NU472 Week 6 HESI Case Study Evolve Elsevier: Intimate Partner Violence and PTSD - 29 Questions

Which is not a symptom that the nurse would expect to see in a client with post-traumatic stress syndrome? o Self-imposed social isolation. o Nightmares related to the event. o Feeling things more deeply than usual. o Being easily startled, such as by sudden noises.

o Feeling things more deeply than usual. · Post-traumatic stress syndrome is often accompanied by feelings of emotional numbness, not exaggerated feelings.

Two weeks after the initial visit, client returns with her two children. She tells the nurse that she is still living in the shelter and that many of the children there are sick with cold symptoms. Both of her children have congestion and a cough, but her oldest child has been wheezing. The healthcare provider prescribes albuterol 0.1 mg/kg. The child weighs 48 pounds. How many mg of albuterol should the nurse administer? o 4.8 mg o 2 mg o 5 mg o 2.2 mg

o 2.2 mg · First convert pounds to kilograms (48 lbs = 22 kg). Then multiply by 0.1 (22 x 0.1=2.2).

The nurse has completed the assessment and has information to create a plan of care for client. Before stepping outside the room, the nurse explains to client that the healthcare provider will perform an examination but that the nurse will return afterward to speak with client again. The nurse exits the room and meets with the healthcare provider. What is the best way for the nurse to communicate client's history of violence with the healthcare provider? o After asking permission from client to inform the healthcare provider of the abuse, give a thorough report of the assessment findings. o Allow the healthcare provider to do an independent assessment in order to find possible inconsistencies in the story. o Keep the information about the abuse private to increase rapport with the client. o Place a note on the chart letting the healthcare provider know that abuse has occurred.

o After asking permission from client to inform the healthcare provider of the abuse, give a thorough report of the assessment findings. · The history of abuse may affect the diagnosis and treatment of the client. It's important that the healthcare provider has all pertinent information. The client should be in control of whether the information that she tells the nurse is shared as much as possible without risking safety of client or others.

How might living in a domestic violence shelter act as an obstacle for recovery from post-traumatic stress syndrome? o All of these scenarios may serve as an obstacle for recovery. o Being away from familiar people, places, and routines may make coping more difficult. o Living with a large number of strangers may cause overstimulation. o Following house rules in the shelter may feel similar to the controlling nature of the abusive relationship.

o All of these scenarios may serve as an obstacle for recovery. · A client with post-traumatic stress syndrome has increased arousal that may include irritability and exaggerated startle response. The client may be more sensitive to stressors such as living with strangers or following house rules in a shelter situation. A client will also likely have developed coping mechanisms that may not be available to them at the shelter, such as talking to a friend or going to the corner store for a coffee.

A nurse is working in the family medicine clinic in a large community health care center. The first client is a young adult woman who arrives at the center with her two children, ages 4 and 6, and an advocate from the local domestic violence shelter. Because the shelter is near the center, many women and children who are living there have also been clients of the clinic. The nurse overhears the advocate tell the front desk staff that client came to the shelter the previous week and asked to be taken to the clinic because she was having trouble sleeping and had several severe headaches. The front desk staff alert the nurse to the fact that client is a new client at the clinic and has not provided prior medical records. The nurse is ready to take a health history and to assess the client, so the nurse takes client to a private room. The children stay with the advocate in the waiting area. Which is the best reason for the nurse to screen this client for intimate partner violence? o All women of childbearing age should be screened for intimate partner violence. o All clients should be screened for intimate partner violence in a primary care setting. o The nurse is worried that children might be abused and asking their mom about intimate partner violence is a good way to start the conversation. o The nurse overheard that she came from a domestic violence shelter.

o All women of childbearing age should be screened for intimate partner violence. · Screening for intimate partner violence is recommended by the U.S. Preventive Service Task Force for all women of childbearing age.

The client tells the nurse that she is not sure whether she will go back or not. Today, she intends to stay at the shelter, but she says she does not know what she will do tomorrow or the next day. She is attempting to take things one day at a time. Which of the following is the most appropriate action to take next based on the principles of bioethics? o Based on beneficence, the nurse should contact the authorities because the client is not willing to protect herself due to trauma. o Based on justice, the nurse should tell the client that she must report her husband to the police before going back. o Based on autonomy, the nurse should respect the client's decision to stay or leave. o Based on veracity, the nurse should tell the client that she would be making a grave mistake if she returned.

o Based on autonomy, the nurse should respect the client's decision to stay or leave. · It is the duty of a nurse to respect the rights of the client to make their own decisions and offer any assistance possible without adding the nurse's own opinions or judgments.

