Interpersonal Violence

What action should the nurse take if abuse of a 10-yr-old is suspected? A. Report the suspicion to local authorities B. Elicit more information from the parents C. Refer the parents to a group therapy meeting D. Notify the HCP of the suspicion

A. A nurse is mandated by law to report suspected child abuse. Child protective services are notified to make appropriate investigations. Assessment is an ongoing process throughout treatment, but legally the nurse is bound to report suspected abuse. Referring the parents to a group therapy meeting is not the primary safety action at this time. The nurse must comply with state (Canada: provincial/territorial) law because all 50 states (Canada: 12 provinces and territories) require the nurse to be a mandated reporter. The HCP can be notified but this is not the priority action.

An 18-yr-old woman is brought to the ED by her two roommates after being found unconscious in the bathroom. Laboratory tests are ordered. The nurse reviewing the findings notes that the urinalysis is positive for flunitrazepam. The nurse knows that flunitrazepam is often used for what? A. As a date rape drug B. To control symptoms of psychosis C. To control symptoms of bipolar mania D. To treat hangover symptoms after excessive alcohol consumption

A. Flunitrazepam, illegal in the U.S., has been used in date rapes; the victim is attacked after consuming a drink spike with the drug. Flunitrazepam is not used to treat psychosis, mania, or hangover symptoms.

A nurse is interviewing a mother accused of physical child abuse. When speaking with this mother, what does the nurse expect her to do? A. Attempt to rationally explain her behavior B. Reveal the belief that her child needed to be disciplined C. Offer a detailed explanation of how her child was injured D. Ask how she can arrange to visit her child on the pediatric unit

B. An abusive parent often indicates that he or she was trying to improve the child's behavior with physical consequences for behavior the parent considered unacceptable. Such parents usually do not admit their behavior, so they do not have a need to rationalize it. These parents offer many vague explanations of how the child was injured; rarely is the explanation detailed. Asking how she can arrange to visit her child on the pediatric unit is an unusual request because the abusive parent usually does not ask to see the child.

The ED nurse is conducting an interview and assisting with the physical examination of a female sexual assault victim. What is most important for the nurse to document on this patient's record? A. Observations about the patient's reaction to male staff members B. Statements by the patient about the sexual assault and the rapist C. Information about the client's previous knowledge of the rapist D. Summary statement about the patient's description of the assault and the rapist

B. Statements by the patient about the sexual assault and the rapist eliminate the nurse's subjectivity from the report. Observations about the patient's reaction to male staff members is unrelated to the sexual assault itself and are subjective. Eliciting information about the patient's previous knowledge of the rapist is not the responsibility of the nurse. A summary statement about the patient's description of the sexual assault and the rapist may invite subjectivity.

A nurse in the ED notes large welts and scars on the back of a toddler who has been admitted for an asthma attack. What additional information must be included in the nurse's assessment? A. History of an injury B. Signs of child abuse C. Presence of food allergies D. Recent recovery from chickenpox

B. When unexplained injuries are found, further assessment is required because it is the nurse's legal responsibility to report suspected child abuse. History of an injury is just one aspect of the assessment for child abuse. The presence of food allergies is not related to scars on the child's back. Although chickenpox may leave scars, it does not cause welts.

A patient comes to a trauma center reporting that she has been raped. She is disheveled, pale, and staring blankly. The nurse asks the patient to describe what happened. What is the nurse's rationale for doing this? A. It will help the nursing staff give legal advice and provide counseling B. Talking about the assault will help the patient see how her behavior may have led to the event C. It will let the victim put the event in better perspective and help begin the resolution process D. Discussing the details will keep the victim from concealing the intimate happenings during the assault

C. Talking about what actually happened helps the patient sort out the truth from confused thoughts and helps the patient begin to accept what has happened as a part of her history. Legal counsel should come from a legal authority, not the nurse; the victim should be told of the legal services available. Sexual assaults are often planned. They are violent acts, and the perpetrators are responsible for their behavior. If the patient does not want to discuss intimate details, this wish should be respected.

Risk for assaultive behavior is highest in the mental health patient who does what? A. Uses profane language B. Touches people excessively C. Exhibits a sudden withdrawal D. Experiences command hallucinations

D. Command hallucinations are dangerous because they may influence the patient to engage in behaviors that are dangerous to self or others. Although profane language, excessive touching of others, and withdrawn behavior may all be cause for concern, none are as dangerous as command hallucinations.

A nurse is teaching a class about child abuse. What defense mechanism most often used by the physically abusive individual should the nurse include? A. Repression B. Manipulation C. Transference D. Displacement

D. Displacement is a defense mechanism in which one's pent-up feelings toward a threatening person are discharged on those who are less threatening. Repression is the unintentional putting out of the mind unacceptable or troubling thoughts, desires, or experiences. Transference is a mechanism by which affects or emotional tones are shifted from one individual to another; it is unrelated to child abuse. Manipulation is a mechanism by which individuals attempt to manage, control, or use others to suit their own purpose or to gain an advantage; it is unrelated to child abuse.

