EAQ 4 - Interpersonal Violence

Which behavior is an early sign of an abusive personality? Select all that apply. a. Verbal abusive b. Jealous, controlling c. Enforces rigid sex roles d. Hypersensitive, easily insulted e. Isolates partner from family and friends f. Makes others responsible for their feelings

A, B, C, D, E, F Abuser behavior has several characteristics. A typical abuser has poor emotional control, a superior attitude toward women, a history of substance abuse, high levels of jealousy and insecurity, and hypersensitivity. Other characteristics include making others responsible for their feelings and using threats, such as verbal abuse, punishment, and physical violence, to control another's behavior. Control may extend to enforcing rigid sex roles and isolating a partner from family and friends. Early recognition of the characteristics of potential violence allows for effective intervention.

Which behavior is client diagnosed with histrionic personality disorder displaying when after being refused a sleeping pill, the client throws a book at the nurse? a. Exploitive b. Acting out c. Manipulative d. Reaction formation

B The client is acting out. Acting out is the process of expressing feelings behaviorally. The action is not exploitive, because no evidence is provided to demonstrate that anyone has been used to get what the client wants. The action is not manipulative, because no evidence is provided to demonstrate that anyone has been influenced against his or her wishes. The action is not disguising unacceptable feelings by expressing opposite emotions (reaction formation).

A 7-year-old child sustains a fractured femur in a bicycle accident. The admission x-ray films reveal evidence of fractures of other long bones in various stages of healing. Which would the nurse suspect as the cause of the fracture? a. Child abuse b. Vitamin D deficiency c. Osteogenesis imperfecta d. Inadequate calcium intake

A Injuries in various stages of healing are the classic sign of child abuse. Vitamin D deficiency, osteogenesis imperfecta, and inadequate calcium intake may all be investigated after child abuse has been ruled out.

The nurse notes bruises on the pregnant client's face and abdomen. There are no bruises on her legs and arms. Further assessment is required to confirm which condition? a. Domestic abuse b. Hydatidiform mole c. Excessive exercise d. Thrombocytopenic purpura

A Domestic abuse is likely to intensify during pregnancy, and attacks are usually directed toward the pregnant woman's abdomen. A hydatidiform mole manifests as an unusually enlarged uterus for gestational age accompanied by hypertension, nausea and vomiting, and vaginal bleeding, not bruises on the face and abdomen. Excessive exercise may cause cardiovascular or pulmonary problems. It will not result in bruising. Thrombocytopenic purpura and other bleeding disorders manifest as bruises and petechiae on many areas of the body's surface, not just the face and abdomen.

Which definition of battery would the nurse include when teaching staff about legal terminology used in child abuse? a. Maligning a person's character while threatening to do bodily harm b. A legal wrong committed by one person against property of another c. The application of force to another person without lawful justification d. Behaving in a way that a reasonable person with the same education would not

C Battery means touching in an offensive manner or actually injuring another person, application of force. Battery refers to actual bodily harm rather than threats of physical or psychological harm. Battery refers to harm against persons, not property. Behaving in a way that a reasonable person with the same education would not is the definition of negligence.

The nurse is caring for a client in preterm labor who reports that she fell down the stairs and hit her chest and abdomen. Bruises are apparent on the left part of the client's lower abdomen, the back of each shoulder, and on both wrists. After obtaining vital signs, assessing the client, and interpreting the fetal monitor strip, which action would the nurse take next? a. Ambulate the client to promote circulation b. Assess for headache, epigastric pain, and blurry vision c. Ask the client if she feels safe at home d. Determine if the client tripped over any object

C Bruising on the backs of both shoulders and both wrists may be a result of physical abuse; asking the client whether she feels safe at home will open a dialogue to discuss the possibility of physical abuse. Determining the safety of the physical environment is helpful in preventing future accidents. However, ruling out physical abuse and ensuring safety at this moment are higher priorities. Ambulation is not appropriate for this client at this time. This client does not report hitting her head and there are is no reported head trauma. Headache, epigastric pain, and blurry vision are associated with preeclampsia.

