MH Chapter 28 Child, Older Adult, and Intimate Partner Violence AQ

2 If a child younger than 2 years of age is shaken violently, its brain may move in the opposite direction as its body. Due to such movement, the baby develops respiratory problems, bulging fontanels, retinal hemorrhages, and central nervous system damage resulting in seizures, vomiting, and coma. This is called shaken baby syndrome. Though a fall may also result in any of these symptoms, as a whole the symptoms are indicative of shaken baby syndrome. Posttraumatic stress disorder occurs after a severe trauma and the characteristic manifestations are nightmares, somatic complaints, and feelings of guilt. A respiratory ailment and gastrointestinal disturbances do not manifest in bulging fontanels or retinal hemorrhage.

A 1-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 Upper respiratory illness 4 Post-traumatic stress disorder

3 Emotional abuse occurs when the child's self-esteem is attacked. It is as devastating to the child as physical abuse.

A 4-year-old child tells the nurse, "I'm a bad boy. Daddy always says I'm not worth a second look." What is this situation an example of? 1 Neglect 2 Harsh parenting 3 Emotional abuse 4 Physical maltreatment

1 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.

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

3 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.

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 The perpetrator should also be included in the plan of care. The person should undergo individual therapy and then, if it is successful and some changes are noticed, the person can undergo family psychotherapy. The expected therapy outcome is that the person should learn to recognize the destructive patterns of behavior and can use alternative responses to refrain from abuse. The perpetrator should learn to control impulses and should not be temperamental in a crisis. The person should learn alternative ways to express anger, disappointment, and frustration and should not just vent to the members of the family. The person should learn to interact in a healthy way with other members of the family so that trust can be established, and openness and directness can help stop the violence.

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 become temperamental and handle a crisis situation impulsively 2 To express anger and disappointment to the members of the family 3 To recognize destructive patterns of behavior and learn alternative responses 4 To develop reclusive behavior and isolate one's self from others in the family

2 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.

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 process

1 Patients who have been neglected experience mental trauma and respond slowly. The nurse should spend some time with the patient to establish trust and rapport. Sitting and spending time with the patient gives him or her assurance and support. Communicating with the patient from a distance of 1 ft would be inappropriate. The patient may feel rejected if the nurse maintains a distance while communicating. The nurse should sit beside the patient to comfort the patient. The nurse should not restate what the patient has said. It could interrupt the patient's conversation and make the patient feel rejected. Patients must be allowed to explain their feelings and situations without interruption to avoid distraction. The nurse should reassure a patient that it was not his or her mistake and that he or she is free from blame. When patients blame themselves, it can make them feel guilty and depressed.

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.

2, 3, 4 Patients who are victims of abuse should be counseled to develop a safety plan to avoid being abused further and to escape from the violence. The nurse should suggest that the patient identify the signs of escalation of violence. This helps the patient avoid being exposed to such stressors. The patient must be told to immediately leave the premises where the abuser resides or is present if there are signs of violence. The patient must be given a checklist of things that he or she should carry before leaving the home. The patient must be advised to pack important things, such as money and birth certificates, in a bag and hide the bag from the abuser. Showing extreme trust will not reduce the abuse. The abuser can take the patient for granted and can be extremely violent with the patient. Staying with the abuser even after identifying the signs of violence will not prevent the abuse.

A nurse is teaching patients in a primary healthcare 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 Showing extreme trust of his or her partner 2 Identifying the signs of escalation of violence 3 Packing a bag with money and birth certificates 4 Leaving the place immediately if there are signs of violence 5 Staying with the abuser to make him or her calm and relaxed

2 Tertiary prevention involves facilitating the healing and rehabilitative process by counseling individuals and families, providing support for groups of survivors, and assisting survivors of violence to achieve their optimal level of safety, health, and well-being. Legal advocacy programs for survivors of intimate partner violence are an example of tertiary prevention. Primary prevention consists of measures taken to prevent abuse, such as identifying individuals and families at risk, providing health teaching, and coordinating supportive services to prevent crises. Secondary prevention involves early intervention in abusive situations to minimize their disabling or long-term effects.

A nurse volunteers once a week at a legal advocacy program for survivors of intimate partner violence. Which level of prevention is this activity? 1 Primary 2 Tertiary 3 Secondary

3 Establishment of trust and rapport is the first outcome. This outcome precedes focusing on details of the injuries because trust is crucial if the child is to feel comfortable enough to self-disclose. Attending school on time, acknowledging abuse by caregivers, and refraining from aggressive behavior may apply later in the relationship.

