Pediatrics-PrepU Chapter 55

A 25-year-old woman is in for her first prenatal visit at 28 weeks' gestation. Which assessment finding would cause the nurse to investigate further the possibility of intimate partner violence?

Multiple bruises in varying stages of healing

Which elements are included in child maltreatment? Select the best answer.

Psychological, physical, and sexual maltreatment and neglect

Which type of abuse is reported most quickly to the police?

Sexual assault

In addition to providing privacy, which action would be most appropriate initially in situations involving suspected abuse?

Tell the client, "Injuries like these don't usually happen by accident."

Which statement made by a new nurse demonstrates an understanding of the prevalence of violence and sexual abuse among the population?

"I've come to realize that I need to include questions related to sexual abuse and violence into the assessment of all my clients."

A group of pediatric nurses is discussing the diagnosis of Munchausen syndrome by proxy. Which statement most accurately describes this disorder?

"It is seen when one person fabricates or induces illness in another to get attention."

The nurse is caring for an abused client needing emotional support. What nursing actions are appropriate for this client? Select all that apply.

-Allow the client to make as many decisions as possible. -Encourage the client to attend support groups. -Teach strategies for problem-solving and stress management.

The nurse is performing a physical examination of a 5-year-old boy. Which documented findings would most strongly indicate maltreatment of the child? Select all that apply.

-Cuts and bruises on the hands -Burns on the dorsal surface of the hand -A curved laceration on the back -Linear lesions across the chest and abdomen

Which assessment findings have made the pediatric nurse suspicious of child abuse? Select all that apply.

-Inconsistent caregiver stories regarding injuries -Injuries with patterns related to common objects -Bruises in the inner aspects of the arms -Bruises assessed on soft tissue areas

The nurse is caring for a pregnant client admitted for abdominal trauma following an assault. The nurse will monitor the client for which potential complications? Select all that apply.

-Miscarriage -Placental abruption -Uterine rupture -Preterm labor

A 6-year-old child is playing. Which play scenarios witnessed by the nurse are indicative that the child is sexually abused? Select all that apply.

-Playing with a boy and girl doll in a sexually graphic manner -Using inappropriate adult language -Arranging dolls in unnatural positions for play

The school nurse is concerned that a young girl is being sexually abused. Which assessment finding supports this concern? Select all that apply.

-expresses fear about going home -reports frequent urinary tract infections -demonstrates low self esteem

The elementary school nurse is caring for four clients with physical injuries. Which child would require follow-up?

An 8-year-old with bruising noted on the inner aspect of the arms

A nurse is performing a physical examination of a pregnant woman. As she is examining her, she notices a bruise on her abdomen. Which action should the nurse take?

Ask the client to account for the bruise.

Which initial interview technique would be least effective in gathering information from a suspected abuse victim?

Ask the client to strip down and show you where she has been hurt.

A nurse suspects that a 6-year-old girl is being sexually maltreated by her father, based on some comments made by the girl. Which of the following methods would be most effective in confirming the nurse's suspicion?

Ask the girl to draw a picture of what happened

Which is essential in working with caregivers who have been affected by abuse?

Developing a therapeutic relationship

The nurse is caring for a young child whose parents have been charged with physical abuse. Which child reaction is noted as a result of the parental behavior?

Fretful and shrinks away when approached

The nurse is caring for a client believed to be a victim of human trafficking. What action is most important for the nurse to perform?

Gain the client's trust.

A caregiver who works in the hospital brings his 9-year-old son to the emergency room with a spiral fracture of the tibia. The caregiver reports that the injury occurred when the boy's 5-year-old sister hit him with wooden bat. The injury is inconsistent with an impact and with the sister's strength. Which of the following would be appropriate for the nurse to do in this situation?

Leave the treatment area and call the social services department in the hospital.

The school nurse observes an elementary school child arriving in the winter in shorts and a short sleeved shirt with no coat. The nurse would consider this as which type of abuse?

Neglect

In caring for a child who has been admitted after being sexually abused, which intervention would be included in the child's plan of care?

Observe for signs of anxiety.

The nurse is receiving shift hand-off and is assigned a client who was recently raped. When developing a plan of care, which consideration is most important?

Women who were raped can find talking about the experience to be therapeutic.

A school nurse is developing a plan of care for a child with suspected violence between the child's parents. The nurse monitors for which behaviors in the child?

aggressive behavior in school

A nurse is developing a plan of care for a woman who is a victim of violence. Which intervention would be least appropriate for the nurse to include?

assisting the client to project her anger

A nurse is describing the cycle of violence to a community group. When explaining the first phase, the nurse would include which description?

characterized by tension-building and minor battery

When describing an episode, the victim reports that she attempted to calm her partner down to keep things from escalating. The nurse interprets this behavior as reflecting which phase of the cycle of violence?

tension-building

The nurse has completed an assessment and interview on a client being treated for lacerations and abrasions. What acquired data support the nurse's suspicion that the client may be a victim of human trafficking? Select all that apply.

