Videbeck Chapter 12: Abuse and Violence Q's

A nurse is caring for a young adult in the mental health clinic. The client tells the nurse that the client was physically neglected as a child. The nurse should assess the client for symptoms of what? A. Narcissistic personality disorder B. Schizophrenia C. Panic disorder D. Major depression

D. Major depression An important outcome of nursing intervention with survivors is appropriate treatment of any disorder resulting from abuse, such as acute stress disorder, posttraumatic stress disorder, anxiety disorders, dissociative identity disorder, major depression, or substance abuse.

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 the honeymoon phase of the cycle of violence? A. "He told me that he was sorry and that he would never hit me again." B. "He threw me against the wall and started punching my face." C. "He called me stupid and incompetent, asking himself why he ever married me." D. "He yelled at me for not having dinner waiting for him when he came home."

A. "He told me that he was sorry and that he would never hit me again." The cycle of violence typically involves three phases. There is a buildup of tension. The perpetrator commits an act of violence. The perpetrator becomes kind, contrite, and loving, begging for forgiveness and promising never to inflict abuse again. This phase is sometimes referred to as the "honeymoon phase." When the violence begins, the victim is not expecting it and thus is often not aware of the buildup of tension; then the assault comes as a surprise.

The nurse is providing care to client who is currently in a sexually abusive relationship. To best manage the development of additional comorbid disorders, what question(s) should the nurse ask this client? Select all that apply. A. "Would you like information on community resources related to HIV and pregnancy?" B. "Do you have a safety and escape plan in place?" C. "What do you do to avoid angering your abuser?" D. "Would you like information on relaxation and sleep hygiene?" E. "Do you know any self-defense strategies to physically protect yourself?"

A. "Would you like information on community resources related to HIV and pregnancy?" B. "Do you have a safety and escape plan in place?" D. "Would you like information on relaxation and sleep hygiene?" Information should focus on effective safety and health promotion interventions including relevant health screenings, early symptom identification, and safety plans. Physical self-defense strategies may be acquired. They may help provide a sense of self empowerment, but they are not an established method of assuring safety in abusive situations. The anger of the abuser is unpredictable, unavoidable, and outside the control of the abused.A nurse is aware of the high incidence of intimate partner violence (IPV) and actively seeks opportunities to screen women for IPV. Which female client represents the best opportunity for assessing for IPV? A client who is currently exploring long-term care options for her elderly father A client who has brought her young son to the emergency department because he fell at the playground and may have an arm fracture A client who expressed interest in joining a grief support group following the death of her husband A client who is in the third trimester of pregnancy and who is having biweekly prenatal appointments at a clinic

What percentage of women can expect to be a victim of an ongoing unwanted pursuit from stalking? A. 12-32% B. 50-60% C. 40-48% D. 5-10%

A. 12-32% Women are 12-32% and men 17% who can expect to be victims of ongoing unwanted pursuit.

Which characteristics are found in violent families? Select all that apply. A. Abuse of power and control B. Alcohol use disorder C. Adequate support systems D. Social isolation

A. Abuse of power and control B. Alcohol use disorder D. Social isolation Abuse of power and control, alcohol use disorder, and social isolation are characteristics of violent families, as is an intergenerational transmission process. Adequate support systems are not a characteristic of a violent family.

A 27-year-old has been brought to the emergency department by emergency medical services following a violent sexual assault that took place in the parking garage of the client's building. Which task would fall most clearly within the scope of practice of a forensic nurse? A. Collecting specimens from the client for use as evidence B. Providing reassurance to the client that the care team and the police will prioritize the client's care C. Assisting with diagnostic tests to determine the extent of the client's injuries D. Asking the client to describe the perpetrator in detail and documenting the client's statement

A. Collecting specimens from the client for use as evidence While a forensic nurse would certainly attempt to reassure a client such as this one, a priority forensic nursing task would be collecting specimens for use as evidence. This would supersede assisting with diagnostics, which falls within the scope of any registered nurse. The police, not a nurse, would be responsible for taking the client's statement.

