Chapter 33: Abuse in the Family and Community

During a prenatal assessment, the nurse observes that the client is quiet and withdrawn. The client keeps asking if her partner can come into the examination room, because the partner does not like to be kept waiting. Which question would be most important for the nurse to ask before the partner comes into the examination room?

"Do you feel safe in your home?" Client safety is the priority. Asking if the client feels safe, before the partner is present, is important. Also, the client may be reluctant to answer this question if the partner is present. Feeling safe is a higher priority than gathering specifics about the relationship, such as what occurs when they argue. The other questions can be asked with the partner present, with the client's permission.

The nurse manager is educating staff about the mandate of health care workers to report suspected child abuse. A staff member asks, "What if you are not certain that it is an abuse situation. What should the nurse do?" The nurse manager is most correct when providing which answer?

"Feel comfortable about reporting your suspicion as the law protects you." It is important that nurses understand that they must report suspicion of abuse without fear of retaliation. Laws have been enacted that protect the nurse who reports suspected child abuse from reprisal by a caregiver. The nurse does not have to confirm the abuse through family confession to file a report. It is appropriate to collaborate with another professional, but ultimately the nurse needs to report the suspicion.

A nurse is discussing concerns about possible child abuse with the nursing supervisor. Which statement by the nurse requires correction by the supervisor?

"HIPAA prevents nurses from disclosing confidential information from parents." The fact that the information was given in a confidential interview does not free a nurse from this responsibility (it is an exception under the confidentiality rules of the Health Insurance Portability and Accountability Act [HIPAA]) (Fraser, Matthews, Walsh, et al., 2010). Therefore, the nursing supervisor would need to correct this misinformation. The other comments are correct. All health care institutions and agencies have protocols on how the reporting of child maltreatment should be managed. It is important to learn the protocol required by your particular agency, community, and state. Nurses are included in the mandatory category in most states; this means they must report suspected child maltreatment when they identify it. Failure to do so can result in a fine, jail time, or loss of nursing licensure.

Which statement by a parent of a 4-year-old child is most likely to suggest child abuse?

"He doesn't ever help me clean house." "Role reversal," or a child taking care of a parent, is frequently seen with child abuse.

A client who has been a victim of intimate partner violence is being counseled on the development of a safety plan. Which statement made by the client suggests the need for additional counseling to ensure the safety of the client and children?

"I have a special telephone card to use if we have to leave in a hurry." Telephone cards leave a trail of calls that can be followed, so they are not a wise choice in this situation. Having copies of social security numbers, a suitcase of clothing, and a practiced escape plan are all appropriate actions.

Which statement made by a new nurse demonstrates an understanding of the prevalence of sexual assault and related violence among the population?

"I've come to realize that I need to include questions related to sexual assault and related violence into the assessment of all my clients." Nurses will come in contact with sexual assault and related violence no matter what health care setting they work in and among all segments of the population. Nurses must be ready to ask the right questions and to act on the answers, because such action could be lifesaving.

While performing an assessment on a female client, the nurse notes signs of sexual assault. When questioned, the client states, "I am married, so I have not been raped or abused." What statement by the nurse is most appropriate?

"If you do not consent, it is still assault when you are married." A married woman still has to provide consent for sexual activities. Without consent, it is rape or sexual assault for married women, just as it is for single women. The length of the marriage is not relevant to defining intimate partner violence.

A 14-year-old girl is brought to the emergency department saying she was sexually assaulted. She tells the nurse that she feels guilty for having gone to a party where alcohol was being served. What is the nurse's best response?

"No one deserves to be raped, even going to a party with alcohol." The girl needs reassurance that even though she made a poor decision going to the party, she still did not deserve to be raped. Chastising her for making a bad decision is only going to make her feel more guilty. It is better not to say, "I understand how you feel" unless the nurse has been in the same situation. It is not sincere or helpful.

