Abuse and violence prepU
Which assessment question should the nurse ask of a client suspected of being ostracized by a school bully? "Do you feel like a part of a group in school?" "Do you smoke or use drugs?" "Can you go to the school principal with personal problems?" "Have you talked to your parents about your problems at school?"
Correct response: "Do you feel like a part of a group in school?" Explanation: 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 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 3 of the cycle of violence? "He threw me against the wall and started punching my face." "He yells at me for not having dinner waiting for him when he comes home." "He calls me stupid and incompetent, asking himself why he ever married me." "He tells me that he is sorry and that he will never hit me again."
Correct response: "He tells me that he is sorry and that he will never hit me again." Explanation: During phase 3 of the cycle, the perpetrator becomes kind, contrite, and loving, begging for forgiveness and promising never to inflict abuse again. The actual violence occurs in phase 2. Yelling at the client for not having dinner ready and calling her stupid and incompetent reflect phase 1, or tension building.
Which statement made by a client raises the greatest concern that the client may be experiencing relationship violence? "He was so much nicer when we started dating." "His father physically abused his mother for years." "He doesn't like it when I go out with my girlfriends." "I don't know what else I can do to keep him from getting angry at me."
Correct response: "I don't know what else I can do to keep him from getting angry at me." Explanation: A warning sign of relationship violence is feeling that you must change your life or yourself so you won't anger him or her. The remaining statements, while troublesome, are not as clearly associated with behaviors of violence.
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? "You have the right to be safe and respected." "Relationship counseling can be very helpful." "I wonder if your perceptions of the relationship are accurate." "I am here to help you through every step of this process."
Correct response: "You have the right to be safe and respected." Explanation: 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, imply doubt about the client's situation, or take charge and do everything for the client.
What percentage of women can expect to be a victim of an ongoing unwanted pursuit from stalking? 5-10% 12-32% 40-48% 50-60%
Correct response: 12-32% Explanation: Women are 12-32% and men 17% who can expect to be victims of ongoing unwanted pursuit.
Approximately what percentage of women rape victims are raped by someone they know? 65% 35% 45% 55%
Correct response: 65% Explanation: 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 nursing student learning about intimate partner violence (IPV) correctly identifies the percentage of deaths attributed to IPV to be what? 70% women and 30% men 70% men and 30% women 50% women and 50% men 90% women and 10% men
Correct response: 70% women and 30% men Explanation: Approximately 70% of victims killed by IPV are women and 30% are men.
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 6-year-old is being seen for the 5th time for a urinary tract infection A baby with contrecoup injuries to the brain A 3-month-old with a fractured femur A 15-month-old with shortness of breath after peanut ingestion A 3-year-old with a deep finger laceration
Correct response: A 6-year-old is being seen for the 5th time for a urinary tract infection A baby with contrecoup injuries to the brain A 3-month-old with a fractured femur Explanation: 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.
Which type of elder abuse involves leaving an older adult and no longer providing care for the individual? Abandonment Emotional Physical Neglect
Correct response: Abandonment Explanation: The six types of elder abuse are physical (injury by hitting, kicking, pushing, slapping, burning, and so on); sexual (unconsented sexual act); emotional (harm of self-worth or emotional well-being); neglect (failure to meet the older adult's basic needs of shelter, food, and so on); abandonment (leaving an older adult alone and no longer providing care); and financial (illegally misusing money, property, or assets).
Which characteristics are found in violent families? Select all that apply. Adequate support systems Abuse of power and control Alcohol use disorder Social isolation
Correct response: Abuse of power and control Alcohol use disorder Social isolation Explanation: 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 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? Inform the client that charges will have to be pressed against the perpetrator Allow the client to make decisions regarding care whenever possible Educate the client about attending a support group as soon as possible Inform the client that the assessment must be completed as soon as possible
Correct response: Allow the client to make decisions regarding care whenever possible Explanation: 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 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. Avoidance of sexually related content Secretiveness of behaviors Open and honest discussion about history High self-esteem Distorted view of sex
Correct response: Avoidance of sexually related content Secretiveness of behaviors Distorted view of sex Explanation: 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.
A school nurse is aware that a student has requested aspirin three times during the past week because his "back hurts." The nurse has noticed that he often wears long-sleeved sweaters and sweatshirts even in warm weather. The nurse suspects that the student may be the victim of physical abuse. The nurse is preparing to ask the child about his ongoing backache. Which of the following would the nurse anticipate being reported by the child if he was being abused? His father is beating him on a regular basis. Be reluctant to report abuse because of shame or fear of retaliation Give the same reason his sister would give were she asked to explain his injuries. Carefully explain that his mother disciplines him because she loves him.
Correct response: Be reluctant to report abuse because of shame or fear of retaliation Explanation: Most survivors do not report violence to health care providers without specifically being asked about it. Survivors may be reluctant to report abuse because of shame and fear of retaliation, especially if the victim depends on the abuser as a caregiver. In addition, children may fear they will not be believed.