A nurse is caring for a child who had experienced sexual abuse. Which are expected behaviors of a child who has experienced sexual abuse? Select all that apply. A. Distorted view of sex B. Secretiveness of behaviors C. High self-esteem D. Open and honest discussion about history E. Avoidance of sexually related content

A. Distorted view of sex B. Secretiveness of behaviors E. Avoidance of sexually related content A victim of prolonged sexual abuse will develop low self-esteem, a feeling of worthlessness, and a distorted view of sex. The child may become withdrawn, distrustful, or suicidal. Other characteristics of children who have been sexually abused include an unusual interest or avoidance of sexually related content, seductiveness, refusal to go to school, delinquency, secretiveness, and unusual aggressiveness.

Which provides the most appropriate example of neglect according to the definition of the term? A. Rejecting a 3-year-old who cries and seek affection after falling B. Disciplining a 6-year-old child for "sassing" by putting tape on the child's mouth C. Correcting a child in front of the entire class for copying homework D. Criticizing a child frequently for being overweight and restricting the child's diet

A. Rejecting a 3-year-old who cries and seek affection after falling Neglect is an act of omission that involves a failure by a parent or other adult to meet a dependent's basic needs, such as by providing appropriate emotional care. Rejecting a crying 3-year-old who seeks comfort after falling is an example of neglect. Harsh or humiliating discipline is an act of commission in which the adult actively inflicts physical or psychological harm. Attempting to improve a child's emotional or physical well-being in a misguided and harmful manner does not fit the definition of neglect.

A nurse is gathering information about a health history of a person who has experienced violence. Which are important caring behaviors a nurse should implement during the interview? Select all that apply. A. Secure open communication. B. Ask questions regarding religious background and preference. C. Maintain a nonjudgmental attitude. D. Discuss the nurse's personal feelings on victims of violence. E. Establish trustworthiness.

A. Secure open communication. C. Maintain a nonjudgmental attitude. E. Establish trustworthiness. Establishing a trusting nurse-client relationship is one of the most important steps in caring for any person experiencing violence. Survivors are unlikely to disclose sensitive information unless they perceive the nurse to be trustworthy and nonjudgmental. Important considerations in establishing open communication are ensuring confidentiality and providing a quiet, private place to which to interact. The nurse must continually monitor personal feelings toward the perpetrator and survivor, especially in cases of child abuse or in situations where the person decides to remain in an abusive relationship. Seeking value clarification by the nurse may prevent negative feelings from influencing the nurse-client relationship that could lead to a nontherapeutic interaction and perhaps re-traumatize the survivor. The nurse should not ask about religious background or disclose personal feelings about the victim.

Which would not increase the likelihood that an older adult will incur physical abuse? A. The older adult is independent with activities of daily living. B. The older adult has difficulty with mobility and can become confused. C. An older adult reports frequent multiple bruises that are related to falls. D. The older adult lives with a son who receives financial aid.

A. The adult is independent with activities of daily living. The correct option indicates that the older adult enjoys independence, an attribute that is not commonly seen in those older adults who experience physical abuse. Common factors that predispose older adult clients to physical abuse include having chronic medical or mental health conditions, living with a familial caregiver who is a male and has financial problems, and the reluctance to report abuse despite the presence of signs such as multiple bruises.

A middle-aged client with young children has been the victim of intimate partner violence (IPV). When providing initial care to this family, the nurse should: A. carefully assess the children for signs of trauma. B. determine what initially caused the violence to begin. C. teach the client life skills for moving on from the relationship. D. reassure the client that this will never happen again.

A. carefully assess the children for signs of trauma. Children are inevitable victims in an IPV situation and must be assessed and cared for accordingly. The nurse must avoid false reassurance. It is unnecessary, and often impossible, to identify specific causes for IPV. Relationship skills can be addressed in follow-up care.