The nurse asks client to have a seat, and then sits in a chair across from her. Client is visibly uncomfortable and seems reticent to talk about why she is seeking medical attention at the clinic. During the health history portion of the assessment, client tells the nurse that she was treated for postpartum depression after her youngest child was born, but she is currently not on any medications. She also discloses that she has been physically and sexually abused by her husband since her first pregnancy and that this is the first time she has disclosed the abuse to a healthcare provider. Describing the abuse, client states that months would go by without any problems, but then her husband would suddenly become violent. She states that her husband was constantly and often violently jealous. Client tells the nurse that she decided to leave her husband last week because her oldest child was having frequent nightmares about his mother being murdered by his father. Her husband knows where all of her friends and family live, so she was not sure where to go. She called a crisis hotline, and they told her a bed was available at the local shelter for her and her two children. At that point, she decided to go to the shelter. Before the child's nightmares started, she said she coped with the violence by going somewhere else and checking out emotionally. Seeing her child's pain, though, was enough to motivate her to leave the relationship. She had been experiencing headaches and trouble sleeping for several months, but the symptoms seemed to get worse after her first night at the shelter. She says that she is hopeful now that she has started receiving services at the shelter but that she also wants to forget the abuse ever happened and erase it from her mind. What risk factors for depression and anxiety are evident in the client's health history? o Marital status and recent move to a shelter. o Number and age of children. o Headaches and trouble sleeping. o Female gender and history of physical abuse.

o Female gender and history of physical abuse. · Female gender and history of physical abuse are risk factors for depression and anxiety.

What information is most important in determining a plan of care for post-traumatic stress syndrome for this client? o Her willingness to go to counseling. o Her access to formal and informal social support. o Her income and education level. o Whether or not she has health insurance.

o Her access to formal and informal social support. · The client's informal resources (such as a church group or friend) and formal resources (such as an advocate at the shelter or a reduced cost clinic in her neighborhood) are the most important factors in determining her plan of care. These resources will determine the emotional and tangible support that she has to cope with the trauma.

The healthcare provider leaves the room after a consultation with the client. The nurse notes on the chart that the HCP diagnosis noted is Post-Traumatic Stress Disorder. The healthcare provider has prescribed paroxetine 20 mg per day by mouth and a referral to see a counselor. The nurse goes back into the room to talk about the plan of care and provide education on the prescription. First, the nurse wants to help client think of strategies to cope with the trauma and set some goals for the first few weeks after the visit. What would be an effective coping mechanism for dealing with post-traumatic stress for this client? o Confront the abuser to show that she is not afraid of him. o Identify and use a coping mechanism that she used and was effective when she was diagnosed with postpartum depression. o Rely upon the medication to address the symptoms. o Avoid any mention of the subject of the abuser or abuse until she no longer has symptoms of post-traumatic stress.

o Identify and use a coping mechanism that she used and was effective when she was diagnosed with postpartum depression. · Using coping mechanisms that have worked before is the safest and most effective way to address symptoms of post-traumatic stress.

While the healthcare provider is in the room, the nurse goes to the desk to write down a plan of care. While working, the nurse notices client's two children in the waiting area. The 6-year-old is sitting quietly next to the advocate. The child is rocking slightly in the chair and seems preoccupied. The 4-year-old is playing with another young child who is accompanied by a parent. The nurse hears the advocate tell the 4-year-old several times, "No hitting! We don't hit!" As the nurse develops a plan of care for client the nurse also begins to think about client's children and how they might be included in the plan of care. Which of the following is true about the affects of intimate partner violence on children? o Intimate partner violence can cause emotional problems in the child even if the child has not seen or heard the violence happening. o Intimate partner violence alone does not directly affect children, but children in violent homes are often abused emotionally and/or physically abused. o Intimate partner violence can cause emotional problems in the child if the violence is fatal or near-fatal, such as the strangulation attempt on the client. o Intimate partner violence usually only causes emotional problems if the child sees the violence happen.

o Intimate partner violence can cause emotional problems in the child even if the child has not seen or heard the violence happening. · If there is intimate partner violence in the home, children can have serious and lasting physical and mental health problems as a result.

