Chapter 28 Questions - Child, Older Adult, and Intimate Partner Violence
Which statement, made by a female adult concerning her boyfriend, should cause the nurse to suspect that the client is at risk for being emotionally abused? "He has a good job and keeps control of all the finances but our electricity still got turned off last week." "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." "He yells a lot and calls me names, but that's because I am so stupid and make so many mistakes." "He has always had a fiery temper."
"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. Describing the boyfriend as having a temper would more likely hint at physical abuse rather than emotional
Which statement made by a new mother should be explored further by the nurse? "I have three children, that's enough" "I think the baby cries just to make me angry" "I wish my husband could help more with the baby" "Babies are a blessing, but they are a lot of work"
"I think the baby cries just to make me angry"
Which statement made by a parent of a child diagnosed with Tourette's syndrome would be assessed as a risk factor for family violence? "My husband lost his job, and it seems all our savings are going to pay for our son's expensive medication and all the other things he needs." "Our son is really a good little boy, but he needs to be disciplined both at home and in school." "We shouldn't be, but we are ashamed of our son's disorder and his inability to control the tics in public." "We have become active in the support group but still find the suggestions extremely difficult to put into practice."
"My husband lost his job, and it seems all our savings are going to pay for our son's expensive medication and all the other things he needs." Job loss, financial problems, and a child who is "different" and has special needs should alert the nurse to the risk for family violence, because all these factors contribute to a crisis situation. None of the other options present with numerous risk factors.
ATI CH 32 - 1. A charge nurse is leading a peer group discussion about family and community violence. Which of the following statements by a member of the group indicates an understanding of the teaching? "Children older than 3 are at greater risk for abuse" "Substance use disorder does not increase the risk for violence" "Entering an intimate relationship increases the risk for violence" "Pregnancy increases the risk for violence toward the intimate partner"
"Pregnancy increases the risk for violence toward the intimate partner"
Which child is at lowest risk for abuse? A 3-month-old who has colic and teenaged parents A 4-year-old who has cerebral palsy and cognitively challenged parents A 2-year-old who has leukemia and two working parents A 5-year-old who has ADHD and a father who was abused as a child
A 2-year-old who has leukemia and two working parents Although the child in option C has a serious physical disorder, she is at lower risk than the child in option A, whose inconsolable crying can be frustrating; the child in option B, who will not be as independent as other children his age and who has parents who may not understand his needs; or the child in option D, whose hyperactivity can be annoying, especially to a parent who himself has been abused.
ATI CH 32 - 5. A nurse is caring for an adult client who has injuries resulting from intimate partner abuse. The client does not wish to report the violence to law enforcement authorities. Which of the following nursing actions is the highest priority? Advise the client about the location of women's shelters Encourage the client to participate in a support group for survivors of abuse Implement case management to coordinate community and social services Educate the client about the use of stress management techniques
Advise the client about the location of women's shelters
Which nursing intervention is best directed at the psychological needs of a physically abused client? Encourage the client to immediately leave the abuser. Affirm that the client did not deserve or cause the abuse. Provide a referral to social services for economic problems. Facilitate contact with law enforcement to take legal action.
Affirm that the client did not deserve or cause the abuse. Abused clients 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 remaining options are directed to either safety or physical needs
When the nurse believes the cycle of abuse is escalating and that a woman may be in severe physical danger, what should the priority nursing intervention be? Advising her to enter counseling at the mental health center Assisting her in developing a plan to go to a shelter in case of a crisis Suggesting that she leave the abuser immediately and go to a trusted friend's home Teaching her to counter verbal abuse with assertive replies
Assisting her in developing a plan to go to a shelter in case of a crisis Every victim of abuse should have an escape plan, but one is particularly important when the nurse believes the client is in severe danger. None of the remaining options are as directly involved in client safety
To best assure the safety of a 3-year-old child whose parent admits to finding it difficult to control his/her anger, what is the most appropriate short-term goal for the parent? Demonstrating understanding of the impact of violence on the child within 2 days Beginning attending anger management training sessions within 2 weeks Stating a willingness to attend a support group for physical abusers within 1 week Showing remorse for their anger management issues within 2 days
Beginning attending anger management training sessions within 2 weeks Perpetrators of violence need help learning how to manage anger. A structured group is an excellent way to provide this teaching. This option most directly addresses the issue of preventing the anger from escalating to physical abuse
Which behavior demonstrated by a woman attempting to escape a chronically abusive relationship presents the greatest personal risk? Relying on alcohol to escape the emotional pain of abuse Adapting an aggressive attitude toward her abuser Considering ways to commit suicide Threatening to call the police if she is abused again
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. None of the other options present the degree of personal risk associated with suicidal ideations
When interviewing an adult victim of abuse, what is the nurse's best approach when asking relevant questions? Confrontational and assertive Gentle but direct Direct and professional Sympathetic but detached
Direct and professional Expressing strong emotion does not help the victim. A direct, honest, and professional manner of asking questions produces the best results. None of the other options are recognized as being effective in this type of interview situation.
