RN Violence and Abuse Assessment

A nurse is working in a primary care clinic. Which of the following is a way the nurse can identify clients who have experienced abuse or violence? Have all clients complete a partner violence screening. Expect adult clients to let the nurse know if there is a history of abuse. Recognize that there is no abuse if an older adult client is accompanied by a caregiver. Assume that an adolescent client's dislike of school is normal.

Have all clients complete a partner violence screening. Screening all clients for partner violence is recommended in identifying past or present abuse.

A nurse is caring for a client in an infectious disease clinic at the health department. The client is being treated for an STI and reports they have left an abusive partner. Which of the following is an example of patient-centered care? Have the client undress, as this is necessary for the examination. Ask the client if they are comfortable with having an examination today. Tell the client they are proud of them for leaving their abusive relationship and they should have done this many months ago. Avoid mentioning the abuse with the client, as it was in the past.

Ask the client if they are comfortable with having an examination today. The nurse who understands the history of trauma will ask if the client is comfortable with an examination today.

A nurse in a pediatric clinic is assessing an infant during a well-child visit. The nurse should identify which of the following as a possible sign of child abuse? The infant's weight and length follow the expected growth curve. The infant is up to date on immunizations. The infant has faded bruise marks on their upper arms. The infant cries when they are held by the nurse.

The infant has faded bruise marks on their upper arms. Unexpected bruises are a possible sign of child abuse.

A home-health nurse is caring for a client in their home. The nurse is concerned that the client may be at risk of neglect. The nurse should identify which of the following as relationship factors that can put the client at an increased risk for neglect? The client does not receive visits from friends or family. The client is 80 years of age. The client lives in a neighborhood with many empty homes. The client has limited services for food delivery in the city.

The client does not receive visits from friends or family. Positive relationships can help protect clients from abuse and neglect.

A nurse is caring for a child who has experienced neglect from a caregiver. Which of the following most accurately describes the caregiver? Perpetrator of violence Attentive caregiver Victim of abuse At risk for abuse

Perpetrator of violence Perpetrators of violence are individuals who are at risk for causing harm to others.

A visiting nurse is assessing an older adult client who is living alone in an apartment. The nurse should identify which of the following as a risk for abuse? The client has back pain from a previous work-related injury. The client keeps medications on the kitchen table. The client has unwashed hair and clothing. The client has prepared meals delivered to their home daily.

The client has unwashed hair and clothing. The nurse should investigate further for possible neglect when finding clients who have poor hygiene.

A nurse is caring for an older adult client and notices bruising on the client's wrists. Which of the following is a concern for the nurse? The client is a perpetrator of abuse. The nurse is not concerned since older adults bruise easily. The client may be experiencing abuse. The client is not taking care of personal hygiene.

The client may be experiencing abuse. The client may be at risk of abuse. The nurse should further assess the client.

A nurse is in a newborn nursery in a rural community. The nurse notices new parents are often isolated at home with their newborns. Which is an example of how the nurse can promote prevention of child abuse in the community? The nurse provides referrals to visiting nurses from the health department. The nurse asks to review visitation policies for new parents in the hospital. The nurse establishes a peer-to-peer new parenting class at the local church. The nurse screens the new parent for partner violence.

The nurse establishes a peer-to-peer new parenting class at the local church. This is a way to build strong relationships in the community. For example, a peer-to-peer program provides the opportunity for new parents to meet other parents for support.

A nurse is caring for a client in an acute pediatric unit. The nurse should identify that which of the following most likely puts the child at risk for exposure to violence? The child's caregiver reports an abusive partner. The child attends a school that is known for high success. The neighborhood has stress reduction technique classes for parents at the community center. The child's sibling has reported bullying at school.

The child's caregiver reports an abusive partner. Children are at risk for exposure to violence when their caregivers are victims of violence.

