Chapter 9: Violence and Abuse

Unsafe rooms in the house

(1) the kitchen because sharp instruments are there and (2) from the bathroom because the space is small and contains many hard surfaces.

Prevalence of IPV

25% and 30%

Intimate partner violence

A pattern of assaultive and coercive behaviors which may include inflicted physical injury, psychological abuse, sexual assault, progressive social isolation, deprivation, intimidation, and threats. These behaviors are perpetrated by someone who is, was, or wishes to be involved in an intimate or dating relationship with an adult or adolescent, and they are aimed at establishing control by one partner over the other (Family Violence Prevention Fund, 1999).

Those at high risk

Age less than 45, low income, lack of employment, recent separation or divorce, education at the high school level or less, and having young children.

When developing a presentation for a local community organization on violence, the nurse is planning to include statistics on intimate partner abuse and its effects on children. In what percentage of the cases in which a parent is abused are the children battered also? A) 50% to 75% B) 25% to 50% C) 10% to 25% D) Less than 5%

Ans: A Feedback: In 50% to 75% of cases when a parent is abused, the children are abused as well.

After teaching a group of students about sexual abuse and violence, the instructor determines that the teaching was successful when the students describe incest as involving which of the following? A) Sexual exploitation by blood or surrogate relatives B) Sexual abuse of individuals over age 18 C) Violent aggressive assault on a person D) Consent between perpetrator and victim.

Ans: A Feedback: Incest is any type of sexual exploitation between blood relatives or surrogate relatives before the victim reaches 18 years of age. Rape is a violent, aggressive assault on the victim's body and integrity. Rape is a legal rather than a medical term. It denotes penile penetration of the vagina, mouth, or rectum of the female or male without consent. It may or may not include the use of a weapon.

When a nurse suspects that a client may have been abused, the first action should be to: A) Ask the client about the injuries and if they are related to abuse. B) Encourage the client to leave the batterer immediately. C) Set up an appointment with a domestic violence counselor. D) Ask the suspected abuser about the victim's injuries.

Ans: A Feedback: The first step is to screen for abuse and identify the connection between the woman's injuries and abuse. Once abuse is detected, the nurse should immediately isolate the woman to provide privacy and prevent retaliation by the abuser. Encouraging the woman to leave the batterer immediately is not realistic. Setting up an appointment with a counselor would be appropriate once the abuse is detected and the woman is safe. Questioning the suspected abuser might worsen the situation.

Which of the following nursing actions would be least helpful for a client who is a victim of violence? A) Assist the client to project her anger. B) Provide information about a safe home and crisis line. C) Teach her about the cycle of violence. D) Discuss her legal and personal rights.

Ans: A Feedback: The goal of intervention is to enable the victim to gain control by providing sensitive, predictable care in an accepting setting. Assisting the client to project her anger would not be helpful when the woman needs support and education.

When the nurse is alone with a client, the client says, "It was all my fault. The house was so messy when he got home and I know he hates that." Which response would be most appropriate? A) "It is not your fault. No one deserves to be hurt. " B) "What else did you do to make him so angry with you?" C) "You need to start to clean the house early in the day." D) "Remember, he works hard and you need to meet his needs."

Ans: A Feedback: The nurse needs to communicate nonjudgmental support and explain that no one deserves to be abused. Doing so helps to establish trust and rapport. Asking the woman what she did to make the partner so angry, telling her to clean the house earlier in the day, and telling her that she needs to meet his needs all shift the blame to the victim and are thus inappropriate.

After teaching a class on sexual violence, the instructor determines that the teaching was successful when the class identifies which of the following as a type of sexual violence. (Select all that apply.) A) Female genital cutting B) Bondage C) Infanticide D) Human trafficking E) Rape

Ans: A, B, C, D, E Feedback: Female genital cutting, bondage, infanticide, human trafficking, and rape are all examples of sexual violence.

A nurse is working with a victim of intimate partner violence and helping her develop a safety plan. Which of the following would the nurse suggest that the woman take with her? (Select all that apply.) A) Driver's license B) Social security number C) Cash D) Phone cards E) Health insurance cards

Ans: A, B, C, E Feedback: When leaving an abusive relationship, the woman should take her driver's license or photo ID, social security number or green card/work permit, birth certificates, any court papers or orders, credit cards, cash, and health insurance cards. The woman should avoid phone cards because they leave a trail to follow.

