial about what is happening. Journaling can be a helpful way to cope, but it does not help the patient stay safe.

The nurse is assessing the plan of care initiated for a patient who is a victim of rape. Which finding indicates that the plan of care should be revised? The patient has agreed to the physical assessment. The patient has asked for a rape counselor. The patient has allowed the physical evidence to be collected. The patient has refused to report the rape or accept help.

The patient has refused to report the rape or accept help. The plan of care will be revised if the patient refuses to report the rape or accept help. The refusal of help indicates that the patient is still in the shock phase. Allowing the nurse to perform a physical assessment, requesting a rape counselor, and allowing physical evidence to be collected indicate the patient is meeting the goals of the plan of care.

A young child is brought to the emergency department for evaluation after the parents are arrested for repeated child abuse. Which test should the nurse anticipate the provider to order for assessing old fractures? X-rays DNA swabs Urine samples Focused assessment by sonography in trauma (FAST)

X-rays X-rays can help the provider visualize and locate new and old bone fractures. DNA swabs and urine samples are usually ordered after a sexual assault to help identify the abuser or identify a bladder infection. The FAST test looks for internal bleeding.

The nurse is caring for a patient who reports flashbacks and nightmares due to a rape that occurred over a year ago. Which statement by the nurse about this patient is accurate? The patient is experiencing posttraumatic stress disorder (PTSD). The patient is in the acute phase of rape-trauma syndrome. The patient is in the reorganization phase of rape-trauma syndrome. The patient is demonstrating the ability to recover from the trauma.

The patient is experiencing posttraumatic stress disorder (PTSD). PTSD occurs when an individual is unable to recover from a trauma and is characterized by flashbacks and nightmares. Rape-trauma syndrome (RTS) is a series of psychologic sequelae that many individuals experience following rape in addition to physiological sequelae. Flashbacks and nightmares are not descriptive characteristics of the acute and reorganization phases of RTS. The patient's symptoms indicate the patient is unable to recover from the trauma.

The nurse is assessing a rape victim who reports insomnia and flashbacks. Which finding demonstrates that the patient has not recovered from the incident? The patient demonstrates effective coping. The patient reports a decrease in negative feelings. The patient reports a decrease in physical symptoms. The patient reports reoccurring memories of the rape.

The patient reports reoccurring memories of the rape. The finding that demonstrates the patient has not recovered from the incident is reoccurring memories of the rape. Coping skills are a part of recovery. A decrease in negative feelings and a decrease in physical symptoms related to anxiety and stress indicate adaptation and coping.

Which scenario describes an adverse medication event? The nurse gives the patient the wrong medication. The nurse is late with the patient's medication by 1 hour. While waiting for a surgery, a patient stops breathing and resuscitation attempts fail. The patient's tongue swells and breathing is difficult after taking a new medication.

The patient's tongue swells and breathing is difficult after taking a new medication. An adverse drug event is defined as harm to a patient as a result of receiving a medication, such as an allergic reaction. The nurse must respond promptly to make sure the respiratory status of the patient does not deteriorate. A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in control of the healthcare professional, patient, or consumer. The patient waiting for surgery who stopped breathing had not yet received any medication.

The nurse is preparing a training program to introduce quality management. Which information should the nurse include? Staff will plan in silos. Staff satisfaction surveys will be used to track the effectiveness of changes. The purpose is to improve the experience of patient care, population, and value. Programs will be staff focused.

The purpose is to improve the experience of patient care, population, and value. Quality management plans address the needs of engagement (improving the experience of care), population health, and value (per capita costs). These plans are patient focused, and collect and evaluate data for improvement of patient outcomes, expectations, and satisfaction. Patient satisfaction surveys are used to track the effectiveness of changes from the patient's perspective. Most organizations will develop quality management plans that require cooperation between departments as well as unit-specific plans. Teams will work cooperatively, not in silos.