• Female • Age 16 • Speaks only minimal English

A nurse working in the emergency department who suspects child abuse should do which of the following?

Report it to the authorities.

A 10-year-old accompanies a parent to the emergency department. The child reports that the parent has taken pills and "a lot" of alcohol. The child assists the parent onto a stretcher. The parent states, "I wouldn't be drinking if it wasn't for you!" In what type of situation are the parent and child existing?

Role reversal

Which type of fracture is most indicative of child abuse?

Spiral fracture

Which action is most helpful in encouraging the expression of feelings in a pediatric client who is abused?

Using play to reduce stress

Deborah has been verbally abusive to her 6-year-old daughter and belittles her routinely. What type of maltreatment is Deborah engaging in?

psychological maltreatment

In addition to physical examination, what is another important way that nurses know physical abuse is confirmed?

radiography

A nurse is interviewing a client who is a survivor of abuse. The client is telling the nurse about how the violence occurred. Which statement would the nurse interpret as reflecting phase three of the cycle of violence?

"He tells me that he is sorry and that he will never hit me again."

The nurse is interviewing the caregiver of a 5-year-old child who has been admitted with bruises on the abdomen and thighs as well as additional bruises in various stages of healing. Which statement made by the caregiver might alert the health care team to the possibility of child abuse?

"His brother just plays too rough with him."

Place the three phases of intimate partner violence in the order in which they occur. All options must be used.

1. Tension-building phase 2. Acute violence phase 3. Honeymoon phase

The nurse is caring for a client who has been sexually abused. How can the nurse best support the necessary grieving process?

Actively listening to the client as he or she talks about the experience

A 5-year-old child has frequent visits to the school nurse's office. Which assessment data should alert the nurse that this child may be a victim of physical neglect?

malnourished with frequent absences from school

The nurse is caring for a client suspected of being a victim of human trafficking. Which question, when given priority by the nurse during the admission interview, demonstrates a need for additional training?

"Are you working towards achieving American citizenship?"

The nurse manager is educating staff about the mandate of health care workers to report suspected child abuse. A staff member asks, "What if you are not certain that it is an abuse situation. What should the nurse do?" The nurse manager is most correct when providing which answer?

"Feel comfortable about reporting your suspicion as the law protects you."

A nurse is discussing concerns about possible child abuse with the nursing supervisor. Which statement by the nurse requires correction by the supervisor?

"HIPAA prevents nurses from disclosing confidential information from parents."

Which statement made by a participant at a workshop needs further clarification?

"Mostly low income people commit sexual violence against children."

Which statement made by a male who has a history of abusing his partner reflects a known factor that is characteristic of this behavior?

"My classmates always called me a bully."

A 14-year-old girl is brought to the emergency department saying she was sexually assaulted. She tells the nurse that she feels guilty for having gone to a party where alcohol was being served. What is the nurse's best response?

"No one deserves to be raped, even going to a party with alcohol."

The health care provider is unsure of physical symptoms and diagnosis of a pediatric client. The health care provider is prescribing diagnostic testing to determine possible poisoning by the parent. When the parent asks why laboratory work is being drawn, which response is best?

"Since we have not found the cause of the illness yet, the health care provider has ordered more blood tests."

A new nurse in the emergency department is caring for a pregnant woman who was beaten by her partner. Which statement by the new nurse would require intervention from the supervising nurse?

"That woman must be doing something to get beaten like that."

A 19-year-old pregnant client presents to the office for the third time this week. While completing the client's admission, the nurse screens for abuse. The client responds, "I have already told you twice this week I am not being abused. Why do you keep asking me these questions?" What is the nurse's best response?

"We screen all clients for abuse during every visit."

The nurse is educating college students on ways to protect themselves from date and acquaintance rape. What will the nurse include in the teaching? Select all that apply.

-Do not attend parties where alcohol will be served. -Pour out drinks left unattended for any length of time. -Accept drinks in closed containers or from bartenders only.

A nurse is working with the burn clinic at a local hospital. Which types of burns would the nurse address with the health care provider and social worker? Select all that apply.

-Small, round burns -Hand burns with a pattern -Linear pattern burns

A woman arrives at the prenatal clinic and is accompanied by her partner. Which behaviors would be suggestive of intimate partner violence (IPV)? Select all that apply.

-The partner is overly protective of the pregnant client. -Poor weight gain during the pregnancy and low birth weight infant -The partner answers questions for the pregnant client.