Which are forms of psychological abuse? Select all that apply. A. isolating a person from family B. Incest C. Insulting D. Humiliating E. Rape

A. isolating a person from family C. Insulting D. Humiliating Psychological abuse includes behaviors such as criticizing, insulting, humiliating, or ridiculing someone in private or in public. It can also involve actions such as destroying another's property, threatening or harming pets, controlling or monitoring spending and activities, or isolating a person from family and friends. Rape and incest are forms of sexual assault.

Which is a pattern of repeated unwanted contact, attention, and harassment that often increases in frequency? A. Physical abuse B. Rape C. Incest D. Stalking

D. Stalking Stalking is a pattern of repeated unwanted contact, attention, and harassment that often increases in frequency. Stalking is a crime of intimidation. Rape is the penetration of any bodily orifice by the penis, fingers, or an object. Incest involves sexual contact between family members. Physical abuse involves bodily harm.

The psychiatric nurse recognizes that a male rape victim is less likely to report the crime due to which reason? A. Fear of being accused of engaging in socially inappropriate or illegal activities leading to the rape B. The belief that his masculinity will be in question C. The social ramifications of possibly contracting AIDS D. The impact it will have on his family

B. The belief that his masculinity will be in question It is a common misconception that males cannot be sexually abused, that only "sissies and weaklings allow abuse," leading to the possibility that his masculinity is at stake if he is identified as a victim.

Which question does the nurse include when assessing a client for physical violence associated with intimate partner abuse (IPV)? A. "Does your partner humiliate you in public settings?" B. "Does your partner ever strike or kick you?" C. "Does your partner criticize or insult you?" D. "Does your partner destroy your property?"

B. "Does your partner ever strike or kick you?" Physical abuse involves any act of aggression with or without use of an object or weapon that results in injury, pain, or impairment to another. Examples include striking, kicking, shoving, choking, burning. Based on this information, the question the nurse asks when assessing for physical violence associated with IPV is "Does your partner ever strike or kick you?" Criticism, insults, destroying personal property, and humiliation in public settings are examples of psychologic, not physical, violence associated with IPV.

The nurse provides care to a client who is experiencing intimate partner violence (IPV). The client lives in a rural area and asks the nurse how they can receive support. Which response by the nurse is appropriate? A. "I think it is best if you just make a plan to leave and stick to it." B. "I can provide you with a list of virtual support groups." C. "You should find a support group that that meets during your lunch hour." D. "You should discuss this issue with your practitioner."

B. "I can provide you with a list of virtual support groups." Because this client lives in a rural area, the response by the nurse that is appropriate is "I can provide you with a list of virtual support groups." The nurse should educate the client that most websites and chats designed for IPV survivors have escape features to disconnect quickly if necessary. The client should also be warned to clear their search histories if there is a risk they are being checked. The internet is a valuable source of information and support when using reliable sources such as hotlines, particularly for survivors who are not emotionally ready for in-person meetings or who do not have ready access to nearby services. Telling the client to discuss the issue with her practitioner is not appropriate because it is within the scope of nursing practice to educate regarding resources. Although ultimately the best option to ensure the client's safety is to plan to leave the abuser, this is a difficult process for many survivors of IPV and is not therapeutic based on the client's statement.

A nurse is working in the emergency department. Which situation would lead the nurse to suspect possible abuse of a client? Select all that apply. A. A 15-month-old with shortness of breath after peanut ingestion B. A baby with contrecoup injuries to the brain C. A 3-year-old with a deep finger laceration D. A 3-month-old with a fractured femur E. A 6-year-old is being seen for the 5th time for a urinary tract infection

B. A baby with contrecoup injuries to the brain D. A 3-month-old with a fractured femur E. A 6-year-old is being seen for the 5th time for a urinary tract infection. Re-occurring urinary tract infections signal the possibility of sexual abuse of the child. The nurse must assess for further signs of abuse both with parents present and without. A fracture of the femur in a 3-month-old is uncommon given the infant's age and level of development. Contrecoup injuries of the brain in a baby should generate suspicion that the baby has been shaken. A 15-month-old with an allergic reaction to a peanut ingestion and a 3-year-old with a deep finger laceration should not signal abuse to the assessor. The problems are commonly seen in the pediatric emergency room.