In addition to providing privacy, which of the following would be most appropriate initially in situations involving suspected abuse? A) Allow the client to have a good cry over the situation. B) Tell the client, "Injuries like these don't usually happen by accident." C) Call the police immediately so they can question the victim. D) Ask the abuser to describe his side of the story first.

Ans: B Feedback: Communicating support through a nonjudgmental attitude and telling her that no one deserves to be abused are the first steps in establishing trust and rapport. Allowing the client to cry is appropriate after the client is safe, her privacy is protected, and the nurse has emphasized that there is a problem. Notifying the police is done once the assessment reveals suspicion or actual indications of abuse. Asking the abuser to describe his side of the story is inappropriate.

A nurse is reading a journal article about sexual abuse. Which age range would the nurse expect to find as the peak age for such abuse? A) 7-10 years B) 8-12 years C) 14-18 years D) 18-22 years

Ans: B Feedback: Current estimates indicate that 1 of 5 girls is sexually abused, and the peak ages of such abuse are from 8 to 12 years of age. At every age in the life span, females are more likely to be sexually abused by father, brother, family member, neighbor, boyfriend, husband, partner or ex-partner than by a stranger or anonymous assailant.

Which of the following would the nurse describe as a characteristic of the second phase of the cycle of violence? A) The batterer is contrite and attempts to apologize for the behavior. B) The physical battery is abrupt and unpredictable. C) Verbal assaults begin to escalate toward the victim. D) The victim accepts the anger as legitimately directed at her.

Ans: B Feedback: During the second phase of the cycle of violence, the violence explodes and the batterer loses control physically and emotionally. During the honeymoon or third phase, the batterer is contrite and attempts to apologize for the behavior. During the first phase or tension-building phase, verbal or minor battery occurs and the woman often accepts her partner's building anger as legitimately directed toward her.

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) One in three B) One in six C) Two in 15 D) Three in 20

Ans: B Feedback: The National Center for Prevention and Control of Sexual Assault estimates that one out of six women will be sexually assaulted sometime in her life, and two thirds of these assaults will not be reported.

A nurse is caring for a woman who was recently raped. The nurse would expect this woman to experience which of the following first? A) Denial B) Disorganization C) Reorganization D) Integration

Ans: B Feedback: The acute phase of rape recovery is disorganization characterized by shock, fear, disbelief, anger, shame, guilt and feelings of uncleanliness. This is followed by denial (outward adjustment), reorganization, and finally integration and recovery.

A battered pregnant woman reports to the nurse that her husband has stopped hitting her and promises never to hurt her again. Which of the following is an appropriate response? A) "That's great. I wish you both the best." B) "The cycle of violence often repeats itself." C) "He probably didn't mean to hurt you." D) "You need to consider leaving him."

Ans: B Feedback: The cycle of violence typically increases in frequency and severity as it is repeated over and over again. The woman needs to understand this.

When describing the cycle of violence to a community group, the nurse explains that the first phase usually is: A) Somehow triggered by the victim's behavior B) Characterized by tension-building and minor battery C) Associated with loss of physical and emotional control D) Like a honeymoon that lulls the victim

Ans: B Feedback: The cyclic behavior begins with a time of tension-building arguments, progresses to violence, and settles into a making-up or calm period.

A nurse is assessing a rape survivor for post-traumatic stress disorder. The nurse asks the woman, "Do you feel as though you are reliving the trauma?" The nurse is assessing for which of the following? A) Physical symptoms B) Intrusive thoughts C) Avoidance D) Hyperarousal

Ans: B Feedback: The question is used to assess the woman 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 woman of the rape. Hyperarousal would be noted by irritability and an exaggerated startle response.

