Chapter 28 - Child, older adult, and intimate partner violence (Psych) EAQ's

An abuse victim tearfully tells the nurse in the emergency department, "Don't tell my husband that you know he beats me because if he thinks anyone knows, he will beat me again." Based on this information, what is the most appropriate nursing diagnosis? 1 Fear 2 Chronic pain 3 Post-trauma syndrome 4 Risk for self-directed violence

1 - Fear The patient is expressing fear based on a known threat. Text Reference - p. 530, Table 28.4

The community health nurse is teaching about prevention of abuse. Which are examples of tertiary prevention? Select all that apply. 1 Support groups for survivors 2 Reduction of stress for the abuser 3 Teaching of coping skills to the abuser 4 Legal advocacy programs for survivors 5 Screening programs for high-risk individuals

1 - Support groups for survivors 4 - Legal advocacy programs for survivors Tertiary prevention involves treating survivors of abuse, for example with support groups and legal advocacy programs. Reducing stress for the abuser and increasing his or her coping skills are strategies for primary prevention of abuse. Screening programs for high-risk individuals are examples of secondary prevention of abuse. Text Reference p. 533

What is commonly the result of abuse in childhood? Select all that apply. 1 Running away 2 The onset of clinical depression 3 Confrontation with family members 4 Posttraumatic stress disorder (PTSD) 5 Faster physical and social development

1 - Running away 2 - The onset of clinical depression 4 - Posttraumatic stress disorder (PTSD) Abuse during childhood may manifest in depression later in life. The patient may have low self-esteem and feelings of worthlessness. Posttraumatic stress disorder (PTSD) develops from a trauma that the patient experienced. Violence is ofent seen in childhood histories of runaways, juvenile offenders, and prostitutes. Those who face abuse in childhood have slower physical and mental development as 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 Rather, the abused person is more likely to become withdrawn and avoid confrontation. Text Reference - p. 522

Nurses who work on a maternity unit interact with new parents who may be at an increased risk for abuse. Which patient is at the highest increased risk for abuse? 1 A young new mother who grew up in a divorced family 2 A teenage parent who has a strong family support system 3 A new mother who requests that the infant be kept in the nursery at all times 4 A homosexual couple who had in-vitro fertilization to assist with the pregnancy

3 - A new mother who requests that the infant be kept in the nursery at all times A new mother who requests the infant be kept in the nursery at all times may be experiencing abuse. There is nothing to indicate that the mother who grew up with divorced parents, the teenage parent, or the homosexual couple are experiencing abuse. Text Reference - p. 532

A 4-year-old child tells the nurse, "I'm a bad boy. Daddy always says I'm not worth a second look." What is this situation an example of? 1 Neglect 2 Harsh parenting 3 Emotional abuse 4 Physical maltreatment

3 - Emotional abuse Emotional abuse occurs when the child's self-esteem is attacked. It is as devastating to the child as physical abuse. Text Reference - p. 521

A child arrives in the emergency department with cigarette burns on the arm. Which type of abuse does the nurse document? 1 Neglect 2 Sexual abuse 3 Physical abuse 4 Economic abuse

3 - Physical abuse Physical abuse is inflicting physical pain, such as burning. Neglect is the failure to provide for physical, emotional, educational, and medical needs. Sexual abuse is any form of sexual contact without consent. Economic abuse is denying a person's access to economic resources. Text Reference - p. 521

A patient was admitted to a healthcare facility after a suicide attempt resulting from family violence. After the crisis is resolved, what should be the next intervention? 1 Give the patient an outpatient referral. 2 Refer the patient to an inpatient psychiatric unit. 3 Ask the patient if he or she has a plan to repeat this. 4 Identify the perpetrator and have him or her arrested.

3 - Ask the patient if he or she has a plan to repeat this. The first step after the crisis resolution is to know about the lethality of the situation. For this, the nurse needs to carefully question the patient. If the patient is looking forward to the future and has no further suicidal plans, a referral to outpatient care can be done. If the patient is still suicidal, then a referral to a psychiatric unit can be done. The patient's safety is the main concern. The nurse should not be judgmental about the perpetrator. Text Reference - p. 528

What are the elementary causes for a perpetrator to use violence? Select all that apply. 1 Effect of peer pressure 2 Feeling of hopelessness 3 Ineffective impulse control 4 Lack of any support system 5 Lack of problem-solving skills

3 - Ineffective impulse control 4 - Lack of any support system 5 - Lack of problem-solving skills The perpetrators of violence have problems with impulse control. They are unable to think before they act and may even repent their act later. They do not have any healthy support systems which could prevent them from resorting to violence. They do not have problem-solving abilities and break down under stress. Peer pressure does not force them to become violent. They may live in social isolation and, with an inability to make friends, they have ineffective coping during crisis situations. A victim of abuse rather than the perpetrator feels hopeless and powerless. Text Reference - p. 521

A school nurse assesses multiple bruises and welts in odd shapes on a child's back. Lately, this child has been frequently tardy and has had episodes of aggressive behavior in school. What is the nurse's initial action? 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.

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. Text Reference - p 530

A group of nursing students was given an assignment to assess the abuse victims in the gynecology ward using the abuse assessment screen. The students find that the majority of the patients got a score of 2. Which incident of abuse does this score indicate? 1 Threats of abuse using a weapon 2 Use of weapon; wound from weapon 3 Slapping, pushing; no injuries or continuing pain 4 Punching, kicking, bruises, cuts, or continuing pain

3 - Slapping, pushing; no injuries or continuing pain The abuse assessment screen can be used to assess physical abuse of the patients. The screen consists of six scores based on the type of abuse and presence of wounds on the body. A score of 2 indicates slapping, pushing; no injuries or continuing pain. A score of 6 indicates use of weapon; wound from weapon. A score of 1 indicates threats of abuse (including threatening abuse with a weapon). A score of 3 indicates punching, kicking, bruises, cuts, and/or continuing pain. Text Reference - p. 526, Figure 28.2

The nurse is counseling a victim of family violence. What key idea does the nurse need to emphasize to the victim during crisis intervention? 1 An abuser can be changed when the abuser learns coping skills. 2 Skills to manage a stressful situation can help in preventing a crisis. 3 People can turn to support groups to manage a stressful situation. 4 People have a right to live without fear of violence, physical harm, or assault.