What are some ways to decrease the effects of the large changes on the children while they are in the shelter? o Provide the children a structured schedule so that they do not have time to dwell on unpleasant thoughts. o Allow the children to make all decisions about daily activities. o Maintain normalcy by keeping to family rituals as much as possible. o Be more permissive about behavior problems as punishment is more likely to exacerbate the children's emotional problems.

o Maintain normalcy by keeping to family rituals as much as possible. · The goal for a family with disruption of family dynamics should be to return to as much normalcy as possible. Having expected ways of doing things, like praying before meals or reading a story before bed, will help to minimize stress for the children.

While working on the care plan and observing the children, the nurse begins to feel emotional and angry. The nurse thinks that it is not fair to the children to be subjected to violence in the home. At first the nurse is angry at client's husband for the violence, and then becomes angry at the client for what has been a bad relationship decision. The nurse realizes that the community health center does not have a standard way of addressing potential negative feelings related to hearing about trauma from clients even though the staff members at the center frequently interact with women from the domestic violence shelter and many people who work or volunteer there. What should the nurse do as soon as negative emotions toward the client are realized? o Ask the other nurse working that day to take over care of the client to avoid letting the client know the nurse is angry. o Talk to a friend about the client situation to get the feelings out in the open so that the nurse can move past them. o Ignore the feelings and move forward with care as if the nurse never had them. o Perform a self-assessment to determine the source of the feelings so that the nurse can address them before returning to speak with the client.

o Perform a self-assessment to determine the source of the feelings so that the nurse can address them before returning to speak with the client. · It is common to have negative feelings about clients or their behaviors, but the nurse must still do the assigned task to care for the client. It is most appropriate for the nurse to determine the source of their feelings so that they can work through them and provide the client appropriate care.

What is the nurse most concerned about for this client, knowing her history of depression and intimate partner violence? o Body image issues and eating disorders. o Possibility of suicide or self-harm. o An increase in a chronic disease like hypertension. o Potential for substance abuse.

o Possibility of suicide or self-harm. · Because of the serious nature of suicide and self-harm, this would be the most concerning outcome of depression and history of intimate partner violence for the nurse.

Based on client's experiences of physical and sexual abuse and her symptoms found during the assessment, the nurse realizes that the priority nursing problem relates to possible post-traumatic stress syndrome since the client has been subjected to multiple instances of abuse. The nurse is ready to begin a plan of care for the client. Which is the most important piece of information that the nurse needs at this point to address for post-traumatic stress syndrome? o Previous history of abuse in childhood and adulthood. o Whether or not her children have been abused. o The client's income and education level. o Family psychiatric medical history.

o Previous history of abuse in childhood and adulthood. · Cumulative trauma is an important factor in the severity and duration of post-traumatic stress syndrome. The more traumatic incidences that the client has had in their lifetime, the greater risk they have for more severe and lengthy problems after a traumatic event.

What activity should the nurse suggest to the nurse's supervisor to help the nurses and other staff at the community health center deal with the emotional issues of interacting with traumatized clients in the future? o Provide a venue for talking about feelings related to interacting with traumatized clients while protecting the client's privacy. o Encourage nurses who experience secondary trauma to seek counseling from their own healthcare provider. o Hire a psychologist to talk to traumatized clients because it is beyond the nurse's scope of practice. o Have clients do a violence screen on the computer so the nurses do not have to hear about specific violent incidences.

o Provide a venue for talking about feelings related to interacting with traumatized clients while protecting the client's privacy. · Secondary trauma is common in nurses that interact with individuals who have experienced intimate partner violence. It is appropriate for a clinic to provide a venue where nurses who are at risk for secondary trauma can talk about feelings and learn strategies for self-care.

Based on the history of violence, which physical health conditions would the nurse expect the healthcare provider to screen for? o Type 2 diabetes due to risk for disordered eating. o Liver failure due to risk for substance abuse. o Dementia due to head trauma. o Sexually transmitted disease due to forced sex.

o Sexually transmitted disease due to forced sex. · Clients with a history of sexual abuse should be screened for sexually transmitted diseases if they have not been screened since the assault.

