Chapter 28 Child, Older Adult, and Intimate Partner Abuse

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Which statement demonstrates a risk for abusive parenting? Select all that apply. 1 "I can't remember ever being told I was loved." 2 "Drinking a beer or two helps me to calm down." 3 "It's been really hard since the divorce became final." 4 "We've gone to counseling but nothing seems to help." 5 "If the children would only listen to me things would be okay."

1 - "I can't remember ever being told I was loved." 2 - "Drinking a beer or two helps me to calm down." 3 - "It's been really hard since the divorce became final." 5 - "If the children would only listen to me things would be okay." Characteristics of abusive parents include a history of abuse, neglect, or emotional deprivation as a child, a history of drug or alcohol abuse, involvement in a crisis situation: unemployment, divorce, financial difficulties, projection of blame onto the child for parents' "troubles," and the inability to seek help from others. Text Reference p. 522, Box 28.1

The nurse is working with an abused patient and is concerned about the potential for a lethal situation. Which questions should the nurse ask the patient? Select all that apply. 1 "Is there a gun in the home?" 2 "Have you ever felt neglected?" 3 "Is your abuser ever extremely jealous?" 4 "Do you ever have feelings of inadequacy?" 5 "How much alcohol does your abuser drink?"

1 - "Is there a gun in the home?" 3 - "Is your abuser ever extremely jealous?" 5 - "How much alcohol does your abuser drink?" Assessing for a potential lethal situation includes asking the patient if there is a gun in the home, if the abuser displays extreme jealousy, and if he or she has excessive alcohol intake. Feelings of inadequacy assesses for other types of abuse but not lethality. Text Reference - p. 528

Which mental health disorder has been identified as a comorbid disorder associated with childhood abuse that can last the child's entire life? Select all that apply. 1 Anxiety 2 Suicidal ideations 3 Chronic depression 4 Post-traumatic stress disorder (PTSD) 5 Obsessive-compulsive disorder (OCD)

1 - Anxiety 2 - Suicidal ideations 3 - Chronic depression 4 - Post-traumatic stress disorder (PTSD) The secondary effects of abuse, such as anxiety, depression, and suicidal ideation, are health care issues that can last a lifetime. Depression and PTSD are two of the most prevalent disorders resulting from childhood trauma. OCD is not associated with abuse as frequently Text Reference - p. 522

Which is the most serious behavior for a woman attempting to escape a chronically abusive relationship to adapt? 1 Considering ways to commit suicide 2 Threatening to call the police if she is abused again 3 Relying on alcohol to escape the emotional pain of abuse 4 Adapting an aggressive attitude toward her abuser to scare him or her

1 - Considering ways to commit suicide A person experiencing violence may feel so trapped in a detrimental relationship, yet so desperate to get out, that suicide may seem the only answer. A suicide attempt may be the presenting symptom in the emergency department. At least 10% of abused women attempt suicide. The other reports are not realistic for a woman who is being abused. Text Reference - p. 528

The nurse is caring for a victim of elder abuse. What are the issues addressed in abuse protection support for older adults? Select all that apply. 1 Identification of high-risk, dependent elder relationships 2 Education on preventing family interaction to reduce abuse 3 Prevention of infliction of physical, sexual, or emotional harm 4 Prevention of neglect of the older adult's basic necessities of life 5 Education on maintaining older adult's power in relationships

1 - Identification of high-risk, dependent elder relationships 3 - Prevention of infliction of physical, sexual, or emotional harm 4 - Prevention of neglect of the older adult's basic necessities of life A nurse as a case manager works closely with the victims to support abuse protection. At first, they identify the high-risk, dependent elder relationships. If there is actual or suspected abuse, the nurse helps the victim to learn ways to prevent possible or further infliction of physical, sexual, or emotional harm. The nurse works towards preventing the neglect of basic necessities of life. Family interactions should not be decreased, as this will increase self-isolation in older adults. The perpetrators behave in a controlling way and try to maintain their power in a relationship. This should not be encouraged. Older adults are vulnerable and remain dependent on the perpetrators. Text Reference - pp. 524, 532, Box 28.6

What should a community health nurse include in the assessment of an older patient when elder abuse is suspected? Select all that apply. 1 Medication mismanagement 2 Inadequate utilities and space 3 Unavailability of transportation 4 Use of a wheelchair in the house 5 Lack of access to basic necessities

1 - Medication mismanagement 2 - Inadequate utilities and space 5 - Lack of access to basic necessities A community health nurse visits the home of older adults who are in the vulnerable category and may be subject to abuse. Lack of access to basic necessities like food, water, and medications is a definite indicator of elder abuse and needs intervention. Adequate utilities, ventilation, and space are required to maintain good health. Medication mismanagement is one of the factors that requires intervention from the nurse to protect the older adult from abuse. Use of a wheelchair in the house means the older adult is being provided assistive devices as needed. Lack of necessary assistive devices for an older adult may indicate elder abuse. Availability of personal transportation is subject to the economic status of the family. Text Reference p. 528, Box 28.4

A child comes into the physician's office with several infected wounds on the extremities. The nurse notes the child has poor hygiene, is malnourished, and there is dirt in the wounds. Which type of abuse does the nurse suspect? 1 Neglect 2 Sexual abuse 3 Physical abuse 4 Economic abuse

1 - Neglect Neglected children appear malnourished, have poor hygiene, and have untreated medical conditions. Sexual abuse in children may be demonstrated by sexual misbehavior. Physical abuse can be evident in children who complain of headaches, dizziness, and have frequent accidents. Economic abuse occurs when the abuser fails to provide for the needs of the victim when financial funds are available. Text Reference p. 527

Place the following forms of reported child abuse in order of frequency. 1 Physical 2 Neglect 3 Emotional 4 Sexual

1 - Neglect 2 - Physical 3 - Sexual 4 - Emotional In 2014, there were 3.6 million referrals for child abuse. The most common form of abuse was neglect (78%), followed by physical abuse (18%), sexual abuse (9%), and other types of abuse including emotional and threatened abuse, parent's drug/alcohol abuse, or lack of supervision (11%). Text Reference - p. 521

Which action is considered a nursing responsibility related to the abuse of a patient? Select all that apply. 1 Reporting is a legal obligation. 2 Abuse need only be suspected. 3 Most states require a report within 24 hours. 4 The nurse is required to display a neutral attitude. 5 The report needs support by another healthcare provider.

1 - Reporting is a legal obligation. 2 - Abuse need only be suspected. 4 - The nurse is required to display a neutral attitude. Nurses are mandated legally to report suspected or actual cases of child and vulnerable adult abuse. Nurses must attempt to maintain both an appropriate level of suspicion and a neutral, objective attitude. Each state has specific guidelines for reporting, including whether the report can be oral, written, or both, and within what time period the suspected abuse or neglect must be reported (immediately, within 24 hours, or within 48 hours). No collaboration by another nurse is required. Text Reference - p. 530

The community health nurse is teaching about prevention of abuse. Which are examples of tertiary prevention? Select all that apply. 1 Support groups for survivors 2 Reduction of stress for the abuser 3 Teaching of coping skills to the abuser 4 Legal advocacy programs for survivors 5 Screening programs for high-risk individuals

1 - Support groups for survivors 4 - Legal advocacy programs for survivors Tertiary prevention involves treating survivors of abuse, for example with support groups and legal advocacy programs. Reducing stress for the abuser and increasing his or her coping skills are strategies for primary prevention of abuse. Screening programs for high-risk individuals are examples of secondary prevention of abuse. Text Reference p. 533

A mother brings her 4-year-old daughter to the emergency department and states that the child has been "acting funny." The mother states, "She touches her vagina and rubs herself down there all the time and she never did that before." This behavior best supports which conclusion? 1 The child has been sexually abused. 2 The mother needs education in parenting skills. 3 This is normal developmental behavior in a 4-year-old child. 4 The child has been exposed to graphic sexual images on television.