A school nurse is caring for an adolescent who has been the victim of cyberbullying. What concerns may the nurse have for the school community? The child may also be a perpetrator of violence with peers. This is an isolated event between 2 students that should be handled by the caregivers. The school may need student education on social media and bullying to encourage students to share when they are victims. The school nurse does not have control over cyberbullying.

The child may also be a perpetrator of violence with peers. Children who are victims of bullying may bully their peers in turn. Identifying perpetrators is an important step in preventing violence.

A nurse is creating a plan of care for a client who has experienced abuse. Which of the following steps should the nurse take when creating the plan? (Select all that apply.) Takes the lead in deciding what is best for the client Works with the client to create a plan of care Respects the client's decision not to call a domestic abuse hotline immediately Supports the client's decision to incorporate holistic measures in the plan of care Makes a referral to an agency without the client's consent

Works with the client to create a plan of care is correct. Patient-centered care involves the client in all decisions. Respects the client's decision not to call a domestic abuse hotline immediately is correct. Patient-centered care involves the client in all decisions. Supports the client's decision to incorporate holistic measures in the plan of care is correct. Patient-centered care involves the client in all decisions.

A nurse in an acute setting has witnessed a peer make uncivil remarks to a new staff member in the unit. The nurse should take which of the following actions to promote a safe work culture in the unit? (Select all that apply.) Advocate for a zero-tolerance policy regarding incivility in the workplace. Create peer-to-peer conflict resolution programs. Reprimand the nurse who made the uncivil remarks. Speak with the new staff member about any concerns they have regarding adjusting to the unit. Advocate to terminate the employee that made the inappropriate remark.

Advocate for a zero-tolerance policy regarding incivility in the workplace is correct. This is an example of establishing social norms that do not support incivility in the workplace. Create peer-to-peer conflict resolution programs is correct. This is an example of building relationships in the workplace, which can promote a safe work culture. Speak with the new staff member about any concerns they have regarding adjusting to the unit is correct. This is an example of facilitating a safe work culture among peers.

A nurse is working in the NICU. The nurse should take which of the following actions to advocate for protective factors to prevent abuse for infants and parents in the community? (Select all that apply.) Present to all the staff the use of IPV screening on the unit. Provide breastfeeding support for nursing parents. Teach infant development classes at the local library. Start a parenting class for expectant partners at the hospital. Confirm the parent has a well-child visit scheduled for their infant.

Present to all the staff the use of IPV screening on the unit is correct. This is an example of advocacy on community level prevention. Teach infant development classes at the local library is correct. This is an example of advocacy on community level prevention. Start a parenting class for expectant partners at the hospital is correct. This is an example of advocacy on community level prevention.

A nurse is caring for a client in an emergency department who is being seen for treatment of injuries sustained from their partner. The nurse should take which of the following actions to provide care to this client? (Select all that apply.) Provide a partner violence crisis number to the client. Ask the client how they make their partner angry. Advise the client to leave their partner immediately. Provide the client with information on healthy relationships. Provide information on how people may experience abuse in relationships.

Provide a partner violence crisis number to the client is correct. Provide a partner violence crisis number to the client is correct. Provide the client with a crisis number that they can call. Provide the client with information on healthy relationships is correct. Provide the client with information on healthy relationships is correct. The nurse provides information on healthy relationships and provides support for the client to make decisions. Provide information on how people may experience abuse in relationships is correct. Provide information on how people may experience abuse in relationships. The nurse supports the client and their decisions on creating their safety plan.

A nurse in a newborn nursery is caring for a parent with their first child. The parent shares with the nurse that they were abused as a child. Which of the following are steps the nurse can take to break the possible intergenerational cycle of violence? (Select all that apply.) Provide the parent with information on parenting classes at their local library. Refer the parent to a case manager. Provide information on the location of nutritional services in their local health department. Follows the usual discharge plan for all parents to assure they have a car seat. Refer the parent for a visiting nurse program that visits parents and newborns in their community.

