Abuse: Exemplar 32.1- Pearson
The school nurse teaches elementary school teachers about occurrences of violence towards children. The nurse knows that further teaching is necessary if a teacher makes which statement? "Poor hygiene and inappropriate clothing are possible signs of child abuse." "Children with special needs are less vulnerable to physical abuse than other children." "Physically abused children may appear overly submissive and eager to please their teacher." "Children who are physically abused by their parents are more likely to abuse siblings."
"Children with special needs are less vulnerable to physical abuse than other children." Rationale: Caregiver stress and frustration may lead to abuse or even homicide of children with special needs. Children who are physically abused by their parents are more likely to abuse siblings; sibling abuse is the most unrecognized form of abuse. Physically abused children may appear overly submissive and eager to please their teacher; abused children are frequently overly compliant in response to all adults. Inadequate physical care or lack of care for a child may be a sign of child abuse.
A client who is a victim of intimate partner abuse attends a group therapy session. Which comment by the client indicates a desired outcome? "I should have kept my mouth shut and none of this would have happened." "I am not afraid to be alone with my significant other even though he is the reason I am here." "I can't leave the situation. There is nowhere for me to go." "I realize now that I am not responsible for the abuse and I do not deserve to be treated this way."
"I realize now that I am not responsible for the abuse and I do not deserve to be treated this way Rationale: The client is demonstrating a desired outcome by stating, "I realize now that I am not responsible for the abuse and I do not deserve to be treated this way." The desired goal is for the client to verbalize awareness that they are not responsible for the abuse and that they do not deserve it. The other responses demonstrate negative outcomes. Desired outcomes would include the client openly communicating fears in regards to the abuse and demonstrating knowledge of available resources to those in abusive situations.
A client who has been physically abused asks the nurse, "What makes people so violent toward others?" Which is the best response to this question? "Hormones are the primary reason for violence in men." "It is difficult to give one specific reason for violent behavior." "If women were more agreeable, there wouldn't be any violence." "Violence is inherited from a person's family."
"It is difficult to give one specific reason for violent behavior." Rationale: Many theories exist concerning the motivation for violent behavior and abuse within families. Some of those theories propose that individuals are genetically predisposed to violence, while other theories discuss the influences of society and family structure. No definite causes of family violence have ever been agreed upon, but theories such as the psychopathology theory and the social learning theory lead into one another to help highlight some contributing factors to abusive behavior.
A client who is a victim of elder abuse has been attending counseling sessions with their family. The nurse evaluates that an abusive family member has learned positive coping skills when which statement is made? "I will make sure that my parent's needs are met." "I am sorry for the abuse; it won't happen again." "Now that I know what my resources are, I think I can do a better job of caring for my parent." "I will need to change my behavior when my parent moves in with us."
"Now that I know what my resources are, I think I can do a better job of caring for my parent." Rationale: Elder abuse can occur when family are expected to care for the aging parent. This causes frustration, overextension, and sometimes is a financial burden. Stating that the abuser will use assistance from resources is a positive action toward behavior change. Stating that they will meet the needs of the client, that they are sorry, or that they need to change behavior are not demonstration of a positive change; it is simply lip service and a hallmark response by habitual abusers.
A 63-year-old client with Alzheimer disease is brought to the emergency department (ED) with pressure sores and severe dehydration. Upon further assessment, the nurse notices bruises on the client's neck, arms, and legs. Which question could the nurse ask the client's spouse? "Have you considered placing your spouse in a nursing home?" "How long do you leave your spouse at home alone?" "What kind of support do you have at home to care for your spouse?" "How often do you turn your spouse while your spouse is in bed?"
"What kind of support do you have at home to care for your spouse?" Rationale: Asking about support at home will assess the support system and ability of the spouse to care for the client in a safe manner. This question also indicates that the nurse is aware of possible stress on the caregiver without accusing the spouse of abuse. Asking about placing the client in a nursing home subtly implies the spouse is abusing the client and is unable to care for the client properly. The nurse first assesses the client before planning interventions. Asking about turning the client in bed does not assess the possibility of caregiver strain nor does it offer support to the caregiver. Asking about the length of time the client is alone assumes that the client's injuries are signs of neglect or abuse.
A client comes to the emergency department with multiple bruises on the face and head. The nurse suspects that domestic violence may be the cause of the injuries. What is the most appropriate initial action for the nurse to take? Call a social worker to evaluate the client for domestic violence. Refer the client to a shelter for battered partners. Ask if the client is afraid of being hurt by someone at home. Document the concern, but do nothing else.