4 - People have a right to live without fear of violence, physical harm, or assault. As a key to crisis intervention, the nurse needs to emphasize that no one has the right to harm anyone and that people have a right to live without fear of violence, physical harm, or assault. Understanding this is the first step for the victim to be able to resist abuse and seek help if needed. An abuser should also be treated and counseled about using appropriate social and coping skills in a stressful situation but this is not a step for immediate crisis intervention. Various social skills are learned by the patient and planning is done to avoid a crisis situation. The nurse can support the victim by counseling about safety and providing other resources to prevent further crisis. Along with counseling, people are given referrals to various support groups to help treatment. Text Reference - p. 531

Which statement demonstrates a risk for abusive parenting? Select all that apply. 1 "I can't remember ever being told I was loved." 2 "Drinking a beer or two helps me to calm down." 3 "It's been really hard since the divorce became final." 4 "We've gone to counseling but nothing seems to help." 5 "If the children would only listen to me things would be okay."

1 - "I can't remember ever being told I was loved." 2 - "Drinking a beer or two helps me to calm down." 3 - "It's been really hard since the divorce became final." 5 - "If the children would only listen to me things would be okay." Characteristics of abusive parents include a history of abuse, neglect, or emotional deprivation as a child, a history of drug or alcohol abuse, involvement in a crisis situation: unemployment, divorce, financial difficulties, projection of blame onto the child for parents' "troubles," and the inability to seek help from others. Text Reference p. 522, Box 28.1

The nurse is working with an abused patient and is concerned about the potential for a lethal situation. Which questions should the nurse ask the patient? Select all that apply. 1 "Is there a gun in the home?" 2 "Have you ever felt neglected?" 3 "Is your abuser ever extremely jealous?" 4 "Do you ever have feelings of inadequacy?" 5 "How much alcohol does your abuser drink?"

1 - "Is there a gun in the home?" 3 - "Is your abuser ever extremely jealous?" 5 - "How much alcohol does your abuser drink?" Assessing for a potential lethal situation includes asking the patient if there is a gun in the home, if the abuser displays extreme jealousy, and if he or she has excessive alcohol intake. Feelings of inadequacy assesses for other types of abuse but not lethality. Text Reference - p. 528

Which is the most serious behavior for a woman attempting to escape a chronically abusive relationship to adapt? 1 Considering ways to commit suicide 2 Threatening to call the police if she is abused again 3 Relying on alcohol to escape the emotional pain of abuse 4 Adapting an aggressive attitude toward her abuser to scare him or her

1 - Considering ways to commit suicide A person experiencing violence may feel so trapped in a detrimental relationship, yet so desperate to get out, that suicide may seem the only answer. A suicide attempt may be the presenting symptom in the emergency department. At least 10% of abused women attempt suicide. The other reports are not realistic for a woman who is being abused. Text Reference - p. 528

Which are risk factors for older adult abuse? Select all that apply. 1 Female 2 African American 3 Over the age of 75 4 Living with a relative 5 Physical or mental impairm

1 - Female 3 - Over the age of 75 4 - Living with a relative 5 - Physical or mental impairment Risk factors for older adult abuse include being female, living with a relative, being over 75, and having physical or mental impairment. Caucasians are at a higher risk for older adult abuse than are African Americans. Text Reference - p. 524

A child comes into the physician's office with several infected wounds on the extremities. The nurse notes the child has poor hygiene, is malnourished, and there is dirt in the wounds. Which type of abuse does the nurse suspect? 1 Neglect 2 Sexual abuse 3 Physical abuse 4 Economic abuse

1 - Neglect Neglected children appear malnourished, have poor hygiene, and have untreated medical conditions. Sexual abuse in children may be demonstrated by sexual misbehavior. Physical abuse can be evident in children who complain of headaches, dizziness, and have frequent accidents. Economic abuse occurs when the abuser fails to provide for the needs of the victim when financial funds are available. Text Reference p. 527

The nurse is teaching a class on strategies to prevent the occurrence of abuse, such as reducing stress in the home. This is an example of which type of prevention? 1 Primary 2 Tertiary 3 Primordial 4 Secondary

1 - Primary Primary prevention includes measures taken to prevent the occurrence of abuse, such as reducing stress. Tertiary prevention involves counseling and support for individuals who are survivors of violence. Secondary prevention involves screening programs for high-risk individuals. Primordial prevention is preventing the risk factors in social and environmental conditions Text Reference - p. 533

A community health nurse starts working with the family of a victim of domestic abuse. What strategies for primary prevention are helpful in this case? Select all that apply. 1 Reducing stress in the family 2 Decreasing family interactions 3 Increasing the use of coping skills 4 Arranging a legal advocacy program 5 Increasing the amount of social support

1 - Reducing stress in the family 3 - Increasing the use of coping skills 5 - Increasing the amount of social support Reducing stress in the family and increasing coping skills will help the family prevent future crisis situations. Increasing social support helps reduce the feeling of isolation and increases self-worth and self-esteem in the members of the family. Decreasing family interactions will increase the self-isolation behavior, which will lead to family disorganization. A legal advocacy program is needed in the tertiary prevention of domestic abuse. Text Reference - p. 533

In the tertiary prevention method, what measures are taken to assist the survivors of abuse in the healing process? Select all that apply. 1 Counsel the survivors to hate and stay away from the perpetrator. 2 Counsel the individuals and families for healing and rehabilitation. 3 Assist in dealing with the legal proceedings against the perpetrator. 4 Support the survivors to remain in social isolation and avoid interaction. 5 Assist the survivors of violence to achieve safety, health, and well-being.

2 - Counsel the individuals and families for healing and rehabilitation. 3 - Assist in dealing with the legal proceedings against the perpetrator. 5 - Assist the survivors of violence to achieve safety, health, and well-being. In the tertiary prevention method, the nurse provides care to the individuals or groups of survivors of family abuse. The measures are taken to support the healing process through counseling. A legal advocacy program can be in place to advise the survivors on legal proceedings. Overall assistance is given to the survivors to achieve an optimal level of safety, health, and well-being. Negative thoughts against the perpetrator are addressed and reduced. Support groups are in place to provide social supports and group interactions to decrease isolation behavior. Text Reference p. 533

When interviewing an adult victim of abuse, what is the nurse's best approach? 1 Gentle and direct 2 Direct and professional 3 Sympathetic and outraged 4 Confrontational and assertive

2 - Direct and professional Expressing strong emotion does not help the victim. A direct, honest, and professional manner of asking questions produces the best results. Being confrontational and assertive, gentle and direct, or sympathetic and outraged does not help establish the necessary nurse-patient relationship needed in this situation. Text Reference - p. 525, Box 28.2

