Abuse/Neglect Practice Questions (Test #4, Fall 2020)

Jana, age 5, is sent to the school nurse's office with an upset stomach. She has vomited and soiled her blouse. When the nurse removes her blouse, she notices that Jana has numerous bruises on her arms and torso, in various stages of healing. She also notices some small scars. Jana's abdomen protrudes on her small, thin frame. From the objective physical assessment, the nurse suspects that a. Jana is experiencing physical and sexual abuse. b. Jana is experiencing physical abuse and neglect. c. Jana is experiencing emotional neglect. d. Jana is experiencing sexual and emotional abuse.

B

Sharon, a woman with multiple cuts and abrasions, arrives at the ED with her three small children. She tells the nurse her husband inflicted these wounds on her. In the interview, Sharon tells the nurse, "He's been getting more and more violent lately. He's been under a lot of stress at work the last few weeks, so he drinks a lot when he gets home. He always gets mean when he drinks. I was getting scared. So I just finally told him I was going to take the kids and leave. He got furious when I said that and began beating me with his fists." With knowledge about the cycle of battering, what does this situation represent? a. Phase I. Sharon was desperately trying to stay out of his way and keep everything calm. b. Phase I. A minor battering incident for which Sharon assumes all the blame. c. Phase II. The acute battering incident that Sharon provoked with her threat to leave. d. Phase III. The honeymoon phase where the husband believes that he has "taught her a lesson and she won't act up again."

C

A client tells the nurse that she has been raped but has not reported it to the police. After determining whether the client was injured, whether it is still possible to collect evidence, and whether to file a report, the nurse's next priority is to offer which of the following to the client? 1.Legal assistance. 2.Crisis intervention. 3.A rape support group. 4.Medication for disturbed sleep.

2 The experience of rape is a crisis. Crisis intervention services, especially with a rape crisis nurse, are essential to help the client begin dealing with the aftermath of a rape. Legal assistance may be recommended if the client decides to report the rape and only after crisis intervention services have been provided. A rape support group can be helpful later in the recovery process. Medications for sleep disturbance, especially benzodiazepines, should be avoided if possible. Benzodiazepines are potentially addictive and can be used in suicide attempts, especially when consumed with alcohol.

A 3-year-old child with a history of being abused has blood drawn. The child lies very still and makes no sound during the procedure. Which of the following comments by the nurse would be most appropriate? "It's okay to cry when something hurts." 2."That really didn't hurt, did it?" 3."We're mean to hurt you that way, aren't we?" 4."You were very good not to cry with the needle.

1 It is not normal for a preschooler to be totally passive during a painful procedure. Typically, a preschooler reacts to a painful procedure by crying or pulling away because of the fear of pain. However, an abused child may become "immune" to pain and may find that crying can bring on more pain. The child needs to learn that appropriate emotional expression is acceptable. Telling the child that it really didn't hurt is inappropriate because it is untrue. Telling the child that nurses are mean does not build a trusting relationship. Praising the child will reinforce the child's response not to cry, even though it is acceptable to do so

After months of counseling, a client abused by her husband tells the nurse that she has decided to stop treatment. There has been no abuse during this time, and she feels better able to cope with the needs of her husband and children. In discussing this decision with the client, the nurse should: 1.Tell the client that this is a bad decision that she will regret in the future. 2.Find out more about the client's rationale for her decision to stop treatment. 3.Warn the client that abuse commonly stops when one partner is in treatment, only to begin again later. 4.Remind the client of her duty to protect her children by continuing treatment.

2 The nurse needs more information about the client's decision before deciding what intervention is most appropriate. Judgmental responses could make it difficult for the client to return for treatment should she want to do so. Telling the client that this is a bad decision that she will regret is inappropriate because the nurse is making an assumption. Warning the client that abuse commonly stops when one partner is involved in treatment may be true for some clients. However, until the nurse determines the basis for the client's decision, this type of response is an assumption and therefore inappropriate. Reminding the client about her duty to protect the children would be appropriate if the client had talked about episodes of current abuse by her partner and the fear that her children might be hurt by him.