A 4-year-old child tells the nurse, "I'm a bad boy. Daddy always says I'm not worth a second look." This situation can be an example of which form of abuse? Neglect Physical Emotional Tough love
Emotional Emotional violence occurs when the child's self-esteem is attacked. It is as devastating to the child as physical abuse. None of the other options are focused on damaging a child's self-esteem. Tough love is a form of parenting that includes consequence but does not involve emotional abuse
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? Hopelessness Fear Post-trauma syndrome Risk for self-directed violence
Fear The client is expressing fear based on a known threat. None of the other options are supported by information provided in the scenario
An elderly client pays the bills because she fears that her family will make her live elsewhere if she doesn't "help out." The nurse assesses as the client may be at risk for what form of abuse? Neglect Physical violence Psychological Financial maltreatment
Financial maltreatment Financial maltreatment 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 does not supply funds. None of the remaining options is as directly associated with money as is the correct option.
When there is reason to suspect that a child is being abused, the nurse must initially implement which intervention? Call the local police to report it. Follow agency policy for reporting. Confront the parent or parents. Question the child to obtain proof.
Follow agency policy for reporting. Nurses are mandated reporters of child abuse. They must follow the rules set forth by the state regarding the steps to take to report child abuse
Perpetrators of domestic violence tend to: select all that apply Have relatively poor social skills and have grown up with poor role models Believe they, if male, should be dominant and in charge in relationships Force their mates to work and expect them to handle the financial decisions Be controlling and willing to use force to maintain their power in relationships Prevent their mates from having relationships and activities outside the family
Have relatively poor social skills and have grown up with poor role models Believe they, if male, should be dominant and in charge in relationships Be controlling and willing to use force to maintain their power in relationships Prevent their mates from having relationships and activities outside the family
The nurse performing the assessment of a wheelchair-bound client suspects that his wife's explanation of how he sustained facial contusions and a broken nose may not be entirely truthful. The nurse should implement which assessment intervention? Confront the wife with the suspicion that her husband's injuries are the result of abuse. Have the wife wait in the waiting room so her husband can be interviewed in private. Report the husband's injuries to the police and ask for a confidential investigation. Document the suspicion and follow a policy of "wait and see" whether he returns again.
Have the wife wait in the waiting room so her husband can be interviewed in private. Suspected victims of abuse should always be interviewed in private. If the perpetrator is in the room, the victim cannot speak freely. Confronting the wife would likely cause her to be uncooperative and increase tensions. Neither of the other options address the assessment interview process.
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 recognizes that the client is describing which stage of the cycle of violence? Tension building Acute battering Honeymoon Escalation
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. None of the other stages in this cycle are characterized by this behavior
ATI CH 32 - 4. A nurse is preparing a community education seminar about family violence. When discussing types of violence, the nurse should include which of the following? Refusing to pay bills for a dependent, even when funds are available, is neglect Intentionally causing an older adult to fall is an example of physical violence Striking an intimate partner is an example of sexual violence Failure to provide a stimulating environment for normal development is emotional abuse
Intentionally causing an older adult to fall is an example of physical violence refusing to pay bills is a form of economic maltreatment
What distinction can be made between abuse and neglect? Neglect occurs in the psychological domain; abuse occurs in the physical domain. Neglect is always physical; abuse can be verbal, physical, sexual, or emotional. Neglect is perpetrated against children; abuse victims can be children or adults. Neglect is a failure to provide; abuse is a failure to control aggression.
Neglect is a failure to provide; abuse is a failure to control aggression. Neglect is failure to provide necessary care, and abuse is physical maltreatment
What safety related responsibility does the nurse have in any situation of suspected abuse? Protect the patient from future abuse by the abuser Inform the suspected abuser that the authorities have been notified Arrange for counseling for all involved parties but especially the patient Report suspected abuse to the proper authorities
Report suspected abuse to the proper authorities
Which of the following persons has the highest risk factors for physical abuse? Emma, a 7-month-old baby who has colic and doesn't sleep through the night Roland, a 53-year-old man with cardiovascular disease living with his son Penny, a 28-year-old wife whose husband has a diagnosis of an anxiety disorder Rose, a 77-year-old woman living with her daughter and son-in-law
Rose, a 77-year-old woman living with her daughter and son-in-law Older women dependent on family members for care are at higher risk for abuse. The other options do not describe specific characteristics that put them at higher risk for abuse
When treatment for injuries sustained during an incident of abuse is sought from the primary physician, the client is receiving which form of treatment? Primary prevention Secondary prevention Tertiary prevention Stop-gap therapy
Secondary prevention Secondary prevention involves early intervention in abusive situations to minimize their disabling or long-term effects. This scenario demonstrates actions only associated with secondary prevention
What situation associated with a caregiver presents the greatest risk that an older adult will experience abuse by that caregiver? The caregiver is a single male relative The caregiver was neglected as a child The caregiver is under the age of 30 The caregiver has little experience with the elderly
The caregiver was neglected as a child
An appropriate expected outcome in individual therapy regarding the perpetrator of abuse would be: A decrease in family interaction so that there are fewer opportunities for abuse to occur The perpetrator will recognize destructive patterns of behavior and learn alternate responses The perpetrator will no longer live with the family but have supervised contact while undergoing intensive inpatient therapy A triad of treatment modalities, including medication, counseling, and role-playing opportunities
The perpetrator will recognize destructive patterns of behavior and learn alternate responses
The nurse is assisting a patient to identify safety issues that may occur now that she has left an abusive partner. What telephone numbers should be available to the patient? select all that apply The police department An abuse hotline A responsible friend or family member A domestic violence shelter The hospital emergency department
The police department An abuse hotline A responsible friend or family member A domestic violence shelter
What is the priority outcome for a toddler who has been sexually abused? The mother will learn coping techniques to support the child. The child will be able to verbalize exactly what happened to her. The child will no longer demonstrate inappropriate sexual behavior. The sexual abuse will cease immediately.