A client who has a history of aggressive, violent behavior becomes very angry and starts screaming at the nurse and pounding on the table. Which assessment is the priority? a. Range of expressed anger b. Extent of orientation to reality c. Degree of control over the behavior d. Level of perceived justification

C Degree of control over the behavior is the most important assessment because it will influence the nurse's intervention. Depending on the extent of the client's control, the nurse may or may not need assistance. The behavior needs to be assessed, not the degree of anger. Orientation to reality could influence the ability to control behavior, but the factors that influence control are secondary to immediate safety issues. Anger is always justifiable to the person, but this can be explored after the client has gained control.

Which important nursing action would be taken after a health care provider prescribes losartan for a client? a. Assess the client for hypokalemia b. Administer the medication with food c. Monitor the client's blood pressure d. Monitor serum glucose levels

C Losartan is an aldosterone receptor blocking antihypertensive. A lowering of the client's blood pressure reflects a therapeutic response and should be monitored regularly. The client may be at risk for hyperkalemia, not hypokalemia. Losartan may be taken without regard to meals. Although it may be beneficial for clients with diabetes, it does not affect serum glucose levels.

The nurse in a hospital skilled nursing unit witnesses a client's spouse vigorously shaking the elderly client who has dementia after the client has had an episode of incontinence. After discussing concerns with the nurse manager, to whom would the nurse report this observation? a. The client b. The client's spouse c. The primary HCP d. Adult Protective Services

D The nurse has a legal responsibility to report suspicions of abuse to the appropriate agency, which in this instance is Adult Protective Services. The client will not be able to understand the discussion. It is not the nurse's responsibility to directly challenge the spouse's behavior in this situation; the nurse may act as a client advocate by interrupting the spouse's behavior and providing immediate physical and emotional care. The nurse should then report suspicions of abuse to Adult Protective Services. Although the nurse may report suspicions about the spouse's behavior to the health care provider, the law requires that Adult Protective Services be notified. The term Adult Protective Services refers to the range of laws and regulations enacted to deal with abusive situations. The laws and regulations are typically administered by an agency within the state, for example, the Department of Social Services, which receives and investigates complaints.

Which definition of assault would the nurse include in teaching a group of parents about child abuse? a. Threat to do bodily harm to another person b. An unintentional act committed by one person against another person c. A legal wrong committed against the public that is punishable by federal law d. The application of force to another person without lawful justification

A Assault is a threat or an attempt to do violence to another. Assault implies harm to persons rather than property. Assault is not defined as an unintentional act committed by one person against another.A legal wrong committed against the public that is punishable by federal law is too broad to describe assault. Application of force to another person without lawful justification is the definition of battery.

Which additional assessments should be conducted on an 18-year-old woman who was confused when found on the bathroom floor and her urinalysis tested positive for flunitrazepam? a. Assess for signs of sexual assault b. Observe for hallucinations or delusions c. Directly ask about suicidal intentions d. Monitor for renal failure

A Flunitrazepam, illegal in the United States, has been used in date rapes; the side effects include sedation, muscle relaxation, confusion, memory loss, dizziness, and impaired coordination. Flunitrazepam is not used to treat psychosis or depression, or hangover symptoms.

The nurse is working with a child who was physically abused by a parent. Which is the most important goal for this family? a. The child will live in a safe environment b. The parents will use verbal discipline effectively c. The family will feel comfortable in its relationship with the counselor d. The parents will gain an understanding of their abusive behavior patterns

A The most important goal and top priority is to ensure the safety of the child. Once this is ensured, other goals can be identified and fulfilled, including the parents using verbal discipline effectively, the family feeling comfortable in its relationship with the counselor, and the parents gaining an understanding of their abusive behavior patterns.

Which intervention would the nurse use to prevent injury to others when caring for a client with intermittent explosive disorder? Select all that apply. a. Administer antipsychotics b. Set limits and expectations c. Use seclusion and time out d. Provide structure and boundaries e. Ignore attention-seeking behaviors

B, D, E When caring for clients with intermittent explosive disorder, interventions to promote safety and prevent injury to others include setting limits and expectations, providing structure and boundaries, and ignoring attention-seeking behavior. Antipsychotics and seclusion are used only as last-resort measures.