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? Providing reassurance to the client that the care team and the police will prioritize the client's care Collecting specimens from the client for use as evidence Assisting with diagnostic tests to determine the extent of the client's injuries Asking the client to describe the perpetrator in detail and documenting the client's statement
Correct response: Collecting specimens from the client for use as evidence Explanation: 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.
What are some types of behavior that the nurse would recognize as qualifying as psychological abuse? Select all that apply. Criticizing Ridiculing Threatening a victim's dog Asking for time alone when frustrated Using assertive language
Correct response: Criticizing Ridiculing Threatening a victim's dog Explanation: 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.
What assessment data, related to a 77 year old client, would be considered the highest risk for possible elder abuse? Lives with adult daughter Diagnosed with mild dementia Requires assistance with food preparation Widowed, female
Correct response: Diagnosed with mild dementia Explanation: While the risk of elder abuse exists in all the options provided, such abuse is more likely when the elder client has chronic mental and/or physical health problems that limit there ability to express their concerns and/or describe their current living conditions.
A mental health nurse is interviewing a child for suspected abuse. The parent states that the child is having disciplinary problems at school and stutters when approached. From the listed behavioral indicators, the nurse would suspect which type of abuse? Physical Financial Emotional Sexual
Correct response: Emotional Explanation: A behavioral profile of an emotionally abused child includes stuttering, enuresis, overeating, disciplinary problems, and failure to thrive. The scenario does not refer to physical, financial, or sexual abuse.
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? Importance of measuring the clients' progress in small steps Expectation that survivors will accept change right away Encouragement for staff discussion about specific clients to gain support Identification of consequences from changes made by survivors as minimal
Correct response: Importance of measuring the clients' progress in small steps Explanation: 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.
Which type of abuse includes name calling and belittling? Psychological abuse Physical abuse Sexual abuse Sodomy
Correct response: Psychological abuse Explanation: Name calling and belittling are examples of psychological abuse. Physical abuse ranges from shoving and pushing to severe battering and choking. Sexual abuse includes assaults during sexual relations such as pulling hair, slapping, hitting, and rape. Sodomy is anal intercourse.
Which statement requires additional education regarding the truth about rape? Rape is a crime of passion. No person wants to be raped. No person deserves to be raped. Rape can occur between married individuals.
Correct response: Rape is a crime of passion. Explanation: Rape is a crime of violence and humiliation of the victim expressed through sexual means. The remaining options present accurate information about the act of rape so no further education or correction is needed.
A nurse is working on developing a safety plan with a client who is a survivor of violence. Which would the nurse address first? Devising an escape route Recognizing the signs of danger Identifying a safe place to hide Identifying a signal to indicate it is safe to leave
Correct response: Recognizing the signs of danger Explanation: One of the most important teaching goals is to help survivors develop a safety plan. The first step in developing such a plan is helping the survivor recognize the signs of danger. Changes in tone of voice, use of alcohol and other drugs, and increased criticism may indicate that the perpetrator is losing control. Detecting early warning signs helps survivors to escape before battering begins. The next step is to devise an escape route. This involves mapping the house and identifying where the battering usually occurs and what exits are available. The survivor needs to have a bag packed and hidden, but readily accessible, containing what is needed to get away. If children are involved, the adult survivor should make arrangements to get them out safely. That might include arranging a signal to indicate when it is safe for them to leave the house and to meet at a prearranged place. A safety plan for a child or dependent older adult might include safe places to hide and important telephone numbers, including 911, police and fire departments, and other family members and friends.
During an interview, a 6-year-old child tells a nurse that the child is often left alone at home by the child's parents. Which action should the nurse take? Continue with the interview and ignore the accusations. Report the child's information to the child protection agency. Tell the parents about the accusations. Do nothing—the nurse should not get involved in any possible criminal investigation.
Correct response: Report the child's information to the child protection agency. Explanation: If a child reports family violence, in this case, by neglect, the nurse has a legal responsibility to report the abuse to child protection agencies.
Which type of rapist derives erotic gratification from the victim's suffering? Sadistic rapist Power rapist Anger rapist Premeditated rapist
Correct response: Sadistic rapist Explanation: Sadistic rapists derive erotic gratification from the victim's suffering. Power rapists often attack people their own age and use intimidation and minimal physical force to control their victims. Their assaults are premeditated. Anger rapists use extreme force and restraint that results in physical injury to the victim. There is not a type of rapist called premeditated.
A nurse is screening a new client for intimate partner violence (IPV). What aspect of this woman's current circumstances is the most significant risk factor? The client's family lives on less than $1,000 per month. The client immigrated less than 5 years ago. The client has four children. The client has no extended family in the area.