5. A sexual assault victim tells the nurse "I should have tried to fight him off! But I was so terrified that I could not move. My whole body felt as though it was made of lead. I should have tried harder." A supportive response for the nurse to make would be "Try not to think about it. Put it out of your mind." "We each behave in characteristic ways in a crisis. That was your way." "Do you think others will think badly of you for not trying to fight?" "The way you behaved was the right thing to do at the time."

The way you behaved was the right thing to do at the time." Correct The victim should always be told that staying alive was the priority, and that whatever she did to that end was the right thing to do.

A specialty trauma center is adopting the concept of Plan-Do-Study-Act to improve their quality and productivity. Which quality assurance program should the nurse identify that the organization is trying to adopt? Total Quality Management Lean Six Sigma Quality management Continuous Quality Improvement

Total Quality Management Total Quality Management uses the PDSA approach of Plan-Do-Study-Act. The Define-Measure-Analyze-Improve-Control and the Define-Measure-Analyze-Design-Verify methods are used in Six Sigma. Quality management is more a concept than a plan. Continuous Quality Improvement is a system-organized program. Lean Six Sigma combines the strategies of Six Sigma, described above, with the Lean system. The objective of the Lean system is to eliminate waste to maximize value.

The nurse follows up with a female client several weeks after providing counseling about safe ways to leave an abuser. Which outcome indicates successful nursing​ care? The woman has obtained a weapon to protect herself in case her spouse gets violent again. The woman has left her abuser and stays in a shelter for victims of domestic abuse. The woman has initiated counseling with a psychotherapist. The woman has no new injuries from the abuser.

The woman has left her abuser and stays in a shelter for victims of domestic abuse. The best outcome for this woman is that she has left the abuser and has resettled in a safe​ place, such as a shelter for women who are victims of domestic violence. Not having new injuries and starting counseling are positive steps but do not ultimately decrease the risk for violence. Getting a gun for​ self-protection actually increases the risk for injury or death.

The school nurse is assessing a third-grade child for symptoms of sexual abuse. Which behavioral manifestations support this concern? Stuttering, impulsivity, and being the team leader when playing games with peers Enuresis, impulsivity, and decline in school performance Hyperactivity, stuttering, and isolating self from peers on the playground Thumb-sucking, isolating self from peers on playground, and excessive fear of strangers

Thumb-sucking, isolating self from peers on playground, and excessive fear of strangers Behavioral symptoms of children who have been sexually abused include regression (thumb-sucking would be regressive behavior in a third-grade child, who is 8-9 years of age), clinging behaviors, lack of peer friendship, and crying out or showing fear when approached by strangers. Impulsivity, hyperactivity, stuttering, and leadership traits are not manifestations of abuse.

The nurse is preparing a presentation of the major goals of the National Database of Nursing Quality Indicators (NDNQI). Which goal should the nurse include? To assist nurses in reducing medication errors To determine the root causes of sentinel events To identify patient safety goals every year To use data to help nurses and other leaders to improve the quality of care

To use data to help nurses and other leaders to improve the quality of care The goal of the NDNQI is to use data to provide nurses and other leaders with information needed to improve quality of care. The Institute for Safe Medication Practice reduces nursing medication errors by identifying high-risk medications. The Joint Commission, which accredits hospitals and agencies, requires root cause analysis of sentinel events; it also identifies patient safety goals every year.

A hospital administrator wants to improve quality care and workflow process within the organization by involving the whole​ organization, suppliers, and customers in the process. Which quality management program should the nurse understand the manager is​ using? Lean Six Sigma Six Sigma Total quality management Continuous quality improvement

Total quality management Total quality management​ (TQM) is a comprehensive management philosophy that is used to improve quality and productivity by using data and statistics to improve systems processes. TQM involves teamwork throughout the​ organization, involving all departments and employees and including both suppliers and customers. Its essential elements include​ communication, feedback,​ fact-based decision​ making, and a focus on continual improvement.