A married woman is brought to the ED of a local hospital. Her eyes are swollen shut, and she has a bruise on her neck. She reports that she is being beaten by her husband. How does the nurse expect the husband to behave when he arrives at the ED? A. Fearful B. Confused C. Charming D. Indifferent

C. Abusers are often extremely charming to mask their abusive tendencies and convince the abused mate and others that change is possible. After an abusive episode there is often a "honeymoon" period because the tensions of the abuser have been released. Abusers mask their fears by becoming angry and aggressive. Abusers are not confused; they are manipulative of others. Abusers are rarely indifferent; they tend to be opinionated and demanding.

A 6-yr-old child with a leg fracture of suspicious origin is brought into the ED by the mother and the mother's boyfriend. It is the child's first visit to this hospital. After assessing the child, a nurse anticipates the the HCP will order a skeletal survey. Why is a skeletal survey the preferred diagnostic tool? A. The exact location and extent of the fracture will be pinpointed B. Three separate x-ray films of the leg and hip should be ordered, making it more cost-effective C. The skeletal history of the current fracture and and previous healing or healed fractures are identified D. It is the first step toward a complete assessment before computed tomography and magnetic resonance imaging are done

C. Abusive parents may "shop" for hospitals that do not have previous record of their child; the skeletal survey will provided a revealing injury history if abuse has occurred. Pinpointing the exact location of a fracture is necessary to plan appropriate treatment and can be done with a single x-ray film of the area; a skeletal survey is more extensive and helpful when abuse is suspected. Cost-effectiveness is not the primary concern if abuse is suspected. Computed tomography and magnetic resonance imaging are not required unless internal injuries are suspected.

A 6-yr-old child has a fractured arm and multiple old injuries. Child maltreatment is suspected. What parental characteristic supports this suspicion? A. Inquiring about the time of discharge B. Displaying signs of guilt about the injuries C. Expressing concern about the child's health D. Offering inconsistent stories about the injuries

D. Typically, abusive parents resist questioning; however, when pressured to explain the injuries they offer a variety of stories in an attempt to cover up the real origin of the injuries. Abusive parents display little interest in the child's care or progress. Rather than guilt, battering parents tend to feel angry at the child for the injury. An abusive parent typically has difficulty showing concern for the child. The parent is unable to comfort the child, such as through touch, and gives little indication of realizing how the child feels.

Battery

The carrying out of a verbal threat in a physical manner

Aggression

The display of anger in a socially inappropriate manner

While assessing an older adult during a regular health checkup, a nurse finds signs of elder abuse. Which physical findings would further confirm the nurse's suspicion? Select all that apply. A. Presence of hyoid bone damage B. Presence of cognitive impairment C. Presence of burns from cigarettes D. Presence of bed sores E. Presence of unexplained bruises on the wrist(s)

C, D, E. A physical finding of abuse in older adults can be the presence of burns from cigarettes. The physical presence of bed sores also indicates patient abuse. Unexplained bruises on the wrist(s) may also be an indication of abuse in older adults. The presence of hyoid bone damage is an indication of intimate partner violence. The presence of cognitive impairment is a behavioral finding in older adult abuse.

A mother is worried about the sudden behavioral changes in her child. The child has suddenly developed a fear of certain people and places. The child's school performance is declining rapidly, and the child has developed poor relationships with peers. After assessing the physical findings of the child, the nurse suspects child abuse. Which physical findings might have led the nurse to this suspicion? A. Sunken eyes and weight loss B. Uncommunicative and uninteractive with others C. Foreign bodies in the rectum, urethra, or vagina D. Strangulation marks on neck from rope burns or bruises

C. One of the physical findings that may be required to confirm child abuse is the presence of foreign bodies in the rectum, urethra, or vagina. Weight loss and sunken eyes may be a physical finding of older adult abuse. When the abuse is related to an intimate partner, the nurse may observe strangulation marks on the neck from rope burns or bruises. Staying isolated and not communicating with others are behavior findings that may be related to older adult abuse.

A nurse, providing care in a hospital skilled nursing unit, witnesses a patient's spouse shaking the elderly patient vigorously because the patient has had an episode of incontinence. Because of the suspicion of physical abuse, legally the nurse should discuss the concerns with managers and report the abuse to which party? A. The patient B. The patient's spouse C. The patient's 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 patient 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 patient 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 HCP, the law requires that Adult Protective Services by 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 the agency within the state, for example, the Department of Social Services, which receives and investigates complaints.