Violence & Abuse / Adult

Childhood aggression

____________ is the strongest predictor of childhood violence

initimate partner violence

What is the leading cause of pregnancy related deaths?

2 Following agency policy for reporting Nurses are mandated reporters of child abuse. They must follow the rules set forth by the state regarding the steps to take to report child abuse. Calling the police, confronting the parents, and interrogating the child would not be the nurse's initial steps.

Which action would the nurse implement initially when suspecting that a child has been abused? 1 Calling the local police to report it 2 Following agency policy for reporting 3 Confronting the parent or parents 4 Interrogating the child to obtain proof

not highly effective

treatment for batterer are

2 Love, gifts, and praise from the abusive partner In the cycle of abuse, the serious battering phase is followed by a honeymoon phase in which the abuser shows loving behavior to the victim.

female patient in a relationship characterized by a long history of battering and abuse tells the nurse, "We've had a rough time lately. I admit it; he beat me last night but then said he was sorry." Which event would the nurse most expect to occur next in this relationship? 1 Another beating by the abusive partner 2 Love, gifts, and praise from the abusive partner 3 A brief period in which the partners ignore each other 4 An absence of the abusive partner from the relationship for a short time

2 The child has been sexually abused. Sexualized behavior is one of the most common symptoms of sexual abuse in children. Younger children may draw sexually explicit images, demonstrate sexual aggression, or act out sexual interactions in play, for example, with dolls. Masturbation may be excessive in sexually abused children.

A mother brings her 4-year-old daughter to the emergency department and states that the child has been "acting funny." The mother states, "She touches her vagina and rubs herself down there all the time, and she never did that before." Which conclusion can most likely be drawn from this behavior? 1 This is normal developmental behavior in a 4-year-old child. 2 The child has been sexually abused. 3 The mother needs education regarding age-appropriate parenting skills. 4 The child has been exposed to graphic sexual images on television.

1 "You are safe now. I will stay with you in this private room." A sexual assault victim who arrives at the ED needs compassionate supportive care and would not be left alone. People who go to the ED after a sexual assault are frequently seeking reassurance of their safety, so the first priority is to communicate that the patient is safe and will not be left alone.

An emergency department (ED) nurse is talking with a newly admitted victim of rape. Which communication would the nurse first offer to this patient? 1 "You are safe now. I will stay with you in this private room." 2 "Would you like your family member to stay with you during the examination?" 3 "You made a good decision to come to the hospital after you were raped." 4 "What questions do you have about your sexual assault forensic examination?"

4 Check the underlying cause of delirium and treat the cause. Delirium is a state in which a patient can become agitated and go in and out of reality. Such patients can have visual hallucinations during which they see people, animals, or bugs that are not there. The best course of treatment for such patients is to identify the underlying cause and treat it.

Which action is appropriate for the nurse to take to manage the care of a patient diagnosed with delirium who has unpredictable violent behavior and reports that someone is hiding under the bed and the person must be killed? 1 Calm the patient using validation therapy. 2 Restrain the patient using mechanical restraint. 3 Check under the patient's bed to see whether someone is there. 4 Check the underlying cause of delirium and treat the cause.

3 Move to the rear of the staff group. There is no need for the nurse to stand his or her ground to save face. The goal is to de-escalate the situation. When the patient makes a request that can be met without compromising safety, granting the request is acceptable. The nurse should move to the rear of the staff group. The nurse should not continue to manage the situation personally, tell the patient, "It isn't safe for me to leave the room," or apologize for upsetting the patient.

Which action would the nurse take when the patient shouts, "I will calm down when that nurse isn't in my face"? 1 Continue to manage the situation personally. 2 Tell the patient, "It isn't safe for me to leave the room." 3 Move to the rear of the staff group. 4 Apologize for upsetting the patient.

1 γ-Hydroxybutyric acid (GHB) GHB is legally used for treating narcolepsy. This drug has a high potential to cause relaxation, euphoria, and disinhibition. This drug is also known to be used for date rape. Flunitrazepam is associated with date rape and is not legal in the United States

Which date rape drug is used legally to treat narcolepsy? 1 γ-Hydroxybutyric acid (GHB) 2 Flunitrazepam 3 Ketamine 4 Phencyclidine (PCP)

2 The parents were teenagers when the children were born. The classic frustration-aggression hypothesis proposes that when frustration is high in response to negative societal situations, frustration may lead to aggression. Early parenthood is considered such a stressor. A father who stays at home, families who socialize only with other immigrant families, and parents of different backgrounds are not considered triggers for abusive behaviors.

