Bullying, Interpersonal violence
Studies show bullying occurs in what percentage of children? 1. Bullying is overemphasized and is not really a major problem. 2. 20% to 50% of children 3. 100% of children 4. 5% to 10% of children
ANS: 2 Feedback 1. Bullying is a significant problem in school-age children and is increasing with new social media. 2. Some studies show 20% while others show up to 50% of children have been bullied. 3. 100% of children is significantly higher than has been found in studies. 4. 5% to 10% is much smaller of a percentage than has been reported in studies.
According to statistical research data, which of these children currently being followed by the pediatric nurse practitioner is at the greatest risk for fatal abuse? a. A child who is 2 years old and has cerebral palsy b. A child who is 5 years old and has chicken pox c. A child who is 8 years old and has appendicitis d. A child who is 11 years old and has a fractured humerus
Answer A
A toddler was brought to the hospital with a broken humerus and upper arm bruising. The child's father states that he shook the child while disciplining him to teach him to be quiet. An appropriate family-related nursing diagnosis is: a. Anxiety related to physical abuse b. Powerlessness related to inability to keep child quiet c. Impaired parenting related to unrealistic expectations for child d. Risk for impaired parenting related to harsh disciplinary methods
ANS: C This diagnosis is supported by data in the scenario. Violence has occurred, so a risk diagnosis is not appropriate. The remaining diagnoses are not supported by data.
What would be appropriate interventions for a victim of interpersonal violence? Select all that apply. A) Educating the client on how to avoid future incidents of violence B) Distracting the client to avoid overwhelming feelings about the situation C) Using a supportive, nurturing approach D) Helping the client identify intra- and interpersonal strengths E) Maintaining objectivity and offering short, to-the-point responses
Answer: C, D Explanation: The nurse should use a supportive, nurturing approach because it is important for victims of interpersonal violence to feel supported and cared for in order to develop trust and work through their issues. The nurse should also help the client identify intra- and interpersonal strengths because recognition of strengths will decrease feelings of helplessness. Educating the client on how to avoid future incidents of violence is not therapeutic and implies that the incident might have been the client's fault. Distracting the client will prolong the grieving process, and the client will be left with unresolved conflicted feelings. Maintaining objectivity and providing short responses discourages communication and does not offer the client the empathy and support that are needed.
The school nurse is implementing a program to decrease bullying. Which interventions are appropriate for the school nurse to implement? Standard Text: Select all that apply. 1. Train teachers about the behaviors 2. Ensure adult supervision in the hallways 3. Teach children to report behaviors 4. Ensure that immunizations are up-to-date 5. Set up anti-hazing policies
Correct Answer: 1,2,3 Appropriate interventions for the school nurse to implement when dealing with bullying in a school include training the teachers on the signs of bullying; ensuring adult supervision in the hallways, as this is where bullying tends to take place; and teach children to report bullying behaviors. Ensuring that immunizations are up to date is not an intervention aimed at decreasing bullying. Hazing and bullying are two separate problems.
A child is admitted to the hospital unit with physical injuries. The nurse is taking the child's history. Which statement by the parent would arouse suspicion of abuse? 1. "I did not realize that my baby was able to roll over yet, and I was just gone a minute to check on dinner when the baby rolled off of the couch and onto our tile floor." 2. "The baby's 18-month-old brother was trying to pull the baby out of the crib and dropped the baby on the floor." 3. "I placed the baby in the infant swing. His 6-year-old brother was running through the house and tripped over the swing, causing it to fall." 4. "I was walking up the steps and slipped on the ice, falling while carrying my baby."
Correct Answer: 2 All of the statements made by the parent are plausible from a developmental perspective except the statement "The baby's 18-month-old brother was trying to pull the baby out of the crib and dropped the baby on the floor." Developmentally, it would be very difficult for an 18-month-old child to pull an infant out of a crib.
According to statistical research data, which of these children currently being followed by the pediatric nurse practitioner is at the greatest risk for fatal abuse? a. A child who is 2 years old and has cerebral palsy b. A child who is 5 years old and has chicken pox c. A child who is 8 years old and has appendicitis d. A child who is 11 years old and has a fractured humerus
ANS: A At highest risk for fatal abuse are children under 3 years of age and those with disabilities. The remaining options do not present children meeting the criteria.