1 - The child has been sexually abused. Sexualized behavior is one of the most common symptoms of sexual abuse in children. Younger children may draw sexually explicit images, demonstrate sexual aggression, or act out sexual interactions in play, for example, with dolls. Masturbation may be excessive in sexually abused children. This is not normal developmental behavior for a 4-year-old child. The mother may need education in parenting skills or the child may have been exposed to graphic sexual images, but sexual abuse is more likely and must be investigated. Text Reference - pp. 526-527

A nurse plans to give secondary prevention to a patient who was sexually abused. Which action by the nurse indicates effective nursing practice? Select all that apply. 1 The nurse treats the injuries of the patient. 2 The nurse identifies families at high risk for abuse. 3 The nurse teaches mindfulness techniques to the patient. 4 The nurse arranges a housekeeper for the patient's family. 5 The nurse arranges a legal advocacy program for the patient.

1 - The nurse treats the injuries of the patient. 4 - The nurse arranges a housekeeper for the patient's family. Secondary prevention involves interventions to reduce the long-term effects of abuse in the patient. Patients who are victims of sexual abuse get depressed and fearful, so the nurse should teach them mindfulness techniques. This helps to reduce the stress in the patient. The nurse should treat the physical injuries of the patient to reduce the risk of infection. Such patients have feelings of hopelessness and suicidal intentions. Patients who are victims of sexual abuse develop suicidal intentions, so constant monitoring of the patient must be done. Caregiving becomes a burden to the patient's family members so the nurse should arrange a housekeeper to reduce the burden. Mindfulness-based stress reduction and legal advocacy programs are arranged for the survivors of abuse in tertiary prevention. Identifying families at high risk for abuse is part of primary prevention of abuse. Text Reference p. 533

Abuse comes in which forms? Select all that apply. 1 Economic 2 Emotional 3 Sexual 4 Physical 5 Intellectual

1 Economic 2 Emotional 3 Sexual 4 Physical

When a woman reports an injury after being abused by her husband, the nurse listens to her attentively and asks her necessary questions to understand the history. What should the nurse do next to help this woman? 1 Assess safety and help explore alternatives to reduce dangers. 2 Provide a counseling session for the woman and send her home. 3 Advise the woman that she is "in trouble" and needs to find a shelter. 4 Display anger and shock and accuse the patient's husband of abuse.

1.Assess safety and help explore alternatives to reduce dangers.

A nurse interacts with a patient while documenting a report of abuse. The nurse finds that the patient has poor eye contact and feels ashamed. What appropriate diagnosis should the nurse make from the patient's behavior? 1 Disabled family coping 2 Chronic low self-esteem 3 Ineffective individual coping 4 Dysfunctional family

2 - Chronic low self-esteem Patients with the signs of poor eye contact and feelings of shame indicate chronic low self-esteem. The signs of ineffective individual coping are poor coping skills, hostility, impulsivity, and inadequate problem solving. The signs of dysfunctional family process are family disorganization, conflict, denial of problem, and resistance to change. The signs of disabled family coping are ineffective problem solving, chaotic family environment, and abandonment. Text Reference p. 530, Table 28.4

Which principle will guide the nursing interview that is focused on identifying possible family-centered violence? Select all that apply. 1 Stop the telling of the abuse whenever clarification is needed. 2 Establishing a trustful rapport is the initial nursing intervention. 3 Tension is best minimized by asking the sensitive questions first. 4 Focus upon identifying problems and acceptable ways of solving them. 5 Open-ended questions can be less threatening and elicit more relevant information.

2 - Establishing a trustful rapport is the initial nursing intervention. 4 - Focus upon identifying problems and acceptable ways of solving them. 5 - Open-ended questions can be less threatening and elicit more relevant information. Important and relevant information about the family situation can be gathered by routine assessment conducted with tact, understanding, and a calm, relaxed attitude. Open-ended questions can be less threatening and elicit more relevant information than questions that are direct and can be answered with "yes" or "no." It is better to ask about ways of solving disagreements or methods of disciplining children. When interviewing, spend time establishing trust and rapport before focusing on the details of the violent experience. Establishing trust is crucial if the patient is to feel comfortable enough to self-disclose. The person who experienced the violence should be allowed to tell the story without interruption. Text Reference - p. 525

The nurse suspects that a patient is a victim of family violence. What should the nurse assess to identify family violence? Select all that apply. 1 Mismanagement of medicine 2 Family coping patterns of abuse 3 Characteristics of the perpetrator 4 Drug or alcohol use in the family 5 Presenting signs and symptoms of abuse

2 - Family coping patterns of abuse 4 - Drug or alcohol use in the family 5 - Presenting signs and symptoms of abuse The nurse documents the family coping patterns and past or current history of drug or alcohol use. The nurse assesses the presenting signs and symptoms of the victims carefully. The mismanagement of medicine is assessed when neglect of older adults is suspected. It is not a feature of family violence. The characteristics of the perpetrators are assessed in the secondary prevention method. Text Reference - pp. 525-529

A nurse interacts with a patient who was physically abused. The nurse diagnoses the patient as in the serious battering phase. Which signs and symptoms does the nurse find in the patient? Select all that apply. 1 The patient begins to indulge in self-harm. 2 The patient tries to cover up injuries with a scarf. 3 The patient requests to be rescued from the abuser. 4 The patient accepts the blame for being physically abused. 5 The patient believes that the partner will stop physical abuse.

2 - The patient tries to cover up injuries with a scarf. 3 - The patient requests to be rescued from the abuser. The cycle of abuse consists of three stages, the tension-building phase, the serious battering phase, and the honeymoon phase. In the serious battering phase, the patient has serious injuries and tries to cover them up with a cloth or scarf. The patient wants to escape from the abuser and asks for help from the nurse and others. In the tension-building phase, the patient blames himself or herself for the partner's abusive behavior. In the honeymoon phase, the patient develops feelings of trust and hope toward the abuser. The abuser shows love and care toward the victim and showers the victim with gifts and flowers, so the patient hopes that the partner will stop physically abusing. Patients who are suicidal or manic are usually found to indulge in self-harm. Text Reference - p. 523, Figure 28.1

Nurses who work on a maternity unit interact with new parents who may be at an increased risk for abuse. Which patient is at the highest increased risk for abuse? 1 A young new mother who grew up in a divorced family 2 A teenage parent who has a strong family support system 3 A new mother who requests that the infant be kept in the nursery at all times 4 A homosexual couple who had in-vitro fertilization to assist with the pregnancy

3 - A new mother who requests that the infant be kept in the nursery at all times A new mother who requests the infant be kept in the nursery at all times may be experiencing abuse. There is nothing to indicate that the mother who grew up with divorced parents, the teenage parent, or the homosexual couple are experiencing abuse. Text Reference - p. 532

What are the elementary causes for a perpetrator to use violence? Select all that apply. 1 Effect of peer pressure 2 Feeling of hopelessness 3 Ineffective impulse control 4 Lack of any support system 5 Lack of problem-solving skills

3 - Ineffective impulse control 4 - Lack of any support system 5 - Lack of problem-solving skills The perpetrators of violence have problems with impulse control. They are unable to think before they act and may even repent their act later. They do not have any healthy support systems which could prevent them from resorting to violence. They do not have problem-solving abilities and break down under stress. Peer pressure does not force them to become violent. They may live in social isolation and, with an inability to make friends, they have ineffective coping during crisis situations. A victim of abuse rather than the perpetrator feels hopeless and powerless. Text Reference - p. 521

A child arrives in the emergency department with cigarette burns on the arm. Which type of abuse does the nurse document? 1 Neglect 2 Sexual abuse 3 Physical abuse 4 Economic abuse

3 - Physical abuse Physical abuse is inflicting physical pain, such as burning. Neglect is the failure to provide for physical, emotional, educational, and medical needs. Sexual abuse is any form of sexual contact without consent. Economic abuse is denying a person's access to economic resources. Text Reference - p. 521

What statement by a female patient about her boyfriend or husband would support the suspicion that she is being emotionally abused? 1 "He is Latin American and has a fiery temper." 2 "I didn't tell him I was coming because he is under so much stress at work I didn't want to add to it." 3 "He has a good job and keeps control of all the finances but our electricity still got turned off last week." 4 "He yells a lot and calls me names, but that's because I am so stupid and make so many mistakes."

