Chapter 30: Mental Health Care for Survivors of Violence

A nurse is talking to a female client who is a survivor of intimate partner violence. The woman relates that her husband has been told that he has the characteristics of an antisocial personality disorder. The woman also informs the nurse that her husband has an extensive criminal record. The nurse interprets this information and suspects that the woman's husband would most likely demonstrate which behavior? A) A risk for aggressive and assaultive violence toward people within and outside of his family B) Intermittent remorse for the violence and abuse that he commits C) Symptoms of depression along with harboring feelings of inadequacy D) Purposefully remaining socially isolated from people other than those in his family

A) A risk for aggressive and assaultive violence toward people within and outside of his family Feedback: Evidence suggests that when people with borderline personality disorder are distressed, they are predisposed to interpret social situations as threatening and to respond with emotional dysregulation, verbal attacks, and physical violence. People who meet the diagnostic criteria of antisocial personality disorder, have an extensive history of criminal behavior, and who are generally violent are also more likely to be both aggressive and assaultive. These perpetrators have a heightened sensitivity to emotional displays that predispose them to interpret social situations as threatening and to respond with emotional dysregulation, verbal attacks, and physical violence.

A nurse is assessing a client who is a survivor of abuse. Which of the following would be most appropriate to use when conducting a lethality assessment? A) Danger Assessment Screen B) Abuse Assessment Screen C) Burgess-Partner Abuse Scale D) Beck Depression Inventory

A) Danger Assessment Screen Feedback: The Danger Assessment Screen, developed by Jacquelyn Campbell and colleagues, is a useful tool for assessing the risk that either an adult survivor or perpetrator will commit homicide. It would be appropriate to use when conducting a lethality assessment. The Abuse Assessment Screen and Burgess-Partner Abuse Scale are appropriate tools to use to screen for violence and abuse. The Beck Depression Inventory is used to screen for depression.

A nurse is caring for a young adult in the mental health clinic. The client tells the nurse that he was physically neglected as a child. The nurse should assess the client for symptoms of which of the following? A) Major depression B) Schizophrenia C) Narcissistic personality disorder D) Panic disorder

A) Major depression Feedback: An important outcome of nursing intervention with survivors is appropriate treatment of any disorder resulting from abuse, such as acute stress disorder, posttraumatic stress disorder, anxiety disorders, dissociative identity disorder, major depression, or substance abuse..

A nurse is presenting to a church group a program about domestic violence. During the presentation, a member of the audience asks the nurse to explain what "intergenerational transmission of violence" means because he has seen that phrase used in the media. Which of the following responses by the nurse would be most appropriate? A) "People who are violent are that way because of the various neurochemical imbalances in their brains." B) "People who grow up in violent home situations tend to be involved in domestic violence situations as an adult." C) "Recent research has identified a gene that is responsible for transmission of a risk for violent behavior that is passed on from generation to generation." D) "Domestic violence seems to skip every other generation when it is traced in families."

B) "People who grow up in violent home situations tend to be involved in domestic violence situations as an adult." Feedback: Violent families create an atmosphere of tension, fear, intimidation, and tremendous confusion about intimate relationships. Children in violent homes often learn violent behavior as an approved and legitimate way to solve problems, especially within intimate relationships. The social learning or intergenerational transmission of violence theory posits that children who witness violence in their homes often perpetuate violent behavior in their own families as adults. Moreover, children who grow up in violent homes learn to accept violence and expect it in their own adult relationships. Neurochemical imbalances, genetics, or skipping generations are unrelated to this theory.

A school nurse is aware that a student has requested aspirin three times during the past week because his "back hurts." The nurse has noticed that he often wears long-sleeved sweaters and sweatshirts even in warm weather. The nurse suspects that the student may be the victim of physical abuse. The nurse is preparing to ask the child about his ongoing backache. Which of the following would the nurse anticipate being reported by the child if he was being abused? A) His father is beating him on a regular basis B) Be reluctant to report abuse because of shame or fear of retaliation C) Give the same reason his sister would give were she asked to explain his injuries D) Carefully explain that his mother disciplines him because she loves him

B) Be reluctant to report abuse because of shame or fear of retaliation Feedback: Most survivors do not report violence to health care providers without specifically being asked about it. Survivors may be reluctant to report abuse because of shame and fear of retaliation, especially if the victim depends on the abuser as a caregiver. In addition, children may fear they will not be believed.