A client is brought to the Emergency Department by a family member that reports being sexually assaulted while leaving work. What action by the nurse would best promote placing control back to the client? A. Educate the client about attending a support group as soon as possible B. Allow the client to make decisions regarding care whenever possible C. Inform the client that charges will have to be pressed against the perpetrator D. Inform the client that the assessment must be completed as soon as possible

B. Allow the client to make decisions regarding care whenever possible The nurse can best offer support by allowing decisions to be made about care, who to call, and allow the care to be delivered at a pace that is comfortable for the client. It is the clients decision about whether or not to file charges and testify against the perpetrator. Educating the client about attending a support group may be done after the assessment and would be important but does not directly offer the support that is needed at this time. The assessment can be very traumatic for the client and should not be hurried or rushed through.

A client comes to the clinic for a prenatal visit. While the client is in the examining room, her estranged husband appears and insists on seeing the client. The client tells the nurse that they are in the process of getting a divorce and she does not want to be around him. "He's been following me to work and at my home everyday." What should the nurse suspect? A. Intimate partner violence B. Stalking C. Sexual assault D. Neglect

B. Stalking Stalking is a pattern of repeated unwanted contact, attention, and harassment that often increases in frequency (CDC, 2016b). Stalking is a crime of intimidation. Stalkers harass and terrorize their victims through behavior that causes fear or substantial emotional distress. Stalking may include such behaviors as following someone, showing up at the person's home or workplace, vandalizing property, or sending unwanted gifts. Intimate partner violence is the mistreatment or misuse of one person by another in the context of an emotionally intimate relationship. In this case, the relationship is spousal, and 15-25% of pregnant women experience violence during pregnancy. Sexual assault is the act of forcing unwanted sexual activity on a person. In this case, the nurse should first suspect intimate partner violence and can further inquire if unwanted sexual activity is also a feature of the client's situation. Neglect is considered in the context of child abuse.

The nurse conducts a wellness visit for a pediatric client. Which findings could indicate an increased risk for child abuse and the potential need for an additional assessment? Select all that apply. A. The parent states, "We use time-out as a form of punishment." B. The child has bruises in various degrees of healing on the buttock and upper legs. C. The child is average height and weight for chronological age. D. The parent states, "Our child was conceived using in vitro fertilization (IVF)." E. The child is diagnosed with a developmental delay.

B. The child has bruises in various degrees of healing on the buttock and upper legs. E. The child is diagnosed with a developmental delay. Child abuse includes acts of commission and acts of omission. Acts of commission are intentional harmful behaviors directed toward a child and include physical, sexual, and psychological abuse. Child neglect is an act of omission, which occurs when a child's basic physical, emotional, educational, and health care needs are not met. Children who are younger than 4 years of age, who are products of unwanted pregnancies, or who have developmental or physical disabilities are at highest risk of abuse. Based on this information, the finding that indicates a need for additional assessment for child abuse is a diagnosis of developmental delay in addition to the bruises in various degrees of healing on the buttock and upper legs because this finding is indicative of chronic abuse. A child who is underweight for height and chronological age could be experiencing child neglect; however, this child is of average height and weight for age. Time-out is an acceptable form of discipline for children. A child who is conceived via IVF is wanted; therefore, this finding does not indicate a need for additional assessment for child abuse.

Which is not a risk factor for child sexual abuse? A. The child suffers from developmental delays. B. The child is aged 10 years or younger. C. The child has primary caretaker who is mentally ill. D. The child lives in a home where substance abuse occurs.