A teenage boy has been periodically beaten by his father. The boy tells the nurse, "He'll pay for this one way or another." The nurse treating his contusions should assess for behaviors suggesting: a. Aggression b. Depression c. Regression d. Withdrawal
ANS: A Research suggests that children who are abused are at high risk for antisocial behavior and associated aggressive behaviors for a period of at least 2 years after the battering incident. The boy's remark is not consistent with any of the other options.
An anti-bullying program is being launched in the community by a multidisciplinary team. The community health nurse has been asked to help facilitate a conversation about factors that are associated with being a bully. Identify the factors. A. Parents/caregivers with lower educational levels B. Small stature C. Good academic standing D. Age E. ADHD (Attention Deficit and Hyperactivity Disorder) 1. A, C, D, E 2. A and D 3. A, B, D 4. A, B, D, E
ANS: 3 Feedback 1. Academic standing and ADHD do not have a higher rate of risk for being a bully. 2. Not all the risk factors for being bullied are noted. 3. The three factors are leading indicators for a child to be at risk of being bullied. 4. ADHD does not have a higher risk for being bullied.
The nurse is providing care to a toddler-age child. Which assessment finding is indicative of abuse? 1. Parents indicating that they did not see the event occur 2. Inconsistency of stories between caregivers 3. Bruising noted on the knees and shins 4. Acting out behavior of the child
Correct Answer: 2 Inconsistency of stories is a red flag for abuse. All other answers are logical explanations for this age group.
The nurse is developing a care plan for the parents of a toddler who was born prematurely and was in the neonatal intensive care unit for 2 months. The mother has been using a belt to discipline the child. The father is not very attentive to the needs of the mother or the baby. Which of the following nursing diagnoses would best fit this situation? a. interrupted family processes due to disrupted attachment b. deficient knowledge related to lack of parenting instructions c. high risk for injury to others related to mood disturbance d. marital discord in need of therapy related to lack of information
A Correct: The nursing diagnosis that would best fit this situation is interrupted family processes due to disrupted attachment. An infant who was separated from his parents for the first 2 months of life due to prematurity and hospitalization has not established a nurturing bond or appropriate attachment. Weak attachment bonds can result in caregivers viewing the child as an "imperfect child" and place him at risk for abuse. B Incorrect: This nursing diagnosis does not best fit this situation. C Incorrect: This nursing diagnosis does not best fit this situation. D Incorrect: This nursing diagnosis does not best fit this situation
Common factors for why a child can be bullied include all of the following except: 1. Age. 2. Socioeconomic status. 3. Following the crowd. 4. Sexual orientation.
ANS: 3 Feedback 1. Older children may tend to bully younger children, as they are easier targets. 2. Children who come from a family with a lower socioeconomic status may be bullied due to many factors, including not maintaining the styles and clothing the other children do. 3. Children who follow the crowd are not bullied as often as those that don't. Bullies tend to gravitate toward those that are different in some way. 4. Reports of bullying due to children who identify with a sexual orientation that is not "traditional" are significant.
A parent brings a toddler to the pediatric clinic. The nurse observes a number of bruises on the child in various stages of healing. The parent claims the toddler bruises easily. The best action on the part of the pediatrician and the nurse would be to: a. believe the parents and schedule an appointment in 2 weeks b. report this to child and family services and order a screening battery of bleeding and clotting blood work c. check with the other parent or another caregiver to see what he or she might be able to add to this history d. tell the parent that it is clear that he or she is lying and to tell the truth
A Incorrect: A number of bruises in various stages of healing is a "red flag" indicator for abuse. So the best action to be suspicious of the parent's explanation. B Correct: Physical abuse indicators include bruises in various stages of healing. The color of the bruises helps determine if the injury occurred as a single episode or over a period of time. Bruises resulting from physical abuse will be various colors, from reddish blue or purple to yellow, brown and fading. To avoid errors in diagnosis, children who present with multiple bruises that do not reflect the use of an object should be reported to child and family services. Screening tests of bleeding and clotting should be ordered to evaluate for a bleeding disorder. C Incorrect: A number of bruises in various stages of healing is a "red flag" indicator for abuse. So checking with the other parent or another caregiver to see what he or she might be able to add to this history is not the best action. D Incorrect: This is an inappropriate action. It is important to establish a trusting relationship with the parent so a supportive, nonblaming approach is best.