Which family characteristic is a possible trigger for abusive behaviors? 1 The father is a stay-at-home parent. 2 The parents were teenagers when the children were born. 3 The family socializes only with other immigrant families. 4 The parents are of different ethnic and religious backgrounds.

2 Fear of parking lots 3 Frequent nightmares

Which finding in a patient raped 6 weeks ago at a local shopping mall parking lot indicates that the patient is now in the long-term phase of rape-trauma syndrome? Select all that apply. One, some, or all responses may be correct. 1 Lethargy 2 Fear of parking lots 3 Frequent nightmares 4 Complaints of numbness 5 Feelings of shock and disbelief

2 Talk with the patient individually about familiar family and friends. Patients with cognitive deficits, such as multi-infarct dementia, are vulnerable to agitation. When a nurse shows interest in the patient's life, the nurse establishes him- or herself as a safe, understanding person. In turn, the patient often becomes calmer and more open to redirection.

Which intervention is appropriate for de-escalating a 78-year-old patient who is agitated because an unfamiliar staff person is providing care? 1 Repeatedly reinforce the patient's orientation. 2 Talk with the patient individually about familiar family and friends. 3 Administer a medication with sedative properties to reduce agitation. 4 Reduce environmental stimulation by placing the patient in a quiet room until the agitation subsides.

1 Being assertive with the patient 3 Responding as early as possible 4 Assuming a nonaggressive posture 5 Giving several options to the patient Nurses should know the de-escalation techniques when dealing with an angry patient. Some of the techniques to be used include being assertive with the patient, responding as early as possible, utilizing a nonaggressive posture, and giving several options to the patient. If the nurse does not respond immediately, then the patient could become more aggressive.

Which intervention is appropriate when dealing with an angry patient? Select all that apply. One, some, or all responses may be correct. 1 Being assertive with the patient 2 Purposefully delaying response 3 Responding as early as possible 4 Assuming a nonaggressive posture 5 Giving several options to the patient

1 Giving playing cards to the patient for distraction 2 Leaving the room immediately when the patient starts verbal abuse 4 Scheduling contact with the patient every 30 to 60 minutes Playing cards can be provided to keep the patient busy and distracted. It also helps build rapport and gives reassurance to the patient. If the patient starts verbal abuse, the nurse should immediately leave the room. The patient must be left alone and can be informed that the nurse will be back after 20 minutes if the situation becomes calmer. Patients who verbally abuse can be managed by following scheduled contact, such as interacting once for every 30 to 60 minutes.

Which intervention would the nurse implement when a patient is unable to control aggressive and verbally abusive behavior? Select all that apply. One, some, or all responses may be correct. 1 Giving playing cards to the patient for distraction 2 Leaving the room immediately when the patient starts verbal abuse 3 Sitting silently when the patient starts verbal abuse 4 Scheduling contact with the patient every 30 to 60 minutes 5 Continuing to interact even while the patient starts abusing

1 Antibiotics 2 Antidepressants 3 Benzodiazepines 5 Emergency contraception The nurse should administer antibiotics to prevent sexually transmitted infections, antidepressants to manage posttraumatic stress disorder, benzodiazepines to manage anxiety, and emergency contraception to prevent pregnancy.

Which medication would the nurse anticipate giving a female patient who presents to the emergency department after reporting a sexual assault? Select all that apply. One, some, or all responses may be correct. 1 Antibiotics 2 Antidepressants 3 Benzodiazepines 4 Antihypertensives 5 Emergency contraception

3 Physical evidence supports that vaginal penetration occurred. Documentation would be made without use of pejorative terms and would be accurate and meticulous. Penetration is the preferred term when describing the sexual aspects of the assault. Pejorative terms often reflect old myths and a lack of knowledge and understanding regarding the rape victim's experience and need for immediate intervention. Words such as alleged, refused, and intercourse and phrases such as "no acute emotional distress" would all minimize the devastation of the event.

Which notation made by the emergency department (ED) nurse demonstrates appropriate nonjudgmental documentation when treating a patient after a sexual assault? 1 An alleged sexual assault of the patient took place inside a local parking garage. 2 No acute emotional distress during assessment was noted. 3 Physical evidence supports that vaginal penetration occurred. 4 Treatment for facial abrasions was refused.