Ask if the client is afraid of being hurt by someone at home. Rationale: Asking if the client is being hurt is a critical step in a comprehensive assessment. Referring the client to a shelter without assessment may be a disservice; the nursing process requires assessment before intervention. After assessment and the determination of domestic violence, collaboration with social services is appropriate. Documenting the assessment does nothing to help the client resolve the issue.
A nurse came to work with a black eye and a swollen lip. Coworkers have noticed that the partner calls the nurse at least 10 times during a 12-hour shift. The nurse has refused all invitations to go out with coworkers, saying that the partner will be there after work and doesn't like to wait. Which action taken by the coworkers would be most helpful? Encourage the nurse to talk to a professional. Enlist the parents' aid in getting the nurse away from the partner. Encourage the nurse to get a restraining order against the partner. Convince the nurse to leave the partner.
Encourage the nurse to talk to a professional. Rationale: Encourage the nurse to talk to a professional. Nurses encourage the client to accept help in seeking an abuse-free living situation, but the decision ultimately lies with the client. Some individuals will not be ready to seek help, and while the nurse may disagree with this decision, he must refrain from judgment and be respectful of the client's decision. All nurses can do in these situations is offer assistance and resources, the victim will then know that help will be available if it is needed in the future. Trying to convince abused adults to leave their abuser does not empower the adult. Friends and coworkers should provide support without telling the nurse what to do. Encouraging the nurse to get a restraining order against the partner is inappropriate because a restraining order may actually increase the violent behavior of the partner. Involving the parents may complicate the situation and result in more abuse, which further isolates the nurse from family and friends
The nurse is caring for an elderly client who has been admitted with a recent fall. The admission assessment revealed several bruised areas on the back and legs. During the interview with the caregiver, the caregiver states, "I don't know what to do with her when I go to work during the day so I leave her home alone." What is the most appropriate action for the nurse to take? Encourage play therapy. Suggest art therapy. Provide resource information on adult day cares. Threaten to contact the authorities.
Provide resource information on adult day cares. Rationale: Providing resource information on adult day cares is most appropriate in this situation. The client's caregiver is expressing concern about leaving them home alone and an adult day care may give the caregiver a safe option for the times the caregiver is at work. Play therapy most commonly helps children play out traumatic themes, fears, and distorted beliefs. It is a nonthreatening way to process thoughts and feelings associated with the abuse, both symbolically and directly. Art therapy provides an opportunity to express feelings for which there are no words. While elder abuse is a reportable event, the lack of the caregiver's knowledge of resources has attributed to the safety issue.
Which nursing diagnosis would be priority for a homosexual client who has been repeatedly physically assaulted by the partner? Powerlessness related to feelings of dependence on significant other Risk for injury related to history of abuse by significant other Chronic low self-esteem related to guilt and shame for being a victim of abuse Social isolation related to control by the significant other and feelings of inadequacy
Risk for injury related to history of abuse by significant other Rtionale: The safety of the client is the priority diagnosis. The greatest predictor of continued violence is the previous history of violence by the partner. Although powerlessness related to feelings of dependence on the significant other is an appropriate diagnosis, a concern for safety is the number-one priority. Chronic low self-esteem related to guilt and shame for being a victim of abuse may be appropriate for this client, but safety is the first concern. Social isolation related to control by the significant other and feelings of inadequacy may be an appropriate diagnosis for this client, but a threat to safety would supersede this diagnosis.
Which behavior does the school nurse recognize as an indicator that a school-age child has been physically abused? The child tells other children that they will get a "time-out" if they continue to misbehave. The child sits quietly with a friend in the schoolyard instead of playing kickball. The child bullies other children and threatens them to "keep quiet about it." The child acts obediently when a parent scolds the child to be quiet.
The child bullies other children and threatens them to "keep quiet about it." Rationale: It is common for children to model the behaviors of parents, siblings, other adults, or actions they see on television. Therefore, children have a high likelihood of adopting abusive tendencies perpetrated by their parents or siblings. Acting obediently when being scolded indicates appropriate discipline by the parent. There may be many reasons why the child does not want to participate in a physical sport. An abused child may be withdrawn and isolated from peers. Nonphysical interventions such as time-outs are more effective than spanking at modifying unwanted behavior.
