A woman was in the emergency department with a bruised and broken leg. She explained that she had accidentally opened the car door on a trip and the door had blown back on her leg
Her husband was very attentive, constantly asking the nurse to make his wife more comfortable. Which of the following actions should be taken by the nurse?
a.
Ask the husband to step out of the room while you get a urine specimen, and, after he leaves, ask the woman, "Have you ever been deliberately hurt by someone?"
b.
Call x-ray immediately, and prepare for the leg to have a cast applied.
c.
Put ice bags on the area until the leg can be repaired.
d.
Try to get an additional pain medication order from the physician.
ANS: A
Abuse of women is often explained as accidental injury. Approximately 6% of visits made by women to emergency departments are for injuries that result from physical battering by their husbands, former husbands, boyfriends, or lovers. It is important for the nurse to understand the state laws related to reporting known or suspected domestic violence. The AMA and ANA advocate that all women should be assessed for intimate partner violence. Questions should be posed privately, in nonjudgmental specific terms (i.e., "Do you feel safe?" "Have you ever been hit, punched, slapped, or kicked?") with follow-up questions if the woman responds "yes." In this situation, with a questionable explanation for the injury and an overly attentive husband, it would be important to complete this assessment. This invention would be more important than calling for x-ray, applying ice, or administering additional pain medication.
You might also like to view...
Complete documentation is essential and must include an accurate picture of the type and quality of care given, as well as the effectiveness of the plan of care. The model that provides this is the:
a. caretaker. b. nursing process. c. home health care. d. nursing efficiency.
A client in the long-term reorganization phase of the rape-trauma syndrome is experiencing intrusive
thoughts of the rape and over the past week has developed a fear of being alone. Indicators for the outcome of fear self-control that should be monitored by the nurse include the client a. planning coping strategies for fearful situations. b. using increased activity to reduce fear. c. temporarily withdrawing from social situations. d. expressing willingness to be sexual.
The nurse would uphold principles of sterile technique by doing which of the following when setting up a sterile field?
1. considering anything below the knees to be unsterile 2. avoiding pouring liquids on drapes to avoid strike-through 3. reaching across a sterile field 4. using a package that is wet as long as the contents seem dry
The faculty member is reviewing a process recording with the student nurse. The student has been working with a client who has had an amputation of the lower left leg and is emotionally fragile
The student receives positive feedback from the faculty member for the following response made to the client: 1. "Why are you so upset today?" 2. "I'm sure that everything will be all right." 3. "You shouldn't cry. The wound will heal soon." 4. "It must be very difficult to have this happen to you."