Ch 33 Survivors of Violence and Trauma

A patient recovering from violence and trauma typically goes through what three stages? Choose three. a. Tension stage b. Impact stage c. Serious battering stage d. Recoil stage e. Reorganization stage f. Denial stage

B. Impact D. Recoil E. Reorganization Typically, three stages of recovery are defined: (1) initial disorganization (impact), (2) a struggle to adapt (recoil), and (3) reconstruction (reorganization)

What is the third stage of the cycle of violence?

Three stages of the cycle of violence 1. Tension-building stage 2. Serious battering incident stage 3. Honeymoon stage- occurs when the victim sees the abusers' loving behaviors as the real person and tries to make up. Also, the victim wants to believe that the abuse will never happen again and believes in the permanency of the relationship. pg. 446

Which comment by the nurse would best support relationship building with a client who has experienced partner abuse? a. "It's normal to feel violated, because you thought you could trust your partner." b. "I'm here for you. I want you to tell me about the bad things that happened to you." c. "I'm very worried about you. I know you were living in a potentially violent situation." d. "Abusers often target people who are passive. I will refer you to an assertiveness class."

a. "It's normal to feel violated, because you thought you could trust your partner." This response shows empathy, an important nursing attribute for establishing rapport and building a relationship built on acceptance. Pg. 447

Which interventions should a nurse include in the plan of care for a woman who has been physically abused by a partner for 10 years? (Select all that apply.) a. Be objective and nonthreatening. b. Help the victim to assess strengths. c. Make referrals contingent on leaving the abuser. d. Inform the woman that marital counseling is rarely effective. e. Help the victim recognize that the perpetrator's behavior is abusive.

a. Be objective and nonthreatening. b. Help the victim to assess strengths. e. Help the victim recognize that the perpetrator's behavior is abusive. An objective, nonthreatening approach builds trust. Identifying the perpetrator's behavior as abusive is honest and supports the seriousness of the behavior. Helping the victim assess strengths will be necessary if the patient is to see herself as having sufficient resources to leave the abusive relationship.

Which intervention would the nurse incorporate if she suspects the patient is a victim of partner abuse? a. Give the patient distance during this difficult time b. Directly ask patient if abuse is occurring c. Push the patient to leave the abuser d. Refuse to help the patient if they do not agree to leave the abuser

b. Directly ask patient if abuse is occurring Pg 447

A patient who is a survivor of intimate partner violence states, "I had a fear of being alone." Which factor did this patient experience that caused long term abuse? a. Cultural b. Emotional c. Physical d. Situational

b. Emotional Box 33.4 Why Women Stay as Long as They Do-pg 446 Emotional Factors • Fear of being alone • Being in a state of denial and living a secret • Personal embarrassment and protecting the image of husband and family • Insecurity and lack of emotional support • Guilt about failure of marriage or relationship • Fear that partner is unable to survive alone • Belief that partner is sick and needs her help • Belief that partner will change • Fear of being alone and feeling overwhelmed

Which stage of abuse would the victim NOT leave an abusive situation? a. Tension building b. Honeymoon c. Battering d. Validation

b. Honeymoon III Honeymoon She sees his loving behaviors as the real person and tries to make up. She wants to believe that the abuse will never happen again. She feels that if she stays, he will get help; the thought of leaving makes her afraid. She believes in the permanency of the relationship. pg. 446

The nurse is caring for a victim of domestic violence who states that the victim is not ready to leave the abuser. Which statement by the nurse is an effective therapeutic communication response? a. Do you believe that the abuse will stop occurring? b. I want you to know that you are not alone, and there are people who want to help you when you are ready. c. You must prepare to leave him before things escalate to the point of no return. d. Staying with your abuser is to the best decision for you or your family

b. I want you to know that you are not alone, and there are people who want to help you when you are ready. Pg. 447

Which patient below would the nurse suspect has been a victim of serial ritual abuse? a. Lying in a fetal position; echolalia; body tremors b. Multiple scars and burns; missing teeth; fear of being examined c. Scarred knuckles; tooth enamel erosion; sores around mouth d. Acting-out; verbal aggression; arrested for pickpocketing

b. Multiple scars and burns; missing teeth; fear of being examined Scarring, burns, and missing teeth fit the picture of ritual abuse. The fear of examination relates to having to remove clothes in preparation for torture.

