chapter 28: Child, Older Adult, and Intimate Partner Violence

The parents of a 15-year-old seek to have this teen declared a delinquent because of excessive drinking, habitually running away, and prostitution. The nurse interviewing the patient should recognize these behaviors often occur in adolescents who a. have been abused. b. are attention seeking. c. have eating disorders. d. are developmentally delayed.

a. have been abused.

What situation associated with a caregiver presents the greatest risk that an older adult will experience abuse by that caregiver? a. The caregiver is a single male relative. b. The caregiver was neglected as a child. c. The caregiver is under the age of 30. d. The caregiver has little experience with older adults.

b. The caregiver was neglected as a child.

What is a nurse's legal responsibility if child abuse or neglect is suspected? a. Discuss the findings with the child's parent and health care provider. b. Document the observation and suspicion in the medical record. c. Report the suspicion according to state regulations. d. Continue the assessment.

c. Report the suspicion according to state regulations.

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

c. The sexual abuse will cease immediately.

Several children are seen in the emergency department for treatment of various illnesses and injuries. Which assessment finding would create the most suspicion for child abuse? The child who has a. complaints of abdominal pain. b. repeated middle ear infections. c. bruises on extremities. d. diarrhea.

c. bruises on extremities.

Which statement made by a parent of a child diagnosed with Tourette's syndrome would be assessed as a risk factor for family violence? a. "We shouldn't be, but we are ashamed of our son's disorder and his inability to control the tics in public." b. "Our son is really a good little boy, but he needs to be disciplined both at home and in school." c. "We have become active in the support group but still find the suggestions extremely difficult to put into practice." d. "My husband lost his job, and it seems all our savings are going to pay for our son's expensive medication and all the other things he needs."

d. "My husband lost his job, and it seems all our savings are going to pay for our son's expensive medication and all the other things he needs."

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

d. Beginning attending anger management training sessions within 2 weeks

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

d. Considering ways to commit suicide

A young adult has recently had multiple absences from work. After each absence, this adult returned to work wearing dark glasses and long-sleeved shirts. During an interview with the occupational health nurse, this adult says, "My partner beat me, but it was because I did not do the laundry." What is the nurse's next action? a. Call the police. b. Arrange for hospitalization. c. Call the adult protective agency. d. Document injuries with a body map

d. Document injuries with a body map

An abuse victim tearfully tells the nurse in the emergency department, "Don't tell my husband that you know he beats me because if he thinks anyone knows, he will beat me again." Based on this information, what is the most appropriate nursing diagnosis? a. Post-trauma syndrome b. Hopelessness c. Risk for self-directed violence d. Fear

d. Fear

An elderly client pays the bills because she fears that her family will make her live elsewhere if she doesn't "help out." The nurse assesses for suggestions that the client may be at risk for what form of abuse? a. Psychological b. Neglect c. Physical violence d. Financial maltreatment

d. Financial maltreatment

An adult has recently been absent from work for 3-day periods on several occasions. Each time, the individual returned wearing dark glasses. Facial and body bruises were apparent. What is occupational health nurse's priority assessment? a. Interpersonal relationships b. Work responsibilities c. Socialization skills d. Physical injuries

d. Physical injuries

What safety-related responsibility does the nurse have in any situation of suspected abuse? a. Protect the patient from future abuse by the abuser. b. Inform the suspected abuser that the authorities have been notified. c. Arrange for counseling for all involved parties, but especially the patient. d. Report suspected abuse to the proper authorities.

d. Report suspected abuse to the proper authorities.

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

d. Secondary prevention

What feelings are most commonly experienced by nurses working with abusive families? a. Outrage toward the victim and discouragement regarding the abuser b. Helplessness regarding the victim and anger toward the abuser c. Unconcern for the victim and dislike for the abuser d. Vulnerability for self and empathy with the abuser

b. Helplessness regarding the victim and anger toward the abuser

Which of the following is a likely behavior for a woman attempting to escape a chronically abusive relationship? a. Relying on alcohol to escape the emotional pain of abuse b. Adapting an aggressive attitude toward her abuser to scare him c. Considering ways to commit suicide d. Threatening to call the police if she is abused again

c. Considering ways to commit suicide

A 4-year-old child tells the nurse, "I'm a bad boy. Daddy always says I'm not worth a second look." This situation can be an example of which form of abuse? a. Tough love b. Physical c. Emotional d. Neglect

c. Emotional

An 11-year-old reluctantly tells the nurse, "My parents don't like me. They said they wish I was never born." Which type of abuse is likely? a. Sexual b. Physical c. Emotional d. Economic