B. The child is aged 10 years or younger. Children at high risk for sexual abuse include those who... - Are aged 3 years or younger - Suffer from a developmental delay - Live in a home where substance abuse occurs - Have adolescent parents or a single parent - Are in foster care - Have primary caretakers who were sexually abused themselves - Have primary caretakers who are mentally ill or have a developmental delay

What are some types of behavior that the nurse would recognize as qualifying as psychological abuse? Select all that apply. A. Asking for time alone when frustrated B. Threatening a victim's dog C. Using assertive language D. Criticizing E. Ridiculing

B. Threatening a victim's dog D. Criticizing E. Ridiculing Psychological abuse includes behaviors such as criticizing, insulting, humiliating, or ridiculing someone in private or public. It can also involve actions such as destroying another's property, threatening or harming pets, controlling or monitoring spending and activities, or isolating a person from family and friends. Asking the client for time alone when frustrated or using assertive language reflect healthy, adaptive communications skills during conflict management. These are not examples of psychological abuse.

The nurse provides care for a client who reports intimate partner violence (IPV). Which intervention does the nurse include in the client's plan of care to address safety planning? A. teaching about sleep hygiene techniques B. educating about perpetrator about behaviors indicative of losing control C. providing the client with supplies to treat physical injuries D. initiating the paperwork required for a guardianship

B. educating about perpetrator about behaviors indicative of losing control Safety planning includes providing education to the client regarding manifestations that are indicative that the perpetrator is losing control. Teaching about sleep hygiene is an intervention that promotes healthy daily activity. Guardianship paperwork may be necessary for older adult or children who are survivors of abuse; however, this is not appropriate based on the current client data. Providing the client with supplies needed to treat injuries addresses the client's physical health.

When assessing a 6-year-old child believed to be a victim of emotional abuse, the possibility is supported when the child is ... A. showing signs of developmental delays. B. observed to be anxious and rejecting adult attention. C. attending day care 5 days a week. D. parented by a single parent.

B. observed to be anxious and rejecting adult attention. While anxiety can be a sign of many different problems, an anxious child who rejects the attention of an adult may raise a red flag encouraging the nurse to assess further and possibly making a report. Developmental delays are not necessarily an indicator of emotional abuse, nor is attending day care on a regular basis. Being raised by a single parent is also not necessarily an indicator of emotional abuse.

Which assessment question should the nurse ask of a client suspected of being ostracized by a school bully? A. "Can you go to the school principal with personal problems?" B. "Do you smoke or use drugs?" C. "Do you feel like a part of a group in school?" D. "Have you talked to your parents about your problems at school?"

C. "Do you feel like a part of a group in school?" Ostracism, ignoring and excluding a target individual, has recently emerged as one of the more common and damaging forms of bullying. The victim experiences threats to belonging, self-esteem, meaningful existence, and sense of control. Ostracism may pose an even greater threat to children's adjustment than bullying. Those who bully are more likely to have poor grades and to use alcohol and tobacco. None of the remaining options are directly associated with the issue of ostracizing.

A client states to the nurse, "My husband hits me. I want to leave him, but I have to be sure that I can leave and won't have to go back." Which question does the nurse ask during the psychosocial interview to assess the client's social network? A. "Did you experience any form of abuse when you were a child?" B. "Does your husband criticize and belittle you?" C. "Do you have any friends who can provide emotional support?" D. "Does your husband blame you for his abusive behavior?"

C. "Do you have any friends who can provide emotional support?" An evaluation of social networks provides additional clues of psychological abuse and controlling behavior. Having supportive family or friends is crucial in short-term planning for developing a safety plan and is also important to long-term recovery. A survivor cannot leave an abusive situation with nowhere to go. Supportive family and friends may be willing to provide shelter and safety, as well as emotional support. Asking if the spouse criticizes and belittles the client assesses self-esteem, and inquiring about blame assesses for guilt and shame. Asking the client if they experienced any form of abuse as a child assesses for revictimization.

Which assessment finding can help the nurse differentiate a child experiencing child neglect rather than child abuse? A. A child tells a social worker that the child does not like it when the child's mother's boyfriend touches the child "down there." B. A child exhibits multiple scars on the back and buttocks upon examination. C. A young child is admitted to the hospital with hypothermia because the child is inadequately dressed. D. A child is brought to a clinic by a parent who is unable to adequately explain how the child broke an arm.