A 4-year-old has been sexually abused. As you watch her play with anatomically correct dolls, she inserts the male doll's penis into the female doll's mouth. What is your best response to this action?

"What are the dolls doing?" It is easy to lead children into supplying answers they think are the ones wanted. An open-ended question does not suggest an answer.

Of the following children, which child is in the group of children who are most often victims of child abuse?

A 2-year-old girl The age group of children from birth to 4 years old has the highest number of victims of child abuse, with girls being abused more frequently than boys.

If the following data was collected on a group of children, which of the following would most likely be evaluated as possibly related to child abuse? Select all that apply.

A child whose X-ray shows bone fractures in various stages of healing. A child who has a spiral fracture in the femur. A child whose CT scan shows an unexplained cerebral hemorrhage. Signs or possible evidence of child abuse can be further evaluated by the use of technology. On a radiograph, bone fractures in various stages of healing may be noted. Spiral fractures of the long bones of a young child are not common, and their presence might indicate possible abuse. Children who have been harshly shaken may not show a clear picture of abuse, but computed tomography may demonstrate cerebral edema or cerebral hemorrhage. Anemia, nausea and vomiting are not typically associated with abuse.

In which example of a burn would the nurse most likely suspect abuse?

A partial-thickness or second-degree burn on the child's bottom The degree of the burn does not necessarily signify abuse as much as the location of the burn. The nurse is most likely to suspect child abuse in the burn on the buttocks. The buttocks are an uncommon place for a child to receive a burn accidentally. Splash marks on the forearm and burns on the palm are more commonplace. A sunburn is also common in children.

The elementary school nurse is caring for four clients with physical injuries. Which child would require follow-up?

An 8-year-old with bruising noted on the inner aspect of the arms Bruising on soft tissue and particularly on the inner aspect of the arms is highly suspicious and would require immediate follow-up and, most likely, reporting. Bruising on the inner aspect of the arms indicates the child was in a defensive position at contact. The other options indicate areas of bruising on boney prominences in alignment with developmental age.

When beginning care for a victim of rape, the nurse asks the patient to "talk about what happened" to her. For which nursing diagnosis is the nurse using this approach?

Anxiety related to recent rape One need of any victim after a violent act is to talk about what happened because a person who can describe an incident can also begin to "put a fence around" or bring the event down from "something terrible has happened," a situation which leaves the person with a continuing high anxiety level, to "this specific thing has happened," a situation that allows the traumatic event to be examined and managed. Asking the victim to describe the incident to with an introduction such as "Most people find it helps to talk about what happened to them" helps the victim begin to put a fence around the incident. The nurse is not asking the patient to "talk about what happened" because of fear of maltreatment, disabling family coping related to the rape, or risk for violence related to poor self-control.

A client at 36 weeks' gestation presents in the emergency department with a broken arm. The client states, "I fell while cooking dinner." During the assessment, the nurse notes no prenatal care for this pregnancy, as well as bruises in multiple stages of healing on the client's abdomen, arms, and chest. What action will the nurse perform next?

Ask the client how she acquired the bruises First, the nurse will ask how the client acquired the multiple bruises. This will provide information on possible violence. The nurse would also notify the health care provider and document the findings. Information would be provided based on the finding of intimate partner violence.

A nurse suspects that a 6-year-old girl is being sexually maltreated by her father, based on some comments made by the girl. Which of the following methods would be most effective in confirming the nurse's suspicion?

Ask the girl to draw a picture of what happened Incest is sexual activity between family members. Asking the child to draw a picture of what happened may be an effective way of revealing sexual maltreatment. Incest results in a destructive relationship because it causes a great deal of guilt and loss of self-esteem in both the abusing and the maltreated person. Other members of the family are likely to suspect the maltreatment is occurring but are helpless to do anything about it; this leads to guilt and feelings of worthlessness on their part for not being able to protect the victim. Thus, the child's mother may not reveal anything when questioned by the nurse due to guilt or fear. Sexual maltreatment does not always involve physical maltreatment, such as would result in fractures. The father may not be listed as a sexual perpetrator.