Which of the following observations by the nurse should suggest that a 15-month-old toddler has been abused? 1.The child appears happy when personnel work with him. 2.The child plays alongside others contentedly. 3.The child is underdeveloped for his age. 4.The child sucks his thumb

3 An almost universal finding in descriptions of abused children is underdevelopment for age. This may be reflected in small physical size or in poor psychosocial development. The child should be evaluated further until a plausible diagnosis can be established. A child who appears happy when personnel work with him is exhibiting normal behavior. Children who are abused often are suspicious of others, especially adults. A child who plays alongside others is exhibiting normal behavior, that of parallel play. A child who sucks his thumb contentedly is also exhibiting normal behavior.

Adolescents and adults who were sexually abused as children commonly mutilate themselves. The nurse interprets this behavior as: 1.The need to make themselves less sexually attractive. 2.An alternative to binging and purging. 3.Use of physical pain to avoid dealing with emotional pain. 4.An alternative to getting high on drugs.

3 Dealing with the physical pain associated with mutilation is viewed as easier than dealing with the intense anger and emotional pain. The client fears an aggressive outburst when anger and emotional pain increase. Self-mutilation seems easier and safer. Additionally, self-mutilation may occur if the client feels unreal or numb or is dissociating. Here, the mutilation proves to the client that he or she is alive and capable of feeling. The client may want to be less sexually attractive, but this aspect usually is not related to self-mutilation. Binging and purging is commonly done in addition to, not instead of, self-mutilation. Although a few clients report an occasional high with self-mutilation, usually the experience is just relief from anger and rage

In the process of dealing with intense feelings about being raped, victims commonly verbalize that they were afraid they would be killed during the rape and wish that they had been. The nurse should decide that further counseling is needed if the client voices which of the following? 1."I didn't fight him, but I guess I did the right thing because I'm alive." 2."Suicide would be an easy escape from all this pain, but I couldn't do it to myself." 3."I wish they gave the death penalty to all rapists and other sexual predators." 4."I get so angry at times that I have to have a couple of drinks before I sleep."

4 Use of alcohol reflects unhealthy coping mechanisms. A client's report of needing alcohol to calm down needs to be addressed. Survival is the most important goal during a rape. The client's acknowledging this indicates that she is aware that she made the right choice. Although suicidal thoughts are common, the statement that suicide is an easy escape but the client would be unable to do it indicates low risk. Fantasies of revenge, such as giving the death penalty to all rapists, are natural reactions and are a problem only if the client intends to carry them out directly.

A young woman who has just undergone a sexual assault is brought into the ED by a friend. The priority nursing intervention would be to a. help her to bathe and clean herself up. b. provide physical and emotional support during evidence collection. c. provide her with a written list of community resources for survivors of rape. d. discuss the importance of a follow-up visit to evaluate for sexually transmitted diseases.

B

Kate is an 18-year-old freshman at the state university. She was extremely flattered when Don, a senior star football player, invited her to a party. On the way home, he parked the car in a secluded area by the lake. He became angry when she refused his sexual advances. He began to beat her and finally raped her. She tried to fight him, but his physical strength overpowered her. He dumped her in the dorm parking lot and left. The dorm supervisor rushed Kate to the emergency department. Kate says to the nurse, "It's all my fault. I shouldn't have allowed him to stop at the lake." The nurse's best response is, a. "Yes, you're right. You put yourself in a very vulnerable position when you allowed him to stop at the lake." b. "You are not to blame for his behavior. You obviously made some right decisions, because you survived the attack." c. "There's no sense looking back now. Just look forward, and make sure you don't put yourself in the same situation again." d. "You'll just have to see that he is arrested so he won't do this to anyone else."

B

Sharon, a woman with multiple cuts and abrasions, arrives at the emergency department (ED) with her three small children. She tells the nurse her husband inflicted these wounds on her. She says, "I didn't want to come. I'm really okay. He only does this when he has too much to drink. I just shouldn't have yelled at him." The best response by the nurse is, a. "How often does he drink too much?" b. "It is not your fault. You did the right thing by coming here." c. "How many times has he done this to you?" d. "He is not a good husband. You have to leave him before he kills you."

B

A school nurse notices bruises and scars on a child's body, but the child refuses to say how she received them. Another way in which the nurse can get information from the child is to a. have her evaluated by the school psychologist. b. tell her she may select a "treat" from the treat box (e.g., sucker, balloon, junk jewelry) if she answers the nurse's questions. c. explain to her that if she answers the questions, she may stay in the nurse's office and not have to go back to class. d. use a "family" of dolls to role-play the child's family with her

D

A woman who has a long history of being battered by her husband is staying at the woman's shelter. She has received emotional support from staff and peers and has been made aware of the alternatives open to her. Nevertheless, she decides to return to her home and marriage. The best response by the nurse to the woman's decision is, a. "I just can't believe you have decided to go back to that horrible man." b. "I'm just afraid he will kill you or the children when you go back." c. "What makes you think things have changed with him?" d. "I hope you have made the right decision. Call this number if you need help."

