Forsyth Technical Community College - NUR 212 / NUR212 QUIZ 2 UNIT 2 / VIOLENCE Latest 2021 Graded A

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Question 1 The nurse tells a rape victim that even if she was protected against pregnancy by a contraceptive and has no intention of taking any legal action against her assailant, she should still ... be checked by a health care provider (HCP) for early detection of: Correct response:  sexually transmitted disease. Explanation: The post-rape examination is important for detecting the possibility of sexually transmitted disease, which can be spread through rape. The client should also be examined for infection that can result from trauma. Additionally, if the victim or the rapist was not using a contraceptive, postcoital contraceptive methods should be discussed. The information provided does not indicate anxiety or physical injury, such as periureteral tears, and these are not the primary reason for the examination. Menstrual difficulties are not a common result of rape. Question 2 The nurse is planning care for a client who has a history of making verbal threats and acting violently toward family members. The client is currently displaying intense anger towards the staff. What nursing diagnosis is most appropriate? Correct response:  Risk for other-directed violence Explanation: A history of violence, threats, violent antisocial behavior, and threatening body language all suggest the nursing diagnosis of Risk for other-directed violence. The client's behavior doesn't fit the criteria for the nursing diagnoses in options 1, 3, and 4. Question 3 A client with a diagnosis of antisocial personality disorder has a potential for violence and aggressive behavior. Which short-term client outcome is most appropriate for the nurse to include in the plan of care? Correct response:  Discuss feelings of anger with staff. Explanation: The nurse assists the client with identifying and putting feelings into words during oneto-one interactions. This helps the client express her feelings in a nonthreatening setting and avoid directing anger toward other clients. A client with an antisocial personality disorder needs to understand how others feel and react to her behaviors and why they react the way they do. The client also needs to understand the consequences of her behaviors. Using humor or indirect behaviors to express anger is a passive–aggressive method that will not help the client learn how to express her anger appropriately. Asking the nurse for medication when upset is a way to avoid dealing with feelings and is not helpful. However, medication may be necessary if talking and engaging in a physical activity have not been effective in lowering anxiety or if the client is about to lose control of her behavior. Question 4 The client is admitted to the hospital because of threatening, aggressive behavior toward the client’s family. Which factor is most important for the nurse to consider when assessing the angry client’s potential for violence? You Selected:  the client's past history of violent behavior Correct response:  the client's past history of violent behavior Explanation: The client’s past history of violent behavior is the most accurate predictive factor. Violent behavior is more likely when there is a demand for high activity; however, this is not the strongest risk factor. There is an increased chance of violent behavior when the staff feels hopeless about a client because the client can recognize their feelings and may be unwilling to learn adaptive coping. However, this is not the strongest risk factor. With inadequate staffing, the chance for violent behavior increases because timely intervention before escalation of agitation may not be possible. However, this is not the strongest risk factor. Question 5 See full question In working with a rape victim, which intervention is most important? You Selected:  periodically reminding the client that she did not deserve and did not cause the rape Correct response:  periodically reminding the client that she did not deserve and did not cause the rape Explanation: Guilt and self-blame are common feelings that need to be addressed directly and frequently. The client needs to be reminded periodically that she did not deserve and did not cause the rape. Continually encouraging the client to report the rape pressures the client and is not helpful. In most cases, resuming sexual relations is a difficult process that is not likely to occur quickly. It is not necessarily true that the rapist will be caught, tried, and jailed. Most rapists are not caught or convicted. Question 6 See full question As an angry client becomes more agitated while talking about his problems, the nurse decides to ask for staff assistance in taking control of the situation when the client demonstrates which behavior? You Selected:  picking up a pool cue stick and telling the nurse to get out of his way Correct response:  picking up a pool cue stick and telling the nurse to get out of his way Explanation: Asking the staff for assistance is appropriate when the client demonstrates behaviors that involve the direct threat of violence. Holding a stick and telling the nurse to move is the most direct threat of violence. Swearing and pounding on a table may be disturbing, but these actions are less of a threat. Coming out of his room may indicate noncompliance with directions. However, further assessment is needed to determine whether this behavior was a direct threat of violence. Question 7 See full question A client is admitted to the psychiatric hospital for evaluation after numerous incidents of threatening others, angry outbursts, and two episodes of hitting a coworker at the grocery store where he works. The client is very anxious and tells the nurse who admits him, “I did not mean to hit him. He made me so mad that I just could not help it. I hope I do not hit anyone here.” To ensure a safe environment, the nurse should first: [Show More]

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