A client has been seen and treated in the emergency room several times for injuries that are deemed suspicious. The client is reluctant to participate in a screening process. How best can the nurse provide reassurance to this client?

Being nonjudgmental During the screening process the victim is most likely to be uncomfortable and not want to participate. Victims are concerned about being judged by the interviewer, provoking more violence, and being disappointed by the provider's response to the disclosure. The nurse can best help the victim participate in screening by ensuring confidentiality and being nonjudgmental. There is no guarantee the nurse can assure the woman of help. At best, the nurse can provide information of agencies and services. Having the client be honest about the injuries can cause much distress for the client who may feel it will only lead to more injuries after the partner realizes details have been disclosed. Helping the client find community resources to develop a plan of protection is best done with the social worker and community agencies rather than the emergency room nurse. The nurse should make a referral to the social worker to help with this situation.

When initiating care for a client suspected of being a victim of human trafficking, what is the nurse's primary responsibility?

Building trust Building trust is the top priority. Although the other actions are appropriate, they are less achievable without first establishing a trusting relationship with the client.

The nurse visits the foster home of a newborn with failure to thrive syndrome. Which observation indicates a successful outcome for this child's care?

Child eagerly takes a bottle and is gaining weight. A successful outcome for the care of a child with failure to thrive syndrome would be that the child shows interest in bottle feedings and begins to gain weight. The child crying and having bruises over the legs could indicate physical abuse or another medical problem. The mother not visiting the child indicates ongoing psychological issues with the mother bonding with the child. The father bringing toys does not indicate that the care of the child has been successful. The father's bonding with the child cannot be determined by this action of bringing toys.

The nurse gives a preschool-age child two anatomically correct dolls to play with in efforts to determine if the child has been sexually abused. Which observation indicates to the nurse that this is a possibility?

Child inserts the male doll's penis into the female doll's mouth. Allowing young children to play with anatomically correct dolls is a common method for determining whether sexual maltreatment is occurring. The child who is involved in an incestuous relationship may make the dolls perform a sexual act, such as placing the male doll's penis into the female doll's mouth. The average reaction of a preschool-age child who has not been maltreated is to undress the dolls, giggle for a moment or two about how they look, and then redress or put them aside. Playing with the dolls so that they hold hands and hug does not indicate that the child has been sexually abused.

During a routine well-child visit, the mother of a preadolescent patient asks the nurse to explain signs of sexual abuse. The mother is concerned because an older male neighbor has been making comments and overtly admiring the child when playing outdoors. What signs of sexual abuse should the nurse tell the mother to look out for? Select all that apply.

Child reports abdominal pain. Child has a change in school performance. Child demonstrates anxiety or trouble sleeping. Child does not want to be left alone with a certain adult. Signs of sexual maltreatment include vague reports of abdominal pain, a change in school performance, anxiety or trouble sleeping, and not wanting to be left alone with a certain adult. Spending time with peer-group friends is an expected preadolescent behavior and is not a sign of sexual maltreatment.

The nurse is completing the physical assessment of a 12-year-old child who has a series of bruises in various stages of healing. When asked about the bruises the child appears frightened and offers inconsistent accounts about how the child got the bruises. The nurse suspects abuse. Which initial action of the nurse is most appropriate?

Document the bruises and any statements made by the child relating to them. Nurses in each state have a legal requirement to report suspicions of child abuse or maltreatment. The nurse must document all findings. The medical record will be of importance in establishing the findings. Once the findings are documented, the nurse will need to closely follow the agency policies regarding the reporting process. The nursing supervisor will need to also be involved but that will take place after the documentation has been completed. The child cannot be photographed without appropriate approvals. The child may indeed be asked to provide a more detailed reporting of the bruising, but it is not the role of the nurse to request it. The child's parents will also become a part of the investigation but the interviewing process does not come before the documentation of the findings.