C. A young child is admitted to the hospital with hypothermia because the child is inadequately dressed. Child neglect is the failure to provide for a child's basic physical, medical, or educational needs. Examples of child neglect include withholding adequate clothing. Injuries and sexual touching are examples of child abuse.

A frightened young woman calls the emergency department and tearfully tells the nurse, "I've been raped! Please help me!" Before telling the client what to do, the nurse would need to know if A. If she had bathed, douched, or changed clothes B. If the client knew her assailant, knew her location, and had notified the police C. If the client was injured, was in a safe place, and had transportation available D. If she has insurance, if she could get to the hospital by herself, and if pregnancy is a possibility

C. If the client was injured, was in a safe place, and had transportation available If the client is injured, she may need immediate medical attention; if she is in a safe place, she can talk to the nurse on the phone. All other questions can wait until the client's safety is ensured.

A nurse manager is working with the nursing staff of a busy community-based walk-in clinic that provides care to a large number of survivors of domestic violence. When helping the staff provide care, which information would be most important for the nurse manager to convey to the staff? A. Encouragement for staff discussion about specific clients to gain support B. Expectation that survivors will accept change right away C. Importance of measuring the clients' progress in small steps D. Identification of consequences from changes made by survivors as minimal

C. Importance of measuring the clients' progress in small steps Nurses must become accustomed to measuring gains in small steps when working with survivors. Making any changes in significant relationships has serious consequences and can be done only when the adult survivor is ready. It is easy to become angry or discouraged with survivors, so it is important not to communicate such feelings. Discussing such feelings with other staff provides a way of dealing with them appropriately. In such discussions with supervisors or other staff, it is a must to protect the patient's confidentiality by discussing feelings around issues, not particular patients.

An older adult client has been attending a local day program for the elderly. The nurse who facilitates the program notices the client has multiple bruises on the arms, has scrapes to the hands and face, and is socially withdrawn. A referral to the client's family physician confirms the client has genital herpes. Which type of elder abuse should the nurse suspect? A. Financial abuse B. Physical neglect C. Sexual abuse D. Psychological abuse

C. Sexual abuse The physical bruising and presence of genital herpes indicate abuse that is sexual in nature. Older adults are increasingly the victims of abuse (e.g., physical, sexual, psychological, or neglect).

A nurse is giving a talk about child abuse to a local community group. When discussing risk factors for child abusers, which would the nurse identify as the most likely profile of the perpetrator of fatal child abuse? A. Young college graduate who recently gave birth to her first child B. Middle-aged woman with a college degree C. Unemployed young woman who dropped out of high school D. Middle-aged, wealthy businessman

C. Unemployed young woman who dropped out of high school Perpetrators of fatal child abuse are most likely to be caregivers who are young, poorly educated, and living at or below poverty level.

A nurse is presenting to a church group a program about domestic violence. During the presentation, a member of the audience asks the nurse to explain what "intergenerational transmission of violence" means because the person has seen that phrase used in the media. Which response by the nurse would be most appropriate? A. "Recent research has identified a gene that is responsible for transmission of a risk for violent behavior that is passed on from generation to generation." B. "Domestic violence seems to skip every other generation when it is traced in families." C. "People who are violent are that way because of the various neurochemical imbalances in their brains." D. "People who grow up in violent home situations tend to be involved in domestic violence situations as an adult."

D. "People who grow up in violent home situations tend to be involved in domestic violence situations as an adult." Violent families create an atmosphere of tension, fear, intimidation, and tremendous confusion about intimate relationships. Children in violent homes often learn violent behavior as an approved and legitimate way to solve problems, especially within intimate relationships. The social learning or intergenerational transmission of violence theory posits that children who witness violence in their homes often perpetuate violent behavior in their own families as adults. Moreover, children who grow up in violent homes learn to accept violence and expect it in their own adult relationships. Neurochemical imbalances, genetics, or skipping generations are unrelated to this theory.