A nurse is caring for a pediatric patient who has severe injuries on his or her face and neck. The nurse says to the nurse manager, "I empathize with the patient; I wish I could make this patient happy by resolving all the problems." What response does the nurse have to the patient? 1 Confusion 2 Helplessness 3 Embarrassment 4 Discouragement

2 - Helplessness The nurse caring for a victim of violence often develops common responses, such as helplessness. The nurse wishes to do more for the patient and resolving all the patient's problems to make him or her feel happy. The nurse's statement does not indicate embarrassment, confusion, or discouragement. Embarrassment is a feeling of shame or awkwardness. Confusion is the state of being bewildered or unclear in one's mind about something. The nurse does not seem to be confused about the patient's condition. When the patient doesn't respond to long-term treatment, the nurse feels discouraged or disappointed. Text Reference - p. 529, Table 28.3

A nurse visits an old age home to assess the presence of abuse. Which response of a patient would indicate that he or she has been neglected? 1 "I spend my time by interacting with my neighbors; we pour our hearts out." 2 "I sit near this window in the morning; the warm sunrays and cool breeze lift my mood." 3 "I am grateful for this wheelchair; without it I would be dependent on my children to move." 4 "I am unable to administer the medications; the medication bottles are not clearly marked."

4 - "I am unable to administer the medications; the medication bottles are not clearly marked." The nurse should assess factors like mismanagement of medication and unmarked bottles that indicate that the geriatric patients are neglected by their children. The response "I am unable to administer the medications; the medication bottles are not clearly marked" indicates that the patient is unable to manage the medications. Patients who are victims of abuse avoid interacting with others and don't share their feelings due to fear and shame. The response "I spend my time by interacting with my neighbors; we pour our hearts out" indicates that the patient has good social interactions with the neighbors. Lack of assistive devices like wheelchairs, eyeglasses, and hearing aids are factors that indicate neglect. The response "I am thankful for this wheelchair; without it I would be dependent on my children to move" indicates that the patient has an assistive device and is happy to have it. Inadequate ventilation and space are also factors that can indicate abuse. The response "I sit near this window in the morning; the warm sunrays and cool breeze lift my mood" indicates that the patient's house has good space and ventilation. Text Reference - p. 528, Box 28.4

The nurse suspects that a person is abusing his or her child. What type of questions would help the nurse to elicit information from the person? 1 Direct questions that can be answered with "yes" or "no" 2 Threatening questions that can elicit information easily 3 Thought-provoking questions that help elicit information 4 Open-ended questions that require descriptive responses

4 - Open-ended questions that require descriptive responses A nurse should ask open-ended questions to the suspected perpetrator that require descriptive responses. Direct questions do not produce much information and should not be used. The perpetrator should not be threatened. The nurse should be supportive and nonthreatening. Thought-provoking questions can be helpful during counseling but are not required to elicit information. Text Reference - p. 525

When counseling a woman who has been in an abusive relationship for 5 years, the nurse facilitates the woman's sense of empowerment when the nurse does which of the following? 1 Assisting the woman in developing a plan to assure her safety 2 Suggesting that the woman needs to leave the abuser immediately 3 Asking the woman to identify behaviors that trigger her partner's violence 4 Offering the woman several different suggestions regarding how to stop the abuse

1 - Assisting the woman in developing a plan to assure her safety Empowerment is fostered when the nurse and the woman work together to end the abuse. Acting as the expert and providing options is an example of the paternalist model of care rather than the empowerment model. Suggesting that the woman is responsible for the violence is not empowering. Text Reference - p. 531

What statement by a female patient about her boyfriend or husband would support the suspicion that she is being emotionally abused? 1 "He is Latin American and has a fiery temper." 2 "I didn't tell him I was coming because he is under so much stress at work I didn't want to add to it." 3 "He has a good job and keeps control of all the finances but our electricity still got turned off last week." 4 "He yells a lot and calls me names, but that's because I am so stupid and make so many mistakes."

4 - "He yells a lot and calls me names, but that's because I am so stupid and make so many mistakes." Emotional abuse may be less obvious and more difficult to assess than physical violence, but it can be identified through indicators such as low self-esteem, reported feelings of inadequacy, and anxiety. Controlling the finances and having the electricity turned off describes the possibility of economic abuse. Not wanting to add to the boyfriend's stress does not describe an abusive situation. The spouse with a temper would more likely hint at physical abuse rather than emotional. Text Reference p. 527

When can a victim of abuse expect the abuse to worsen? 1 When the perpetrator feels he or she is in complete control 2 When the perpetrator is feeling remorseful for being abusive 3 When the victim submits to the domination of the perpetrator 4 When the victim moves toward independence from the abuser

4 - When the victim moves toward independence from the abuser When the abuser thinks he or she is losing control over the victim, the violence escalates. Remorse by the perpetrator and submission by the victim have not been shown to increase violence. Text Reference - p. 524

Which new parent is at risk for abusing his or her newborn? Select all that apply. 1 A mother who recently immigrated to the United States 2 A teenage father with moderately impaired cognitive skills 3 A mother of three who requests the infant be kept in the nursery at night. 4 A teenage mother who denied being pregnant until the 7 th month of gestation 5 A father who states, "I don't see myself changing diapers and cleaning up spit."

2 A teenage father with moderately impaired cognitive skills 4 - A teenage mother who denied being pregnant until the 7th month of gestation 5 - A father who states, "I don't see myself changing diapers and cleaning up spit." Nurses who work on a maternity unit are often in a position to identify risk factors for abuse between new parents and initiate appropriate interventions, including education about effective parenting and coping techniques. Parents who are candidates for special attention include new parents whose behavior toward the infant is rejecting, hostile, or indifferent; teenage parents who require special help in handling the baby and discussing their expectations of the baby and their support systems; and parents with cognitive deficits, for whom careful, explicit, and repeated instructions on caring for the child and recognizing the infant's needs are indicated. Recent immigration is not generally considered a risk for child abuse. It is not unusual that the mother of three would make the request to enable uninterrupted sleep before returning home. Text Reference - p. 532

A nurse is assessing an infant and concludes that he or she has shaken baby syndrome. Which symptoms has the nurse found in the infant? Select all that apply. 1 Ear infection 2 Malnourishment 3 Bulging fontanels 4 Respiratory problems 5 Retinal hemorrhages

3 - Bulging fontanels 4 - Respiratory problems 5 - Retinal hemorrhages Shaken baby syndrome occurs in children younger than 2 years old. The infant has injuries due to the movement of the brain in the opposite direction of the injury. Symptoms of shaken baby syndrome are respiratory problems, bulging fontanels, retinal hemorrhages, and central nervous system damage. Due to brain damage, the infant may develop seizures, vomiting, and coma. Malnourishment is caused by a deficiency of nutrients like vitamins and proteins in the body. It is caused by improper food habits or inadequate absorption of nutrients from the food. Ear infection is caused by bacterial and viral infections of the ear. Text Reference - p. 526

The nurse is caring for a patient and suspects the patient is a victim of sexual abuse by a member of the family. The patient speaks and comprehends Spanish only. Which strategy should the nurse use while assessing the patient? 1 Communicate with graphics. 2 Ask a family member to interpret. 3 Use a translator computer program. 4 Work with a trained medical interpreter.