4 - "He yells a lot and calls me names, but that's because I am so stupid and make so many mistakes." Emotional abuse may be less obvious and more difficult to assess than physical violence, but it can be identified through indicators such as low self-esteem, reported feelings of inadequacy, and anxiety. Controlling the finances and having the electricity turned off describes the possibility of economic abuse. Not wanting to add to the boyfriend's stress does not describe an abusive situation. The spouse with a temper would more likely hint at physical abuse rather than emotional. Text Reference p. 527

A school nurse interviews a student who has vague somatic complaints. Which assessment finding alerts the nurse to a high risk for sexual abuse? 1 Both parents work in a factory. 2 The parents are of Asian heritage. 3 Neither parent completed high school. 4 Both parents were sexual abuse victims.

4 - Both parents were sexual abuse victims. Victims of sexual abuse are at high risk to become perpetrators. Abuse is uncommon among persons of Asian descent. Abuse occurs in families from a variety of economic and educational backgrounds. Text Reference - p. 522, Box 28.1

From a psychosocial perspective, the nurse is most troubled when witnessing the parents of 6-year-old twins ignoring the boys being physically aggressive toward each other because this behavior: 1 Suggests that the family has very weak social skills. 2 Indicates a severe lack of parental attachment to the children. 3 Greatly increases the risk of the children being physically injured. 4 Can lead to the children developing violence as a coping mechanism.

4 Can lead to the children developing violence as a coping mechanism.

A nurse is caring for a pediatric patient who has severe injuries on his or her face and neck. The nurse says to the nurse manager, "I empathize with the patient; I wish I could make this patient happy by resolving all the problems." What response does the nurse have to the patient? 1 Embarrassment 2 Confusion 3 Discouragement 4 Helplessness

4 Helplessness

When the nurse believes the cycle of abuse is escalating and that a woman may be in severe physical danger, the priority nursing intervention is to A. advise her to enter counseling at the mental health center. B. assist her to develop a plan to go to a shelter in case of a crisis. C. suggest she leave the abuser and go to a trusted friend's home. D. teach her to counter verbal abuse with assertive replies.

B. assist her to develop a plan to go to a shelter in case of a crisis.

When treatment for injuries sustained during an incident of abuse is sought from the primary physician, the client is receiving A. primary prevention. B. secondary prevention. C. tertiary prevention. D. stopgap therapy.

B. secondary prevention.

Which child is at lowest risk for abuse? A. A 3-month-old who has colic and teenaged parents. B. A 4-year-old who has cerebral palsy and retarded parents. C. A 2-year-old who has leukemia and two working parents. D. A 5-year-old who has ADHD and a father who was abused as a child.

C. A 2-year-old who has leukemia and two working parents.

When interviewing an adult victim of abuse, the nurse's best approach is to be A. confrontational and assertive. B. gentle and direct. C. direct and professional. D. sympathetic and outraged.

C. direct and professional.

The use of a patient-centered interview technique works well for gathering information about abusive situations. It is a good use of clinical time to sit near the patient and: a) Establish trust and rapport. b) Asks lots of questions. c) Interrupt the patients' story to allow for decompression. d) utilize closed-ended questions.

a) Establish trust and rapport.

Perpetrators of domestic violence tend to: select all that apply. a) Have relatively poor social skills and have to grown up with poor role models. b) Believe they, if male, should be dominant and in charge in relationships. c) Force their mates to work and expect them to handle the financial decisions. d) Be controlling and willing to use force to maintain their power in relationships. e) Prevent their mates from having relationships and activities outside the family.

a) Have relatively poor social skills and have to grow up with poor role models. b) Believe they, if male, should be dominant and in charge in relationships. d) Be controlling and willing to use force to maintain their power in relationships. e) Prevent their mates from having relationships and activities outside the family.

Which problem is observed in children who regularly witness acts of violence in their family? Select all that apply. a) Phobias b) Low-self esteem c) Major depressive disorder d) Narcissistic personality disorder e) Posttraumatic stress disorder

a) Phobias b) Low-self esteem c) Major depressive disorder e) PTSD

The nurse is assisting a patient to identify safety issues that may occur now that she has left an abusive partner. What telephone numbers should be available to the patient? Select all that apply. a) The police department. b) An abuse hotline. c) A responsible friend or family member. d) A domestic violence shelter. e) The hospital emergency department.

a) The police department. b) An abuse hotline. c) A responsible friend or family member. d) A domestic violence shelter.

Which statement made by a new mother should be explore further by the nurse? a) "I have three children, that's enough." b) "I think my baby cries just to make me angry." c) "I wish my husband could help more with the baby." d) "Babies are a blessing, but they are a lot of work."

b) "I think my baby cries just to make me angry"

Which nursing intervention is best directed at the psychological needs of a physically abused client? a) Encourage the client to immediately leave the abuser. b) Affirm that the client did not deserve or cause the abuse. c) Provide a referral to social services for economic problems. d) Facilitate contact with law enforcement to take legal action.

b) Affirm that the client did not deserve or cause the abuse. Abused clients often believe that they are deserving of the abuse and, in some way, prompt the abuser to attack. They need specific reassurance that they did not deserve to be abused and they did not cause the attack (page 531).

Secondary effects of abuse often manifest as arrested development in children due to the fact that: a) Coping is easier than emotional growth. b) Energy for development is diverted to coping. c) Children cannot differentiate love from abuse. d) Abuse fosters a sense of belonging, even if dysfunctional.

b) Energy for development is diverted to coping.

What situation associated with a caregiver presents the greatest risk that an older adult will experience abuse by that caregiver? a) The caregiver is a single male relative. b) The caregiver was neglected as a child. c) The caregiver is under the age of 30. d) The caregiver has little experience with the elderly.

b) The caregiver was neglected as a child

An appropriate expected outcome in individual therapy regarding the perpetrator of abuse would be: a) A decrease in family interaction so that there are fewer opportunities for abuse to occur. b) The perpetrator will recognize destructive patterns of behavior and learn alternate responses. c) The perpetrator will no longer live with the family but have supervised contact while undergoing intensive inpatient therapy. d) A triad of treatment modalities, including medication, counseling, and role-playing opportunities.

b) The perpetrator will recognize destructive patterns of behavior and learn alternative responses.

The abused person is often in a dependent position, relying on the abuse for basic needs. At particular risk are children and the elderly due to: a) The love they have for parents and children. b) Their limited options. c) The need to feel safe at home. d) Other relatives do not warn them.

b) Their limited options.

An individual with substance abuse problems is more likely to behave as a perpetrator in family violence. How do alcohol and other drugs trigger this behavior in an individual? a. The person learns and uses new social skills. b. The person has a desire to be socially accepted. c. The person develops a disregard for social rules. d. The person develops feelings of worthlessness.

Several children are seen in the emergency department for treatment of various illnesses and injuries. Which assessment finding would create the most suspicion for child abuse? The child who has a. complaints of abdominal pain. b. repeated middle ear infections. c. bruises on extremities. d. diarrhea.

What safety-related responsibility does the nurse have in any situation of suspected of abuse? a) protect the patient from future abuse by the abuser. b) Inform the suspected abuser that the authorities have been notified. c) Arrange for counseling for all involved parties but especially the patient. d) Report suspected abuse to the proper authorities.

d) Report suspected abuse to the proper authorities.

A person with a history of abusing an intimate partner says, "When my partner leaves home, I think it's because she's meeting someone she likes better than me." Which emotion is most evident by this comment? 1 Guilt 2 Anxiety 3 Jealousy 4 Remorse

3 Jealousy

A 79-year-old patient in the emergency department is 5'6", weighs 93 pounds, and is wearing old, dirty clothes that have holes. The patient is diagnosed with pneumonia. Which comment by this patient suggests a significant risk for abuse? 1 "Our family is poor, so my daughter gets my monthly retirement and Social Security checks." 2 "Volunteers from our community food bank have been bringing my groceries for the last few months." 3 "I've lived alone all my life. I have my own ways of doing things and I don't like others to interfere." 4 "I've had a bad cold for months. My daughter made chicken noodle soup for me, but I kept getting worse."

1 "Our family is poor, so my daughter gets my monthly retirement and Social Security checks."

