A 12-year-old male is brought to his primary care provider to determine whether sexual abuse has occurred. The mother states, 'Because there is no permanent physical damage, he does not need any more treatment.' The nurse's response should be based on which of the following pieces of information?
- A. Male victims of sexual abuse seldom have long-term psychological problems.
- B. Survivors of male sexual abuse might become confused about their sexual identity.
- C. Unless treated, all male sex abuse survivors grow up to abuse other children.
- D. All children who have been sexually abused have the same needs, regardless of gender.
Correct Answer: B
Rationale: Male children are sexually abused nearly as often as female children. Perpetrators are usually men but can be women. Needs of male children who have been sexually abused might be different from the needs of female survivors. Male survivors might respond in anger, question their sexuality, use alcohol and other drugs, and might try to prove their masculinity by performing daring acts.
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A corporate executive works 60-80 hours a week. The client is experiencing some physical signs of stress. The nurse teaches the client biofeedback techniques. This is an example of which of the following health-promotion interventions?
- A. structure
- B. relaxation technique
- C. time management
- D. regular exercise
Correct Answer: B
Rationale: Biofeedback is a relaxation technique that helps manage stress by teaching control over physiological responses, addressing the client's stress-related symptoms.
A nurse is instructing a person who had a left CVA and right lower extremity hemiparesis to use a quad cane. Which of the following is the most appropriate gait sequence?
- A. Place the cane in the patient's left upper extremity, encourage cane, then right lower extremity, then left upper extremity gait sequence.
- B. Place the cane in the patient's left upper extremity, encourage cane, then left lower extremity, then right upper extremity gait sequence.
- C. Place the cane in the patient's right upper extremity, encourage cane, then right lower extremity, then left upper extremity gait sequence.
- D. Place the cane in the patient's right upper extremity, encourage cane, then left lower extremity, then right upper extremity gait sequence.
Correct Answer: A
Rationale: The cane should be placed in the patient's strong upper extremity (left), and the sequence should coordinate the weak side (right leg) with the cane for support, followed by the strong side (left leg).
Support systems during the grieving process include all of the following except:
- A. a despondent friend.
- B. a nurse.
- C. a social worker.
- D. a family member.
Correct Answer: A
Rationale: A despondent friend, even though this could be a support to the grieving person, is in a state of despondency. Therefore, he or she might not do well with a grieving friend.
The nurse is assessing an elder who the nurse suspects is being physically abused. The most important question for nurse to ask is:
- A. How much money do you keep around the house?
- B. Who provides your physical care?
- C. How close does your nearest relative live?
- D. What form of transportation do you use?
Correct Answer: B
Rationale: The most common abuser is a caregiver living with the client. Research reveals that the spouse is currently the most common abuser, followed by an adult child.
Appropriate nursing strategies to assist a client in maintaining a sense of self include:
- A. using the client's first name when addressing the client
- B. treating the client with dignity
- C. explaining procedures only if the client is attentive
- D. discouraging the use of personal items
Correct Answer: B
Rationale: Treating the client with dignity respects their individuality and fosters a sense of self, unlike the other options, which may undermine autonomy or engagement.