What other factors may affect client's risk for being murdered by her husband? o She will have a lower risk of being murdered after recently leaving the abusive relationship. o She will have a higher risk of being murdered if she believes he is capable of killing her. o She will have a higher risk of being murdered if her husband has a job. o She will have a lower risk of being murdered if she has access to a gun in the home.

o She will have a higher risk of being murdered if she believes he is capable of killing her. · Women who have experienced intimate partner violence are often accurate in their own risk assessment. Therefore, if a woman believes her intimate partner is capable of killing her, it is an important indication that she has a high risk of being murdered by the abuser.

After discussing the possibility of client returning to her husband, the nurse knows that the most important intervention that can be done immediately is to create a safety plan. What would not be an appropriate item to include on a safety plan? o Shredding important documents with personal information. o Hiding money or opening a savings account in her own name. o Telling neighbors or friends to call the police if they hear or see violent behavior. o Keeping important phone numbers handy.

o Shredding important documents with personal information. · Making copies of important documents, such as birth certificates or health insurance cards, and keeping them in a safe place is important in case the woman needs to leave quickly.

What does the nurse know about client's level of danger, based on the strangulation incident? o Because the strangulation was non-fatal, it is likely that her husband is not capable of murdering her, so her future risk for being murdered is low. o Strangulation is an extremely rare form of intimate partner violence and no information is available on her future risk of murder. o Strangulation is an indication that her risk of being murdered by her husband is high. o The client has no increased risk of being murdered based on strangulation alone. The nurse needs to assess further to determine risk.

o Strangulation is an indication that her risk of being murdered by her husband is high. · Strangulation is an indication that the client's level of danger, including risk for murder, is high.

How should the nurse assess the children for post-traumatic stress syndrome? o It is not possible for these children to have post-traumatic stress syndrome because they are not old enough. o The assessment should only include the feelings of safety and security as talking about the event may worsen the trauma. o The assessment should include their exposure to a traumatic event, their understanding of the event, and their feeling of safety after the event. o The assessment for children is the same as assessment for adults.

o The assessment should include their exposure to a traumatic event, their understanding of the event, and their feeling of safety after the event. · It is important to assess for post-traumatic stress in a developmentally appropriate way, including gaining an understanding of their perception of the event and how it has affected their feelings of security after the event.

Which is not an important reason for the nurse to consider the children's mental health in the formulation of the plan of care for this particular client? o The children have a better chance of recovery from trauma than their mother due to their young age, so it is best to focus on them. o The client's parenting might be affected by her post-traumatic stress syndrome, so gathering information about the children may help in planning outcomes. o If the children are experiencing behavioral problems, it may further traumatize the client and exacerbate her mental health problems. o The children have multiple risk factors for mental health problems.

o The children have a better chance of recovery from trauma than their mother due to their young age, so it is best to focus on them. · If the mother has poor mental health, it places her children at risk for mental health problems as well. Ignoring the mental health issues of the mother is not appropriate.

What are some realistic short-term outcome goals that the nurse should set with client related to the HCP's diagnosis of Post-Traumatic Stress Disorder? o The client will effectively suppress memories of the event to avoid distress. o The client will return to pre-trauma level of functioning. o The client will complete daily tasks without needing assistance from social support. o The client will speak about the trauma and express feelings of rage, guilt, fear, anxiety, and hopelessness.

o The client will speak about the trauma and express feelings of rage, guilt, fear, anxiety, and hopelessness. · Confronting feelings and memories is an important part of recovery from trauma.

The nurse begins the assessment. The client's vital signs are as follows: temperature 98.5° F (36.9° C), heart rate 85 beats/minute, respirations 19 breaths/minute, and blood pressure 140/88 mmHg. Her neurological assessment is within normal limits. While client's vital signs and demeanor are indicative of someone under stress, the nurse does not see any visible signs of injury. During the assessment, client tells the nurse the story of the most recent violent incident. She arrived home late from her job due to traffic. Her husband accused her of having an affair with a co-worker and coming home late as a result of spending time with the co-worker. She denied it and yelled at him for being overly jealous. After she yelled, he knocked her to the ground and put his knees on her chest. He then placed his hands on her neck and cut off her air until she passed out. When she woke up, he was gone. She was confused at first and realized that she had an episode of incontinence while unconscious. One child was at his grandmother's house, but the other was at home with her when the incident happened. She could not say how long she had been unconscious, but child was sitting next to her on the floor when she awoke. This incident happened about one or two months ago. She cannot remember precisely when. She did not seek medical care or report the incident to the police because she was afraid of her husband and what he might do to her or her family because he had made threats against her parents and her sibling in the past. Now that the nurse knows that a specific violent event has occurred, what is the nurse's responsibility to report the incident? o The nurse is not required to report the incident because it may put the client at greater risk. o The nurse is not required to report the incident because it is the healthcare provider's responsibility. o The nurse is required to report the incident to Child Protective Services (CPS) because the children may be in danger. o The nurse is required to report the incident to the police because reporting acts of violence against adults is required by law.