When the nurse sees a child who has burns on the backs of the legs and the top of the buttocks, and an area that is not burned in the center of the buttocks, the nurse will: a. tend to believe the parents who say the child got into the tub accidentally before it cooled off b. suspect that the child's buttocks were held forcibly against the bottom of the tub c. suspect that the parents poured hot liquids on some areas of the legs and buttocks d. think that the child backed up against a heater or was held there by the parents
A Incorrect: An accidental burn as a result of a child getting into a bathtub before the water cooled off will occur on the child's feet. So the nurse should be suspicious because the explanation of burn doesn't seem consistent with the injury. B Correct: The description of this burn indicates an immersion burn often used as a form of punishment for problem behaviors in toilet training. It is caused by purposefully placing the child's buttocks in hot water and holding her or him against the bottom of the tub. C Incorrect: When a parent pours hot liquids on a child, it usually involves the back, lateral side of the face, or shoulder, not the legs and buttocks. D Incorrect: The description of this burn is inconsistent with this explanation of how it occurred.
Which of the following children are at greatest risk of abuse or neglect by the parents? a. postmaturity babies b. 13-year-old children c. children with high intelligent quotient (IQ) d. premature infants
A Incorrect: Postmature babies are not at greatest risk of abuse or neglect by the parents. B Incorrect: 13-year-old children are not at greatest risk of abuse or neglect by the parents. Instead young children (particularly those younger than 3 years) are at high risk for abuse or neglect. C Incorrect: Children with high intelligent quotient (IQ) are not at greatest risk of abuse or neglect by the parents. D Correct: Premature infants are at greatest risk of abuse or neglect by the parents because they place great demands on the parents.
A child is brought to the pediatric clinic for immunizations for school. The parent wants the immunizations to be given in the arm. The nurse explains that at least one of the injections has to be given in the buttocks. When the nurse pulls the diaper down, the nurse sees bite marks around the genital and buttock area. Which of the following explanations is most likely? a. A neighborhood toddler is in a biting stage. b. This child is in a biting stage, and the parents bit him back to get him to stop biting. c. The child is a victim of sexual or physical abuse. d. This must have happened then the dog slept with the child.
A Incorrect: This is not a credible explanation. Children tend to bite other children on areas other than the genitals or buttocks. B Incorrect: This is not a likely explanation of the bite marks. C Correct: Bite marks around the genital and buttock area are indicators of physical or sexual abuse. Lesions from bites are oval or semicircular. If the diameter across the lesion is greater than 3 cm, it was probably inflicted by an adult. D Incorrect: A bite from an animal such as a dog has sharp, puncture, slash or tear marks. This is not a likely explanation.
When assessing home safety of the adolescent, it is essential to ask about all of the following except: 1. Living arrangements. 2. If they feel safe at home. 3. Family income. 4. Relationships with siblings.
ANS: 3 1. Assessment of the home includes asking where the adolescent lives. 2. Assessment of the home includes asking about violence in the home. 3. Assessment of the home does not include family income because all levels of income can have an unsafe living environment. 4. Assessment of the home includes asking about the relationships with siblings.
The nurse in the Emergency Department is taking a history from a family accompanying a child with suspicious traumatic injuries. The nurse should: a. Be open, concerned, and honest. b. Obtain information as covertly as possible. c. Avoid responding to hints that abuse has occurred. d. Separate the family from the child during the interview.
ANS: A The nurse serves as a role model for the parents and the child. Being open and honest and showing appropriate concern for the child is the most appropriate approach. Direct questioning is necessary to obtain the history. Concerns about the possibility of abuse must be addressed in a sensitive manner. The family will be able to remain with the child during history taking. It is helpful for the nurse to observe family interactions.
A kindergarten student is frequently violent toward other children. A school nurse notices bruises and burns on the child's face and arms. What other symptom should indicate to the nurse that the child might have been physically abused? A. The child shrinks at the approach of adults. B. The child begs or steals food or money. C. The child is frequently absent from school. D. The child is delayed in physical and emotional development.
ANS: A The nurse should determine that a child who shrinks at the approach of adults in addition to having bruises and burns might be a victim of abuse. Whether or not the adult intended to harm the child, maltreatment should be considered.
Which assessment data should a school nurse recognize as signs of physical neglect? A. The child is often absent from school and seems apathetic and tired. B. The child is very insecure and has poor self-esteem. C. The child has multiple bruises on various body parts. D. The child has sophisticated knowledge of sexual behaviors.