The nurse is caring for a client believed to be a victim of human trafficking. What action is most important for the nurse to perform?

Gain the client's trust. It is most important for the nurse to gain the trust of the victim. This will allow the nurse to obtain the most information to appropriately help the client. The nurse may notify the authorities and test for pregnancy if the client is a victim. The client will be assessed, but it isn't the priority.

Which clinical symptoms are documented as being indications of sexual abuse? Select all that apply.

Gastrointestinal upset Changes in bowel and bladder habits Behaviors of aggression and hostility Each case is unique; however, common characteristics indicating sexual abuse are gastrointestinal upset, changes in bowel and bladder habits, and behaviors in aggression and hostility. A decreased performance in academics and a lack of participation in extracurricular activities are most commonly seen in victims of sexual abuse.

A nursing instructor is discussing child maltreatment. What response by the student shows an understanding of what is included in the description of child maltreatment? Select all that apply.

Intentional physical maltreatment Intentional psychological maltreatment Sexual maltreatment Negligence by someone responsible for the care of a child "Child maltreatment" means any intentional act of physical, psychological, or sexual maltreatment, including acts of negligence, committed by a person responsible for the care of the child.

The nurse is caring for a client in an abusive situation. In developing a plan of care, which factors does the nurse consider? Select all that apply.

It often takes several attempts before a woman leaves an abusive situation. Women in abusive relationships usually feel isolated and unsupported. Substance use is a common factor in abusive relationships. Factors that need to be considered include the following: It often takes several attempts before a woman leaves an abusive situation; women in abusive relationships usually feel isolated and unsupported; and substance use is a common factor in abusive relationships. Economic factors are often a factor because the partner/abuser usually controls the financial resources. Toddlers and preschool-age children can be affected by parental discord and intimate partner violence (physical, emotional, verbal) that takes place in the household.

The nurse has documented the following on the medical record of four children. When caring for the client assignment, for which child would the nurse initiate additional abuse screening?

Linear abrasions on ankles and wrists Linear abrasions at the ankles and wrists suggest a restraint was used to tie the child to a bed. Scald burns to the chest often happen from accidental spills of coffee.

Which patient's physical assessment finding of a school-age child should the nurse question as a potential indication of abuse?

Linear abrasions on his ankles and wrists Abrasions or ecchymotic areas on the wrists or ankles may be present if the child was tied to a bed or against a wall. Being thin and tall is not an indication of abuse. A scald burn on the chest could have occurred while eating a meal at home. A rash on the buttocks is not an indication of physical abuse.

The nurse is caring for a child who has unusual bruises and marks that do not match the child's developmental age. When completing an admission assessment, which other information does the nurse identify as a potential factor in child abuse?

Long-term unemployment without supplemental income Long term unemployment places strain on the family, which may increase the risk for child abuse. Characteristics that are commonly seen with abusers are that they were abused themselves, have psychological or emotional disabilities, or have severe circumstances that lead to high levels of strain. Living with family members may be helpful and provide support for the family. Age and having health insurance coverage are unrelated factors when one is attempting to identify who may be a potential abuser.

The nurse is working with a client who is in a relationship with a man who controls her activities, calls her names, and occasionally hits her. What are the goals in the treatment of this client? Select all that apply.

Maximize the client's safety Empower the client to take control Provide support to the client The goal is to provide support, to empower the woman, and to maximize her safety. Hospitalization might keep her safe in the short-term, but is not a solution. It is not the nurse's place to involve the police in the client's situation. It is beyond the nurse's scope of practice as well as a HIPAA violation.

A nurse is performing a routine physical for a 7-year-old girl who is thin, unwashed, and dressed in rags. Although it is winter time, she has no coat with her. Her teenage brother in the waiting room, however, is dressed in trendy clothes and looks healthy and well-fed. Which of the following should the nurse most strongly suspect regarding this girl?

