A nurse is assessing a client who presents with injuries and signs that may suggest intimate partner violence. Which of the following statements by the client would most likely indicate the need for further assessment and intervention?
"I have bruises from a recent sports injury."
"I'm experiencing stress from work and it's affecting my health."
"I fell down the stairs and injured my arm."
"I often feel afraid at home, but I don't want to talk about it."
The Correct Answer is D
Rationale:
A. Bruises from a sports injury are less likely to indicate intimate partner violence without additional context.
B. Stress from work is a general issue and does not directly suggest intimate partner violence.
C. A fall down the stairs could be an accident; however, further context is needed to assess if this is related to violence.
D. Fear at home and reluctance to discuss it could indicate underlying intimate partner violence, requiring further assessment and intervention.
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Correct Answer is A
Explanation
Rationale:
A. Understanding culture is crucial because it influences how individuals perceive and respond to violence, which can impact their engagement with support services and interventions.
B. While cultural considerations can help with referrals, the primary focus should be on understanding the patient's responses and needs in the context of their cultural background.
C. Asking about culture is not merely a habit; it’s a critical aspect of providing comprehensive care that respects and understands the patient's background.
D. Culture is not directly related to deciding on the scope of physical assessments but is essential for understanding the patient’s context and needs.
Correct Answer is A
Explanation
Rationale:
A. Tertiary prevention is correct as it involves managing and improving the quality of life for individuals who already have a chronic disease or disability. Rehabilitation and strength training aim to help the client live better despite the existing condition.
B. Primary prevention aims to prevent the onset of disease, which is not the focus here.
C. Workplace prevention is not a specific level of prevention; it may include aspects of primary and secondary prevention.
D. Secondary prevention involves early detection and intervention to prevent the progression of a disease, but since the client already has the condition, tertiary prevention is more applicable.