ANS: A The nurse should recognize that a child who is often absent from school and seems apathetic and tired might be a victim of neglect. Other indicators of neglect are stealing food or money, lacking medical or dental care, being consistently dirty, lacking sufficient clothing, or stating that there is no one home to provide care.
A community health nurse visits a family with four children. The father behaves angrily, finds fault with the oldest child, and asks twice, "Why are you such a stupid kid?" The wife says, "I have difficulty disciplining the children. It's so frustrating." Which comments by the nurse will facilitate an interview with these parents? Select all that apply. a. "Tell me how you discipline your children." b. "How do you stop your baby from crying?" c. "Caring for four small children must be difficult." d. "Do you or your husband ever spank your children?" e. "Calling children 'stupid' injures their self-esteem."
ANS: A, B, C An interview with possible abusing individuals should be built on concern and carried out in a nonthreatening, nonjudgmental way. Empathetic remarks are helpful in creating rapport. Questions requiring a descriptive response are less threatening and elicit more relevant information than questions that can be answered by yes or no.
A 10-year-old cares for siblings while the parents work because the family cannot afford a babysitter. This child says, "My father doesn't like me. He calls me stupid all the time." The mother says the father is easily frustrated and has trouble disciplining the children. The community health nurse should consider which resources as priorities to stabilize the home situation? Select all that apply. a. Parental sessions to teach childrearing practices b. Anger management counseling for the father c. Continuing home visits to give support d. A safety plan for the wife and children e. Placing the children in foster care
ANS: A, B, C Anger management counseling for the father is appropriate. Support for this family will be an important component of treatment. By the wife's admission, the family has deficient knowledge of parenting practices. Whenever possible, the goal of intervention should be to keep the family together; thus, removing the children from the home should be considered a last resort. Physical abuse is not suspected, so a safety plan would not be a priority at this time.
While planning care for a preschool child who has been physically and sexually abused, the nurse includes play therapy because it assists the child to: a. Learn adaptive behaviors through acting. b. Express feelings that cannot easily be verbalized. c. Act out aggression in a sociably acceptable manner. d. Interact with other children in the appropriate age group.
ANS: B Abused children, especially young children, are unable to put feelings into words as they describe events. Play therapy affords the tools through which the child can access and work through feelings. The other options are not purposes of play therapy.
The nurse caring for a school-age child who has been sexually abused by a close family member demonstrates an understanding of communication barriers in this situation by: a. Realizing that repeated questioning by others will occur b. Assuring the child that the story they are telling is believed c. Reinforcing that the child will not be in trouble with the police d. Promising to tell only those who need to know about the incident
ANS: B Fear of being blamed or of being disbelieved is a powerful motivator of silence. When the child fears that there will be no support, there is no reason to disclose the abuse. The other options are much more remote.
A child was admitted to the children's unit, having been sexually abused by an acquaintance of her family. The child refuses to talk and participate in unit activities, choosing to stay in her room with her stuffed animals. Which therapeutic intervention will best help the child release pent-up feelings about the abuse? a. Family therapy b. Play therapy c. Individual communication with the nurse d. Role-play with other children on the unit
ANS: B Play helps communicate and release feelings about the child's problems. A child may have difficulty expressing feelings verbally. Family therapy may be useful, but it is not designed for releasing feelings. Role-playing is more effective with older children or adults.
A young child is being evaluated in the Emergency Department for injuries her mother reports resulted from a fall down the stairs. Which of these findings indicates that physical abuse may be a chronic problem for the child? a. The mother's description of the child as being 'clumsy' b. Several fractures revealed on x-ray in varying degrees of healing c. Clinging to her mother as she attempted to leave the examining room d. Struggling with the staff when attempts to obtain a blood specimen were made
ANS: B Unhealed fractures indicate both numerous injuries and that medical intervention was not sought at the time of injury. Although unkind, the mother's description of the child is not reason to believe chronic abuse has occurred. The remaining options reflect normal behavior, especially if pain or separation is suspected.
What is a nurse's legal responsibility if child abuse or neglect is suspected? a. Discuss the findings with the child's parent and health care provider. b. Document the observation and suspicion in the medical record. c. Report the suspicion according to state regulations. d. Continue the assessment.
ANS: C Each state has specific regulations for reporting child abuse that must be observed. The nurse is a mandated reporter. The reporter does not need to be sure that abuse or neglect occurred, only that it is suspected. Speculation should not be documented, only the facts.