D

A woman who was sexually assaulted six months ago by a man with whom she was acquainted has since been attending a support group for survivors of rape. From this group, she has learned that the most likely reason the man raped her was that a. because he had been drinking, he was not in control of his actions. b. he had not had sexual relations with a girl in many months. c. he was predisposed to become a rapist by virtue of the poverty conditions under which he was reared. d. he was expressing power and dominance by means of sexual aggression and violence.

D

A nurse is assessing a client who is being abused. The nurse should assess the client for which characteristic? Select all that apply. 1.Assertiveness. 2.Self-blame. 3.Alcohol abuse. 4.Suicidal thoughts. 5.Guilt.

2,3,4,5 The victim of abuse is usually compliant with the spouse and feels guilt, shame, and some responsibility for the battering. Self-blame, substance abuse, and suicidal thoughts and attempts are possible dysfunctional coping methods used by abuse victims. The victim of abuse is not likely to demonstrate assertiveness

While interviewing a 3-year-old girl who has been sexually abused about the event, which approach would be most effective? 1.Describe what happened during the abusive act. 2.Draw a picture and explain what it means. 3."Play out" the event using anatomically correct dolls. 4.Name the perpetrator."

3 A 3-year-old child has limited verbal skills and should not be asked to describe an event, explain a picture, or respond verbally or nonverbally to questions. More appropriately, the child can act out an event using dolls. The child is likely to be too fearful to name the perpetrator or will not be able to do so

When obtaining a nursing history from parents who are suspected of abusing their child, which of the following characteristics about the parents should the nurse particularly assess? 1.Attentiveness to the child's needs. 2.Self-blame for the injury to the child. 3.Ability to relate the child's developmental achievements. 4.Difficulty with controlling aggression.

4 Parents of an abused child have difficulty controlling their aggressive behaviors. They may blame the child or others for the injury, may not ask questions about treatment, and may not know developmental information

A battered woman presents to the ED with multiple cuts and abrasions. Her right eye is swollen shut. She says that her husband did this to her. The priority nursing intervention is a. tending to the immediate care of her wounds. b. providing her with information about a safe place to stay. c. administering the prn tranquilizer ordered by the physician. d. explaining how she may go about bringing charges against her husband.

A

A school nurse notices bruises and scars on a child's body. The nurse suspects that the child is being physically abused. How should the nurse proceed with this information? a. As a health-care worker, report the suspicion to the Department of Health and Human Services. b. Check Jana again in a week and see if there are any new bruises. c. Meet with Jana's parents and ask them how Jana got the bruises. d. Initiate paperwork to have Jana placed in foster care.

A

A young child who has been sexually abused has difficulty putting feelings into words. Which of the following should the nurse employ with the child? 1.Engaging in play therapy. 2.Role-playing. 3.Giving the child's drawings to the abuser. 4.Reporting the abuse to a prosecutor

1 The dolls and toys in a play therapy room are useful props to help the child remember situations and re-experience the feelings, acting out the experience with the toys rather than putting the feelings into words. Role-playing without props commonly is more difficult for a child. Although drawing itself can be therapeutic, having the abuser see the pictures is usually threatening for the child. Reporting abuse to authorities is mandatory, but doesn't help the child express feelings

A married female client has been referred to the mental health center because she is depressed. The nurse notices bruises on her upper arms and asks about them. After denying any problems, the client starts to cry and says, "He didn't really mean to hurt me, but I hate for the kids to see this. I'm so worried about them." Which of the following is the most crucial information for the nurse to determine? 1.The type and extent of abuse occurring in the family. 2.The potential of immediate danger to the client and her children. 3.The resources available to the client. 4.Whether the client wants to be separated from her husband.

2 The safety of the client and her children is the most immediate concern. If there is immediate danger, action must be taken to protect them. The other options can be discussed after the client's safety is assured

A preadolescent child is suspected of being sexually abused because he demonstrates the self-destructive behaviors of self-mutilation and attempted suicide. Which common behavior should the nurse also expect to assess? 1.Inability to play. 2.Truancy and running away. 3.Head banging. 4.Overcontrol of anger.