2 "Are you feeling any desire to kill your abuser?" Safety always comes first. Therefore the nurse would assess the patient's homicide potential. If a victim has any desire to kill the perpetrator, an intervention would be needed so that any such possibility can be prevented. For anxiety or depression, counseling can be done, and the patient can be referred to a proper care facility. If the patient wants further treatment, based on the patient's condition, a psychiatric inpatient care facility or an outpatient facility can be referred. After knowing about the abuse, the nurse mandatorily reports it to the police. The patient can take legal action, and the health care record of abuse will be helpful in legal proceedings.

Which nursing assessment question has the most significance when planning discharge for a victim of severe domestic abuse? 1 "Are you feeling anxious or depressed?" 2 "Are you feeling any desire to kill your abuser?" 3 "Are you willing to engage in further treatment?" 4 "Are you willing to have your abuser arrested?"

2 Affirming that the patient did not deserve or cause the abuse Abused patients often believe that they are deserving of the abuse and, in some way, prompt the abuser to attack. They need specific reassurance that they did not deserve to be abused, and they did not cause the attack. The nurse would remain nonjudgmental about the abuser. Assisting with economic problems and legal action would not address the patient's psychological needs.

Which nursing intervention is directed at the psychological needs of an abused woman? 1 Encouraging the patient to immediately leave the abuser 2 Affirming that the patient did not deserve or cause the abuse 3 Providing a referral to social services for economic problems 4 Facilitating contact with law enforcement to take legal action

3 The child will form a trusting relationship with the nurse. Establishment of trust and rapport is the priority outcome. This outcome precedes focusing on details of the injuries because trust is crucial if the child is to feel comfortable enough to self-disclose. Attending school on time, acknowledging abuse by caregivers, and refraining from aggressive behavior may apply later in the nurse-patient relationship.

Which outcome would the nurse identify as being the initial priority for a child who is suspected of being physically abused? 1 The child will attend school on time. 2 The child will acknowledge abuse by caregivers. 3 The child will form a trusting relationship with the nurse. 4 The child will refrain from aggressive behavior with others.

1 Has a need to be in charge and dominant in the relationship 3 Has a feeling of power when using force and abuse 5 Exhibits extreme pathological jealousy Male perpetrators believe in male supremacy and male dominance. They feel that they are in charge in a relationship, and using force makes them feel more powerful and proves their supremacy. Because of extreme jealousy, they do not want their partners to have personal friends or to take part in any recreational activities outside the home. They sometimes do not want their partner to go outside and work because of extreme jealousy. They use physical aggression to be in a powerful position in a relationship. Forcing the partner to work and an extreme sense of hatred for the abused partner is not typical of a perpetrator's patterns.

Which pattern drives a man to act as a perpetrator in an abusive relationship? Select all that apply. One, some, or all responses may be correct. 1 Has a need to be in charge and dominant in the relationship 2 Forces his partner to work while he is idle 3 Has a feeling of power when using force and abuse 4 Has an extreme sense of hatred for his partner 5 Exhibits extreme pathological jealousy

1 A person who feels judged or accused of wrongdoing is likely to become defensive. 2 Focus should be on identifying problems and acceptable ways of solving them. 5 Establishing a trustful rapport is the initial nursing intervention.

Which principle should guide the nursing interview that is focused on identifying possible family-centered violence? Select all that apply. One, some, or all responses may be correct. 1 A person who feels judged or accused of wrongdoing is likely to become defensive. 2 Focus should be on identifying problems and acceptable ways of solving them. 3 Tension is best minimized by asking the sensitive questions first. 4 The telling of the abuse should be stopped whenever clarification is needed. 5 Establishing a trustful rapport is the initial nursing intervention.

1 Onset of clinical depression 4 Posttraumatic stress disorder (PTSD) 5 Social and specific phobias Domestic abuse during childhood may manifest in depression later in life. The patient may have low self-esteem and feelings of worthlessness. PTSD develops from a trauma that the patient experienced. Later in life, those who lived through domestic abuse in childhood may develop nightmares, somatic complaints, or feelings of guilt. A victim of childhood trauma is in constant fear and may later develop phobias. Those who face abuse in childhood have slower physical and mental development because the energy needed for developmental tasks tends to be spent on coping with abuse. Abuse in childhood does not lead to confrontation with the family; rather, the abused person is more likely to become withdrawn and avoid confrontation.