A nurse is assessing a client in a community clinic who reports feeling anxious lately because she is considering leaving her marriage. The client describes a long history of partner abuse associated with this relationship. How should the nurse respond to this client? A. "I wonder if your perceptions of the relationship are accurate." B. "Relationship counseling can be very helpful." C. "I am here to help you through every step of this process." D. "You have the right to be safe and respected."

D. "You have the right to be safe and respected." When working with someone who is a victim of partner abuse, it is important that the nurse assertively support the client's decision. The affirmation of the client's decision can help to improve the client's self-confidence as she begin the process of leaving her partner. It is important the nurse refrain from recommending couple's counseling or imply doubt about the client's situation. The nurse will likely not be involved in every step of the client's process of leaving the relationship, as the client will use a variety of resources outside the nurse-client relationship, nor should the nurse take charge and do everything for the client or imply that this will happen.

Approximately what percentage of women rape victims are raped by someone they know? A. 45% B. 35% C. 55% D. 65%

D. 65% Approximately two-thirds of women are raped by people they know, including spouses, boyfriends, friends, or acquaintances. Among young women, about 50% of rapes are date rapes.

A nurse is aware of the high incidence of intimate partner violence (IPV) and actively seeks opportunities to screen women for IPV. Which female client represents the best opportunity for assessing for IPV? A. A client who is currently exploring long-term care options for her elderly father B. A client who has brought her young son to the emergency department because he fell at the playground and may have an arm fracture C. A client who expressed interest in joining a grief support group following the death of her husband D. A client who is in the third trimester of pregnancy and who is having biweekly prenatal appointments at a clinic

D. A client who is in the third trimester of pregnancy and who is having biweekly prenatal appointments at a clinic Women who are pregnant have frequent contact with the health care system, creating a useful opportunity for IPV screening. None of the other listed situations precludes screening, but none are as ideal as frequent appointments at a consistent setting.

A young adult client female is assessed after being raped. The client reports being tied up and beaten while the perpetrator forced sexual intercourse. She recalls the perpetrator saying, "I will make you pay." What most accurately describes this category of rapist? A. power assertive B. power reassurance C. anger excitement D. anger retaliation

D. anger retaliation In this case, the most accurate description of this rapist is anger retaliation. In this category, the perpetrator wants to punish the victim and often causes substantial injury. The power assertive rapist desires to dominate and control the victim and may repeat with the same victim. The power reassurance rapist commits rape when the opportunity presents itself, such as when another crime is being committed. An anger excitement rapist acts out fantasies and can be strategic in carrying out the crime, for example, carries a rape kit.

A client runs to the urgent care center because the spouse is at home drinking and waving a gun around while yelling at the children. Which action should the nurse take first? A. call a family member to pick up the children B. assess the client for injuries C. call for an ambulance for transport to the hospital D. contact the police

D. contact the police The client was in a lethal situation and escaped for help. Since children are in the home with an adult who is impaired with a firearm, the police should be immediately notified. There is no evidence to suggest the client is injured. The client should not return to a potentially lethal situation however the children need to be removed. The police should remove the children and not another family member since this could place them all in harm's way.

A nurse is seeing a 3-year-old child who is brought to a pediatric clinic by the mother with concerns about toilet training. The nurse notes the child has multiple bruises of various ages on the arms, trunk, and legs. The nurse should suspect: A. neglect. B. sexual abuse. C. stalking. D. physical abuse.

D. physical abuse. In cases where children are being physically abused, there is often evidence of old injuries such as scars, untreated fractures, or multiple bruises of various ages. Physical abuse of children often results from severe corporal or unjustifiable punishment for having a toileting accident. Neglect should be suspected if the parent refused to seek medical treatment for the child. Although the nurse should further assess for neglect, in this case the clues for physical abuse are more obvious. Stalking refers to repeated or persistent attempts to impose unwanted communication or contact on another person. This happens between adults. Sexual abuse should be suspected if the child's genitals are assessed and there is a sign of redness, swelling, or other type of injury.