HESI Registered Nurse EXIT Practice Exam

In cases suspecting domestic violence, what is the nurse's first action?

1. Ask client if there are any old injuries

2. Interview the client without the persons who came with the client

3. Gain client's trust by not being hurried during the intake process

4. Photograph the specific injuries in question

The correct answer is: Interview the client without the persons who came with the client

In cases of suspected domestic violence, the first action the nurse should take is to interview the client without the individuals accompanying them. This is crucial because it creates a safe and private environment where the client may feel more comfortable disclosing sensitive information regarding their situation. Being alone can help ensure that the client feels less pressured and more secure, which is essential when discussing potentially dangerous circumstances. By removing potential bystanders, such as partners or family members who could be perpetrators of violence, the nurse can better assess the situation and establish rapport. Trust is critical in these scenarios; victims of domestic violence may fear retaliation or feel shame, and having a private conversation helps facilitate an open dialogue about their experiences. While other options may seem relevant, they do not prioritize the immediate need for confidentiality and a safe space for the client to share their experiences. For instance, asking about old injuries or photographing injuries may be important steps later in the assessment process but should not precede ensuring the client's safety and comfort in speaking freely. Gaining trust is vital, but it is fundamentally tied to ensuring privacy first.