The sexual abuse will cease immediately. The highest priority in this case is that the abuse stops so that the patient can be safe and undergo recovery. The question is asked about the priority outcome for the victim, not the mother. Verbalizing exactly what happened is not a priority. The victim will most likely stop the sexualized behavior when the abuse has stopped and recovery is supported by age-appropriate interventions.
When should the nurse expect the abuse of a victim to worsen? The perpetrator feels he is in complete control. The perpetrator is feeling remorseful for being abusive. The victim moves toward independence from the abuser. The victim submits to the domination of the perpetrator.
The victim moves toward independence from the abuser. When the abuser thinks they are losing control over the victim, the violence escalates. None of the other options are associated with the escalation of abuse by the perpetrator against the victim
The risk of elder abuse in a home is best determined by conducting which assessment? The vulnerability of the elder and the stress of the caregiver The amount of disruption the elder causes in the home How much actual physical assistance the elder needs on a daily basis The financial contribution of the elder and the caregiver's early life experience with abuse
The vulnerability of the elder and the stress of the caregiver Abuse occurs across all segments of society and is reinforced by the society and the culture. The actual occurrence of violence requires (1) a perpetrator, (2) someone who by age or situation is vulnerable (e.g., children, women, men, the elderly, mentally ill persons, and physically challenged persons), and (3) a crisis situation.
The mother of a 4-year-old daughter states that the child has recently begun, "Touching her vagina and rubs herself down there all the time." The child drew a picture showing two people with one on top of the other and said they were "doing sex." Based on the assessment description, what conclusion should the nurse explore further? Educate the mother to normal developmental behavior in a 4-year-old child. There is a possibility that the child has been sexually abused. The mother should be enrolled in parenting classes to improve her parenting skills. The child's exposure to graphic sexual images on television should be monitored closely.
There is a possibility that 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. It is not normal developmental behavior for a 4-year-old child. The other options may be true, but sexual abuse is more likely and must be investigated
Nurses working in emergency departments and walk-in clinics should be aware that some victims of violence may present with which assessment characteristic? Vague physical complaints such as insomnia or pain Extreme anger and unpredictable behavior Family members described as supportive Psychosis and/or mania as a result of long-term abuse
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.
Which statement reflects a fact about family violence? Ninety-five percent of abuse victims are women. The victim's behavior is often the cause of the violence. Violence occurs in families of all backgrounds. Alcohol and stress are the major causes of abuse.
Violence occurs in families of all backgrounds. Family violence is a serious community health problem common among all backgrounds. None of the other statements provide accurate information about family violence
Secondary effects of abuse often manifest as arrested development in children due to the fact that: coping is easier than emotional growth energy for development is diverted to coping children cannot differentiate love from abuse abuse fosters a sense of belonging, even if dysfunctional
energy for development is diverted to coping
The use of a patient-centered interview technique works well for gathering information about abusive situations. It is a good use of clinical time to sit near the patient and: establish trust and rapport ask lots of questions interrupt the patient's story to allow for decompression utilize closed-ended questions
establish trust and rapport
Which problem is observed in children who regularly witness acts of violence in their family? select all that apply phobias low self-esteem major depressive disorder narcissistic personality disorder posttraumatic stress disorder
phobias low self-esteem major depressive disorder posttraumatic stress disorder
ATI CH 32 - 2. A nurse is preparing to assess an infant who has shaken baby syndrome. Which of the following is an expected finding? select all that apply sunken fontanels respiratory distress retinal hemorrhage altered level of consciousness increase in head circumference
respiratory distress retinal hemorrhage altered level of consciousness increase in head circumference bulging, rather than sunken fontanels are an expected finding
ATI CH 32 - 3. A nurse working in an emergency department is assessing a preschool-age child who reports abdominal pain. When conducting a head-to-toe assessment, which of the following findings should alert the nurse to possible abuse? select all that apply abrasions on knees round burn marks on forearms mismatched clothing abdominal rebound tenderness areas of ecchymosis on torso
round burn marks on forearms areas of ecchymosis on torso abdominal rebound tenderness is an indication of appendicitis rather than abuse