Which result commonly occurs from domestic abuse in childhood? Select all that apply. One, some, or all responses may be correct. 1 Onset of clinical depression 2 Faster physical and social development 3 Confrontation with family members 4 Posttraumatic stress disorder (PTSD) 5 Social and specific phobias

2 "I can't allow you to hurt yourself or anyone else." 3 "Tell me what you need to regain control over your anger." 4 "I'm willing to stay here with you as long as you need me to." 5 "You have a right to be angry, but this isn't the way to express yourself." De-escalation techniques include being assertive but genuine and empathetic. Patient safety is the nurse's priority, and this should be communicated to the patient in a caring manner. The nurse should be willing to invest time in helping the patient identify what that patient needs to regain control of anger and distinguishing between the appropriateness of the patient's feelings and actions. Goals must be clearly stated, not vague and undefined, as when stating, "Stop this acting out right now."

Which statement by the nurse demonstrates an appropriate de-escalation technique? Select all that apply. One, some, or all responses may be correct. 1 "I need you to stop this acting out right now." 2 "I can't allow you to hurt yourself or anyone else." 3 "Tell me what you need to regain control over your anger." 4 "I'm willing to stay here with you as long as you need me to." 5 "You have a right to be angry, but this isn't the way to express yourself."

1 Use dolls and role-playing. 'Young children may be afraid of betraying the parents. A technique that can be effective is to have the child role-play using dolls to demonstrate what physical abuse is occurring. The nurse should not reward or bribe the child with candy to have the child talk about the injuries. A 6-year-old child may not have the writing vocabulary to document what happened. The parents would not be present because this can intimidate the child.

Which strategy would the nurse use to facilitate communication with a 6-year-old child who is the victim of parental physical abuse? 1 Use dolls and role-playing. 2 Reward the child with candy. 3 Write out what happened. 4 Allow parents to be present.

1 Indications or patterns of violence 2 Observations of the family's patterns of coping 3 Levels of anxiety and coping responses

Which area would the nurse concentrate on in the context of abuse assessment? Select all that apply. One, some, or all responses may be correct. 1 Indications or patterns of violence 2 Observations of the family's patterns of coping 3 Levels of anxiety and coping responses 4 Approaching the abuser 5 Assessment by a group of interviewers

1 Reports excessive masturbation 4 Expresses an extreme fear of the dark 5 Experiences feelings of anxiety frequently

Which assessment information would the nurse record in the case report of a patient who has been sexually abused? Select all that apply. One, some, or all responses may be correct. 1 Reports excessive masturbation 2 No record of adequate immunization 3 History of several untreated diseases 4 Expresses an extreme fear of the dark 5 Experiences feelings of anxiety frequently

2 A history of violence

Which factor most contributes to the risk for violence in a patient? 1 Poor coping skills 2 A history of violence 3 A diagnosis of schizophrenia 4 A diagnosis of avoidant personality disorder

Tension building Acute building Honeymoon

Cycle of Violence

childhood violence

Many violent adults suffered from

1. Move to a room with one or more exits (Avoid rooms with knives) 2. know the quickest route out of the home 3. Tell neighbors about abuse, and tell them to call the police if they hear a disturbance. 4. Code word for family and friends when in trouble 5. Safe place selected for when you leave 6. Pack a bag beforehand (put in an easy place to grab) only essentials. DO NOT bring cell phone b/c of tracker. Just a Prepaid phone. Legal Documents

Safety plan for IPV

Priority

Somebody who comes into the ED who has been raped should be?

Anger, Pacing, Profanity (Verbal abuse)

Symptoms of Violence

4 The children hesitate to interact with the nurse. Physically abused children may be mistrustful and wary of adults. They may hesitate to interact with the nurse. Physically abused patients give vague reasons and explanations for their injuries. The reason for the injury does not correlate with the severity of the injury. Nonspecific bruising in children older than 2 years of age can be considered common. Nonspecific bruising can occur in older children while playing. Physically abused patients do not maintain proper eye contact because they try to hide their feelings. They believe that others will not trust or understand their situation.

During a health screening, the nurse suspects that the older children have been physically abused. Which assessment data would serve to support this suspicion? 1 The children give seemingly appropriate reasons for their injuries. 2 The children have nonspecific bruising on their hands. 3 The children tend to keep eye contact with the nurse. 4 The children hesitate to interact with the nurse.

more likely violent

If a patient is setting fires, abusing animals or has repetitive (conduct) behavior

reported

Instead of alleged, what should you use?

Describe the behavior

Instead of in no acute distress, what should you use?