An adolescent patient has a history of excessive drinking, habitually running away, and prostitution. The nurse recognizes these behaviors are related to? a. Antisocial personality disorder b. Ritual physical abuse c. Childhood sexual abuse d. Intimate partner abuse

c. Childhood sexual abuse Self-mutilation; alcohol and drug abuse; bulimia; and unstable, unsatisfactory relationships are frequently seen in teens who are sexually abused

A patient recovering from trauma is in the recoil stage. The nurse is aware the patient will be experiencing what? a. Disturbed eating and sleeping patterns b. Blaming self c. Fantasizing about revenge d. Bouts of hysteria and fear

c. Fantasizing about revenge In the recoil stage, victims begin the struggle to adapt. The immediate danger might be over, but a great deal of emotional distress remains. In the beginning of this phase, there are periods in which victims look and act normal and are able to carry out daily routines at home and at work.Activity helps to suppress fears, anger, and sadness. Later in this phase, there may or may not be a desire to talk about all the details of and feelings about the trauma ("What happened?"). Victims often need support, and some may become temporarily dependent. Fantasies of revenge for the crime are natural during this stage. Pg. 434 A and C- Impact stage B- Reorganization stage

Which manifestations of childhood sexual abuse leads to intrusive thoughts and memories as an adult? a. Fear of authority b. Fear of rejection c. Intense nightmares d. Memory gaps

c. Intense nightmares Intrusive thoughts and memories -Intense nightmares, unwanted thoughts -Flashbacks-feeling, seeing, smelling, tasting, hearing Box 33.3, pg. 442

Which manifestation of childhood sexual abuse leads to identity issues as an adult? a. Difficulty connecting with others b. Fear of authority c. Negative self image d. Promiscuity

c. Negative self image Identity issues -Confusion about identity or roles -Negative self-image -Need to be perfect or perfectly bad -Underachievement or overachievement -Need to be totally competent Box 33.3, pg. 442

Which intervention will provide a patient who is a rape survivor protection against further harm? a. Counseling b. Housing c. Retraining order d. Testing for STDs

c. Retraining order Pg 438

A female client demonstrating characteristics of battered woman syndrome may also have which comorbid psychological condition?

PTSD Survivors often report nightmares, flashbacks, recurrent fears of more violence, emotional detachment, numbness, startle response, sleep problems, guilt, impaired concentration, and hypervigilance. Similar to patients with PTSD, battered men and women show typical reactions to a chronic trauma, not symptoms of psychopathology. Pg. 446

The patient states, "I was forced to touch someone in the genital area." The nurse acknowledges that this patient is a survivor of which type of abuse? a. Human trafficking b. Rape c. Sexual assault d. Sexual violence

c. Sexual assault rape is defined as unwanted, nonconsensual, or forced vaginal, oral, or anal intercourse. Any other form of forced sexual contact (from touch to mutilation) is considered sexual assault. Despite sexual contact, it is generally acknowledged that sexual violence is not sexually motivated but involves a fear tactic to prevent rejection, or a need to immobilize, dominate, and humiliate the victim. Pg. 437

The nurse in the ED is caring for a patient with slashes to the wrist. EHR confirms a history of substance abuse, binge eating, and unstable relationships with others. This history leads the nurse to suspect that the patient has been a victim of? a. Rape b. Domestic partner abuse c. Serial ritual abuse d. Childhood sexual abuse

d. Childhood sexual abuse Self-mutilation; alcohol and drug abuse; bulimia; and unstable, unsatisfactory relationships are frequently seen in patients who were sexually abused as children and have repressed the trauma