4 - Work with a trained medical interpreter. If a patient does not speak English, it is the nurse's responsibility to work with a trained medical interpreter. Communicating with graphics is not appropriate. Asking a family member to interpret does not ensure privacy and confidentiality. Using a translator computer program can lead to error. Text Reference - p. 530

Place the following forms of reported child abuse in order of frequency. 1 Physical 2 Neglect 3 Emotional 4 Sexual

1 - Neglect 2 - Physical 3 - Sexual 4 - Emotional In 2014, there were 3.6 million referrals for child abuse. The most common form of abuse was neglect (78%), followed by physical abuse (18%), sexual abuse (9%), and other types of abuse including emotional and threatened abuse, parent's drug/alcohol abuse, or lack of supervision (11%). Text Reference - p. 521

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." This behavior best supports which conclusion? 1 The child has been sexually abused. 2 The mother needs education in parenting skills. 3 This is normal developmental behavior in a 4-year-old child. 4 The child has been exposed to graphic sexual images on television.

1 - 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. This is not normal developmental behavior for a 4-year-old child. The mother may need education in parenting skills or the child may have been exposed to graphic sexual images, but sexual abuse is more likely and must be investigated. Text Reference - pp. 526-527

A school nurse interviews a student who has vague somatic complaints. Which assessment finding alerts the nurse to a high risk for sexual abuse? 1 Both parents work in a factory. 2 The parents are of Asian heritage. 3 Neither parent completed high school. 4 Both parents were sexual abuse victims.

4 - Both parents were sexual abuse victims. Victims of sexual abuse are at high risk to become perpetrators. Abuse is uncommon among persons of Asian descent. Abuse occurs in families from a variety of economic and educational backgrounds. Text Reference - p. 522, Box 28.1

When treatment for injuries sustained during an incident of abuse is sought from the primary healthcare provider, the patient is receiving 1 Stop-gap therapy 2 Tertiary prevention 3 Primary prevention 4 Secondary prevention

4 - Secondary prevention Secondary prevention involves early intervention in abusive situations to minimize their disabling or long-term effects. Primary prevention is meant to prevent the occurrence of abuse. Tertiary prevention facilitates the healing and rehabilitative process after abuse has occurred. This type of intervention is not associated with stop-gap therapy. Text Reference - p. 533

A 79-year-old patient in the emergency department is 5' 6", weighs 93 pounds, and is wearing old, dirty clothes that have holes. The patient is diagnosed with pneumonia. Which comment by this patient suggests a significant risk for abuse? 1 "Our family is poor, so my daughter gets my monthly retirement and Social Security checks." 2 "Volunteers from our community food bank have been bringing my groceries for the last few months." 3 "I've lived alone all my life. I have my own ways of doing things and I don't like others to interfere." 4 "I've had a bad cold for months. My daughter made chicken noodle soup for me, but I kept getting worse."

1 - "Our family is poor, so my daughter gets my monthly retirement and Social Security checks." Economic abuse is controlling a person's access to economic resources. This patient may be a victim of economic abuse. "Volunteers from our community food bank have been bringing my groceries for the last few months," "I've lived alone all my life. I have my own ways of doing things and I don't like others to interfere" and "I've had a bad cold for months. My daughter made chicken noodle soup for me, but I kept getting worse" reflect challenges faced by many elderly people. Text Reference - pp. 521, 527

Which mental health disorder has been identified as a comorbid disorder associated with childhood abuse that can last the child's entire life? Select all that apply. 1 Anxiety 2 Suicidal ideations 3 Chronic depression 4 Post-traumatic stress disorder (PTSD) 5 Obsessive-compulsive disorder (OCD)

1 - Anxiety 2 - Suicidal ideations 3 - Chronic depression 4 - Post-traumatic stress disorder (PTSD) The secondary effects of abuse, such as anxiety, depression, and suicidal ideation, are health care issues that can last a lifetime. Depression and PTSD are two of the most prevalent disorders resulting from childhood trauma. OCD is not associated with abuse as frequently Text Reference - p. 522

During a health screen in a boarding school, the nurse finds that the older children have been physically abused. Which signs and symptoms does the nurse find in the children? 1 The children hesitate to interact with the nurse. 2 The children have nonspecific bruising on their hands. 3 The children give appropriate reasons for their injuries. 4 The children tend to maintain stable eye contact with the nurse.

1 - The children hesitate to interact with the nurse. Physically abused patients hesitate to interact with the nurse. The patients feel guilty, and due to fear of the abuser, try to avoid interacting with others. Physically abused patients give vague reasons and explanations for their injuries. The reason for the injury doesn't correlate with the severity of the injury. Nonspecific bruising on children older than 2 years can be considered common. Nonspecific bruising can be caused in older children while playing. Physically abused patients don't maintain proper eye contact as they try to hide their feelings. They believe that others will not trust or understand their situation. Text Reference - p. 527

A nurse plans to give secondary prevention to a patient who was sexually abused. Which action by the nurse indicates effective nursing practice? Select all that apply. 1 The nurse treats the injuries of the patient. 2 The nurse identifies families at high risk for abuse. 3 The nurse teaches mindfulness techniques to the patient. 4 The nurse arranges a housekeeper for the patient's family. 5 The nurse arranges a legal advocacy program for the patient.