Correct response: The client's family lives on less than $1,000 per month. Explanation: Low income is a salient risk factor for IPV. Recent immigration, larger than average numbers of children, and a lack of extended family are not noted as major risk factors.
The nurse provides care to individuals who have been sexually assaulted during their childhood. Which characteristic is most commonly noted by the nurse during an assessment of such clients? Overly self-confident Unusually aggressive Overly social Too trustful
Correct response: Unusually aggressive Explanation: A child who is a survivor of prolonged sexual abuse will develop low self-esteem, as well as developing feelings of worthlessness, and become socially withdrawn, distrustful, or suicidal. Other characteristics of children who have been sexually abused include becoming unusually aggressive.
Which is an inaccurate picture of the cycle of abuse that occurs over time? Violent episodes are less frequent Violent episodes are more frequent The period of remorse disappears Severity of the injuries worsen
Correct response: Violent episodes are less frequent Explanation: Over time, the violent episodes are more frequent, the period of remorse disappears altogether, and the level of violence and severity of injuries worsen.
The nurse in the emergency room is assessing a client who was brought in by the police for evaluation after receiving a call from a neighbor. The client reports to the nurse that the person who has been cooking and helping around the house has not been home for days. Which type of abuse does the nurse suspect based on the client's statement? neglect physical emotional abandonment
Correct response: abandonment Explanation: Although abandonment can cause neglect and lead to physical and emotional abuse, abandonment is the primary type of abuse that this person is experiencing. The older person is calling for help because the caregiver has not been present for days. Neglect is the failure to meet basic needs of shelter and food. Physical abuse is causing injury by hitting, kicking, or pushing. Emotional abuse is injuring the person's self-worth and emotional well-being.
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? power assertive anger retaliation power reassurance anger excitement
Correct response: anger retaliation Explanation: 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 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: carefully assess the children for signs of trauma. determine what initially caused the violence to begin. teach the client life skills for moving on from the relationship. reassure the client that this will never happen again.
Correct response: carefully assess the children for signs of trauma. Explanation: 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.
The nurse is approached by a teacher who suspects a student is being neglected after observing changes in the student's behavior. The teacher asks the nurse what other behaviors to watch for. Which symptoms of neglect should the nurse include in the discussion ? Select all that apply. fighting with other students deteriorating grades in school smoking a cigarette after school saving lunch items to take home for later refusing to answer when called on in class
Correct response: fighting with other students deteriorating grades in school smoking a cigarette after school refusing to answer when called on in class Explanation: Children who are abused or neglected are at risk for physical, emotional, and behavioral problems. They may have problems getting along with others leading to fights. Cognitive development may be impaired causing academic difficulties. They are at risk for substance abuse such as cigarettes. They may have low self-esteem and not want to participate in class. Saving food for later could indicate food insecurity which not identified as a problem associated with abuse or neglect.
The school health nurse is asked to see a child who has been coming to school with no lunch for the past week. The child tells the nurse, "I don't get a lunch this week, I have been wetting the bed." The nurse identifies that this child is experiencing which type of abuse? physical sexual neglect psychological
Correct response: neglect Explanation: Neglect, in this case, is the malicious withholding of a physical necessity for this child's well-being. For this child, the neglect is intended to be punitive for bed wetting. The nurse would need to investigate further and take the necessary action in reporting this as abuse. Sexual abuse refers to sexual acts performed by an adult on a child under the age of 18. In this case, the evidence does not support that the child is being sexually abused. Physical abuse refers to a deliberate physical assault by an adult on the child such as burning, biting, poking, or twisting a limb. Psychological abuse refers to verbal assaults such as blaming, screaming, name-calling, and using sarcasm. The child has not reported that this is occurring, therefore, this is most likely a situation in which the form of abuse is neglect.
When assessing a 6-year-old child believed to be a victim of emotional abuse, the possibility is supported when the child is ... observed to be anxious and rejecting adult attention. showing signs of developmental delays. attending day care 5 days a week. parented by a single parent.
Correct response: observed to be anxious and rejecting adult attention. Explanation: 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.
When the school nurse is assessing an adolescent who reports trouble sleeping, which characteristics of the client indicate there may be violence in the home? (Select all that apply.) the client's father monitors contact with friends feeling social pressure to use alcohol feeling left out of peer group has a family history of alcohol abuse must go straight home after school each day
Correct response: the client's father monitors contact with friends has a family history of alcohol abuse must go straight home after school each day Explanation: Having contact with friends monitored by the father indicates there is an abuse of power and control in the home. Having to go straight home after school indicates the client is being forced into social isolation. In addition, there is a family history of alcohol abuse. These are all characteristics of violent families. Adolescents commonly report feelings of being left out and experiencing social pressures to experiment with drugs and alcohol. These are not characteristics of violent families.
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? Intimate partner violence Stalking Sexual assault Neglect
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.
