Psych Chapter 28 (Child, Older Adult, and Intimate Partner Violence) Review Questions

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." Job loss, financial problems, and a child who is "different" and has special needs should alert the nurse to the risk for family violence, because all these factors contribute to a crisis situation (page 528; Box 28-4).

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.

The risk of elder abuse in a home is best determined by conducting which assessment? 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. Abuse occurs across all segments of society and is reinforced by the society and the culture. The actual occurrence of violence requires (1) a perpetrator, (2) someone who by age or situation is vulnerable (e.g., children, women, men, the elderly, mentally ill persons, and physically challenged persons), and (3) a crisis situation (page 527).

Nurses working in emergency departments and walk-in clinics should be aware that some victims of violence may present with which assessment characteristic? a) Vague physical complaints such as insomnia or pain. b) Extreme anger and unpredictable behavior. c) Family members described as supportive. d) Psychosis and/or mania as a result of long-term abuse.

a) Vague physical complaints such as insomnia or pain. Patients may present with symptoms that may be vague and can include chronic pain, insomnia, hyperventilation, or gynecological problems. Attention to the interview process and setting is important to facilitate accurate assessment of physical and behavioral indicators of family violence.

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).

When the nurse believes the cycle of abuse is escalating and that a woman may be in severe physical danger, what should the priority nursing intervention be? a) Advising her to enter counseling at the mental health center. b) Assisting her in developing a plan to go to a shelter in case of a crisis. c) Suggesting that she leave the abuser immediately and go to a trusted friend's home. d) Teaching her to counter verbal abuse with assertive replies.

b) Assisting her in developing a plan to go to a shelter in case of a crisis. Every victim of abuse should have an escape plan, but one is particularly important when the nurse believes the client is in severe danger (page 531).

To best assure the safety of a 3-year-old child whose parent admits to finding it difficult to control his/her anger, what is the most appropriate short-term goal for the parent? a) Demonstrating understanding of the impact of violence on the child within 2 days. b) Beginning attending anger management training sessions within 2 weeks. c) Stating a willingness to attend a support group for physical abusers within 1 week. d) Showing remorse for their anger management issues within 2 days

b) Beginning attending anger management training sessions within 2 weeks. Perpetrators of violence need help learning how to manage anger. A structured group is an excellent way to provide this teaching. This option most directly addresses the issue of preventing the anger from escalating to physical abuse (page 529).

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.

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, what is the most appropriate nursing diagnosis? a) Hopelessness 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 implement which intervention? a) Call the local police to report it. b) Follow agency policy for reporting. c) Confront the parent or parents. d) Question the child to obtain proof.

b) Follow agency policy for reporting. 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 (page 530).

The nurse performing the assessment of a wheelchair-bound 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 implement which assessment intervention? 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. Suspected victims of abuse should always be interviewed in private. If the perpetrator is in the room, the victim cannot speak freely (page 525; Box 28-2).

When treatment for injuries sustained during an incident of abuse is sought from the primary physician, the client is receiving which form of treatment? a) Primary prevention b) Secondary prevention c) Tertiary prevention d) Stop-gap therapy

b) Secondary prevention Secondary prevention involves early intervention in abusive situations to minimize their disabling or long-term effects (page 533).

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.

The mother of a 4-year-old daughter states that the child has recently begun, "Touching her vagina and rubs herself down there all the time." The child drew a picture showing two people with one on top of the other and said they were "doing sex." Based on the assessment description, what conclusion should the nurse explore further? a) Educate the mother to normal developmental behavior in a 4-year-old child. b) There is a possibility that the child has been sexually abused. c) The mother should be enrolled in parenting classes to improve her parenting skills. d) The child's exposure to graphic sexual images on television should be monitored closely.

b) There is a possibility that 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. It is not normal developmental behavior for a 4-year-old child.

Which statement, made by a female adult concerning her boyfriend, should cause the nurse to suspect that the client is at risk for being emotionally abused? a) "He 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 him I was coming because he is under so much stress at work I didn't want to add to it." c) "He yells a lot and calls me names, but that's because I am so stupid and make so many mistakes." d) "He has always had a fiery temper."

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

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 cognitively challenged 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.

Which behavior demonstrated by a woman attempting to escape a chronically abusive relationship presents the greatest personal risk? a) Relying on alcohol to escape the emotional pain of abuse. b) Adapting an aggressive attitude toward her abuser. c) Considering ways to commit suicide. d) Threatening to call the police if she is abused again.

c) 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 (page 526-527).

When interviewing an adult victim of abuse, what is the nurse's best approach when asking relevant questions? a) Confrontational and assertive b) Gentle but direct c) Direct and professional d) Sympathetic but detached

c) Direct and professional Expressing strong emotion does not help the victim. A direct, honest, and professional manner of asking questions produces the best results (page 525; Box 28-2).

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 which form of abuse? a) Neglect b) Physical c) Emotional d) Tough love

c) Emotional

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 recognizes that the client is describing which stage of the cycle of violence? a) Tension building b)Acute battering c) Honeymoon d) Escalation

c) Honeymoon

When should the nurse expect the abuse of a victim to worsen? a) The perpetrator feels he is in complete control. b) The perpetrator is feeling remorseful for being abusive. c) The victim moves toward independence from the abuser. d) The victim submits to the domination of the perpetrator.

c) The victim moves toward independence from the abuser. When the abuser thinks they are losing control over the victim, the violence escalates (page 521).

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.

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 as the client may be at risk for what form of abuse? a) Neglect b) Physical violence c) Psychological d) Financial maltreatment

d) Financial maltreatment Financial maltreatment 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 does not supply funds (page 522-523).

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. Neglect is failure to provide necessary care, and abuse is physical maltreatment (page 521-522).

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.

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. Older women dependent on family members for care are at higher risk for abuse.

What is the priority outcome for a toddler who has been sexually abused? a) The mother will learn coping techniques to support the child. b) The child will be able to verbalize exactly what happened to her. c) The child will no longer demonstrate inappropriate sexual behavior. d) The sexual abuse will cease immediately.

d) The sexual abuse will cease immediately. The highest priority in this case is that the abuse stops so that the patient can be safe and undergo recovery.