Which should the nurse recognize as being the best resource to keep abreast to the changes of the insurance and healthcare​ laws? ​Physicians' groups U.S. Department of Health and Human Services American Medical Association American Nurses Association

U.S. Department of Health and Human Services Keep abreast of the changes in healthcare and insurance laws by visiting the U.S. Department of Health and Human Services.​ Physicians' groups, the American Nurses Association​ (ANA), and the American Medical Association​ (AMA) are not the best place to keep oneself​ up-to-date about the changes in insurance and healthcare laws.

Which governmental agency should the nurse recognize as being instrumental in developing indicators of high-quality care and measures? U.S. Red Cross Centers for Disease Control and Prevention (CDC) U.S. Department of Health and Human Services (HHS) National Institutes of Health (NIH)

U.S. Department of Health and Human Services (HHS) HHS works with the American Medical Association (AMA) and the American Nurses Association (ANA) to develop indicators of high-quality care and measures to document the quality of care. The U.S. Red Cross works to provide support for disaster relief and blood donations. The CDC conducts and supports health promotion, prevention, and preparedness in an effort to improve health, but not actually measurements. The NIH's primary responsibility is biomedical and public health research.

The nurse is caring for a patient who is experiencing delusions. Which factor may indicate that the nurse is not in a safe situation? Use of violent language by the patient The patient describing aural delusions and hallucinations Lack of family sitting with the patient The patient pacing in circles in the room

Use of violent language by the patient Use of threatening or violent language can be a huge clue that the patient may be violent and that the nurse is in an unsafe situation. Describing aural hallucinations, lack of family support, and actively pacing in circles are not behaviors that are associated with violent behavior.

Several medication errors occurred at a facility. Which method should the nurse anticipate being suggested to avoid future​ errors? (Select all that​ apply.) Use smart infusion pumps for intravenous medications. Conduct medication reconciliation at every transition in care. ​Double-check the​ "seven rights" every time medication is administered. Have a second nurse check the medication order. Combine medications with the same active ingredient.

Use smart infusion pumps for intravenous medications. Conduct medication reconciliation at every transition in care. ​Double-check the​ "seven rights" every time medication is administered. Have a second nurse check the medication order. The correct answers to avoid such errors are​ (1) double-check the​ "seven rights" every time medication is​ administered, (2) conduct medication reconciliation at every transition in​ care, (3) use smart infusion pumps for intravenous​ medications, and​ (4) have a second nurse check the medication order. Combining medications with the same active ingredient is incorrect and is not a method in reducing medication errors.

The nurse is conducting an assessment interview of a patient with unexplained rib fractures. To check whether the patient is a possible victim of domestic abuse, the nurse asks, "Has your partner ever hit you when feeling angry?" Which word in the nurse's phrasing of the question may help the patient answer the question honestly? Using the word angry Using the word ever Using the word hit Using the word partner

Using the word ever The nurse makes the individual feel less intimidated in reporting domestic abuse by asking a question that can be answered with "sometimes" instead of only "yes" or "no." The rest of the wording does not affect how the patient will answer the question.

Which outcome should the nurse recognize as being consistent with children exposed to similar risks of environmental exposure to​ violence? (Select all that​ apply.) Violence Problematic behaviors Lethargy Depression Hypertension

Violence Problematic behaviors Depression The outcomes of children with similar risks of environmental exposure to violence include​ violence, depression, and problematic behaviors. Outcomes do not include lethargy or hypertension.

The nurse specializes in caring for victims of domestic violence and abuse and believes in the tenets of social learning theory. Which statement reflects this theory? Some families, cultures, and communities value the subordination of women through power and privilege. The cause of violence lies in the personality of the individual who commits abuse. The tendency to abuse, neglect, and become violent toward others is a result of genetic considerations and distortion in neurotransmitters. Violence related to abuse and neglect is a learned behavior.