c. Emotional

Which of the following persons has the highest risk factors for physical abuse? a. Rose, a 77-year-old woman living with her daughter and son-in-law b. Penny, a 28-year-old wife whose husband has a diagnosis of an anxiety disorder c. Roland, a 53-year-old man with cardiovascular disease living with his son d. Emma, a 7-month-old baby who has colic and doesn't sleep through the night

a. Rose, a 77-year-old woman living with her daughter and son-in-law

A community health nurse visits a family with four children. The father behaves angrily, finds fault with the oldest child, and asks twice, "Why are you such a stupid kid?" The wife says, "I have difficulty disciplining the children. It's so frustrating." Which comments by the nurse will facilitate an interview with these parents? (Select all that apply.) a. "Tell me how you discipline your children." b. "How do you stop your baby from crying?" c. "Caring for four small children must be difficult." d. "Do you or your husband ever spank your children?" e. "Calling children 'stupid' injures their self-esteem."

a. "Tell me how you discipline your children." b. "How do you stop your baby from crying?" c. "Caring for four small children must be difficult."

Which comment by the nurse would best support relationship building with a survivor of intimate partner abuse? a. "You are feeling violated because you thought you could trust your partner." b. "I'm here for you. I want you to tell me about the bad things that happened to you." c. "I was very worried about you. I knew you were living in a potentially violent situation." d. "Abusers often target people who are passive. I will refer you to an assertiveness class."

a. "You are feeling violated because you thought you could trust your partner."

The use of a patient-centered interview technique works well for gathering information about abusive situations. It is a good use of clinical time to sit near the patient and: a. Establish trust and rapport b. Ask lots of questions c. Interrupt the patients' story to allow for decompression d. Utilize closed-ended questions

a. Establish trust and rapport

A 10-year-old cares for siblings while the parents work because the family cannot afford a babysitter. This child says, "My father doesn't like me. He calls me stupid all the time." The mother says the father is easily frustrated and has trouble disciplining the children. The community health nurse should consider which resources as priorities to stabilize the home situation? (Select all that apply.) a. Parental sessions to teach childrearing practices b. Anger management counseling for the father c. Continuing home visits to give support d. A safety plan for the wife and children e. Placing the children in foster care

a. Parental sessions to teach childrearing practices b. Anger management counseling for the father c. Continuing home visits to give support

Which statement made by a new mother should be explored further by the nurse? a. "I have three children, that's enough." b. "I think the baby cries just to make me angry." c. "I wish my husband could help more with the baby." d. "Babies are a blessing, but they are a lot of work."

b. "I think the baby cries just to make me angry."

A survivor of physical spousal abuse was treated in the emergency department for a broken wrist. This patient said, "I've considered leaving, but I made a vow and I must keep it no matter what happens." Which outcome should be met before discharge? The patient will a. facilitate counseling for the abuser. b. name two community resources for help. c. demonstrate insight into the abusive relationship. d. reexamine cultural beliefs about marital commitment.

b. name two community resources for help.

Which statement, made by a female adult concerning her boyfriend, should cause the nurse to suspect that the client is at risk for being emotionally abused? a. "He has a good job and keeps control of all the finances but our electricity still got turned off last week." b. "I didn't tell him I was coming because he is under so much stress at work I didn't want to add to it." c. "He yells a lot and calls me names, but that's because I am so stupid and make so many mistakes." d. "He has always had a fiery temper."

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

Which referral will be most helpful for a woman who was severely beaten by intimate partner, has no relatives or friends in the community, is afraid to return home, and has limited financial resources? a. A support group b. A mental health center c. A women's shelter d. Vocational counseling

c. A women's shelter

The nurse performing the assessment of a wheelchair-bound client suspects that his wife's explanation of how he sustained facial contusions and a broken nose may not be entirely truthful. The nurse should implement which assessment intervention? a. Document the suspicion and follow a policy of "wait and see" whether he returns again. b. Report the husband's injuries to the police and ask for a confidential investigation. c. Have the wife wait in the waiting room so her husband can be interviewed in private. d. Confront the wife with the suspicion that her husband's injuries are the result of abuse.

c. Have the wife wait in the waiting room so her husband can be interviewed in private.

An adult tells the nurse, "My partner abuses me when I make mistakes, but I always get an apology and a gift afterward. I've considered leaving but haven't been able to bring myself to actually do it." Which phase in the cycle of violence prevents this adult from leaving? a. Tension-building b. Acute battering c. Honeymoon d. Stabilization

c. Honeymoon

An older adult with Lewy body dementia lives with family and attends a day care center. A nurse at the day care center noticed the adult had a disheveled appearance, strong odor of urine, and bruises on the limbs and back. What type of abuse might be occurring? a. Psychological b. Financial c. Physical d. Sexual

c. Physical

Which child is at lowest risk for abuse? a. A 3-month-old who has colic and teenaged parents b. A 4-Year-Old who has cerebral palsy and cognitively challenged parents c. A 5-year-old who has ADHD and a father who was abused as a child d. A 2-year-old who has leukemia and two working parents

d. A 2-year-old who has leukemia and two working parents

An adult has a history of physical violence against family when frustrated, followed by periods of remorse after each outburst. Which finding indicates a successful plan of care? The adult a. expresses frustration verbally instead of physically. b. explains the rationale for behaviors to the victim. c. identifies three personal strengths. d. agrees to seek counseling.

a. expresses frustration verbally instead of physically.