An 11-year-old reluctantly tells the nurse, "My parents don't like me. They said they wish I was never born." Which type of abuse is likely? a. Sexual b. Physical c. Emotional d. Economic
ANS: C Examples of emotional abuse include having an adult demean a child's worth, frequently criticize, or belittle the child. No data support physical battering or endangerment, sexual abuse, or economic abuse.
Several children are seen in the emergency department for treatment of various illnesses and injuries. Which assessment finding would create the most suspicion for child abuse? The child who has: a. complaints of abdominal pain. b. repeated middle ear infections. c. bruises on extremities. d. diarrhea.
ANS: C Injuries such as immersion or cigarette burns, facial fractures, whiplash, bite marks, traumatic injuries, bruises, and fractures in various stages of healing suggest the possibility of abuse. In older children, vague complaints such as back pain may also be suspicious. Ear infections, diarrhea, and abdominal pain are problems that were unlikely to have resulted from violence.
A patient in her early teens who is being treated for irritable bowel syndrome has just disclosed that she has been the victim of child abuse for 8 years. For what other condition should the nurse assess this patient? a. Schizophrenia b. Agoraphobia c. Posttraumatic stress disorder d. Obsessive-compulsive disorder
ANS: C The state of chronic hyperarousal caused by the abuse is the basis for three common outcomes of childhood abuse: PTSD, depression, and irritable bowel syndrome. The conditions mentioned in the other options are not related to child abuse.
To provide nursing care to abused children and their families, the nurse must first: a. Recommend removal of the children from the family. b. Complete a comprehensive physical and mental assessment. c. Refer each case to the appropriate social worker for follow-up. d. Examine personal feelings regarding the trauma of child abuse and neglect.
ANS: D Self-examination is required in order for the nurse to be objective and therapeutic in providing care. Although important, an assessment is not the initial step in this situation. Removal is not always recommended. A social service referral may not be required, depending on the situation.
The nurse is considering making a child abuse or neglect report to protective services. To make the report, the nurse needs to: a. Have strong evidence that the abuse/neglect has occurred. b. Obtain the supervisor's permission to make the report. c. Notify the parents of the intent to file the report. d. Have suspicions that the abuse has occurred.
ANS: D Suspicions are all that are required by state mandatory child abuse and neglect reporting laws. The agency bears the burden of collecting evidence. As a mandated reporter, the nurse does not need anyone's permission to make the report. Only a suspicion is required. Parent notification is unnecessary.
A young client is brought into the Emergency Department by a friend who says the client was "beat up" at school. The client is reluctant to provide the names of parents or a home address. What should the nurse suspect has occurred with this client? A) The client does not want the individual who did the beating to get in trouble. B) The client does not know his parents. C) The client does not want the school to get in trouble. D) The client is a victim of interpersonal violence
Answer: D Explanation: Although the nurse may initially believe that the client is telling the truth about being beaten up at school, the client's reluctance to provide parents' names or address could suggest the client is a victim of interpersonal violence. Reluctance to provide personal information could mean fear of further abuse. It is unlikely that the client does not know his parents. It is also unlikely that the client does not want to get the school or the individual who did the beating in trouble.
An experienced nurse correctly notes that an important factor in assessing survivors of childhood sexual abuse is to be aware that they often experience long-term symptoms most closely resembling DSM-IV-TR criteria for: a. Adjustment disorders b. Schizophreniform reaction c. Posttraumatic stress disorder d. Obsessive-compulsive personality disorder
C Although childhood sexual abuse produces a wide variety of long-term sequelae, the most common psychosocial problems are PTSD, self-damaging behavior, mood disturbances, interpersonal problems, and sexual difficulties. The other options are rarely noted.
The pediatric nurse is working with a parent who is suspected of Münchausen Syndrome by Proxy. Which action by the nurse is the priority? 1. Confront the parent with concerns of possible abuse. 2. Carefully document parent-child interactions. 3. Try to keep the parent separated from the child as much as possible. 4. Explain to the child that the parent is causing the illness and that the health team will prevent the child from being harmed.
Correct Answer: 2 Münchausen Syndrome by Proxy is very difficult to prove, and evidence provided by the careful documentation of the nursing staff can be very influential. Care must be taken not to make the parent suspicious and to keep the child in the hospital until enough evidence is collected. Confronting the parent or separating the parent from the child may alienate the parent and cause him or her to leave with the child. Talking to the child about the health-care team's suspicions may be confusing and frightening for the child.