The nurse is presenting a class at a local community health center on violence during pregnancy. Which of the following would the nurse include as a possible complication? A) Hypertension of pregnancy B) Chorioamnionitis C) Placenta previa D) Postterm labor

Ans: B Feedback: Women assaulted during pregnancy are at risk for chorioamnionitis, placental abruption, preterm labor, stillbirth, miscarriage, uterine rupture, and injuries to the mother and fetus. Hypertension of pregnancy is not associated with violence during pregnancy.

A group of nurses are researching information about risk factors for intimate partner violence in men. Which of the following would the nurses expect to find related to the individual person? (Select all that apply.) A) Dysfunctional family system B) Low academic achievement C) Victim of childhood violence D) Heavy alcohol consumption E) Economic stress

Ans: B, C, D Feedback: Individual risk factors associated with intimate partner violence include young age, heavy drinking, low academic achievement, and experience of or witnessing of violence as a child. Dysfunctional family system and economic stress are risk factors associated with the relationship.

A group of students are preparing a class discussion about rape and sexual assault. Which of the following would the students include as being most accurate? (Select all that apply.) A) Most victims of rape tell someone about it. B) Few women falsely cry "rape." C) Women have rape fantasies desiring to be raped. D) A rape victim feels vulnerable and betrayed afterwards. E) Medication and counseling can help a rape victim cope.

Ans: B, D, E Feedback: The majority of women never tell anyone about a rape. Almost two thirds of victims never report it to the police. The victim feels vulnerable, betrayed, and insecure after a rape. Few women falsely cry "rape." Reality and fantasy are different and dreams have nothing to do with the brutal violation of rape. Medication can help initially, but counseling is usually needed.

When describing an episode, the victim reports that she attempted to calm her partner down to keep things from escalating. This behavior reflects which phase of the cycle of violence? A) Battering B) Honeymoon C) Tension-building D) Reconciliation

Ans: C Feedback: During the first phase, tension-building, the woman attempts to keep the situation from exploding based on her belief that the partner's anger is legitimately directed at her. The battering phase involves the explosion of violence. The honeymoon or reconciliation phase is manifested by a period of calm, loving, contrite behavior on the part of the batterer. The batterer may be genuinely sorry for the pain he caused.

During a follow-up visit to the clinic, a victim of sexual assault reports that she has changed her job and moved to another town. She tells the nurse, "I pretty much stay to myself at work and at home." The nurse interprets these findings to indicate that the client is in which phase of rape recovery? A) Disorganization B) Denial C) Reorganization D) Integration

Ans: C Feedback: During the reorganization phase, the survivor attempts to make life adjustments by moving or changing jobs and uses emotional distancing to cope. The disorganization phase is characterized by shock, fear, disbelief, anger, shame, guilt, and feelings of uncleanliness. During the denial or outward adjustment phase, the survivor appears outwardly composed and returns to work or school and refuses to discuss the assault and denies the need for counseling. During the integration and recovery phase, the survivor begins to feel safe and starts to trust others.

Teaching for victims who are recovering from abusive situations must focus on ways to: A) Enhance their personal appearance and hairstyle B) Develop their creativity and work ethic C) Improve their communication skills and assertiveness D) Plan more nutritious meals to improve their own health

Ans: C Feedback: Providing reassurance and support to a victim of abuse is key if the violence is to end. Appropriate actions can help victims express their thoughts and feelings in constructive ways and strengthen their control over their lives. Although interventions related to personal appearance and creativity can enhance the woman's self-esteem, they are not helpful in dealing with the abuse. Planning nutritious meals helps to promote a healthy lifestyle but is ineffective in dealing with the abuse.

The primary goal when working with victims of intimate partner violence is to: A) Convince them to leave the abuser soon B) Help them cope with their life as it is C) Empower them to regain control of their life D) Arrest the abuser so he or she can't abuse again

Ans: C Feedback: The goal of intervention is to enable the victim to gain control over her life. Although the nurse can encourage the woman to leave the abuser, the choice to leave must be made by the woman. The nurse can provide support and assistance with coping, but the ultimate goal is for the woman to become empowered. Arresting the abuser does not necessarily stop the abuse.

Which approach would be most appropriate when counseling a woman who is a suspected victim of violence? A) Offer her a pamphlet about the local battered women's shelter. B) Call her at home to ask her some questions about her marriage. C) Wait until she comes in a few more times to make a better assessment. D) Ask, "Have you ever been physically hurt by your partner?"