A nurse prepares the case report of a patient who was sexually abused. What information does the nurse record in the patient's case report? Select all that apply. 1 Nightmares 2 Feelings of guilt 3 Untreated diseases 4 Excessive masturbation 5 Inadequate immunization

1 - Nightmares 2 - Feelings of guilt 4 - Excessive masturbation Sexually abused patients often indulge in excessive masturbation. Masturbation is a sexualized behavior commonly seen in sexually abused children in response to the traumatic event. The sexually abused patients may exhibit post-traumatic stress disorder, which is characterized by nightmares and feelings of guilt. Inadequate immunization and untreated diseases are seen in neglected patients due to inadequate medical care. Text Reference - pp. 526-527

A victim of domestic abuse is being treated for low selfesteem. What are the expected treatment outcomes? Select all that apply. 1 Describes positive level of confidence 2 Has neglectful behaviors towards the abuser 3 Expects positive responses from others 4 Conveys a desire to kill the perpetrator 5 Maintains eye contact and erect posture

1 Describes positive level of confidence 3 Expects positive responses from others 5 Maintains eye contact and erect posture

What findings are important for the nurse to document at the initial assessment of a case of domestic abuse? Select all that apply. 1 Physical evidence of sexual abuse, whenever possible 2 Body map to describe the injuries along with explanations 3 Verbatim statements of who caused the injury and when 4 Discussion with other interviewers and their comments 5 The reactions of the nurse on the severity of the event

1 Physical evidence of sexual abuse, whenever possible 2 Body map to describe the injuries along with explanations 3 Verbatim statements of who caused the injury and when

What are the three levels of help that can be provided to the abusive family to build a healthy therapeutic environment? Select all that apply. 1 Providing family therapy 2 Helping to prosecute the perpetrator 3 Discouraging social interactions 4 Arranging visits by a nurse 5 Providing economic support

1 Providing family therapy 4 Arranging visits by a nurse 5 Providing economic support

A community health nurse starts working with the family of a victim of domestic abuse. What strategies for primary prevention are helpful in this case? Select all that apply. 1 Reducing stress in the family 2 Increasing the amount of social support 3 Increasing the use of coping skills 4 Arranging a legal advocacy program 5 Decreasing family interactions

1 Reducing stress in the family 2 Increasing the amount of social support 3 Increasing the use of coping skills

A nurse is assessing an infant and concludes that he or she has shaken baby syndrome. Which symptoms has the nurse found in the infant? Select all that apply 1 Retinal hemorrhages 2 Ear infection 3 Bulging fontanels 4 Respiratory problems 5 Malnourishment

1 Retinal hemorrhages 3 Bulging fontanels 4 Respiratory problems

The nurse is preparing a safety plan for a victim of family violence. How does a safety plan help the victim? 1 The victim can identify signs of occurrence of violence and leave. 2 The victim can call law enforcement to intervene in a crisis situation. 3 The victim can call the nurse if there is any suicidal ideation. 4 The victim can stay calm and relaxed during an episode of violence.

1 The victim can identify signs of occurrence of violence and leave.

A married couple that has had a violent marriage decides to participate in family or marital therapy. What are the expected outcomes of family psychotherapy for the perpetrator? 1 To recognize destructive patterns of behavior and learn alternative responses 2 To become temperamental and handle a crisis situation impulsively 3 To express anger and disappointment to the members of the family 4 To develop reclusive behavior and isolate one's self from others in the family

1 To recognize destructive patterns of behavior and learn alternative responses

Which are risk factors for older adult abuse? Select all that apply. 1. Female 2. African American 3. Over the age of 75 4. Living with a relative 5. Physical or mental impairment

1. Female 3. Over the age of 75 4. Living with a relative 5. Physical or mental impairment

A nurse interacts with a patient who was physically and sexually abused. Which action of the nurse is indicative of an effective nurse-patient interaction? 1. The nurse establishes trust and rapport. 2. The nurse maintains a distance of 1 ft from the patient. 3. The nurse helps the patient to acknowledge his or her mistake. 4. The nurse frequently restates the statements made by the patient.

1. The nurse establishes trust and rapport.

In the tertiary prevention method, what measures are taken to assist the survivors of abuse in the healing process? Select all that apply. 1 Support the survivors to remain in social isolation and avoid interaction. 2 Counsel the individuals and families for healing and rehabilitation. 3 Counsel the survivors to hate and stay away from the perpetrator. 4 Assist the survivors of violence to achieve safety, health, and well-being. 5 Assist in dealing with the legal proceedings against the perpetrator.

2 Counsel the individuals and families for healing and rehabilitation. 4 Assist the survivors of violence to achieve safety, health, and well-being. 5 Assist in dealing with the legal proceedings against the perpetrator.

A nurse assesses a victim of intimate partner violence and observes bruises, lacerations, scars, burns, and wounds in various phases of healing. The patient says, "He's going to kill me next time if I don't do something." Which nursing diagnosis has the highest priority? 1 Pain 2 Powerlessness 3 Risk for infection 4 Impaired skin integrity

2 Powerlessness

The nurse is caring for a victim of elder abuse. What are the issues addressed in abuse protection support for older adults? Select all that apply. 1 Education on preventing family interaction to reduce abuse 2 Prevention of infliction of physical, sexual, or emotional harm 3 Identification of high-risk, dependent elder relationships 4 Education on maintaining older adult's power in relationships 5 Prevention of neglect of the older adult's basic necessities of life

2 Prevention of infliction of physical, sexual, or emotional harm 3 Identification of high-risk, dependent elder relationships 5 Prevention of neglect of the older adult's basic necessities of life

A patient prepares for discharge from the emergency department after treatment for injuries associated with intimate partner violence. The patient plans to return home. Which action by the nurse has priority? 1 Refer the patient for pastoral counseling. 2 Provide the patient with contact information for the local shelter. 3 Encourage the patient to file criminal charges against the perpetrator. 4 Tell the patient, "I have documented your injuries and treatment thoroughly."

2 Provide the patient with contact information for the local shelter.

A one-year-old child has respiratory problems and is vomiting. Examinations show the child has bulging fontanels and a retinal hemorrhage. What should the nurse suspect? 1 Injuries due to a fall 2 Shaken baby syndrome 3 Posttraumatic stress disorder 4 Upper respiratory illness

2 Shaken baby syndrome

A school nurse assesses multiple bruises and welts in odd shapes on a child's back. Lately, this child has been frequently tardy and has had episodes of aggressive behavior in school. What is the nurse's initial action? 1 Ask the child, "Who did this to you?" 2 Discuss the findings with the child's teacher. 3 Notify the appropriate child protective agency of the findings. 4 Report the findings at the multidisciplinary educational meetings.

3 - Notify the appropriate child protective agency of the findings. The nurse is a mandated reporter of suspected abuse. It is not necessary for the nurse to determine whether abuse actually occurred. Asking the child the identity of the person who caused the injury is premature. Discussing the findings with the child's teacher and reporting the findings at educational meetings may apply later. Text Reference - p 530

A group of nursing students was given an assignment to assess the abuse victims in the gynecology ward using the abuse assessment screen. The students find that the majority of the patients got a score of 2. Which incident of abuse does this score indicate? 1 Threats of abuse using a weapon 2 Use of weapon; wound from weapon 3 Slapping, pushing; no injuries or continuing pain 4 Punching, kicking, bruises, cuts, or continuing pain

3 - Slapping, pushing; no injuries or continuing pain The abuse assessment screen can be used to assess physical abuse of the patients. The screen consists of six scores based on the type of abuse and presence of wounds on the body. A score of 2 indicates slapping, pushing; no injuries or continuing pain. A score of 6 indicates use of weapon; wound from weapon. A score of 1 indicates threats of abuse (including threatening abuse with a weapon). A score of 3 indicates punching, kicking, bruises, cuts, and/or continuing pain. Text Reference - p. 526, Figure 28.2

An emergency department nurse whispers to a colleague, "That woman is back again. She does the same thing repeatedly. He beats her up, she comes to the emergency department, we stitch her up, they make up, and then he beats her again. Why does she let it keep happening?" What is the colleague's best action? 1 Determine whether the nurse is a victim of abuse. 2 Suggest the nurse consider transfer to a different hospital unit. 3 Encourage the nurse to discuss this reaction with the supervisor. 4 Recommend that the nurse share these sentiments with the patient.

3 Encourage the nurse to discuss this reaction with the supervisor.

Which data obtained during a family assessment could be considered an early indicator of the greatest potential for family-focused abuse? 1 The oldest child is legally blind. 2 The children often play violent video games. 3 The mother's brother is in jail for assault and battery. 4 The father travels for work and is home only on weekends.

