Which assessment has priority when a nurse interviews a rape victim in the emergency department?
a. Coping mechanisms the patient is using
b. Patient's previous sexual experience
c. Adequacy of interpersonal relationships
d. Patient's history of sexually transmitted diseases
ANS: A
Of the options listed, the priority assessment is the victim's coping mechanisms. The other options have little relevance.
You might also like to view...
What best explains the reason for the increased incidence of hypoglycemia in the infant with intrauterine growth restriction?
a. Cold stress c. Exposure at birth b. Depleted nutrient stores d. Large body surface area
The nurse is assessing a client for asterixis. Which instruction to the client is most appropriate?
a. "Close your eyes and take turns touching your nose with your fingers." b. "Sit on the edge of the bed and hold your legs straight out for 30 seconds." c. "Extend your arm, flex your wrist upward, and extend your fingers." d. "Say ‘EEEEE' while I listen to your lungs in the back on both sides."
The nurse is teaching a patient about proper administration of eardrops. Which statements are correct?
(Select all that apply.) a. Remove cerumen with a cotton-tipped swab before instilling the drops. b. Instill the drops while still cool from refrigeration. c. Warm the eardrops to room temperature before instillation. d. The adult patient should pull the pinna of the ear up and back. e. Insert a dry cotton ball firmly into the ear canal after instillation. f. Massage the earlobe after instillation.
The scrub nurse notices a small tear in one glove during the surgical procedure. Which does the scrub nurse implement?
1. Remove the damaged glove and scrub the hand again. 2. Ignore a very small tear if procedure is nearly finished. 3. Apply a new, sterile glove over the contaminated glove. 4. Ask circulating nurse to remove the contaminated glove.