A nurse is working with a female client who is anticipating the possibility of leaving an abusive relationship. In helping the client make the decision to leave or to stay in the abusive situation, which of the following would be most important for the nurse to do? A) Ensure that the client can effectively describe the behaviors inherent in each phase of the cycle of domestic violence. B) Inform the client that if she leaves the abusive situation, there is a possibility her partner will attempt to murder her. C) Assist the client in finding a new apartment and a new job so she will be safe after she leaves her current situation. D) Suggest that the client legally change her name and move out of state so she will be safe from future harm.

B) Inform the client that if she leaves the abusive situation, there is a possibility her partner will attempt to murder her. Feedback: Survivors must understand the cycle of violence and the danger of homicide that increases as violence escalates or when the survivor attempts to leave the relationship. Although survivors also need information about resources (e.g., shelters for battered women), legal services, government benefits, and support networks, the nurse first needs to discuss the possibility of the perpetrator's reaction and the possibility of extreme violence leading to death.

A group of nursing students is reviewing information about the types of abuse. The students demonstrate understanding of the information when they identify stalking as a crime of which of the following? A) Violence B) Intimidation C) Jealousy D) Fear

B) Intimidation Feedback: Stalking is a crime of intimidation in which stalkers harass and terrorize their victims through behavior that causes fear or substantial emotional distress. Rape is a crime of violence.

A group of nursing students is reviewing information about intimate partner violence (IPV). The group demonstrates understanding of this topic when they identify which of the following? A) Men are more likely to be seriously injured even though more women are typically victims. B) Men may not consider behaviors such as slapping or shoving as abuse. C) IPV in same-sex couples occurs less frequently than in heterosexual relationships. D) The reactions to IPV are similar in male and female victims.

B) Men may not consider behaviors such as slapping or shoving as abuse. Feedback: Men are sometimes hesitant to report victimization or may not consider behaviors such as shoving or slapping "abuse." Nearly one in four women and one in nine men are victims of IPV at some point in their lives. Women are much more likely than men to be seriously injured as a result of IPV and to require medical treatment. IPV in same-sex couples occurs with at least the same frequency as in heterosexual relationships, but individuals with same-sex partners may not be afforded the same support. The reaction to IPV may differ by gender.

A nurse is working on developing a safety plan with a client who is a survivor of violence. Which of the following would the nurse address first? A) Devising an escape route B) Recognizing the signs of danger C) Identifying a safe place to hide D) Identifying a signal to indicate it is safe to leave

B) Recognizing the signs of danger Feedback: One of the most important teaching goals is to help survivors develop a safety plan. The first step in developing such a plan is helping the survivor recognize the signs of danger. Changes in tone of voice, use of alcohol and other drugs, and increased criticism may indicate that the perpetrator is losing control. Detecting early warning signs helps survivors to escape before battering begins. The next step is to devise an escape route. This involves mapping the house and identifying where the battering usually occurs and what exits are available. The survivor needs to have a bag packed and hidden, but readily accessible, containing what is needed to get away. If children are involved, the adult survivor should make arrangements to get them out safely. That might include arranging a signal to indicate when it is safe for them to leave the house and to meet at a prearranged place. A safety plan for a child or dependent older adult might include safe places to hide and important telephone numbers, including 911, police and fire departments, and other family members and friends.

A nurse is assessing a survivor of intimate partner violence. During the interview, the nurse determines that the survivor's partner is using power and control over the client through coercion and threats. Which client statement would lead the nurse to suspect this? A) "He always tells me that the abuse never happened." B) "He tells me who I can and cannot see." C) "He tells me that he'll tell Child Services I'm a bad mother." D) "He acts like he's the master of his castle and I'm his servant."

C) "He tells me that he'll tell Child Services I'm a bad mother." Feedback: The statement about telling child services that the client is a bad mother reflects coercion and threats. The statement about the abuse never happening reflects power and control through minimizing, denying, and blaming. The statement about whom the client can and cannot see reflects power and control through the use of isolation. The statement about the partner being the master of his castle reflects power and control through the use of the male privilege.