A patient stumbles into the ED crying, disheveled, and stating that she was just sexually assaulted. What is the nurse's immediate focus of care? a. Documenting the victim's statement for future use in court b. Collecting evidence for prosecution c. Contacting law enforcement on her behalf d. Ensuring the victim feels safe both physically and emotionally

d. Ensuring the victim feels safe both physically and emotionally Nurse-Patient Relationship The rape or sexual assault survivor needs continual empathy, support, and an opportunity to process the events and manage the intense feelings as well as to regain a sense of psychological and physical safety. Although it is time-intensive and energy-consuming, the best approach in collecting evidence and providing nursing care is to move slowly and supportively at the individual survivor's pace and to give rationales for and descriptions of procedures and referrals. Pg. 439

A patient discloses that a spouse injured the family's pet cat. The nurse acknowledges that this patient is experiencing which type of hostile exchange? a. Coercion b. Emotional abuse c. Physical abuse d. Intimidation

d. Intimidation Intimidation includes destroying the partner's possessions and property, and harming pets. Coercion includes threatening to harm or leave the pattern. Emotional abuse includes name calling, insults, yelling, and humiliation. Physical abuse includes pushing, hitting, and choking. Pg. 445

What long term outcome would the nurse include in the care plan of a patient who was physically abused by her spouse? a. Patient will verbalize confidence in developing and carrying out safety plan b. Patient will confirm housing in rural county c. Patient will design an escape plan d. Patient will move from victim to survivor

d. Patient will move from victim to survivor A, B, and C are examples of short term goals (see care plan pg 448). Moving from victim to survivor is al long term goal because survivors frequently need long-term counseling and social services to recover. Pg. 447

Which specialized care is most appropriate for a patient who is in the recoil stage of recovery? a. A focus on the patient's need for physical safety b. Crisis intervention c. Hospitalization d. Support group with other survivors

d. Support group with other survivors During this stage, survivors need validation of their self-worth and rights. The patient can receive info, encouragement, and companionship from others in the support group. A, B, and C- impact stage Pg. 434, 435

Which medication would the nurse expect the HCP to prescribe to a patient who is a survivor of violence and is having difficulty sleeping? a. Duloxetine b. Fluoxetine c. Lorazepam d. Trazodone

d. Trazodone Psychopharmacology Survivors of violence and trauma may benefit from antianxiety agents (benzodiazepines), prescribed occasionally for short-term use to decrease anxiety, and trazodone (Desyrel) to facilitate sleep. Pg. 434

The nurse is caring for a patient in the ED who sustained injuries from domestic violence. Which interventions would the nurse incorporate into the care of this patient? SATA a. Convey empathy and compassion b. Demand she leave the abusive partner c. Develop a safety plan with the patient d. Establish rapport and trust e. Provide a concealed card with numbers for police and shelter

All but B! BOX 33.7 Helpful Responses to Partner Abuse • Be nonjudgmental, objective, and nonthreatening. • Ask directly if abuse is occurring. • Acknowledge the seriousness of the abuse. • Assist the victim in assessing strengths. • Encourage the use of personal resources. • Give the victim a list of resources—shelters, financial aid, police, and legal assistance. • Allow victim to choose own options. • Offer names of relevant support groups. • Help victim to develop a safety or escape plan. • Do not disbelieve or blame the victim. • Do not get angry with the victim. • Do not refuse to help if the victim is not ready to separate from the abuser. • Do not push the victim to separate from the abuser before ready.

Which nursing interventions are most appropriate for the patient in the impact stage following a violent crime? a. Support expression of feelings b. Ask about feelings of revenge c. Provide physical safety d. Use empathetic responses e. Provide clear, simple directions

All but B. Because the individual experiences disorganization during the impact stage, the nurse must provide for safety and security via use of empathy, encourage expression of feelings, and provide simple clear directions.

Primary motivation for most rapes and sexual assault?

Despite sexual contact, it is generally acknowledged that sexual violence is not sexually motivated but involves a fear tactic to prevent rejection (Weldon, 2016), or a need to immobilize, dominate, and humiliate the victim pg 437