Violence related to abuse and neglect is a learned behavior. Social learning theory suggests that violence related to abuse and neglect is a learned behavior. Violent individuals are conditioned to respond aggressively and violently. Neurobiological theory suggests that the tendency to abuse, neglect, and become violent toward others is a result of genetic considerations and distortion in neurotransmitters. Interpersonal theory suggests that the cause of violence lies in the personality of the individual who commits abuse; the perpetrator uses violence as a display of anger. Gender-bias theory proposes that some families, cultures, and communities value the subordination of women through power and privilege.

The community nurse is presenting information about domestic violence to students at the local high school. Which factor that could increase an​ individual's chances of becoming a victim of violence should the nurse​ include? (Select all that​ apply.) Risk factors Protective factors Vulnerability factors Precipitating factors Predisposing factors

Vulnerability factors Predisposing factors Both predisposing factors and vulnerability factors increase an​ individual's risk of becoming a victim of violence. Risk factors increase the possibility of​ someone's becoming a​ perpetrator, not a​ victim, of violence. Precipitating factors cause a violent event. Protective factors decrease an​ individual's chances of violence.

The nurse is presenting to a community group about how​ parents' activities can decrease the risk of violence in their family. Which action supported by the Centers for Disease Control and Prevention research should the nurse​ include? (Select all that​ apply.) Achieving financial success Watching the​ child's sports team play Showing interest in the​ child's homework Rewarding good report cards Regularly attending worship services together

Watching the​ child's sports team play Showing interest in the​ child's homework Rewarding good report cards Regularly attending worship services together The Centers for Disease Control and Prevention​ (CDC) found that parents can decrease the risk of violence by showing an interest in their​ child's experiences, such as​ homework, sports, and grades. Parents can also participate in such cultural or religious practices as attending worship services. Financial success was not found by the CDC to be a protective factor.

The nurse chairs a committee tasked with improving the number of hospital-acquired infections and is asked for a definition of "benchmarking."Which response should the nurse give? A. Comparison of the performance of an individual or organization to industry standards B. Minimum starting point used for comparisons C. Process to identify vulnerabilities within an organization D. Analysis used to prevent certain events from repeating

a

The nurse in the blood bank is part of a team effort to reduce the cost of collecting and storing blood components. The nurse conducts an inventory to check for expired sterile supplies.Which quality improvement method is the team using in seeking to reduce waste? A. Lean Six Sigma B. Quality assurance C. Root cause analysis D. Utilization review

a

The nurse is discussing the purpose of a just culture.Which information should the nurse include? A. Balancing the blame-free environment with appropriate accountability B. Balancing the blame-free environment with discipline C. Balancing quality with justice D. Balancing discipline with accountability

a

The nurse is participating in a quality improvement process related to improving care for clients at risk for skin breakdown. Which best describes the purpose of this process? A) To improve client outcomes B) To advance the nurse's career C) To fulfill legal requirements D) To maintain accreditation

a

Which statement correctly describes quality management? A) Quality management compares nursing processes to accepted standards to prevent errors in treatment. B) Quality management refers to systematic actions that lead to improvements in healthcare services. C) Quality management is the degree to which health services increase the likelihood of desired health outcomes. D) Quality management provides clients with appropriate service in a technically competent manner

a

8. A rape victim in the emergency department repeats "I don't know why he did it." Although the nurse does not necessarily give the answer at this juncture, the nurse correctly identifies the motivation for most perpetrators of rape as anxiety relief. overwhelming sexual desire. a desire to dominate and humiliate. a wish to be apprehended and punished.

a desire to dominate and humiliate. Correct Power and domination as well as humiliation of the victim are the motivations for rape. In this scenario the nurse understands that rape is not a sexual act. Rape is a violent expression of aggression, anger, and the need for power. Awarded 0.0 points out of 1.0 possible points.

A community health nurse visits a family with four children. The father behaves angrily, finds fault with the oldest child, and asks twice, "Why are you such a stupid kid?" The wife says, "I have difficulty disciplining the children. It's so frustrating." Which comments by the nurse will facilitate an interview with these parents? (Select all that apply.) a. "Tell me how you discipline your children." b. "How do you stop your baby from crying?" c. "Caring for four small children must be difficult." d. "Do you or your husband ever spank your children?" e. "Calling children 'stupid' injures their self-esteem."

a. "Tell me how you discipline your children." b. "How do you stop your baby from crying?" c. "Caring for four small children must be difficult."