Physical neglect Physical neglect is a more subtle form of maltreatment than physical maltreatment, but it can be just as damaging to a child's welfare. A neglected child may appear unwashed, thin, and malnourished or be dressed inappropriately, such as without mittens, a coat, or shoes in cold weather. In some families, no one has a warm coat to wear or receive enough food because there is no money for these things; that is different from the family in which parents do have these things, but the children or one particular child does not. There is no evidence in this scenario of physical, sexual, or psychological maltreatment, although they could be present.

A 6-year-old child is playing. Which play scenarios witnessed by the nurse are indicative that the child is sexually abused? Select all that apply.

Playing with a boy and girl doll in a sexually graphic manner Using inappropriate adult language Arranging dolls in unnatural positions for play Children should have no knowledge of the particulars of sexual activity at age 6. If they do, it is inappropriate. Playing with dolls in a sexually graphic manner or placing the dolls in unnatural positions identifies that the child has been exposed to sexual activity. Using adult language also identifies inappropriate exposure. Common contact is saying that boys and girls love each other, or wanting to play house and having the girl have a baby. This can be reflective of what is happening in the house.

Which symptoms does the nurse identify as potential clinical manifestations resulting from physical abuse in the home? Select all that apply.

Poor attendance in school Feelings of guilt Behavioral issues Bedwetting The child who lives in a home where domestic violence occurs many times has a variety of behaviors such as poor attendance in school, feelings of guilt related to not being able to protect the abused, behavioral issues and bedwetting. These symptoms and others manifested are referred to as symptoms associated with post-traumatic stress disorder. High academic standards and an outgoing personality are not associated with manifestations from physical abuse.

A 16-year-old girl presents to the emergency department following a rape. Which action will the nurse complete first?

Provide the client privacy and assess for injuries. Following sexual assault (rape), the nurse's first action should focus on physical safety for the client, which includes providing privacy to help the client feel safe and assessing for physical injuries that may require medical treatment. After stabilizing the client, the nurse will allow the sexual assault nurse examiner (SANE) to collect evidence, if desired by the client, before assisting the client with showering/hygiene. Next, the nurse can arrange for counseling and a follow-up visit as needed to ensure appropriate psychological and physical care is provided.

A pregnant woman comes to the clinic with a head injury. She tells the nurse that her partner came home drunk and she made him angry by not having dinner ready. He lashed out, she got in the way, and her head hit the corner on the table. What action should the nurse take in this situation?

Provide the client with contact information for a 24-hour shelter and social worker on discharge. The nurse should empower the client by making her aware of the resources and options available to her. The client cannot be forced to leave her situation, stay at a friend's home, or to report the abuse.

When caring for a 12-year-old child who has been admitted after being physically abused, which action should be the initial psychosocial intervention to include in the plan of care?

Provide the opportunity to express feelings Since child abuse has been confirmed, the child is more willing to talk about experiences. In other words, there is no need to hide the abuse. Initially, provide the child the opportunity to express feelings, which can be helpful in reducing anxiety. All of the other options are appropriate if needed.

Which elements are included in child maltreatment? Select the best answer.

Psychological, physical, and sexual maltreatment and neglect Child maltreatment refers to any physical, psychological, or sexual maltreatment, including physical neglect.

A nurse working in the emergency department who suspects child abuse should do which of the following?

Report it to the authorities. State laws require health care personnel to report suspected child abuse. This law overrides the concern for confidentiality. Laws also have been enacted that will protect the nurse who reports from reprisal by a caregiver (eg, being sued for slander). If a nurse does not report suspected child abuse, the penalty can be loss of his or her nursing license.

When evaluating a child with recurrent urinary tract infections, the nurse notices that this child is walking with a wide gait and refuses to sit in the chair provided. What type of maltreatment would the nurse suspect?