1 - The nurse treats the injuries of the patient. 4 - The nurse arranges a housekeeper for the patient's family. Secondary prevention involves interventions to reduce the long-term effects of abuse in the patient. Patients who are victims of sexual abuse get depressed and fearful, so the nurse should teach them mindfulness techniques. This helps to reduce the stress in the patient. The nurse should treat the physical injuries of the patient to reduce the risk of infection. Such patients have feelings of hopelessness and suicidal intentions. Patients who are victims of sexual abuse develop suicidal intentions, so constant monitoring of the patient must be done. Caregiving becomes a burden to the patient's family members so the nurse should arrange a housekeeper to reduce the burden. Mindfulness-based stress reduction and legal advocacy programs are arranged for the survivors of abuse in tertiary prevention. Identifying families at high risk for abuse is part of primary prevention of abuse. Text Reference p. 533

The nurse is formulating a plan of care for a patient who is a victim of sexual abuse. What is a priority nursing diagnosis? 1 Self-care deficit 2 Risk for violence 3 Impaired mobility 4 Impaired self-image

2 - Risk for violence Safety is an urgent need, so the risk for violence is the priority nursing diagnosis for a patient who is a victim of sexual abuse. Self-care deficit, impaired self-image, and impaired mobility are lower-priority nursing diagnoses. Text Reference - p. 529

Which child is at lowest risk for abuse? 1 A 3-month-old who has colic and teenaged parents 2 A 2-year-old who has leukemia and two working parents 3 A 4-year-old who has cerebral palsy and mentally challenged parents 4 A 5-year-old who has attention deficit hyperactivity disorder (ADHD) and a father who was abused as a child

2 - A 2-year-old who has leukemia and two working parents Although the child who has leukemia and two working parents has a serious physical disorder, he or she is at the lowest risk for abuse. Risk factors for abuse in parents include teenage parents, parents with cognitive deficits, and parents who were abused. Text Reference - p. 532

Which of the following is a nursing intervention directed at the psychological needs of an abused person? 1 Encourage the patient to immediately leave the abuser. 2 Affirm that the patient did not deserve or cause the abuse. 3 Provide a referral to social services for economic problems. 4 Facilitate contact with law enforcement to take legal action.

2 - Affirm 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 other interventions do not primarily address psychological needs. Text Reference - p. 531

In the context of abuse assessment, on which areas should a nurse concentrate? Select all that apply. 1 Approaching the abuser 2 Assessment by a group of interviewers 3 Levels of anxiety and coping responses 4 Observations of the family's patterns of coping 5 Indications or patterns of violence in vulnerable families

3 - Levels of anxiety and coping responses 4 - Observations of the family's patterns of coping 5 - Indications or patterns of violence in vulnerable families In an abuse assessment, the nurse should include violence indicators, family coping patterns, and levels of anxiety and coping responses to plan the interventions. The nurse should not express horror, anger, shock, or disapproval of the perpetrator, or make any judgmental comment to the perpetrator. The interview should not be conducted by a group of interviewers. Rather, the patient should be made to feel comfortable and build up a rapport with the interviewing nurse. Text Reference - pp. 527, 529

What is the most appropriate statement about the victims of abuse? 1 Elder abuse is uncommon. 2 Children face physical abuse more than any other abuse. 3 Females face intimate partner abuse more often than males. 4 Girls facing child abuse die at a slightly higher rate than boys.

3 - Females face intimate partner abuse more often than males. In intimate partner abuse, four out of five victims are women. Elders commonly face abuse both in domestic and institutional settings, and it is reported that 1 out of every 10 adults older than age 60 are victims of abuse. Neglect is the most common form of child abuse. It is followed by physical abuse. Girls are slightly more likely to be abused but boys die at a slightly higher rate than girls. Text Reference - p. 523

A patient who was physically abused is diagnosed with hopelessness related to social isolation, fear related to perceived physical threat, and risk of infection related to injuries. What outcomes indicate effective treatment? 1 Has nightmares quite often 2 Has minor pain in the joints 3 Has effective wound healing 4 Needs assistance to set goals

3 - Has effective wound healing Effective wound healing is an outcome of the effective treatment of the patient with risk of infection. The patient is free from pain and doesn't complain of joint pain. An effective outcome of treatment for a patient with hopelessness would be that the patient has a positive insight for the future. The patient should also be able to set goals after effective treatment. The patient with fear feels risk free and doesn't have nightmares after an effective treatment. The patient expresses the feeling of being safe and secure. Text Reference - p. 530, Table 28.4

A nurse interacts with a patient while documenting a report of abuse. The nurse finds that the patient has poor eye contact and feels ashamed. What appropriate diagnosis should the nurse make from the patient's behavior? 1 Disabled family coping 2 Chronic low self-esteem 3 Ineffective individual coping 4 Dysfunctional family

2 - Chronic low self-esteem Patients with the signs of poor eye contact and feelings of shame indicate chronic low self-esteem. The signs of ineffective individual coping are poor coping skills, hostility, impulsivity, and inadequate problem solving. The signs of dysfunctional family process are family disorganization, conflict, denial of problem, and resistance to change. The signs of disabled family coping are ineffective problem solving, chaotic family environment, and abandonment. Text Reference p. 530, Table 28.4

When a woman reports an injury after being abused by her husband, the nurse listens to her attentively and asks her necessary questions to understand the history. What should the nurse do next to help this woman? 1 Assess safety and help explore alternatives to reduce dangers. 2 Provide a counseling session for the woman and send her home. 3 Advise the woman that she is "in trouble" and needs to find a shelter. 4 Display anger and shock and accuse the patient's husband of abuse.

1 - Assess safety and help explore alternatives to reduce dangers. A clear and detailed history is obtained from the woman. The nurse should assess the safety of the woman and help her explore alternatives to reduce danger upon being discharged. The patient should not be just counseled and sent home if there is a risk of danger once the patient is discharged. The nurse should not tell the patient that the patient is in trouble. The nurse should remain calm and objective. There should not be any display of anger or shock. The nurse should not be judgmental. Text Reference - p. 525, Box 28.2

The nurse is caring for a victim of elder abuse. What are the issues addressed in abuse protection support for older adults? Select all that apply. 1 Identification of high-risk, dependent elder relationships 2 Education on preventing family interaction to reduce abuse 3 Prevention of infliction of physical, sexual, or emotional harm 4 Prevention of neglect of the older adult's basic necessities of life 5 Education on maintaining older adult's power in relationships

1 - Identification of high-risk, dependent elder relationships 3 - Prevention of infliction of physical, sexual, or emotional harm 4 - Prevention of neglect of the older adult's basic necessities of life A nurse as a case manager works closely with the victims to support abuse protection. At first, they identify the high-risk, dependent elder relationships. If there is actual or suspected abuse, the nurse helps the victim to learn ways to prevent possible or further infliction of physical, sexual, or emotional harm. The nurse works towards preventing the neglect of basic necessities of life. Family interactions should not be decreased, as this will increase self-isolation in older adults. The perpetrators behave in a controlling way and try to maintain their power in a relationship. This should not be encouraged. Older adults are vulnerable and remain dependent on the perpetrators. Text Reference - pp. 524, 532, Box 28.6

