CH 30: Vulnerable Populations

A nurse is conducting an in-service program for a group of clinic nurses about screening for intimate partner violence. One of the participants asks the nurse, "I find it difficult to ask the woman questions about this. What's the best kind of question?" Which response by the nurse would be most appropriate? A) "There is no one best type of question. Use the type that makes you most comfortable." B) "Direct questions are often best since there is no room for interpretation." C) "Indirect questions work well but may take you longer to get the answer." D) "Remember that your question is reflecting your judgment about the situation."

A) "There is no one best type of question. Use the type that makes you most comfortable." To screen for intimate partner violence, nurses need to ask difficult questions in an empathetic and nonthreatening manner and remain nonjudgmental in all responses and interactions. The best question is the type of question that makes the nurse feel most comfortable. Direct and indirect questions produce the same results.

A nurse is caring for a client who was raped at gunpoint. The client does not want any photos taken of the injuries. The client also does not want the police to be informed about the incident even though state laws require reporting life-threatening injuries. Which intervention should the nurse perform to document and report the findings of the case? A) Use direct quotes and specific language. B) Obtain photos to substantiate the client's case in a court of law. C) Document only descriptions of medical interventions taken. D) Respect the client's opinion and avoid informing the police.

A) Use direct quotes and specific language The nurse should use direct quotes and specific language as much as possible when documenting. The nurse should not obtain photos of the client without informed consent. The nurse should, however, document the refusal of the client to be photographed. Documentation must include details as to the frequency and severity of abuse and the location, extent, and outcome of injuries, not just a description of the interventions taken. The nurse is required by law to inform the police of any injuries that involve knives, firearms, or other deadly weapons or that present life-threatening injuries.

A victim of rape is exhibiting symptoms of posttraumatic stress disorder (PTSD) which the nurse interprets as indicative of intrusion. Which symptoms would the client be exhibiting? Select all that apply. A) nightmares B) recurrent thoughts C) flashbacks D) social withdrawal E) emotional numbing

A) nightmares B) recurrent thoughts C) flashbacks

A nurse is a guest speaker for a local college campus group discussing violence and rape. After discussing rape with the group, the nurse determines that additional discussion is needed when the group states which information? A) "It may take victims several years to recover from the rape." B) "Most rape victims tell someone about the rape." C) "A rape victim often feels vulnerable and betrayed afterwards." D) "Rape is not an act of impulsive, uncontrolled passion."

B) "Most rape victims tell someone about the rape." In reality, the most victims never tell anyone about being raped and almost two-thirds of victims never report the rape to the police. It can take several years to recover from rape, and the rape victim often feels vulnerable, betrayed, and insecure afterward. Rape is a premeditated act of violence, it is not an act of impulsive, uncontrolled passion.

A nurse is presenting a discussion on sexual violence at a local community college. When describing the incidence of sexual violence, the nurse would identify that a woman has which chance of experiencing a sexual assault in her lifetime? A) 1 in 3 B) 1 in 5 C) 2 in 15 D) 3 in 20

B) 1 in 5 According to the National Sexual Violence Resource Center (NSVRC), nearly one in five women and one in 9 men in the United States have experienced rape, physical violence, and/or stalking by a partner with IPV-related impact in their lifetimes.

A nurse is assessing a victim of rape. Further assessment reveals that the client received rohypnol. The nurse understands that this drug can lead to memory loss for up to how many hours? A) 2 B) 4 C) 6 D) 8

D) 8 Rohypnol (also known as "roofies," "forget pills," "mind erasers" and the "drop drug") comes in the form of a liquid or pill that quickly dissolves in liquid with no odor, taste, or color. This drug is 10 times as strong as diazepam. The effects can be felt within 30 minutes, and the drug produces memory loss for up to 8 hours.

A nurse is performing a physical examination of a pregnant woman. During examination, the nurse notices a bruise on the client's abdomen. Which action should the nurse take? A) Ask the client to account for the bruise. B) Assume that the bruise is from an accident and not worry about it. C) Make a note in the client's chart regarding the finding, and plan to observe for other signs of intimate partner violence in the future. D) Assume that the bruise is from intimate partner violence, and call the police while the client is still in the room.

A) Ask the client to account for the bruise. Many women seen in emergency departments are there because they have been maltreated by their intimate partner. Common injuries suffered include burns, lacerations, bruises, and head injuries. Asking all women at physical examinations to account for any bruise they have helps detect physical maltreatment. The nurse should not assume that the bruise is just the result of an accident or that it is the result of intimate partner violence; she should question the client to learn more. Depending on how the client responds, it may be appropriate to make a note in the client's chart or to take some other action to help protect the client.