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. 1 The child will attend school on time. 2 The child will acknowledge abuse by caregivers. 3 The child will form a trusting relationship with the nurse. 4 The child will refrain from aggressive behavior with others.

2 During the honeymoon stage, the perpetrator apologizes, promises never to abuse again, and tries to make up for the violence. This stage is usually brief. Tension building, acute battering, and escalation are not accurate descriptions of this situation.

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

3 Working with victims of abuse can be overwhelming for healthcare professionals. Many unhealthy feelings and reactions can develop. Sharing perceptions and feelings with other professionals can help reduce feelings of isolation or discomfort. The nursing supervisor may be able to provide helpful input or refer the nurse to counseling. It is not the colleague's role to assess the nurse's personal history. While transfer to another hospital unit may be needed at some point, the nurse currently is showing sensitivity to the patient's experience. Sensitive healthcare professionals are important in promoting hospital and community awareness to treat and protect people from domestic violence, abuse, and neglect. It is not therapeutic for the nurse to share these sentiments with the patient.

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.

4 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.

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 As a key to crisis intervention, the nurse needs to emphasize that no one has the right to harm anyone and that people have a right to live without fear of violence, physical harm, or assault. Understanding this is the first step for the victim to be able to resist abuse and seek help if needed. An abuser should also be treated and counseled about using appropriate social and coping skills in a stressful situation but this is not a step for immediate crisis intervention. Various social skills are learned by the patient and planning is done to avoid a crisis situation. The nurse can support the victim by counseling about safety and providing other resources to prevent further crisis. Along with counseling, people are given referrals to various support groups to help treatment.

The nurse is counseling a victim of family violence. What key idea does the nurse need to emphasize to the victim during crisis intervention? 1 An abuser can be changed when the abuser learns coping skills. 2 Skills to manage a stressful situation can help in preventing a crisis. 3 People can turn to support groups to manage a stressful situation. 4 People have a right to live without fear of violence, physical harm, or assault

2 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.

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

1 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.

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

4 A nurse should ask open-ended questions to the suspected perpetrator that require descriptive responses. Direct questions do not produce much information and should not be used. The perpetrator should not be threatened. The nurse should be supportive and nonthreatening. Thought-provoking questions can be helpful during counseling but are not required to elicit information.

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

1 Neglect is failure to provide necessary care, and abuse is physical maltreatment. Neglect can occur in both the psychological and physical domains. Neglect is not always physical in its form and can be directed towards all age groups.

What distinction can be made between abuse and neglect? 1 Neglect is a failure to provide; abuse is a failure to control physical aggression. 2 Neglect is perpetrated against children; abuse victims can be children or adults. 3 Neglect is always physical; abuse can be verbal, physical, sexual, or emotional. 4 Neglect occurs in the psychological domain; abuse occurs in the physical domain.

3 In intimate partner abuse, four out of five victims are women. Elders commonly face abuse both in domestic and institutional settings, and it is reported that 1 out of every 10 adults older than age 60 are victims of abuse. Neglect is the most common form of child abuse. It is followed by physical abuse. Girls are slightly more likely to be abused but boys die at a slightly higher rate than girls.

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.

1 A clear and detailed history is obtained from the woman. The nurse should assess the safety of the woman and help her explore alternatives to reduce danger upon being discharged. The patient should not be just counseled and sent home if there is a risk of danger once the patient is discharged. The nurse should not tell the patient that the patient is in trouble. The nurse should remain calm and objective. There should not be any display of anger or shock. The nurse should not be judgmental.

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.

4 When the abuser thinks he or she is losing control over the victim, the violence escalates. Remorse by the perpetrator and submission by the victim have not been shown to increase violence.

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

1 Empowerment is fostered when the nurse and the woman work together to end the abuse. Acting as the expert and providing options is an example of the paternalist model of care rather than the empowerment model. Suggesting that the woman is responsible for the violence is not empowering.

When counseling a woman who has been in an abusive relationship for 5 years, the nurse facilitates the woman's sense of empowerment when the nurse does which of the following? 1 Assisting the woman in developing a plan to assure her safety 2 Suggesting that the woman needs to leave the abuser immediately 3 Asking the woman to identify behaviors that trigger her partner's violence 4 Offering the woman several different suggestions regarding how to stop the abuse

3 Nurses are mandated reporters of child abuse. They must follow the rules set forth by the state regarding the steps to take to report child abuse.

When there is reason to suspect that a child is being abused, what is the nurse's initial action? 1 Call the local police to report it. 2 Confront the parent or parents. 3 Follow agency policy for reporting. 4 Interrogate the child to obtain proof.

1 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.

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