3 The mother's brother is in jail for assault and battery.

What is the most appropriate statement about the victims of abuse? 1. Elder abuse is uncommon. 2. Children face physical abuse more than any other abuse. 3. Females face intimate partner abuse more often than males. 4. Girls facing child abuse die at a slightly higher rate than boys.

3. Females face intimate partner abuse more often than males.

A child arrives in the emergency department with cigarette burns on the arm. Which type of abuse does the nurse document? 1. Neglect 2. Sexual abuse 3. Physical abuse 4. Economic abuse

3. Physical abuse

A nurse delivered a lecture at a community health center on interventions to reduce family abuse. The nurse asks the participants about what they learned from the session. Which statement given by the participants indicates effective learning? 1 "The violent behavior of the victim provokes the abuser to abuse." 2 "One should not interfere with others' family abuse cases." 3 "Violence occurs only between heterosexual partners." 4 "Victims are not believed when they disclose their situation."

4 "Victims are not believed when they disclose their situation."

The nurse is caring for a patient and suspects the patient is a victim of sexual abuse by a member of the family. The patient speaks and comprehends Spanish only. Which strategy should the nurse use while assessing the patient? 1 Communicate with graphics. 2 Ask a family member to interpret. 3 Use a translator computer program. 4 Work with a trained medical interpreter.

4 - Work with a trained medical interpreter. If a patient does not speak English, it is the nurse's responsibility to work with a trained medical interpreter. Communicating with graphics is not appropriate. Asking a family member to interpret does not ensure privacy and confidentiality. Using a translator computer program can lead to error. Text Reference - p. 530

A person was admitted at a health care facility following a suicide attempt resulting from family violence. After the crisis is resolved, what should be the next intervention? 1 Give the patient an outpatient referral. 2 Refer the patient to an inpatient psychiatric unit. 3 Identify the perpetrator and have him or her arrested. 4 Ask the patient if he or she has a plan to repeat this.

4 Ask the patient if he or she has a plan to repeat this.

When planning care for a woman who has been in an abusive relationship for five years, the nurse facilitates the woman's sense of empowerment when: 1 Offering the woman several different suggestions regarding how to stop the abuse. 2 Asking the woman to identify behaviors that trigger her partner's violence. 3 Suggesting that the woman needs to leave the abuser immediately. 4 Assisting the woman in developing a plan to assure her safety.

4 Assisting the woman in developing a plan to assure her safety.

What nursing intervention can be incorporated to assist parents in stopping the use of corporal punishment to discipline their child? 1 The child is separated from its parent and sent to boarding school to stop the abuse. 2 The parents are threatened that a legal action will take place in case of further abuse. 3 The child is given a help line number to call in case of any further abuse by the parents. 4 Parents are referred to parenting resources to learn alternative approaches to discipline.

4 Parents are referred to parenting resources to learn alternative approaches to discipline.

The nurse is physically assessing a 7-year-old who is suspected of being physically abused. Which observation supports this diagnosis? 1 The child stutters when answering questions. 2 The father refuses to leave his child alone with the nurse. 3 The mother informs the nurse that the child is very clumsy. 4 The child has bruises in various stages of healing on his or her arms.

4 The child has bruises in various stages of healing on his or her arms.

During a health screen in a boarding school, the nurse finds that the older children have been physically abused. Which signs and symptoms does the nurse find in the children? 1 The children give appropriate reasons for their injuries. 2 The children have nonspecific bruising on their hands. 3 The children tend to maintain stable eye contact with the nurse. 4 The children hesitate to interact with the nurse.

4 The children hesitate to interact with the nurse.

13. After treatment for a detached retina, a survivor of intimate partner abuse says, "My partner only abuses me when I make mistakes. I've considered leaving, but I was brought up to believe you stay together, no matter what happens." Which diagnosis should be the focus of the nurse's initial actions? a. Risk for injury related to physical abuse from partner b. Social isolation related to lack of a community support system c. Ineffective coping related to uneven distribution of power within a relationship d. Deficient knowledge related to resources for escape from an abusive relationship

A Risk for injury is the priority diagnosis because the partner has already inflicted physical injury during violent episodes. The other diagnoses are applicable, but the nurse must first address the patient's safety. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 537 (Box 28-4) | Page 541-542 TOP: Nursing Process: Diagnosis/Analysis

8. An 11-year-old says, "My parents don't like me. They call me stupid and say they wish I were never born. It doesn't matter what they think because I already know I'm dumb." Which nursing diagnosis applies to this child? a. Chronic low self-esteem related to negative feedback from parents b. Deficient knowledge related to interpersonal skills with parents c. Disturbed personal identity related to negative self-evaluation d. Complicated grieving related to poor academic performance

A The child has indicated a belief in being too dumb to learn. The child receives negative and demeaning feedback from the parents. The child has internalized these messages, resulting in a low self-esteem. Deficient knowledge refers to knowledge of health care measures. Disturbed personal identity refers to an alteration in the ability to distinguish between self and non-self. Grieving may apply, but a specific loss is not evident in the scenario. Low self-esteem is more relevant to the child's statements. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 28û22 | Page 23 | Page 51 (Box 28-4) TOP: Nursing Process: Diagnosis/Analysis

17. An older adult with Lewy body dementia lives with family. After observing multiple bruises, the home health nurse talked with the daughter, who became defensive and said, "My mother often wanders at night. Last night she fell down the stairs." Which nursing diagnosis has priority? a. Risk for injury related to poor judgment, cognitive impairments, and inadequate supervision b. Wandering related to confusion and disorientation as evidenced by sleepwalking and falls c. Chronic confusion related to degenerative changes in brain tissue as evidenced by nighttime wandering d. Insomnia related to sleep disruptions associated with cognitive impairment as evidenced by wandering at night

A The patient is at high risk for injury because of her confusion. The risk increases when caregivers are unable to give constant supervision. Insomnia, chronic confusion, and wandering apply to this patient; however, the risk for injury is a higher priority. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 537 (Box 28-4) | Page 541-542 TOP: Nursing Process: Diagnosis/Analysis

Client Needs: Safe, Effective Care Environment 19. An adult has a history of physical violence against family when frustrated, followed by periods of remorse after each outburst. Which finding indicates a successful plan of care? The adult: a. expresses frustration verbally instead of physically. b. explains the rationale for behaviors to the victim. c. identifies three personal strengths. d. agrees to seek counseling.

A The patient will have developed a healthier way of coping with frustration if it is expressed verbally instead of physically. The incorrect options do not confirm achievement of outcomes. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 541-542 | Page 547-548 TOP: Nursing Process: Evaluation

3. A community health nurse visits a family with four children. The father behaves angrily, finds fault with the oldest child, and asks twice, "Why are you such a stupid kid?" The wife says, "I have difficulty disciplining the children. It's so frustrating." Which comments by the nurse will facilitate an interview with these parents? Select all that apply. a. "Tell me how you discipline your children." b. "How do you stop your baby from crying?" c. "Caring for four small children must be difficult." d. "Do you or your husband ever spank your children?" e. "Calling children 'stupid' injures their self-esteem."

A, B, C An interview with possible abusing individuals should be built on concern and carried out in a nonthreatening, nonjudgmental way. Empathetic remarks are helpful in creating rapport. Questions requiring a descriptive response are less threatening and elicit more relevant information than questions that can be answered by yes or no. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 535-537 (Box 28-3) TOP: Nursing Process: Assessment

2. A nurse assists a victim of intimate partner abuse to create a plan for escape if it becomes necessary. Which components should the plan include? Select all that apply. a. Keep a cell phone fully charged. b. Hide money with which to buy new clothes. c. Have the phone number for the nearest shelter. d. Take enough toys to amuse the children for 2 days. e. Secure a supply of current medications for self and children. f. Assemble birth certificates, Social Security cards, and licenses. g. Determine a code word to signal children when it is time to leave.