A new nurse in the emergency department is caring for a pregnant woman who was beaten by her partner. Which statement by the new nurse would require intervention from the supervising nurse? A) "I don't understand why abused women don't leave their partners." B) "That woman must be doing something to get beaten like that." C) "I will give her information about women's shelters in our area." D) "She needs an emergency plan in case she ever decides to leave."

B) "That woman must be doing something to get beaten like that." It is important not to blame abuse victims for the violence they receive. Therefore, the supervising nurse would need to intervene and clarify for the new nurse not to make comments that place blame on the victim. The other statements are fine; many nurses do not understand why abused women do not leave their partners. It is helpful to give information about women's shelters and provide input on an emergency plan in case the woman wants to leave and maintain safety.

An obese client admits to regularly binging on large amounts of food. The client expresses feelings of guilt and shame but is unable to stop this behavior. What does the nurse recognize is the major treatment goal for this client? A) Eliminate purging episodes B) Normalize potassium levels C) Determine mental health needs D) Reduce number of binge episodes E) Increase daily physical activity level

D) Reduce number of binge episodes Binge eating disorder is frequent binging—or bouts of overeating—without inappropriate compensatory behaviors, such as purging or excessive exercise. Binging is generally considered to be consuming the equivalent of two or more meals or 2,000 calories or more within a given period of time (such as 2 hours). People with binge eating disorder have a higher BMI on average than the general population and are more likely to be obese. The goal of treatment is to reduce the number of binge episodes and decrease weight as needed. Purging is not part of this disorder, so eliminating purging is not an appropriate goal. Potassium levels are a problem for bulimics due to purging. It is not a problem for binge eaters. Although this client may have a mental health disorder, it is not the primary diagnosis. Increasing physical activity levels does not prevent binge eating, although it may help with weight loss.

Which statement made by a male client who has a history of perpetrating intimate partner violence reflects a known factor that is characteristic of this behavior? A) "My classmates always called me a bully." B) "Sports like football and soccer are my life." C) "My mother was the disciplinarian in our family." D) "It was just mom and me after dad died."

A) "My classmates always called me a bully." Risk factors for intimate partner violence in men include taking aggression out on others while growing up as demonstrated by bullying. A male-dominated family life is considered a relationship factor that may trigger such violence. A preference for sports, such as football and soccer, are not considered risk factors for intimate partner violence.

A nurse is caring for a pregnant woman who has multiple bruises in varying stages across her body. Which is the priority nursing action? A) Report this as intimate partner violence. B) Ask if anyone at home has hit or hurt her. C) Tell her about resources for abuse victims. D) Refer her to counseling with her partner.

B) Ask if anyone at home has hit or hurt her. In the case of suspected intimate partner violence, it is best for the nurse to ask direct questions. Asking all women at physical examinations to account for any bruise they have helps detect physical maltreatment. Intimate partner violence is not typically reported by the nurse, but by the adult client. Once the nurse believes abuse is occurring, it is important to give her resources for abuse victims. Referring to counseling may be an option, but it is best to verify first.

A client has been seen and treated in the emergency room several times for injuries that are deemed suspicious. The client is reluctant to participate in a screening process. How best can the nurse provide reassurance to this client? A) Being nonjudgmental B) Giving assurances of help C) Establishing a plan to protect the client D) Having the client be honest about the injuries

A) Being nonjudgmental During the screening process the victim is most likely to be uncomfortable and not want to participate. Victims are concerned about being judged by the interviewer, provoking more violence, and being disappointed by the provider's response to the disclosure. The nurse can best help the victim participate in screening by ensuring confidentiality and being nonjudgmental. There is no guarantee the nurse can assure the woman of help. At best, the nurse can provide information of agencies and services. Having the client be honest about the injuries can cause much distress for the client who may feel it will only lead to more injuries after the partner realizes details have been disclosed. Helping the client find community resources to develop a plan of protection is best done with the social worker and community agencies rather than the emergency room nurse. The nurse should make a referral to the social worker to help with this situation.

To properly assist a victim of intimate partner violence, which action would be most appropriate for the nurse to do? A) Document the details. B) Summarize the details of the incident. C) Discuss the details with the victim. D) Confront the abuser about the details.