What should a community health nurse include in the assessment of an older patient when elder abuse is suspected? Select all that apply. 1 Medication mismanagement 2 Inadequate utilities and space 3 Unavailability of transportation 4 Use of a wheelchair in the house 5 Lack of access to basic necessities

1 - Medication mismanagement 2 - Inadequate utilities and space 5 - Lack of access to basic necessities A community health nurse visits the home of older adults who are in the vulnerable category and may be subject to abuse. Lack of access to basic necessities like food, water, and medications is a definite indicator of elder abuse and needs intervention. Adequate utilities, ventilation, and space are required to maintain good health. Medication mismanagement is one of the factors that requires intervention from the nurse to protect the older adult from abuse. Use of a wheelchair in the house means the older adult is being provided assistive devices as needed. Lack of necessary assistive devices for an older adult may indicate elder abuse. Availability of personal transportation is subject to the economic status of the family. Text Reference p. 528, Box 28.4

A nurse prepares the case report of a patient who was sexually abused. What information does the nurse record in the patient's case report? Select all that apply. 1 Nightmares 2 Feelings of guilt 3 Untreated diseases 4 Excessive masturbation 5 Inadequate immunization

1 - Nightmares 2 - Feelings of guilt 4 - Excessive masturbation Sexually abused patients often indulge in excessive masturbation. Masturbation is a sexualized behavior commonly seen in sexually abused children in response to the traumatic event. The sexually abused patients may exhibit post-traumatic stress disorder, which is characterized by nightmares and feelings of guilt. Inadequate immunization and untreated diseases are seen in neglected patients due to inadequate medical care. Text Reference - pp. 526-527

Which action is considered a nursing responsibility related to the abuse of a patient? Select all that apply. 1 Reporting is a legal obligation. 2 Abuse need only be suspected. 3 Most states require a report within 24 hours. 4 The nurse is required to display a neutral attitude. 5 The report needs support by another healthcare provider.

1 - Reporting is a legal obligation. 2 - Abuse need only be suspected. 4 - The nurse is required to display a neutral attitude. Nurses are mandated legally to report suspected or actual cases of child and vulnerable adult abuse. Nurses must attempt to maintain both an appropriate level of suspicion and a neutral, objective attitude. Each state has specific guidelines for reporting, including whether the report can be oral, written, or both, and within what time period the suspected abuse or neglect must be reported (immediately, within 24 hours, or within 48 hours). No collaboration by another nurse is required. Text Reference - p. 530

An elderly patient pays the bills because the patient fears that his or her family will make him or her live elsewhere if the patient doesn't "help out." The nurse assesses this as what? 1 Neglect 2 Economic abuse 3 Physical violence 4 Psychological abuse

2 - Economic abuse Economic abuse occurs when the perpetrator takes financial advantage of the elderly person, often through the use of subtle threats of what unpleasant or frightening outcome will occur if the elder patient does not supply funds. Neglect, physical violence, and psychological abuse lack the financial component. Text Reference - pp. 521, 527

Which principle will guide the nursing interview that is focused on identifying possible family-centered violence? Select all that apply. 1 Stop the telling of the abuse whenever clarification is needed. 2 Establishing a trustful rapport is the initial nursing intervention. 3 Tension is best minimized by asking the sensitive questions first. 4 Focus upon identifying problems and acceptable ways of solving them. 5 Open-ended questions can be less threatening and elicit more relevant information.

2 - Establishing a trustful rapport is the initial nursing intervention. 4 - Focus upon identifying problems and acceptable ways of solving them. 5 - Open-ended questions can be less threatening and elicit more relevant information. Important and relevant information about the family situation can be gathered by routine assessment conducted with tact, understanding, and a calm, relaxed attitude. Open-ended questions can be less threatening and elicit more relevant information than questions that are direct and can be answered with "yes" or "no." It is better to ask about ways of solving disagreements or methods of disciplining children. When interviewing, spend time establishing trust and rapport before focusing on the details of the violent experience. Establishing trust is crucial if the patient is to feel comfortable enough to self-disclose. The person who experienced the violence should be allowed to tell the story without interruption. Text Reference - p. 525

The nurse suspects that a patient is a victim of family violence. What should the nurse assess to identify family violence? Select all that apply. 1 Mismanagement of medicine 2 Family coping patterns of abuse 3 Characteristics of the perpetrator 4 Drug or alcohol use in the family 5 Presenting signs and symptoms of abuse

2 - Family coping patterns of abuse 4 - Drug or alcohol use in the family 5 - Presenting signs and symptoms of abuse The nurse documents the family coping patterns and past or current history of drug or alcohol use. The nurse assesses the presenting signs and symptoms of the victims carefully. The mismanagement of medicine is assessed when neglect of older adults is suspected. It is not a feature of family violence. The characteristics of the perpetrators are assessed in the secondary prevention method. Text Reference - pp. 525-529

The nurse performing the assessment of a wheelchair-bound patient suspects that the spouse's explanation of how the patient sustained facial contusions and a broken nose may not be entirely truthful. What should the nurse do? 1 Report the patient's injuries to the police and ask for a confidential investigation. 2 Have the spouse stay in the waiting room so the patient can be interviewed in private. 3 Confront the spouse with the suspicion that the patient's injuries are the result of abuse. 4 Document the suspicion and follow a policy of "wait and see" whether the patient returns again.

2 - Have the spouse stay in the waiting room so the patient can be interviewed in private. The initial intervention is the assessment interview, and suspected victims of abuse should always be interviewed in private. If the perpetrator is in the room, the victim cannot speak freely. Confronting the spouse, reporting the injuries to the police, or waiting to see if the patient returns again are not appropriate options; the assessment interview is the initial intervention. Text Reference p. 525

A woman reports being in an abusive relationship with her husband. What drives a man to act as a perpetrator in an abusive relationship? Select all that apply. 1 He forces his partner to work because he feels idle. 2 He feels more powerful when he uses force and abuse. 3 He feels he is in charge and dominant in the relationship. 4 He uses physical aggression because he hates his partner. 5 He imposes restrictions due to extreme pathological jealousy.