A, C, E, F, G The victim must prepare for a quick exit and so should assemble necessary items. Keeping a cell phone fully charged will help with access to support persons or agencies. Taking a large supply of toys would be cumbersome and might compromise the plan. People are advised to take one favorite small toy or security object for each child, but most shelters have toys to further engage the children. Accumulating enough money to purchase clothing may be difficult. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 543-544 (Box 28-6) TOP: Nursing Process: Planning

Which factor is of least importance as a victim of spousal abuse constructs an escape plan? A. How the victim will explain her decision to leave B. Where the victim will go to be safe C. How the victim will arrange for transportation D. What the victim will need to take with her when she leaves

A. How the victim will explain her decision to leave

A battered woman has been referred to a women's shelter. When the woman's abuser demands to be told where she is, the nurse A. refuses to provide any information. B. gives him the telephone number, but not the address, of the shelter. C. informs him that no information can be given for a minimum of 24 hours. D. calls law enforcement to arrest the husband for the assault and battery of his wife.

A. refuses to provide any information.

The risk of elder abuse in a home is best determined by assessing A. the vulnerability of the elder and the stress of the caregiver. B. the amount of disruption the elder causes in the home. C. how much actual physical assistance the elder needs on a daily basis. D. the financial contribution of the elder and the caregiver's early life experience with abuse.

A. the vulnerability of the elder and the stress of the caregiver.

Nurses working in emergency departments and walk-in clinics should be aware that some victims of violence may present: A. with vague physical complaints such as insomnia or pain. B. with extreme anger and unpredictable behavior. C. with many family members there to support them. D. with psychosis and/or mania as a result of long-term abuse.

A. with vague physical complaints such as insomnia or pain.

1. A 10-year-old cares for siblings while the parents work because the family cannot afford a babysitter. This child says, "My father doesn't like me. He calls me stupid all the time." The mother says the father is easily frustrated and has trouble disciplining the children. The community health nurse should consider which resources as priorities to stabilize the home situation? Select all that apply. a. Parental sessions to teach childrearing practices b. Anger management counseling for the father c. Continuing home visits to give support d. A safety plan for the wife and children e. Placing the children in foster care

ABC

Client Needs: Safe, Effective Care Environment 16. An older adult with Alzheimer's disease lives with family in a rural area. During the week, the person attends a day care center while the family is at work. In the evenings, members of the family provide care. Which factor makes this patient most vulnerable to abuse? a. Multiple caregivers c. Living in a rural area b. Alzheimer's disease d. Being part of a busy family

B Older adults are at high risk for violence, particularly those with cognitive impairments. The other characteristics are not identified as placing an individual at high risk. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 534-535 TOP: Nursing Process: Assessment

To best assure the safety of a 3-year-old child whose parent admits to finding it difficult to control their anger, the most appropriate short-term goal would be for the parent to A. understand the impact of violence on the child within 2 days. B. begin attending anger management training sessions within 2 weeks. C. state a willingness to attend a support group for physical abusers within 1 week. D. show remorse for their anger management issues within 2 days.

B. begin attending anger management training sessions within 2 weeks.

18. An older woman diagnosed with Alzheimer's disease lives with family and attends day care. After observing poor hygiene, the nurse talked with the caregiver. This caregiver became defensive and said, "It takes all my energy to care for my mother. She's awake all night. I never get any sleep." Which nursing intervention has priority? a. Teach the caregiver about the effects of sundowner's syndrome. b. Secure additional resources for the mother's evening and night care. c. Support the caregiver to grieve the loss of the mother's cognitive abilities. d. Teach the family how to give physical care more effectively and efficiently

B The patient's caregivers were coping with care until the patient began to stay awake at night. The family needs assistance with evening and night care to resume their pre-crisis state of functioning. Secondary prevention calls for the nurse to mobilize community resources to relieve overwhelming stress. The other interventions may then be accomplished. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 546-547 TOP: Nursing Process: Planning

An abuse victim tearfully tells the nurse in the emergency department, "Don't tell my husband that you know he beats me because if he thinks anyone knows, he will beat me again." Based on this information, the most appropriate nursing diagnosis is A. chronic pain. B. fear. C. post-trauma syndrome. D. risk for self-directed violence.

B. fear.

When there is reason to suspect that a child is being abused, the nurse must initially A. call the local police to report it. B. follow agency policy for reporting. C. confront the parent or parents. D. interrogate the child to obtain proof.

B. follow agency policy for reporting.

The nurse performing the assessment of a wheelchairbound client suspects that his wife's explanation of how he sustained facial contusions and a broken nose may not be entirely truthful. The nurse should A. confront the wife with the suspicion that her husband's injuries are the result of abuse. B. have the wife wait in the waiting room so her husband can be interviewed in private. C. report the husband's injuries to the police and ask for a confidential investigation. D. document the suspicion and follow a policy of "wait and see" whether he returns again.

B. have the wife wait in the waiting room so her husband can be interviewed in private.

A 4-year-old child tells the nurse, "I'm a bad boy. Daddy always says I'm not worth a second look." This situation can be an example of A. neglect. B. physical maltreatment. C. emotional violence. D. harsh parenting.

C Emotional violence occurs when the child's self-esteem is attacked. It is as devastating to the child as physical abuse.REF: Page 532

20. Which referral will be most helpful for a woman who was severely beaten by intimate partner, has no relatives or friends in the community, is afraid to return home, and has limited financial resources? a. A support group c. A women's shelter b. A mental health center d. Vocational counseling

C Because the woman has no safe place to go, referral to a shelter is necessary. The shelter will provide other referrals as necessary. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 537 | Page 544 (Box 28-6) TOP: Nursing Process: Implementation

2. An 11-year-old reluctantly tells the nurse, "My parents don't like me. They said they wish I was never born." Which type of abuse is likely? a. Sexual c. Emotional b. Physical d. Economic

C Examples of emotional abuse include having an adult demean a child's worth, frequently criticize, or belittle the child. No data support physical battering or endangerment, sexual abuse, or economic abuse. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 532 | Page 538-539 TOP: Nursing Process: Assessment

Client Needs: Safe, Effective Care Environment 15. An older adult with Lewy body dementia lives with family and attends a day care center. A nurse at the day care center noticed the adult had a disheveled appearance, strong odor of urine, and bruises on the limbs and back. What type of abuse might be occurring? a. Psychological c. Physical b. Financial d. Sexual

C Lewy body dementia results in cognitive impairment. The assessment of physical abuse would be supported by the nurse's observation of bruises. Physical abuse includes evidence of improper care as well as physical endangerment behaviors, such as reckless behavior toward a vulnerable person that could lead to serious injury. No data substantiate the other options. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 532 | Page 535 | Page 537 (Box 28-4) TOP: Nursing Process: Assessment

12. An adult tells the nurse, "My partner abuses me when I make mistakes, but I always get an apology and a gift afterward. I've considered leaving but haven't been able to bring myself to actually do it." Which phase in the cycle of violence prevents this adult from leaving? a. Tension-building c. Honeymoon b. Acute battering d. Stabilization

C The honeymoon stage is characterized by kind, loving behaviors toward the abused spouse when the perpetrator feels remorseful. The victim believes the promises and drops plans to leave or seek legal help. The tension-building stage is characterized by minor violence in the form of abusive verbalization or pushing. The acute battering stage involves the abuser beating the victim. The violence cycle does not include a stabilization stage.

After arranging for a sexual assault nurse examiner (SANE) to see Lauren and Mikayla for further assessment for abuse and proper reporting and followup, Lauren tells you she lives with her boyfriend, Darrin, who is not Mikayla's father. What statement by Lauren would make you suspect she is being emotionally abused? A. "Darrin has a good job and keeps control of all the finances but our electricity still got turned off last week." B. "I didn't tell Darrin I was coming because he is under so much stress at work I didn't want to add to it." C. "Darrin yells a lot and calls me names, but that's because I am so stupid and make so many mistakes." D. "Darrin is Latin American and has a fiery temper."

C. "Darrin yells a lot and calls me names, but that's because I am so stupid and make so many mistakes."

Which statement reflects a fact about family violence? A. Ninety-five percent of abuse victims are women. B. The victim's behavior is often the cause of the violence. C. Violence occurs in families of all backgrounds. D. Alcohol and stress are the major causes of abuse.

C. Violence occurs in families of all backgrounds.

What distinction can be made between abuse and neglect? A. Neglect occurs in the psychological domain; abuse occurs in the physical domain. B. Neglect is always physical; abuse can be verbal, physical, sexual, or emotional. C. Neglect is perpetrated against children; abuse victims can be children or adults. D. Neglect is a failure to provide; abuse is a failure to control aggression.