A) Document the details. Accurate documentation is critical because this evidence may support the client's case in court. Documentation must include details about the frequency and severity of violence; location, extent, and outcome of injuries; and any treatments or interventions. Documentation should always use direct quotes, and be very specific.

Which statement made by a new nurse demonstrates an understanding of the prevalence of sexual assault and related violence among the population? A) "The vast majority of victims of sexual assault and related violence are seen in the emergency room when they seek treatment." B) "I've come to realize that I need to include questions related to sexual assault and related violence into the assessment of all my clients." C) "It seems obvious that the greatest number of clients experiencing sexual abuse and related violence are the young and middle-aged adults." D) "The greatest need for thorough assessment regarding sexual assault and related violence is among those who are dependent and rely on the care of others."

B) "I've come to realize that I need to include questions related to sexual assault and related violence into the assessment of all my clients." Nurses will come in contact with sexual assault and related violence no matter what health care setting they work in and among all segments of the population. Nurses must be ready to ask the right questions and to act on the answers, because such action could be lifesaving.

A 74-year-old client presents with depression, insomnia, and atypical chest pain. When asked about thoughts of suicide, the client states "Yes, I do think about ending all this." What will the nurse do next? A) Perform an electrocardiography on the client. B) Ask the client if he or she is being mistreated. C) See how long the client has been depressed. D) Notify the health care provider.

B) Ask the client if he or she is being mistreated. This client is presenting with symptoms of elder mistreatment. The nurse should determine if the client is being mistreated first to know how to properly care for the client. An electrocardiography is not needed as these are symptoms of mistreatment. It is not pertinent to know the history of the client's depression or insomnia. The nurse should know what is going on with the client prior to notifying the health care provider.

A nurse is assessing a rape survivor for posttraumatic stress disorder. The nurse asks the survivor, "Do you feel as though you are reliving the trauma?" The nurse is assessing for which effect of the trauma? A) physical symptoms B) Intrusive thoughts C) avoidance D) hyperarousal

B) Intrusive thoughts The question is used to assess the survivor for intrusive thoughts that reflect the client reexperiencing the trauma. Physical symptoms would be assessed with questions about sleeping, eating, palpitations and other problems. Avoidance would be reflected in questions involving withdrawal socially, avoiding situations that remind the survivor of the rape. Hyperarousal would be noted by irritability and an exaggerated startle response.

A woman is being cared for in the emergency department following a sexual assault. In addition to the physical exam and collection of the rape kit, what sexually transmitted infection (STI) testing should the nurse prepare to collect during the initial examination visit? A) Chlamydia, trichomoniasis, gonorrhea and hepatitis B B) HIV, hepatitis B, chlamydia, and human papillomavirus C) HIV, hepatitis C, hepatitis A, and gonorrhea D) Syphilis, HIV, chlamydia, and herpes simplex

A) Chlamydia, trichomoniasis, gonorrhea and hepatitis B When testing for STIs following a sexual assault the following tests should be done: chlamydia, gonorrhea, trichomoniasis, syphilis, HIV and hepatitis B. These should also be rechecked 1 to 2 weeks after the assault. HIV testing includes three different test times after the assault. Checking for human papillomavirus should be done as a visual examination for warts 1 to 2 months after a sexual assault. Hepatitis C testing is not done routinely after a sexual assault, nor is testing for the herpes simplex virus.

A nurse is assessing a client for abuse. Which statement by a client would the nurse interpret as suggesting financial abuse? A) "My spouse constantly insults me by calling me names." B) "My spouse grabbed me so hard that it left bruises." C) "My spouse won't let me go out to find a job." D) "My spouse forces me to have sex with other people."

C) "My spouse won't let me go out to find a job." Financial abuse would be indicated by the partner preventing one's spouse from going out to find a job. Constant insults and name calling suggest emotional abuse. Grabbing in such a way to leave marks suggests physical abuse. Forcing one's spouse to have sex with other individuals would suggest sexual abuse.

Which of the following is TRUE regarding intimate partner violence? Women who are in an abusive relationship experience less abuse while they are pregnant. A) Abusers often have outward signs that they are abusers or have a mental illness. B) Even though women seldom blame themselves for the abuse, they often cannot leave the relationship. C) One in four women will be a victim of violence. D) Women who are in an abusive relationship experience less abuse while they are pregnant.

C) One in four women will be a victim of violence. Approximately 20% to 30% of women will be a victim of violence. Women experience an increase in violence during pregnancy. Abusers often have no outward signs that they are abusers or have a mental illness. Women usually blame themselves and feel they cannot leave the relationship.