2 Truancy and running away are common symptoms for young children and adolescents. The stress of the abuse interferes with school success, leading to the avoidance of school. Running away is an effort to escape the abuse and/or lack of support at home. Rather than an inability to play or a lack of play, play is likely to be aggressive with sexual overtones. Children tend to act out anger rather than control it. Head banging is a behavior typically seen with very young children who are abused.

A shy middle school student set up a Facebook page. A popular student sent a message that included a suggestive picture of himself and suggested the student send a similar picture. When the student sent back a picture of himself dressed only in his boxers, the popular student sent it to all his friends and encouraged them to pass it along. Soon the whole school had seen the picture identified as "Joe's Crotch." The student was so distressed and mortified he tried to hang himself but was found by his parent before he succeeded. Which of the following outcomes would be most realistic and appropriate with regard to this situation? Select all that apply. 1.The Facebook privileges of all those who forwarded the message are revoked for a year. 2.All students in the school are educated about the risks of cyberbullying and how to respond to it. 3.The popular student who sent the message to his friends is disciplined by the school authorities. 4.Joe can use the Internet safely after being educated about cyberbullying and completing a safety plan. 5.Through therapy, Joe learns social skills to improve his confidence level and help him relate more easily"

2,3,4,5 Education of all students in the school about cyberbullying is appropriate and possible as programs exist to educate students in many communities. That education and his therapy should enable Joe to eventually return to using the Internet safely and to feel more confidence interacting with classmates. Disciplining of the student who posted Joe's picture by school authorities is appropriate and can be helpful in reducing further incidents of cyberbullying. It is unrealistic to think that all those who forwarded the message could be identified, much less taken off Facebook.

When working with a group of adult survivors of childhood sexual abuse, dealing with anger and rage is a major focus. Which strategy should the nurse expect to be successful? Select all that apply. 1.Directly confronting the abuser. 2.Using a foam bat while symbolically confronting the abuser. 3.Keeping a journal of memories and feelings. 4.Writing letters to the abusers that are not sent. 5.Writing letters to the adults who did not protect them that are not sent.

2,3,4,5 Using a foam bat while symbolically confronting the abuser, keeping a journal of memories and feelings, and writing letters about the abuse but not sending them are appropriate strategies because they allow anger to be expressed safely. Directly confronting the abuser is likely to result in further harm because the abusers commonly deny the abuse, rationalize about it, or blame the victim

One of the myths about sexual abuse of young children is that it usually involves physically violent acts. Which of the following behaviors is more likely to be used by the abusers? 1.Tying the child down. 2.Bribery with money. 3.Coercion as a result of the trusting relationship. 4.Asking for the child's consent for sex.

3 Coercion is the most common strategy used because the child commonly trusts the abuser. Tying the child down usually is not necessary. Typically, the abusive person can control the child by his or her size and weight alone. Bribery usually is not necessary because the child wants love and affection from the abusive person, not money. Young children are not capable of giving consent for sex before they develop an adult concept of what sex is.

In working with a rape victim, which of the following is most important? 1.Continuing to encourage the client to report the rape to the legal authorities. 2.Recommending that the client resume sexual relations with her partner as soon as possible. 3.Periodically reminding the client that she did not deserve and did not cause the rape. 4.Telling the client that the rapist will eventually be caught, put on trial, and jailed.

3 Guilt and self-blame are common feelings that need to be addressed directly and frequently. The client needs to be reminded periodically that she did not deserve and did not cause the rape. Continually encouraging the client to report the rape pressures the client and is not helpful. In most cases, resuming sexual relations is a difficult process that is not likely to occur quickly. It is not necessarily true that the rapist will be caught, tried, and jailed. Most rapists are not caught or convicted.

When planning interventions for parents who are abusive, the nurse should incorporate knowledge of which factor as a common parental indicator? 1.Lower socioeconomic group. 2.Unemployment. 3.Low self-esteem. 4.Loss of emotional family attachments.

3 Parents who are abusive often suffer from low self-esteem, commonly because of the way they were parented, including not being able to develop trust in caretakers and not being encouraged or offered emotional support by parents. Therefore, the nurse works to bolster the parents' self-esteem. This can be achieved by praising the parents for appropriate parenting. Employment and socioeconomic status are not indicators of abusive parents. Abusive parents usually are attached to their children and do not want to give them up to foster care. Parents who are abusive love their children and feel close to them emotionally.