D. Neglect is a failure to provide; abuse is a failure to control aggression.

Which of the following persons has the highest risk factors for physical abuse? A. Emma, a 7-month-old baby who has colic and doesn't sleep through the night B. Roland, a 53-year-old man with cardiovascular disease living with his son C. Penny, a 28-year-old wife whose husband has a diagnosis of an anxiety disorder D. Rose, a 77-year-old woman living with her daughter and son-in-law

D. Rose, a 77-year-old woman living with her daughter and son-in-law

If it is determined that Mikayla has been sexually abused, what is the priority outcome for Mikayla? A. Mikayla's mother will learn coping techniques to support Mikayla. B. Mikayla will be able to verbalize exactly what happened to her. C. Mikayla will no longer act out sexually. D. The sexual abuse will cease.

D. The sexual abuse will cease.

An elderly client pays the bills because she fears that her family will make her live elsewhere if she doesn't "help out." The nurse assesses it as A. neglect. B. physical violence. C. psychological abuse. D. financial maltreatment.

D. financial maltreatment.

A patient tells the nurse, "My husband lost his job. He's abusive only when he drinks too much. His family was like that when he was growing up. He always apologizes and regrets hurting me." What risk factor was most predictive for the husband to become abusive? a. History of family violence b. Loss of employment c. Abuse of alcohol d. Poverty

The parents of a 15-year-old seek to have this teen declared a delinquent because of excessive drinking, habitually running away, and prostitution. The nurse interviewing the patient should recognize these behaviors often occur in adolescents who a. have been abused. b. are attention seeking. c. have eating disorders. d. are developmentally delayed.

Which comment by the nurse would best support relationship building with a survivor of intimate partner abuse? a. "You are feeling 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 was very worried about you. I knew 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 nurse plans to give secondary prevention to a patient who was sexually abused. Which action by the nurse indicates effective nursing practice? Select all that apply. a. The nurse treats the injuries of the patient. b. The nurse identifies families at high risk for abuse. c. The nurse teaches mindfulness techniques to the patient. d. The nurse arranges a housekeeper for the patient's family. e. The nurse arranges a legal advocacy program for the patient.

A survivor of physical spousal abuse was treated in the emergency department for a broken wrist. This patient said, "I've considered leaving, but I made a vow and I must keep it no matter what happens." Which outcome should be met before discharge? The patient will a. facilitate counseling for the abuser. b. name two community resources for help. c. demonstrate insight into the abusive relationship. d. reexamine cultural beliefs about marital commitment.

What feelings are most commonly experienced by nurses working with abusive families? a. Outrage toward the victim and discouragement regarding the abuser b. Helplessness regarding the victim and anger toward the abuser c. Unconcern for the victim and dislike for the abuser d. Vulnerability for self and empathy with the abuser

Which rationale best explains why a nurse should be aware of personal feelings while working with a family experiencing family violence? a. Self-awareness enhances the nurse's advocacy role. b. Strong negative feelings interfere with assessment and judgment. c. Strong positive feelings lead to healthy transference with the victim. d. Positive feelings promote the development of sympathy for patients.

What is a nurse's legal responsibility if child abuse or neglect is suspected? a. Discuss the findings with the child's parent and health care provider. b. Document the observation and suspicion in the medical record. c. Report the suspicion according to state regulations. d. Continue the assessment.

A young adult has recently had multiple absences from work. After each absence, this adult returned to work wearing dark glasses and long-sleeved shirts. During an interview with the occupational health nurse, this adult says, "My partner beat me, but it was because I did not do the laundry." What is the nurse's next action? a. Call the police. b. Arrange for hospitalization. c. Call the adult protective agency. d. Document injuries with a body map.

An adult has recently been absent from work for 3-day periods on several occasions. Each time, the individual returned wearing dark glasses. Facial and body bruises were apparent. What is occupational health nurse's priority assessment? a. Interpersonal relationships b. Work responsibilities c. Socialization skills d. Physical injuries

The nurse is counseling a victim of family violence. What key idea does the nurse need to emphasize to the victim during crisis intervention? a. An abuser can be changed when the abuser learns coping skills. b. Skills to manage a stressful situation can help in preventing a crisis. c. People can turn to support groups to manage a stressful situation. d. People have a right to live without fear of violence, physical harm, or assault.

An elderly patient pays the bills because the patient fears that his or her family will make him or her live elsewhere if the patient doesn't "help out." The nurse assesses this as what? 1 Neglect 2 Economic abuse 3 Physical violence 4 Psychological abuse

2 - Economic abuse Economic abuse occurs when the perpetrator takes financial advantage of the elderly person, often through the use of subtle threats of what unpleasant or frightening outcome will occur if the elder patient does not supply funds. Neglect, physical violence, and psychological abuse lack the financial component. Text Reference - pp. 521, 527

The nurse is teaching a class on strategies to prevent the occurrence of abuse, such as reducing stress in the home. This is an example of which type of prevention? 1 Primary 2 Tertiary 3 Primordial 4 Secondary

1 - Primary Primary prevention includes measures taken to prevent the occurrence of abuse, such as reducing stress. Tertiary prevention involves counseling and support for individuals who are survivors of violence. Secondary prevention involves screening programs for high-risk individuals. Primordial prevention is preventing the risk factors in social and environmental conditions Text Reference - p. 533

A community health nurse starts working with the family of a victim of domestic abuse. What strategies for primary prevention are helpful in this case? Select all that apply. 1 Reducing stress in the family 2 Decreasing family interactions 3 Increasing the use of coping skills 4 Arranging a legal advocacy program 5 Increasing the amount of social support

1 - Reducing stress in the family 3 - Increasing the use of coping skills 5 - Increasing the amount of social support Reducing stress in the family and increasing coping skills will help the family prevent future crisis situations. Increasing social support helps reduce the feeling of isolation and increases self-worth and self-esteem in the members of the family. Decreasing family interactions will increase the self-isolation behavior, which will lead to family disorganization. A legal advocacy program is needed in the tertiary prevention of domestic abuse. Text Reference - p. 533

In the context of abuse assessment, on which areas should a nurse concentrate? Select all that apply. 1 Assessment by a group of interviewers 2 Approaching the abuser 3 Levels of anxiety and coping responses 4 Observations of the family's patterns of coping 5 Indications or patterns of violence

3 Levels of anxiety and coping responses 4 Observations of the family's patterns of coping 5 Indications or patterns of violence

What is commonly the result of abuse in childhood? Select all that apply. 1 Running away 2 The onset of clinical depression 3 Confrontation with family members 4 Posttraumatic stress disorder (PTSD) 5 Faster physical and social development

1 - Running away 2 - The onset of clinical depression 4 - Posttraumatic stress disorder (PTSD) Abuse during childhood may manifest in depression later in life. The patient may have low self-esteem and feelings of worthlessness. Posttraumatic stress disorder (PTSD) develops from a trauma that the patient experienced. Violence is ofent seen in childhood histories of runaways, juvenile offenders, and prostitutes. Those who face abuse in childhood have slower physical and mental development as the energy needed for developmental tasks tends to be spent on coping with abuse. Abuse in childhood does not lead to confrontation with the family. Rather, the abused person is more likely to become withdrawn and avoid confrontation. Text Reference - p. 522

A nurse is teaching patients in a primary health care center how to escape and avoid being a victim of abuse by their partners. Which action of a participant indicates effective teaching? Select all that apply. 1 Identifying the signs of escalation of violence 2 Staying with the abuser to make him or her calm and relaxed 3 Showing extreme trust of his or her partner 4 Packing a bag with money and birth certificates 5 Leaving the place immediately if there are signs of violence

1 Identifying the signs of escalation of violence 4 Packing a bag with money and birth certificates 5 Leaving the place immediately if there are signs of violence

A nurse is assessing a patient with major injuries. The nurse suspects that the patient was physically abused by his or her intimate partner. The patient is unable to interact due to a language barrier. What appropriate action should the nurse take while documenting the clinical report of abuse? 1 Immediately report against the patient's partner in the community health department. 2 Maintain a balance of suspicion and a neutral, objective attitude. 3 Ask the patient's family member to translate the conversation. 4 Give the patient some time, and conduct the interview after 72 hours.