During a home visit, the nurse discovers that a child in the household who has a disability has been experiencing seizures. The child's parent appears indifferent to the child's physical, emotional, or medical needs and seems to provoke seizure episodes by harsh verbal exchanges with the child. Where would the nurse direct a referral? a. Outpatient clinic b. Hospital pediatric unit c. Child Protective Services d. Bureau of the Handicapped

C All states have laws about obligatory reporting of child abuse to local authorities. This responsibility is delegated by the state to an appropriate local agency such as Child Protective Services. A staff member of the agency investigates allegations of child abuse, and recommendations are made to protect the child's welfare. The clinic treats the client medically, but other agencies handle child abuse and other social problems. The hospital probably will not admit the child unless an immediate medical incident requires it. The Bureau of the Handicapped is concerned with equipment and supplies required for the individual with a disability.

Which term describes a display of anger that is socially unacceptable? a. Abuse b. Battery c. Aggression d. Defensiveness

C Experiencing and demonstrating anger is a normal human reaction; however, aggression is manifest when behaviors are socially and emotionally unacceptable. Abuse is a general term that infers physical, sexual, emotional, or verbal mistreatment of another individual. Battery involves harmful or offensive touching or physical contact. Defensiveness is protection of oneself against a real or perceived threat.

Which intervention is the priority when suspicion of child abuse is confirmed? a. Promoting bonding with the child b. Staying with the parents while they visit c. Protecting the total well-being of the child d. Teaching methods of discipline to the parents

C Protection of the child's total well-being is placed above the parents' rights or wishes. Protecting the child, not promotion of parental attachment, is the priority. Supervision may be necessary, but it is only part of maintaining the child's well-being. Teaching methods of discipline may be included in the long-term plan of care.

Which type of crisis has occurred when a sudden terrorist act causes the deaths of thousands of adults and children and negatively affects their families, friends, communities, and the nation? a. Situation-maturational b. Situational c. Maturational d. Adventitious

D An adventitious crisis is a crisis or disaster that is unplanned and accidental; its subcategories include natural disasters, national disasters, and crimes of violence. A situational-maturational crisis is not a typical category in crisis theory. If 2 events occurred around the same time—for example, retirement (maturational crisis) and the unexpected death of a spouse (situational crisis)—the client would have to deal with both issues. A situational crisis results from an external source and the loss is often unexpected. A maturational crisis occurs as an individual moves into a new stage of development and prior coping styles are no longer effective; maturational crises are usually predictable.

A woman who is frequently physically abused says, "It's my fault that my husband beats me." Which response would the nurse use? a. "Maybe, but it's likely that your husband is also at fault." b. "I can't agree with that - no one should be beaten." c. "Tell me why you believe that you deserve to be beaten." d. "You say that it was your fault - help me understand that."

D Paraphrasing and clarifying are interviewing techniques that promote communication between the nurse and client and help the client hear and explore her words and gain insight into her behavior. A closed declarative statement (husband is also at fault) limits dialogue. Nurse-focused statements (I can't agree) do not empower the client. "Why" questions are generally not therapeutic because most clients cannot respond to these questions with logical explanations.

Which intervention is the most important for a young female client who was raped 3 days ago and continually talks about the trauma of being sexually assaulted? a. Getting her involved with a rape therapy group b. Remaining available and supportive to limit destructive anger c. Exploring her feelings about men to promote future relationships d. Providing a safe environment that permits the ventilation of feelings

D The client needs to be able to express her current feelings in a safe environment. It is too soon after the assault to discuss this topic in a group. Although the nurse should be available and supportive, feelings of anger are usually not the initial response. It is too soon after the assault to discuss her feelings about men and future relationships.

An 8-year-old girl visits the school nurse and reports that she no longer wants to visit her grandfather in his home because he "hugs me too tight and touches me down there" (pointing to her genitals). She has told her parent that she does not want to spend the weekend with her grandparents, but her parent says that she has no choice. What is the most appropriate action by the nurse? a. Planning a home visit to discuss with the parent what the child has shared with the nurse b. Advising the child to again tell her parent why she does not want to go to her grandfather's house c. Arranging a meeting with the principal and the parent to discuss the possibility of child molestation d. Reporting the alleged abuse to the local child protective agency and encouraging an investigation before the weekend visit

D When alleged child abuse (neglect, sexual, or physical) is brought to the attention of the nurse, by law it must be reported to the legal state (Canada: provincial/territorial) agency for further investigation. Discussion with the parent circumvents the law. The child has already talked with her parent, who is not hearing her concerns; the child expects the nurse, an adult she trusts, to help her. Discussion with the parent and principal circumvents the law.