In most cases of suspected child abuse, for how many hours can the health care facility hold a child to complete an investigation?

72 hours

The nurse is caring for four clients on the pediatric unit. Which client scenario provides the highest concern of suspected abuse?

A 7-month-old with multiple bruises on the legs

A 36-week-gestation client presents in the ER with a broken arm. The client states "she fell while cooking dinner." During the assessment, the nurse notes no prenatal care for this pregnancy, as well as bruises in multiple stages of healing on the client's abdomen, arms, and chest. What action will the nurse perform next?

Ask the client how she acquired the bruises

Nurses at an urban emergency department seek to develop a plan to help women involved in abusive relationships. Which component is critical to the success of the plan?

Avenues for referral

A woman has been seen and treated in the emergency room several times for injuries that are deemed suspicious. The woman is reluctant to participate in a screening process. How best can the nurse provide reassurance to this woman?

Being nonjudgmental

Which age group among children has the highest incidence of abuse?

Birth to 3 years

When initiating care for a client suspected of being a victim of human trafficking, what is the nurse's primary responsibility?

Building trust

A nurse is caring for a client who admits to living in an abusive relationship. Which action would be the priority to meet the client's safety needs?

Help the client develop an emergency plan to leave.

The nurse is caring for a child who has unusual bruises and marks that do not match the child's developmental age. When completing an admission assessment, which other information does the nurse identify as a potential factor in child abuse?

Long-term unemployment without supplemental income

Which of the following is TRUE regarding intimate partner violence?

One in four women will be a victim of violence.

A nurse is performing a routine physical for a 7-year-old girl who is thin, unwashed, and dressed in rags. Although it is winter time, she has no coat with her. Her teenage brother in the waiting room, however, is dressed in trendy clothes and looks healthy and well-fed. Which of the following should the nurse most strongly suspect regarding this girl?

Physical neglect

The elementary school teacher invites the nurse into the classroom to observe a pupil's interaction when completing an assignment. Which characteristic alerts the school nurse that the child may be the victim of emotional abuse?

The child is fretful and worried about the project.

The nurse is working in a community setting with families whose children have been abused. The nurse notes that fewer of the families come from higher socioeconomic groups than from lower socioeconomic groups. The nurse recognizes that this is most likely because of which of the following?

The higher socioeconomic families have a greater ability to keep the child abuse from being detected.

A nurse is working with a child she suspects may be a victim of maltreatment in her home. Which combination of characteristics related to the parent, the child, and the circumstances would most strongly indicate the risk for maltreatment of this child?

The mother was maltreated as a child; the child was born prematurely; the father recently lost his job

A nurse is assigned to care for a 7-year-old who has been admitted with infected circular burns to both arms, which resemble cigarette burns. The child states to the nurse, "If I did better in school, this would not happen." What does the nurse understand is most likely the issue with the abusive parents?

The parents have inadequate parenting skills.

A nurse is listening to a client who is a victim of intimate partner violence. The client is describing how events would unfold with her partner. The nurse interprets the client's statements and identifies which action as characteristic of the second phase of the cycle of violence?

The physical battery is abrupt and unpredictable.

As the elementary school nurse is documenting student contact in the health room, which student is most concerning?

The student who repeatedly reports vague physical complaints and has nightmares.

Walter is an 11-year-old boy who was raised in a home where his father beat his mother on a regular basis. Which statement is true regarding children being raised in a home where they have witnessed intimate partner violence?

They are at increased risk for being abused

A group of nurses is discussing child maltreatment and one nurse suggests that inadequate parenting skills may lead to child maltreatment. The nurse recognizes that sometimes child maltreatment occurs because the parent:

may have unrealistic expectations of the child.

A nurse is caring for a baby admitted to the hospital with suspected abusive head trauma. Which assessment finding would confirm this suspicion?

retinal hemorrhages

The generation-to-generation continuum of violence refers to the fact that:

violence is a learned behavior, and children who witness abuse are more likely to become abusers themselves.

As part of a local college awareness program, a nurse is interviewing several of the participants about their views on rape. Which statement would lead the nurse to determine that teaching about rape is necessary?

• "A woman can avoid being raped. If she doesn't want it to happen, then it won't."

If the following data was collected on a group of children, which of the following would most likely be evaluated as possibly related to child abuse? Select all that apply.

• A child whose X-ray shows bone fractures in various stages of healing. • A child whose CT scan shows a cerebral hemorrhage. • A child who has a spiral fracture in the femur.

The nurse is educating women on characteristics of men who abuse their partners. What characteristics of male abusers will the nurse include in the teaching? Select all that apply.

• A history of oxycodone and diazepam abuse • 10 different employers in the past 18 months • Arrested twice in the last year • Dominates the control in personal and social situations