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

a. Assisting her in developing a plan to go to a shelter in case of a crisis

An 11-year-old says, "My parents don't like me. They call me stupid and say they wish I were never born. It doesn't matter what they think because I already know I'm dumb." Which nursing diagnosis applies to this child? a. Chronic low self-esteem related to negative feedback from parents b. Deficient knowledge related to interpersonal skills with parents c. Disturbed personal identity related to negative self-evaluation d. Complicated grieving related to poor academic performance

a. Chronic low self-esteem related to negative feedback from parents

When there is reason to suspect that a child is being abused, the nurse must initially implement which intervention? a. Follow agency policy for reporting. b. Confront the parent or parents. c. Call the local police to report it. d. Question the child to obtain proof.

a. Follow agency policy for reporting.

Perpetrators of domestic violence tend to: Select all that apply. a. Have relatively poor social skills and have grown up with poor role models. b. Believe they, if male, should be dominant and in charge in relationships. c. Force their mates to work and expect them to handle the financial decisions. d. Be controlling and willing to use force to maintain their power in relationships. e. Prevent their mates from having relationships and activities outside the family.

a. Have relatively poor social skills and have grown up with poor role models. b. Believe they, if male, should be dominant and in charge in relationships. d. Be controlling and willing to use force to maintain their power in relationships. e. Prevent their mates from having relationships and activities outside the family.

A patient tells the nurse, "My husband lost his job. He's abusive only when he drinks too much. His family was like that when he was growing up. He always apologizes and regrets hurting me." What risk factor was most predictive for the husband to become abusive? a. History of family violence b. Loss of employment c. Abuse of alcohol d. Poverty

a. History of family violence

Which factor is of least importance as a victim of spousal abuse constructs an escape plan? a. How the victim will explain her decision to leave b. Where the victim will go to be safe c. How the victim will arrange for transportation d. What the victim will need to take with her when she leaves

a. How the victim will explain her decision to leave

A nurse assists a victim of intimate partner abuse to create a plan for escape if it becomes necessary. Which components should the plan include? (Select all that apply.) a. Keep a cell phone fully charged. b. Hide money with which to buy new clothes. c. Have the phone number for the nearest shelter. d. Take enough toys to amuse the children for 2 days. e. Secure a supply of current medications for self and children. f. Assemble birth certificates, Social Security cards, and licenses. g. Determine a code word to signal children when it is time to leave.

a. Keep a cell phone fully charged. c. Have the phone number for the nearest shelter. e. Secure a supply of current medications for self and children. f. Assemble birth certificates, Social Security cards, and licenses. g. Determine a code word to signal children when it is time to leave.

Which problem is observed in children who regularly witness acts of violence in their family? Select all that apply. a. Phobias b. Low self-esteem c. Major depressive disorder d. Narcissistic personality disorder e. Posttraumatic stress disorder

a. Phobias b. Low self-esteem c. Major depressive disorder e. Posttraumatic stress disorder

After treatment for a detached retina, a survivor of intimate partner abuse says, "My partner only abuses me when I make mistakes. I've considered leaving, but I was brought up to believe you stay together, no matter what happens." Which diagnosis should be the focus of the nurse's initial actions? a. Risk for injury related to physical abuse from partner b. Social isolation related to lack of a community support system c. Ineffective coping related to uneven distribution of power within a relationship d. Deficient knowledge related to resources for escape from an abusive relationship

a. Risk for injury related to physical abuse from partner

An older adult with Lewy body dementia lives with family. After observing multiple bruises, the home health nurse talked with the daughter, who became defensive and said, "My mother often wanders at night. Last night she fell down the stairs." Which nursing diagnosis has priority? a. Risk for injury related to poor judgment, cognitive impairments, and inadequate supervision b. Wandering related to confusion and disorientation as evidenced by sleepwalking and falls c. Chronic confusion related to degenerative changes in brain tissue as evidenced by nighttime wandering d. Insomnia related to sleep disruptions associated with cognitive impairment as evidenced by wandering at night

a. Risk for injury related to poor judgment, cognitive impairments, and inadequate supervision

The nurse is assisting a patient to identify safety issues that may occur now that she has left an abusive partner. What telephone numbers should be available to the patient? Select all that apply. a. The police department b. An abuse hotline c. A responsible friend or family member d. A domestic violence shelter e. The hospital emergency department

a. The police department b. An abuse hotline c. A responsible friend or family member d. A domestic violence shelter

The risk of elder abuse in a home is best determined by conducting which assessment? a. The vulnerability of the elder and the stress of the caregiver b. The amount of disruption the elder causes in the home c. The financial contribution of the elder and the caregiver's early life experience with abuse d. How much actual physical assistance the elder needs on a daily basis

a. The vulnerability of the elder and the stress of the caregiver

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

a. There is a possibility that the child has been sexually abused.