o The nurse is not required to report the incident because it may put the client at greater risk. · There is no law requiring nurses to report intimate partner violence. Involving the police without the client's consent may put the client in more danger of violence by her intimate partner.

What else can the nurse determine about these children's risk for emotional and behavioral problems from the assessment of the family so far? o The children would probably have better mental health outcomes if their mother returned to the abuser even if her mental health would suffer. o Any mental health problems that the children have are not likely to affect their development if they are otherwise healthy. o They are more likely to suffer from emotional problems because their mother has a history of depression. o Because of the history of violence in the home, they will definitely develop mental and behavioral health problems.

o They are more likely to suffer from emotional problems because their mother has a history of depression. · Children are at greater risk for emotional problems if a parent has mental health problems.

What is the best explanation for the husband's change in behavior and attitudes from the previous violent event to the Facebook messages asking for forgiveness? o Her husband has likely made a decision to permanently change his behavior based on the client's actions. o Her husband is probably being kind out of fear of the client calling the police or taking him to court. o This behavior is an expected part of the cycle of violence and is termed the honeymoon phase. o Her husband is lying and has no intention of actually changing.

o This behavior is an expected part of the cycle of violence and is termed the honeymoon phase. · The cycle of violence includes a tension-building phase, a serious battering phase, and a honeymoon phase. During the honeymoon phase, the abuser displays loving and apologetic behavior.

Which is the best way for the nurse to screen for intimate partner violence? o Ask client is she has any specific injuries related to violence. o Ask many, specific questions about types of violence so that you can document her history of abuse in the chart in case of legal action. o Tell client that she can trust the nurse and then give her the opportunity to disclose abuse if she wants to. o Use an evidence-based tool such as the Abuse Assessment Screen.

o Use an evidence-based tool such as the Abuse Assessment Screen. · Evidence-based tools like the Abuse Assessment Screen are the best way to screen for intimate partner violence because they have been tested for reliability and validity. They also limit interviewer bias.

Which behavior should the nurse avoid because it could make client less likely to disclose violence to you? o Waiting in silence for her to answer the questions. o Telling her that the nurse is legally required to contact the authorities if she discloses violence against her children. o Using probing language to press for a response. o Interviewing her alone without her children or the advocate.

o Using probing language to press for a response. · Using probing language or pressing for more information than the client is ready to disclose will decrease the likelihood of disclosure.

How should the nurse document an assault such as the one the client just described in the record? o Write down the nurse's own assessment of injuries or symptoms related to the violence, but do not include any information that the nurse does not have evidence to support. o Do not write anything if the client has no intention of going to the police about the incident. o Write down verbatim the statements that the client makes related to who assaulted her and when. o Do not write anything as it is beyond the nurse's scope of practice to collect evidence about violence.

o Write down verbatim the statements that the client makes related to who assaulted her and when. · The notes taken about the incident may be used as evidence or future care. It is best to write word for word what the clients says about the details of the incident, including the person who assaulted her and when it happened.

What is the best thing for the nurse to say in response to client wanting to return to her husband? o Tell the client to think of her children and remind her that they are already showing signs of emotional problems. o Express concerned about the client's safety if returning to a home situation that could result in of being injured or killed. o Remind the client that her husband is an abuser, and he will never change. o Relay to the client that this is very normal and clients often return to their abuser many times before leaving.

o Express concern about client's safety if returning to home situation that could result in injury or death. · It is most appropriate for the nurse to remind the client in a non-judgmental way that returning to the person who assaulted her is a threat to their safety.