Orient them back to reality Catastrophic reaction = calm response Validation therapy = if in an advanced dementia state and cannot orient back to reality , do not reorient. Psychotherapy Talk calmly, unhurried, soothing

Intervention for Cognitive Deficit

LEAVE IMMEDIATELY Let the patient know when you are coming back Avoid punishing the patient. (would make them more mad) If it's during a procedure, discontinue eye contact & conversation and leave when the procedure is complete

Intervention for Verbal Abuse

Administer PO medications FIRST IM injection of a BENZO or antipsychotic if needed due to underlying conditions Seclusion room: prevented from leaving Restraints: Least Restrictive measure have been unsuccessful Monitor q 15 minutes w/ restraints and seclusion

Intervention for assaultive stage?

Benzodiazepines First choice 2nd generation antipsychotics (For emergencies)

Pharmolocial interventions for acute aggression?

substance abuse/ withdrawal

Violence in the hospital is normally due to

Penetration

Instead of intercourse, what should you use?

Risk Factors: - Genetics - Male Gender/ young age 15-24 - Low socioeconomic status - Poor - Angry population - Brain structure/ Neurobiology status

Violence Risk Factors?

True

Violence is a learned behavior and used to control people. True or False

Genetics Low socioeconomic status Poor Angry population Brain structure/ Neurobiology status

What are RISK Factors for Violence?

decline

Instead of refused, what should you use?

Do not be judgmental , and support the women decision

What if the patient wants to stay with her abuser?

initimate partner violence

What is the number one cause of homelessness in women?

1 Get a consent form signed. Once the patient is medically stable, the nurse should have the victim sign a consent form prior to obtaining evidence from the victim. After consent is obtained, the nurse should perform the sexual assault examination,

Which action does the nurse perform before obtaining evidence from a victim if the patient was found by campus police after being sexually assaulted? Select all that apply. One, some, or all responses may be correct. 1 Get a consent form signed. 2 Contact the hospital chaplain. 3 Document the emotional status. 4 Perform a mental-status exam. 5 Notify family of the patient's arrival.

1 "A 4-year-old can be an unreliable source because they have such wonderful imaginations." When child abuse is suspected, persons in authority, including nurses, teachers, spiritual leaders, coaches, counselors, and child care providers are legally responsible for reporting to the appropriate child protective agency. Each state mandates that a report must be filed when suspected abuse or neglect is encountered. It is not necessary to have proof of the abuse. If there is a suspicion or the child says something is happening, that is enough grounds to report. It is then up to the child protective services agency to investigate and make a determination.

The nurse is discussing the possible existence of abuse of a 4-year-old patient currently being treated in the emergency department. Which statement by the nurse would require immediate intervention? 1 "A 4-year-old can be an unreliable source because they have such wonderful imaginations." 2 "It's up to the state's child protection agency to determine if our fears are valid." 3 "I'm absolutely sure every state requires that we report our concerns." 4 "We don't need physical proof of injury to report this situation."

3 State a willingness to attend a support group for physical abusers within 1 week Perpetrators of violence need help learning how to manage anger. A structured training is an excellent way to provide this teaching. Understanding the impact of violence, willingness to attend a support group, and showing remorse may also play a role but are not the most appropriate short-term goals.

The parents of a 3-year-old patient admit to finding it difficult to control their anger when the child acts out. Which short-term goal would the nurse include in the family's plan of care to ensure the child's safety? 1 Understand the impact of violence on the child within 2 days 2 Begin attending anger management training sessions within 1 week 3 State a willingness to attend a support group for physical abusers within 1 week 4 Show remorse for their anger management issues within 2 days

3 Notify the appropriate child protective agency of the findings. The nurse is a mandated reporter of suspected abuse. It is not necessary for the nurse to determine whether abuse actually occurred. Asking the child the identity of the person who caused the injury is premature. Discussing the findings with the child's teacher and reporting the findings at educational meetings may apply later.

The school nurse assesses multiple bruises and welts in odd shapes on a child's back. Lately, the child has been frequently tardy and has had episodes of aggressive behavior in school. Which action would the nurse implement first? 1 Ask the child, "Who did this to you?" 2 Discuss the findings with the child's teacher. 3 Notify the appropriate child protective agency of the findings. 4 Report the findings at the multidisciplinary educational meetings.

1. Medications - Benzo short term for anxiety - SSRIs for depression 2. Psychotherapy - Crisis counseling - Support groups - Safe houses listed - Assess within 24 to 48 hours by telephone

Treatment for sexual assault/ rape