Provide the parent with information on parenting classes at their local library is correct. This is an action the nurse can take to promote a positive relationship between the parent and infant. Provide information on the location of nutritional services in their local health department is correct. This is a way to support the parent and child as poverty may contribute to risks of abuse and neglect in communities. Refer the parent for a visiting nurse program that visits parents and newborns in their community is correct. Supportive services in communities are vital for breaking cycles of violence in communities.

A nurse in a long-term care facility is concerned that residents are showing signs of poor nutrition. What are examples of ways to address environmental factors to prevent neglect of residents? (Select all that apply.) Review policies on number of staff assigned to clients during mealtime. Review policies allowing family visits during mealtime. Review each client's individual meal plan. Review policies on reporting signs of neglect. Assess the client's ability to feed themselves.

Review policies on number of staff assigned to clients during mealtime is correct. Policies on client-to-staff ratios are an example of environmental factors that may increase risk of abuse and neglect. Review policies allowing family visits during mealtime is correct. Policies on family visitation hours are an example of environmental factors that may increase risk of abuse and neglect. Review policies on reporting signs of neglect is correct. Policies that allow staff to report potential neglect are an example of environmental factors that may increase risk of abuse and neglect.

A nurse is assessing a young adult client in the emergency department for abdominal pain. The client is accompanied by an unrelated person. The nurse should identify which of the following signs as a risk for human trafficking? (Select all that apply.) The accompanying person refuses to leave the room during the assessment and examination. The client appears fatigued and anxious. The client states they are traveling and are not sure of the name of the city they are in. The accompanying person leaves the room for the client to be examined and provides transportation. The adolescent requests that the unrelated person remain in the room during interviewing and examination.

The accompanying person refuses to leave the room during the assessment and examination is correct. When a client is accompanied by controlling individuals, it is a potential indicator of abuse. The adolescent appears fatigued and anxious is correct. Poor hygiene, untreated medical conditions, sleep deprivation, and fatigue are signs of human trafficking. The adolescent states they are traveling and are not sure of the name of the city they are in is correct. The client being unaware of their current location is a sign of human trafficking.

A nurse working in a college health center is caring for a student who experienced sexual assault 1 year ago and is having trouble sleeping. Which of the following would be an appropriate plan of care for the client? The incident was 1 year ago, so the nurse advises the client to give it time to fade away from memory. The perpetrator was apprehended, so the nurse advises the client that they have nothing to fear. The nurse refers the client to a campus support group for those who have experienced violence in their lives. The nurse refers the client to a counselor for advice on making wise decisions when choosing partners.

The nurse refers the client to a campus support group for those who have experienced violence in their lives. Referring the client to a support group is appropriate if the client is also in agreement with the plan.

A school nurse is concerned with safety in the school. The nurse wants to address community risk factors that increase the risk of students experiencing violence. The nurse should identify which of the following as community risk factors for the students? Students have low academic performance. The school has known gang groups and graffiti marking territories near the school. Bullying is common among students in the school. The school has a peer-to-peer counseling program.

The school has known gang groups and graffiti marking territories near the school. This is an example of a characteristic in the community that puts individuals at risk for exposure to violence.

A nurse working in a labor and delivery unit has been feeling distressed about the work environment due to comments made by their supervisor. Which of the following would be a form of microaggression by the supervisor? (Select all that apply.) The supervisor remarks that the unit should not hire nurse immigrants. The supervisor does not allow male nurses to rotate into the unit to provide additional coverage. The supervisor hires nurses of all races and ethnicities. The supervisor does not allow the use of interpreters in the labor room for clients who do not speak English. The supervisor encourages clients who are in labor to have support that reflects their cultural practices of childbirth.

The supervisor remarks that the unit should not hire nurse immigrants is correct. Derogatory comments about ethnic groups is an example of bias. The supervisor does not allow male nurses to rotate into the unit to provide additional coverage is correct. Intentionally keeping men from providing care is an example of gender bias. The supervisor does not allow the use of interpreters in the labor room for clients who do not speak English is correct. Restricting access to interpreters is an example of ethnic bias.