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

a. Vague physical complaints such as insomnia or pain

A battered woman has been referred to a women's shelter. When the woman's abuser demands to be told where she is, the nurse a. refuses to provide any information. b. gives him the telephone number, but not the address, of the shelter. c. informs him that no information can be given for a minimum of 24 hours. d. calls law enforcement to arrest the husband for the assault and battery of his wife.

a. refuses to provide any information.

An older adult diagnosed with Alzheimer's disease lives with family in a rural area. During the week, this adult attends a day care center while the family is at work. In the evenings, members of the family provide care. Which factor makes this adult most vulnerable to abuse? a. Multiple caregivers b. Alzheimer's disease c. Living in a rural area d. Being part of a busy family

b. Alzheimer's disease

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

b. Direct and professional

Secondary effects of abuse often manifest as arrested development in children due to the fact that: a. Coping is easier than emotional growth b. Energy for development is diverted to coping c. Children cannot differentiate love from abuse d. Abuse fosters a sense of belonging, even if dysfunctional

b. Energy for development is diverted to coping

An elderly woman who has been abused by her caregiver daughter tells the nurse, "You don't have to worry about me. My daughter cried and apologized. She promised me she will never hit me again." The nurse recognizes that the client is describing which stage of the cycle of violence? a. Escalation b. Honeymoon c. Acute battering d. Tension building

b. Honeymoon

What distinction can be made between abuse and neglect? a. Neglect is perpetrated against children; abuse victims can be children or adults. b. Neglect is a failure to provide; abuse is a failure to control aggression. c. Neglect occurs in the psychological domain; abuse occurs in the physical domain. d. Neglect is always physical; abuse can be verbal, physical, sexual, or emotional.

b. Neglect is a failure to provide; abuse is a failure to control aggression.

An older woman diagnosed with Alzheimer's disease lives with family and attends day care. After observing poor hygiene, the nurse talked with the caregiver. This caregiver became defensive and said, "It takes all my energy to care for my mother. She's awake all night. I never get any sleep." Which nursing intervention has priority? a. Teach the caregiver about the effects of sundowner's syndrome. b. Secure additional resources for the mother's evening and night care. c. Support the caregiver to grieve the loss of the mother's cognitive abilities. d. Teach the family how to give physical care more effectively and efficiently.

b. Secure additional resources for the mother's evening and night care.

Which rationale best explains why a nurse should be aware of personal feelings while working with a family experiencing family violence? a. Self-awareness enhances the nurse's advocacy role. b. Strong negative feelings interfere with assessment and judgment. c. Strong positive feelings lead to healthy transference with the victim. d. Positive feelings promote the development of sympathy for patients.

b. Strong negative feelings interfere with assessment and judgment.

An appropriate expected outcome in individual therapy regarding the perpetrator of abuse would be: a. A decrease in family interaction so there are fewer opportunities for abuse to occur. b. The perpetrator will recognize destructive patterns of behavior and learn alternate responses. c. The perpetrator will no longer live with the family but have supervised contact while undergoing intensive inpatient therapy. d. A triad of treatment modalities, including medication, counseling, and role-playing opportunities.

b. The perpetrator will recognize destructive patterns of behavior and learn alternate responses.

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

b. The victim moves toward independence from the abuser.

The abused person is often in a dependent position, relying on the abuser for basic needs. At particular risk are children and older adults due to: a. The love they have for parents or children. b. Their limited options. c. The need to feel safe at home. d. Other relatives do not want them.

b. Their limited options.

Which statement reflects a fact about family violence? a. Alcohol and stress are the major causes of abuse. b. Violence occurs in families of all backgrounds. c. The victim's behavior is often the cause of the violence. d. Ninety-five percent of abuse victims are women.

b. Violence occurs in families of all backgrounds.

Which nursing intervention is best directed at the psychological needs of a physically abused client? a. Encourage the client to immediately leave the abuser. b. Provide a referral to social services for economic problems. c. Affirm that the client did not deserve or cause the abuse. d. Facilitate contact with law enforcement to take legal action.

c. Affirm that the client did not deserve or cause the abuse.