2 - Maintain a balance of suspicion and a neutral, objective attitude. The nurse should prepare a clinical document to report the physical abuse of the patient. While interacting with the patient, the nurse should maintain a balance of suspicion and a neutral, objective attitude. It helps the nurse not to jump to conclusions and to complete a thorough examination to make proper assessment of the patient's condition. Suspecting the patient's partner without evidence may lead to incomplete assessment of the patient. Without proof the nurse should not come to a conclusion and file a complaint against the patient's partner. The nurse should not ask the patient's family member to translate the interaction. Presence of a family member during documentation of the report results in loss of patient's confidence. The patient can avoid interacting due to threat of future punishment. The report of the abuse must be done within 24-48 hours. So the nurse should interact with the patient within 48 hours and complete the document. Text Reference - p. 530

Which behavior is characteristic of the tension-building stage of the violence cycle? Select all that apply. 1 Remorse is felt and expressed. 2 Rationalization is used to justify the anger. 3 Calmness returns for a short period of time. 4 Tension is released thorough physical violence. 5 Alcohol may be employed to manage the tension.

2 - Rationalization is used to justify the anger. 5 - Alcohol may be employed to manage the tension. The tension-building stage is characterized by abusers rationalizing that their abusive behavior is acceptable. As the tension escalates, both participants may try to reduce it. The abuser may try to reduce the tension with the use of alcohol or drugs. During the acute battering stage, the abuser releases the built-up tension by brutal beatings, which can result in serious injuries. The honeymoon stage may be characterized by kindness and loving behaviors. The abuser, at least initially, feels remorseful and apologetic. Over time, the periods of calmness and safety become briefer, and the periods of anger and fear are more intense. Text Reference - p. 523

The nurse is formulating a plan of care for a patient who is a victim of sexual abuse. What is a priority nursing diagnosis? 1 Self-care deficit 2 Risk for violence 3 Impaired mobility 4 Impaired self-image

2 - Risk for violence Safety is an urgent need, so the risk for violence is the priority nursing diagnosis for a patient who is a victim of sexual abuse. Self-care deficit, impaired self-image, and impaired mobility are lower-priority nursing diagnoses. Text Reference - p. 529

A woman in the sixth month of pregnancy presents in the emergency department with complaints of a severe headache. Her partner answers the assessment questions, even though they are directed to the woman. The woman has a depressed affect and slumped shoulders. The nurse recognizes the need for further assessment related to which of the following? 1 Potential neurologic infection 2 The risk of intimate partner violence 3 The possibility of a hypertensive crisis 4 Development of a major depressive episode

2 - The risk of intimate partner violence Pregnancy is a high-risk period for development or escalation of intimate partner violence. In this instance, the partner is trying to control the interview, which is another indicator of possible abuse. Potential neurologic infection, the possibility of a hypertensive crisis, and development of a major depressive episode are possibilities but less likely options. Text Reference - pp. 524, 527, 532, Table 28.2, Box 28.6

Which new parent is at risk for abusing his or her newborn? Select all that apply. 1 A mother who recently immigrated to the United States 2 A teenage father with moderately impaired cognitive skills 3 A mother of three who requests the infant be kept in the nursery at night. 4 A teenage mother who denied being pregnant until the 7 th month of gestation 5 A father who states, "I don't see myself changing diapers and cleaning up spit."

2 A teenage father with moderately impaired cognitive skills 4 - A teenage mother who denied being pregnant until the 7th month of gestation 5 - A father who states, "I don't see myself changing diapers and cleaning up spit." Nurses who work on a maternity unit are often in a position to identify risk factors for abuse between new parents and initiate appropriate interventions, including education about effective parenting and coping techniques. Parents who are candidates for special attention include new parents whose behavior toward the infant is rejecting, hostile, or indifferent; teenage parents who require special help in handling the baby and discussing their expectations of the baby and their support systems; and parents with cognitive deficits, for whom careful, explicit, and repeated instructions on caring for the child and recognizing the infant's needs are indicated. Recent immigration is not generally considered a risk for child abuse. It is not unusual that the mother of three would make the request to enable uninterrupted sleep before returning home. Text Reference - p. 532

A person comes to the health care facility with a bleeding head injury and some bruises to both hands. What signs would indicate this person is a victim of domestic abuse? Select all that apply. 1 The patient exaggerates the seriousness of the injury. 2 The patient has weak and nervous behavior. 3 The patient's explanation is inconsistent. 4 The patient gives hesitant explanations. 5 The patient makes direct eye contact.

2 The patient has weak and nervous behavior. 3 The patient's explanation is inconsistent. 4 The patient gives hesitant explanations.

An elderly woman who has been abused by her caregiver daughter tells the nurse, "You don't have to worry about me. My daughter cried and apologized. She promised me she will never hit me again." The nurse can assess that this is which stage in the cycle of violence? 1. Escalation 2. Honeymoon 3. Acute battering 4. Tension building

2. Honeymoon

A school nurse assesses multiple bruises and welts in odd shapes on a child's back. Lately, this child has been frequently tardy and has had episodes of aggressive behavior in school. Identify the best initial outcome. The child will: 1 Attend school on time 2 Acknowledge abuse by caregivers 3 Form a trusting relationship with the nurse 4 Refrain from aggressive behavior with others

3 Form a trusting relationship with the nurse

A patient who was physically abused is diagnosed with hopelessness related to social isolation, fear related to perceived physical threat, and risk of infection related to injuries. What outcomes indicate effective treatment? 1 Has minor pain in the joints 2 Needs assistance to set goals 3 Has effective wound healing 4 Has nightmares quite often

3 Has effective wound healing

A woman reports being in an abusive relationship with her husband. What drives a man to act as a perpetrator in an abusive relationship? Select all that apply. 1 He uses physical aggression because he hates his partner. 2 He forces his partner to work because he feels idle. 3 He feels more powerful when he uses force and abuse. 4 He feels he is in charge and dominant in the relationship. 5 He imposes restrictions due to extreme pathological jealousy.

3 He feels more powerful when he uses force and abuse. 4 He feels he is in charge and dominant in the relationship. 5 He imposes restrictions due to extreme pathological jealousy.

The nurse is developing a plan of care for a person who is hostile, demonstrates poor social skills, and is addicted to substances. What would be an appropriate nursing diagnosis for this person? 1 Anxiety and hopelessness 2 Dysfunctional family process 3 Ineffective individual coping 4 Ineffective role performance

3 Ineffective individual coping

A nurse visits an old age home to assess the presence of abuse. Which response of a patient would indicate that he or she has been neglected? 1 "I spend my time by interacting with my neighbors; we pour our hearts out." 2 "I am grateful for this wheelchair; without it I would be dependent on my children to move." 3 "I am unable to administer the medications; the medication bottles are not clearly marked." 4 "I sit near this window in the morning; the warm sunrays and cool breeze lift my mood."

3 "I am unable to administer the medications; the medication bottles are not clearly marked."

The nurse suspects that a person is abusing his or her child. What type of questions would help the nurse to elicit information from the person? 1. Direct questions that can be answered with "yes" or "no" 2. Threatening questions that can elicit information easily 3. Thought-provoking questions that help elicit information 4. Open-ended questions that require descriptive responses

4. Open-ended questions that require descriptive responses

When can a victim of abuse expect the abuse to worsen? 1. When the perpetrator feels he or she is in complete control 2. When the perpetrator is feeling remorseful for being abusive 3. When the victim submits to the domination of the perpetrator 4. When the victim moves toward independence from the abuser

4. When the victim moves toward independence from the abuser

Which statement made by a parent of a child diagnosed with Tourette's syndrome would be assessed as a risk factor for family violence? A. "My husband lost his job, and it seems all our savings are going to pay for our son's expensive medication and all the other things he needs." B. "Our son is really a good little boy, but he needs to be disciplined both at home and in school." C. "We shouldn't be, but we are ashamed of our son's disorder and his inability to control the tics in public." D. "We have become active in the support group but still find the suggestions extremely difficult to put into practice."

A. "My husband lost his job, and it seems all our savings are going to pay for our son's expensive medication and all the other things he needs."

Chapter 28 Child, Older Adult, and Intimate Partner Abuse

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