Ans: D Feedback: If violence is suspected, the nurse must use direct or indirect questions to screen for abuse. Asking the woman if she has ever been physically hurt by her partner is most appropriate. Offering her a pamphlet, calling her at home, or waiting until she returns are inappropriate and do not validate the suspicion.

After teaching a class on date rape, the instructor determines that the teaching was successful when the class identifies which of the following as the most common date rape drug? A) Gamma hydroxybutyrate B) Liquid ecstasy C) Ketamine D) Rohypnol

Ans: D Feedback: Rohypnol is the most common date rape drug. Others include gamma hydroxybutyrate, or liquid ecstasy, and ketamine.

Which of the following statements would be most appropriate to empower victims of violence to take action? A) "Give your partner more time to come around." B) "Remember—children do best in two-parent families." C) "Change your behavior so as not to trigger the violence." D) "You are a good person and you deserve better than this."

Ans: D Feedback: To help the woman gain control over her life, the nurse should emphasize that abuse is never okay and that the woman did not deserve the abuse or ask for it. Telling the woman to give her partner more time, saying that children need two parents, and suggesting that she change her behavior do not promote control; rather, they attempt to excuse the partner's behavior.

Pediatric screening strategies

Asking mothers indirectly (written questionnaire, computer survey) Asking mothers directly, without the child present Having providers inform parents about mandatory reporting laws prior to asking questions Being able to screen for safety and dangerousness of the situation Being aware of resources and referrals

Forensic nursing

Board certification collect evidence, counsel clients, and communicate with professionals in legal systems

Safety planning for victims

Components for safety planning include a crisis/disaster plan, a place to go, how to get there, and other considerations (e.g., if the abused victim stays and the abuser leaves, if victim and the abuser stay together, or if the victim decides to leave).

Relationship factors for IPV

Economic stress Marital conflicts (e.g., fights) Marital instability (e.g., divorce/separation) Dominance/control of relationship by one partner over another Unhealthy family relationships and interactions

Primary prevention examples

Educate high-risk groups

Violence

Framed in the context of "intentional" violence, or stated another way, that which is carried out by a person or persons against another person or persons when there is a conscious choice to act in a violent manner.

Lethality risks

Is there a gun in the house? Is the woman's partner unemployed? What is the worst thing the partner has ever done to the victim? Does the victim feel that the partner is capable of hurting her? Of carrying out his threats? Has the woman's partner ever been arrested? Is the woman's partner using drugs? Drinking excessively?

Individual risk factors for IPV

Low self-esteem Low income Low academic achievement Young age Aggressive behavior as a child Heavy alcohol/drug use Depression Anger and hostility Antisocial personality traits Borderline personality traits History of being physically abused Few friends/isolation and abused Unemployment Emotional dependence and insecurity Belief in strict gender roles Desire for power and control Perpetrating psychological aggression in relationships Victim of physical or psychological abuse as a child Experiencing poor parenting Experiencing physical discipline as a child

Community/social factors for IPV

Poverty and associated factors (e.g., overcrowding) Low social capital—lack of institutions, relationships, and norms that shape a community's social interactions Weak community sanctions against intimate partner violence (e.g., unwillingness of neighbors to intervene when violence is witnessed) Traditional gender roles (e.g., women should stay at home, be submissive, not enter the workforce; men support the family and make the decisions)

Gender based violence

Violence against women and girls

What types of abuse is the nurse required to report?

abuse of an elderly person, a child, or a person with a disability

Tertiary prevention examples

caring for victims affected by, or currently experiencing, violence

Reasons for homelessness

deinstitutionalization efforts of the 1960s to mainstream the mentally ill into society, unemployment and underemployment, domestic violence, abandonment, natural disasters and fires, disability, substance abuse and addiction, immigration, and political unrest and wars

Safest rooms in the house

room with a window or door, carry her cell phone with 911 set to speed dial, and tell family members and neighbors.

Secondary prevention examples

screen women of childbearing age for IPV, and provide intervention services or refer women who screen positive to intervention services