2 - He feels more powerful when he uses force and abuse. 3 - He feels he is in charge and dominant in the relationship. 5 - He imposes restrictions due to extreme pathological jealousy. Male perpetrators believe in male supremacy and male dominance. They feel they are in charge in a relationship and using force makes them feel more powerful and proves their supremacy. Due to extreme jealousy, they do not want their partners to have personal friends or to take part in any recreational activities outside home. They sometimes do not want their partner to go outside and work due to extreme jealousy. They use physical aggression to be in a powerful position in a relationship. Text Reference p. 523

An elderly woman who has been abused by her caregiver daughter tells the nurse, "You don't have to worry about me. My daughter cried and apologized. She promised me she will never hit me again." The nurse can assess that this is which stage in the cycle of violence? 1 Escalation 2 Honeymoon 3 Acute battering 4 Tension building

2 - Honeymoon During the honeymoon stage, the perpetrator apologizes, promises never to abuse again, and tries to make up for the violence. This stage is usually brief. Tension building, acute battering, and escalation are not accurate descriptions of this situation. Text Reference - p. 523

A nurse is teaching patients in a primary healthcare center how to escape and avoid being a victim of abuse by their partners. Which action of a participant indicates effective teaching? Select all that apply. 1 Showing extreme trust of his or her partner 2 Identifying the signs of escalation of violence 3 Packing a bag with money and birth certificates 4 Leaving the place immediately if there are signs of violence 5 Staying with the abuser to make him or her calm and relaxed

2 - Identifying the signs of escalation of violence 3 - Packing a bag with money and birth certificates 4 - Leaving the place immediately if there are signs of violence Patients who are victims of abuse should be counseled to develop a safety plan to avoid being abused further and to escape from the violence. The nurse should suggest that the patient identify the signs of escalation of violence. This helps the patient avoid being exposed to such stressors. The patient must be told to immediately leave the premises where the abuser resides or is present if there are signs of violence. The patient must be given a checklist of things that he or she should carry before leaving the home. The patient must be advised to pack important things, such as money and birth certificates, in a bag and hide the bag from the abuser. Showing extreme trust will not reduce the abuse. The abuser can take the patient for granted and can be extremely violent with the patient. Staying with the abuser even after identifying the signs of violence will not prevent the abuse. Text Reference - p. 531

A nurse is assessing a patient with major injuries. The nurse suspects that the patient was physically abused by his or her intimate partner. The patient is unable to interact due to a language barrier. What appropriate action should the nurse take while documenting the clinical report of abuse? 1 Immediately report against the patient's partner in the community health department. 2 Maintain a balance of suspicion and a neutral, objective attitude. 3 Ask the patient's family member to translate the conversation. 4 Give the patient some time, and conduct the interview after 72 hours.

2 - Maintain a balance of suspicion and a neutral, objective attitude. The nurse should prepare a clinical document to report the physical abuse of the patient. While interacting with the patient, the nurse should maintain a balance of suspicion and a neutral, objective attitude. It helps the nurse not to jump to conclusions and to complete a thorough examination to make proper assessment of the patient's condition. Suspecting the patient's partner without evidence may lead to incomplete assessment of the patient. Without proof the nurse should not come to a conclusion and file a complaint against the patient's partner. The nurse should not ask the patient's family member to translate the interaction. Presence of a family member during documentation of the report results in loss of patient's confidence. The patient can avoid interacting due to threat of future punishment. The report of the abuse must be done within 24-48 hours. So the nurse should interact with the patient within 48 hours and complete the document. Text Reference - p. 530

Which factor is of least importance as a victim of spousal abuse constructs a safety plan? 1 Where the victim will go to be safe 2 How the victim will arrange for transportation 3 How the victim will explain the decision to leave 4 What the victim will need to take when he or she leaves

3 - How the victim will explain the decision to leave Having a destination and transportation, plus important items to bring are important aspects of a safety plan. Having an explanation for the decision to leave is not of great importance. Text Reference - p. 531

A patient prepares for discharge from the emergency department after treatment for injuries associated with intimate partner violence. The patient plans to return home. Which action by the nurse has priority? 1 Refer the patient for pastoral counseling. 2 Provide the patient with contact information for the local shelter. 3 Encourage the patient to file criminal charges against the perpetrator. 4 Tell the patient, "I have documented your injuries and treatment thoroughly."

2 - Provide the patient with contact information for the local shelter. Safety is the nurse's highest priority. Patients should be given the number of the nearest available shelter, even if they decide for the present to stay with their partners. Referral phone numbers may be kept for years before deciding to call. Pastoral counseling may be helpful, but is not the priority. The nurse should not give advice, such as encouraging the patient to file criminal charges against the perpetrator. Documentation is part of the nurse's responsibility, but adamantly informing the patient of the documentation is likely to increase fear. Text Reference - p. 529

Which behavior is characteristic of the tension-building stage of the violence cycle? Select all that apply. 1 Remorse is felt and expressed. 2 Rationalization is used to justify the anger. 3 Calmness returns for a short period of time. 4 Tension is released thorough physical violence. 5 Alcohol may be employed to manage the tension.

2 - Rationalization is used to justify the anger. 5 - Alcohol may be employed to manage the tension. The tension-building stage is characterized by abusers rationalizing that their abusive behavior is acceptable. As the tension escalates, both participants may try to reduce it. The abuser may try to reduce the tension with the use of alcohol or drugs. During the acute battering stage, the abuser releases the built-up tension by brutal beatings, which can result in serious injuries. The honeymoon stage may be characterized by kindness and loving behaviors. The abuser, at least initially, feels remorseful and apologetic. Over time, the periods of calmness and safety become briefer, and the periods of anger and fear are more intense. Text Reference - p. 523

A 1-year-old child has respiratory problems and is vomiting. Examinations show the child has bulging fontanels and a retinal hemorrhage. What should the nurse suspect? 1 Injuries due to a fall 2 Shaken baby syndrome 3 Upper respiratory illness 4 Post-traumatic stress disorder

2 - Shaken baby syndrome If a child younger than 2 years of age is shaken violently, its brain may move in the opposite direction as its body. Due to such movement, the baby develops respiratory problems, bulging fontanels, retinal hemorrhages, and central nervous system damage resulting in seizures, vomiting, and coma. This is called shaken baby syndrome. Though a fall may also result in any of these symptoms, as a whole the symptoms are indicative of shaken baby syndrome. Posttraumatic stress disorder occurs after a severe trauma and the characteristic manifestations are nightmares, somatic complaints, and feelings of guilt. A respiratory ailment and gastrointestinal disturbances do not manifest in bulging fontanels or retinal hemorrhage. Text Reference - p. 526

A person comes to the healthcare facility with a bleeding head injury and some bruises to both hands. What signs would indicate this person is a victim of domestic abuse? Select all that apply. 1 The patient makes direct eye contact. 2 The patient gives hesitant explanations. 3 The patient's explanation is inconsistent. 4 The patient minimizes the seriousness of the injury. 5 The patient exaggerates the seriousness of the injury.