Which comment by the nurse would best support relationship building with a survivor of intimate partner abuse? a. "You are feeling violated because you thought you could trust your partner." b. "I'm here for you. I want you to tell me about the bad things that happened to you." c. "I was very worried about you. I knew you were living in a potentially violent situation." d. "Abusers often target people who are passive. I will refer you to an assertiveness class."

a. "You are feeling violated because you thought you could trust your partner."

A nurse assists a victim of intimate partner abuse to create a plan for escape if it becomes necessary. Which components should the plan include? (Select all that apply.) a. Keep a cell phone fully charged. b. Hide money with which to buy new clothes. c. Have the phone number for the nearest shelter. d. Take enough toys to amuse the children for 2 days. e. Secure a supply of current medications for self and children. f. Assemble birth certificates, Social Security cards, and licenses. g. Determine a code word to signal children when it is time to leave.

a. Keep a cell phone fully charged. c. Have the phone number for the nearest shelter. e. Secure a supply of current medications for self and children. f. Assemble birth certificates, Social Security cards, and licenses. g. Determine a code word to signal children when it is time to leave.

A 10-year-old cares for siblings while the parents work because the family cannot afford a babysitter. This child says, "My father doesn't like me. He calls me stupid all the time." The mother says the father is easily frustrated and has trouble disciplining the children. The community health nurse should consider which resources as priorities to stabilize the home situation? (Select all that apply.) a. Parental sessions to teach childrearing practices b. Anger management counseling for the father c. Continuing home visits to give support d. A safety plan for the wife and children e. Placing the children in foster care

a. Parental sessions to teach childrearing practices b. Anger management counseling for the father c. Continuing home visits to give support

Rape is best described as an act of violence using sex as the weapon. assault by a stranger on an unsuspecting victim. sexual desire satisfied inappropriately. an act prompted by early childhood neglect.

an act of violence using sex as the weapon. Correct Rape is a violent crime. Sex is only the medium for perpetrating the crime. Awarded 1.0 points out of 1.0 possible points.

The nurse is asked to participate in a record review to verify accuracy and proper use of certain interdisciplinary resources. Which best describes the nature of this process? A) Peer review B) Interdisciplinary audit C) Utilization review D) Benchmarking

b

The nurse is presenting a proposal to the board of directors regarding the impact of staffing on quality care. Which data point should the nurse include in the presentation? A. Limiting nursing hours helps to control costs. B. Increased nursing hours are shown to decrease patient mortality. C. Nursing skill does not correlate to patient outcomes. D. Readmission rates do not necessarily correlate with increased nursing staff.

b

The nurse is a member of the utilization review committee that is composed of members from various disciplines within the hospital. Which patient situation should the nurse understand will be of interest to the utilization review committee? A. Routine maintenance of medical equipment B. Routine use of sterile packs in surgery C. Application of adult diapers on every older adult patient D. Each inpatient provided with an admission kit

c

The nursing team is using statistics that reflect the organization's performance in a specific area to compare the quality of care within the organization to industry standards. Which activity is the team performing? A. Root cause analysis B. Auditing C. Benchmarking D. Risk management

c

The nurse is working in a healthcare setting that has implemented Lean Six Sigma. Which of the following should the nurse anticipate with regard to this model? A) Shorter breaks B) Ordering extra supplies C) Replacing licensed with unlicensed personnel D) Decreasing staff when the census is low

d

8. Which statement would be an appropriate outcome for a rape client? The client will integrate the rape event and resume an optimal level of functioning. identify and develop coping skills necessary to reduce level of anxiety. blame the rapist rather than blame herself for the situation. repress feelings of shame, embarrassment, and self-blame.

integrate the rape event and resume an optimal level of functioning. Correct This is the ideal long-term result of treatment for rape trauma syndrome, that life will go on and the client will return to the usual pre-trauma level of functioning.