An emergency department nurse is assessing a female client with traumatic injuries. To assess whether the client's injuries have resulted from abuse, which question would be most appropriate for the nurse to ask the client? A) "Is your partner being mean to you?" B) "Why do you think your husband has beaten you?" C) "It looks like someone has hurt you. Tell me about it." D) "Can you describe the person who did this to you?"

C) "It looks like someone has hurt you. Tell me about it." Feedback: The nurse should say to the client, "It looks like someone has hurt you. Tell me about it." This is an open-ended statement and allows the client to verbalize her thoughts and feelings. Asking whether the partner is being mean or asking why the client thinks the husband has beaten her already assumes that the client has been abused. Asking about the person who did this would be ineffective because survivors of violence are unlikely to disclose sensitive information unless they perceive the nurse to be trustworthy and nonjudgmental. Additionally, this question is a closed question that does not allow the client to verbalize her thoughts and feelings openly.

A nurse is caring for a family in which the elderly mother has been a victim of abuse and neglect by her son, 48 years of age. Which of the following would be most important for the nurse to keep in mind before interviewing the family? A) A top nursing priority would be to legally remove the son from the home. B) The main focus of the nurse's actions should be on improving the elderly mother's self-esteem. C) The nurse must allow the older adult mother to decide whether she wants to leave the situation. D) Placement for the older adult woman in a nursing home within the community is crucial.

C) The nurse must allow the older adult mother to decide whether she wants to leave the situation. Feedback: Removing children and older adults from their families or caregivers often is necessary to ensure immediate safety. If the home of an abused or neglected child or older adult cannot be made safe, the nurse must facilitate the involvement of other professionals in placing the child or older adult in a foster home or nursing home. Still, intervening in cases of elder abuse is not a clear-cut issue. When an older adult's decision making is not impaired (competence is the legal term), he or she must be allowed an appropriate degree of autonomy in deciding how to manage the problem, even if the choice is to remain in the abusive situation. Forcing someone to do something against his or her wishes is in itself a form of victimization and denies autonomous decision making.

A nurse is interviewing a client who is a survivor of abuse. The client is telling the nurse about how the violence occurred. Which statement would the nurse interpret as reflecting phase 3 of the cycle of violence? A) "He threw me against the wall and started punching my face." B) "He yells at me for not having dinner waiting for him when he comes home." C) "He calls me stupid and incompetent, asking himself why he ever married me." D) "He tells me that he is sorry and that he will never hit me again."

D) "He tells me that he is sorry and that he will never hit me again." Feedback: During phase 3 of the cycle, the perpetrator becomes kind, contrite, and loving, begging for forgiveness and promising never to inflict abuse again. The actual violence occurs in phase 2. Yelling at the client for not having dinner ready and calling her stupid and incompetent reflect phase 1, or tension building.

A female client has been admitted to an inpatient psychiatric facility with a diagnosis of posttraumatic stress disorder after a history of violence by her boyfriend. During the initial assessment interview, which assessment would be the priority? A) Nutritional status B) Hydration status C) Sleep patterns D) Suicide risk

D) Suicide risk Feedback: The first, and most important, assessment conducted is a lethality assessment that determines whether the survivor's life is in danger, either from homicide or suicide, and, if children are in the home, whether they are in danger. Then the physiologic areas such as nutrition, hydration, and sleep can be assessed.

A nurse is conducting a public information seminar on the topic of rape and sexual assault at a local community center. Which of the following would the nurse include when describing power rapists? A) Committed by sadistic perpetrators who plan the rape before committing it to experience erotic enjoyment in response to the victim's suffering B) Target very young or elderly victims, may involve extreme force, and often results in victim injury C) Are not planned ahead of time and result from the perpetrator being obsessed with uncontrollable sexual urges D) Target victims near the age of the perpetrators and involve minimal physical force and intimidation in controlling their victims

D) Target victims near the age of the perpetrators and involve minimal physical force and intimidation in controlling their victims Feedback: Power rapists commit 55% of sexual assaults. They often attack people their own age and use intimidation and minimal physical force to control their victims. Their assaults are generally premeditated. Anger rapists commit 40% of sexual assaults. These rapists tend to target either very young or older adult victims. They may use extreme force and restraint that results in physical injury to the victim. Sadistic rapists commit 5% of sexual assaults; however, they are the most dangerous. Their crimes are premeditated, and they often torture and kill their victims. Sadistic rapists derive erotic gratification from their victims' suffering.