2 - The patient gives hesitant explanations. 3 - The patient's explanation is inconsistent. 4 - The patient minimizes the seriousness of the injury. If the patient comes with a bleeding injury, especially to head or face, the nurse should suspect abuse. If the explanation does not match with the injury seen, the nurse should ask the patient direct questions in a nonthreatening way to determine if the injury is caused by some person in the family. If the patient minimizes the seriousness of the injury, the nurse should suspect abuse. The nonverbal responses should be documented. Examples include if the patient hesitates, does not make eye contact, or if the explanation is inconsistent. Good eye contact and a consistent explanation do not reveal any underlying abuse. The patient may minimize, not exaggerate, the seriousness of an injury. Text Reference - pp. 525-526

A nurse interacts with a patient who was physically abused. The nurse diagnoses the patient as in the serious battering phase. Which signs and symptoms does the nurse find in the patient? Select all that apply. 1 The patient begins to indulge in self-harm. 2 The patient tries to cover up injuries with a scarf. 3 The patient requests to be rescued from the abuser. 4 The patient accepts the blame for being physically abused. 5 The patient believes that the partner will stop physical abuse.

2 - The patient tries to cover up injuries with a scarf. 3 - The patient requests to be rescued from the abuser. The cycle of abuse consists of three stages, the tension-building phase, the serious battering phase, and the honeymoon phase. In the serious battering phase, the patient has serious injuries and tries to cover them up with a cloth or scarf. The patient wants to escape from the abuser and asks for help from the nurse and others. In the tension-building phase, the patient blames himself or herself for the partner's abusive behavior. In the honeymoon phase, the patient develops feelings of trust and hope toward the abuser. The abuser shows love and care toward the victim and showers the victim with gifts and flowers, so the patient hopes that the partner will stop physically abusing. Patients who are suicidal or manic are usually found to indulge in self-harm. Text Reference - p. 523, Figure 28.1

A woman in the sixth month of pregnancy presents in the emergency department with complaints of a severe headache. Her partner answers the assessment questions, even though they are directed to the woman. The woman has a depressed affect and slumped shoulders. The nurse recognizes the need for further assessment related to which of the following? 1 Potential neurologic infection 2 The risk of intimate partner violence 3 The possibility of a hypertensive crisis 4 Development of a major depressive episode

2 - The risk of intimate partner violence Pregnancy is a high-risk period for development or escalation of intimate partner violence. In this instance, the partner is trying to control the interview, which is another indicator of possible abuse. Potential neurologic infection, the possibility of a hypertensive crisis, and development of a major depressive episode are possibilities but less likely options. Text Reference - pp. 524, 527, 532, Table 28.2, Box 28.6

The nurse is preparing a safety plan for a victim of family violence. How does a safety plan help the victim? 1 The victim can call the nurse if there is any suicidal ideation. 2 The victim can identify signs of occurrence of violence and leave. 3 The victim can call law enforcement to intervene in a crisis situation. 4 The victim can stay calm and relaxed during an episode of violence.

2 - The victim can identify signs of occurrence of violence and leave. The safety plan helps the patient to identify signs of abuse and to escape the situation by leaving. The patient should be prepared by packing essential items and keeping a packed bag in a secret place. There should be a plan for a destination and transportation. The victim can call the police if the situation warrants and it is not possible for the victim to escape. The victim can call the nurse if there is a suicidal feeling. Staying calm and relaxed does not help the victim avoid a violent situation. Text Reference p. 531

A person with a history of abusing an intimate partner says, "When my partner leaves home, I think it's because she's meeting someone she likes better than me." Which emotion is most evident by this comment? 1 Guilt 2 Anxiety 3 Jealousy 4 Remorse

3 - Jealousy Extreme pathological jealousy is characteristic of an abuser. Many refuse to allow their partners to work outside the home; others demand that their partners work in the same place as they do, so they can monitor activities and friendships. Many accompany their partners to and from all activities and forbid them to have friends or participate in recreational activities outside the home. Anxiety is possible, but jealousy is more specific to the patient's comment. There is no evidence of remorse or guilt, which would signify regret of the abuse. Text Reference - pp. 523-524

A school nurse assesses multiple bruises and welts in odd shapes on a child's back. Lately, this child has been frequently tardy and has had episodes of aggressive behavior in school. Identify the best initial outcome. 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.

3 - The child will form a trusting relationship with the nurse. Establishment of trust and rapport is the first 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 relationship. Text Reference p. 525

A married couple that has had a violent marriage decides to participate in family or marital therapy. What are the expected outcomes of family psychotherapy for the perpetrator? 1 To become temperamental and handle a crisis situation impulsively 2 To express anger and disappointment to the members of the family 3 To recognize destructive patterns of behavior and learn alternative responses 4 To develop reclusive behavior and isolate one's self from others in the family

3 - To recognize destructive patterns of behavior and learn alternative responses The perpetrator should also be included in the plan of care. The person should undergo individual therapy and then, if it is successful and some changes are noticed, the person can undergo family psychotherapy. The expected therapy outcome is that the person should learn to recognize the destructive patterns of behavior and can use alternative responses to refrain from abuse. The perpetrator should learn to control impulses and should not be temperamental in a crisis. The person should learn alternative ways to express anger, disappointment, and frustration and should not just vent to the members of the family. The person should learn to interact in a healthy way with other members of the family so that trust can be established, and openness and directness can help stop the violence. Text Reference - p. 534

Nurses working in emergency departments and walk-in clinics should be aware that victims of violence may commonly present in which manner? 1 With extreme anger and unpredictable behavior. 2 With many family members there to support them. 3 With psychosis or mania as a result of long-term abuse. 4 With vague physical complaints such as insomnia or pain.

4 - With vague physical complaints such as insomnia or pain. Patients may present with symptoms that may be vague and can include chronic pain, insomnia, hyperventilation, or gynecological problems. Attention to the interview process and setting is important to facilitate accurate assessment of physical and behavioral indicators of family violence. Presenting with extreme anger is possible but not as common as presenting with vague physical complaints. Having many family members there is unlikely as many victims keep their history of being battered a secret. It is not known that psychosis or mania is a result of physical violence, and this would not be a usual presenting complaint. Text Reference - p. 525