7. Anticipatory teaching of a rape victim should include information that a common survivor problem often developing during the long-term reorganization phase of rape trauma syndrome is denial of the event. headaches and fatigue. shock and numbness. intrusive thoughts.

intrusive thoughts. Correct Just as in posttraumatic stress disorder, intrusive thoughts haunt the rape victim in the weeks and months during which long-term reorganization is occurring. Knowing this is a common occurrence is reassuring to the client, who often is frightened by the symptom. Awarded 0.0 points out of 1.0 possible points.

4. Care planning for the rape victim is facilitated if the nurse understands that the rape trauma syndrome is actually a variant of posttraumatic stress disorder. a maturational crisis. a dissociative disorder. generalized anxiety disorder.

posttraumatic stress disorder. Correct Most of those who have been raped are eventually able to resume their previous lives after supportive services and crisis counseling. However, many carry with them a constant emotional trauma: flashbacks, nightmares, fear, phobias, and other symptoms associated with PTSD Awarded 1.0 points out of 1.0 possible points.

10. In the acute phase of the rape trauma syndrome, nursing interventions should focus on teaching stress management techniques to the client. helping the client's family clarify feelings. providing client support and safety. ensuring case management.

providing client support and safety. Correct Helping the client feel safe and giving emotional support are two important interventions to combat the disorganization common during the acute phase of the rape trauma syndrome. Awarded 1.0 points out of 1.0 possible points. Continue

4. A sexual assault victim asks to be given "the morning-after pill" to prevent conception. The nurse does not believe in abortion. The action the nurse should take is to "forget" to mention this to the physician. report and document the request. ask the supervising nurse to reassign the client. ask the client to reevaluate her request after 24 hours.

report and document the request. Correct The nurse's ethical beliefs should never interfere with client rights. The nurse should report and document the client's request. If the drug is ordered, however, the nurse can request that another nurse administer the drug.

3. To provide discharge treatment and support, the nurse should realize that the most common sequelae of acquaintance rape is the development of symptoms of sexual distress. anxiety and fear of men. a paranoid psychosis. an eating disorder.

symptoms of sexual distress. Correct Depression occurs in both groups.

10. The nurse working with a rape victim in the week after the event tells her about the possibility of experiencing intrusive thoughts, increased motor activity, and fears and phobias in the next few weeks. The reason for this intervention is to help the client redevelop a sense of control over herself. that anticipatory guidance allows planning to decrease stress. that talking about feelings reduces their intensity. that self-destructive behaviors develop out of negative feelings.

that anticipatory guidance allows planning to decrease stress. Correct Anticipatory guidance helps the client understand what to expect. When the expected occurs it is not as great a shock. Knowing what to expect also allows the client to plan for ways to cope. Text page: 613 Awarded 1.0 points out of 1.0 possible points.

The nurse presented to a community group about violence. Which participant statement indicates the need for further​ teaching? ​"Violence is not​ preventable." ​"Eighty percent of domestic violence victims are​ women." ​"Older adult abuse happens to people over 65 years of​ age." ​"Violence challenges coping​ efforts."

​"Violence is not​ preventable." The nurse would want to make these facts​ clear: Violence is preventable. Older adult abuse happens to people over 65 years old. Eighty percent of domestic violence victims are women. Violence does challenge coping efforts.

The nurse is caring for a woman who is brought into the emergency department after being assaulted by her partner. The woman wishes to leave her partner but is terrified that the partner will kill her. Which is the priority nursing diagnosis for this​ client? ​Injury, Risk for ​Knowledge, Deficient ​Coping, Ineffective Health​ Maintenance, Ineffective

​Injury, Risk for Safety is always a priority when caring for a client who is being abused or at risk for violence or trauma. The best nursing diagnosis is ​Injury, Risk for due to the high risk that the​ client's partner will abuse her again