A third-grade child is referred to the mental health clinic by the school nurse because he is fearful, anxious, and socially isolated. After meeting with the client, the nurse talks with his mother, who says, "It's that school nurse again. She's done nothing but try to make trouble for our family since my son started school. And now you're in on it." The nurse should respond by saying: 1."The school nurse is concerned about your son and is only doing her job." 2."We see a number of children who go to your son's school. He isn't the only one." 3."You sound pretty angry with the school nurse. Tell me what has happened." 4."Let me tell you why your son was referred, and then you can tell me about your concerns.

3 The mother's feelings are the priority here. Addressing the mother's feelings and asking for her view of the situation is most important in building a relationship with the family. Ignoring the mother's feelings will hinder the relationship. Defending the school nurse and the school puts the client's mother on the defensive and stifles communication

A client with suspected abuse describes her husband as a good man who works hard and provides well for his family. She does not work outside the home and states that she is proud to be a wife and mother just like her own mother. The nurse interprets the family pattern described by the client as best illustrating which of the following as characteristic of abusive families? 1.Tight, impermeable boundaries. 2.Unbalanced power ratio. 3.Role stereotyping. 4.Dysfunctional feeling tone

3 The traditional and rigid gender roles described by the client are examples of role stereotyping. Impermeable boundaries, unbalanced power ratio, and dysfunctional feeling tone are also common in abusive families.

Which parental characteristic is least likely to be a risk factor for child abuse? 1.Low self-esteem. 2.History of substance abuse. 3.Inadequate knowledge of normal growth and development patterns. 4.Being a member of a large family.

4 From documented cases of child abuse, a profile has emerged of a high-risk parent as a person who is isolated, impulsive, impatient, and single with low self-esteem, a history of substance abuse, a lack of knowledge about a child's normal growth and development, and multiple life stressors. Just because a parent comes from a large family, there is no increase in the incidence of the parent abusing their own children unless they possess the other risk factors

The mother of a school-aged child tells the nurse that, "For most of the past year, my husband was unemployed and I worked a second job. Twice during the year I spanked my son repeatedly when he refused to obey. It has not happened again. Our family is back to normal." After assessing the family, the nurse decides that the child is still at risk for abuse. Which of the following observations best supports this conclusion? 1.The parents say they are taking away privileges when their son refuses to obey. 2.The child has talked about family activities with the nurse. 3.The parent's are less negative toward the nurse. 4.The child wears long-sleeved shirts and long pants, even in warm weather."

4 Parental use of nonviolent discipline, the child's talk about what the family is doing and the easing of the parent's negativity toward the school nurse are all signs of progress. Avoidance and wearing clothes inappropriate for the weather implies that the child has something to hide, likely signs of physical abuse.

When planning the care for a client who is being abused, which of the following measures is most important to include? 1.Being compassionate and empathetic. 2.Teaching the client about abuse and the cycle of violence. 3.Explaining to the client about the client's personal and legal rights. 4.Helping the client develop a safety plan.

4 The client's safety, including the need to stay alive, is crucial. Therefore, helping the client develop a safety plan is most important to include in the plan of care to ensure the client's safety. Being empathetic, teaching about abuse, and explaining the person's rights are also important after safety is ensured.

After a client reveals a history of childhood sexual abuse, the nurse should ask which of the following questions first? 1."What other forms of abuse did you experience?" 2."How long did the abuse go on?" 3."Was there a time when you did not remember the abuse?" 4."Does your abuser still have contact with young children?

4 The safety of other children is a primary concern. It is critical to know whether other children are at risk for being sexually abused by the same perpetrator. Asking about other forms of abuse, how long the abuse went on, and if the victim did not remember the abuse are important questions after the safety of other children is determined.

When caring for a client who was a victim of a crime, the nurse is aware that recovery from any crime can be a long and difficult process depending on the meaning it has for the client. Which of the following should the nurse establish as a victim's ultimate goal in reconstructing his or her life? 1.Getting through the shock and confusion. 2.Carrying out home and work routines. 3.Resolving grief over any losses. 4.Regaining a sense of security and safety.

4 Ultimately, a victim of a crime needs to move from being a victim to being a survivor. A reasonable sense of safety and security is key to this transition. Getting through the shock and confusion, carrying out home and work routines, and resolving grief over any losses represent steps along the way to becoming a survivor.