Sexual maltreatment Recurrent urinary tract infections in a child and difficulty walking or sitting are signs of sexual maltreatment and warrant further investigation by the nurse.

A nurse is working with the burn clinic at a local hospital. Which types of burns would the nurse address with the health care provider and social worker? Select all that apply.

Small, round burns Hand burns with a pattern Linear pattern burns The health care provider and social worker are alerted to certain style of burns associated with child abuse. Cigarette burns (small round) and burns from hand immersion into hot liquid or onto a hot register, curling iron, or steam iron are pattern burns from objects and commonly seen with child abuse. Some burns are accidental, such as those suffered in house fires or as a sunburn while swimming.

A 3-month-old is brought to the emergency department by a parent who reports that the child won't stop screaming since falling off of a bed 2 hours ago. Physical examination and radiography confirm that the child has a fractured femur. What should the nurse suspect has occurred with this infant?

Spiral fractures of long bones in young children are uncommon and can be seen in child abuse. When a child's physical injury requires medical attention, family caregivers may attribute the injury to some action of the child's that is not in keeping with the child's age or level of development. On a radiograph, bone fractures in various stages of healing may be noted. Spiral fractures of the long bones of young children are not common, and their presence might indicate possible abuse.

What behaviors would the school nurse observe when suspecting that a child is living with a family in which there is an addiction problem? Select all that apply.

The child is a loner and avoids interaction with classmates. The child frequently comes into the nurse's office with vague complaints of a stomach ache. The child has missed a significant amount of school for "illness." Behaviors that may alert nurses and other health care personnel to an addiction problem in a child's family include the loner child who avoids interaction with classmates; the child failing in school or who has numerous episodes of unexcused absences or truancy; the child with frequent minor physical complaints, such as headaches or stomachaches; the child who steals or commits acts of violence; the aggressive child; and the child who abuses drugs or alcohol.

The elementary school teacher invites the nurse into the classroom to observe a pupil's interaction when completing an assignment. Which characteristic alerts the school nurse that the child may be the victim of emotional abuse?

The child is fretful and worried about the project. When completing group work there can be many dynamics in the classroom; however, the child should not be fretful and worried about the project. This indicates that something else is the cause of the worry. The teacher and school nurse work together to help the child as needed.

The nurse is caring for a child who has been hospitalized for maltreatment. When reviewing the child's records which findings may have placed the child at an increased risk for abuse? Select all that apply.

The child's mother has a history of substance use disorder. The child was born prematurely. The child has cerebral palsy. Although not every child abused or child abuser will fit a profile of characteristics, many will. Child abuse occurs across all socioeconomic levels, but the findings are more prevalent in those experiencing poverty. Additional risk factors include prematurity, chronic illnesses, parental substance use disorder, cerebral palsy and cognitive impairment. Parents working outside the home and paternal caregivers are not families facing increased risk for abuse.

A teenage client has been undergoing individual psychotherapy following a sexual assault a few days ago. The nurse would determine that the early stage of therapy is successful when the client meets which outcome?

The client is able to describe what happened and express feelings. In the early stage right after the rape occurs, it is critical that the client be able to describe what happened and verbalize feelings related to the event. The decision on whether or not to press legal charges does not mean that the client is coping with the situation. Nightmares usually begin soon after the event and may continue for a long time. Returning to school and participating in activities is healthy for the victim, but again it does not demonstrate successful therapy has occurred.

The nurse is visiting the home of a family with a previous history of physical neglect. Which observation indicates that interventions have not been successful?

The father allows the children to stay home from school whenever they desire. Not requiring a child to attend school may be interpreted as neglect. Following a vegetarian diet, encouraging participating in sports, and concern about immunization discomfort do not indicate that interventions to address physical neglect have not been successful.

A 1-year-old is a victim of child abuse. Which of the following factors obtained on history is most apt to be associated with the risk of Munchausen syndrome by proxy physical abuse in children?

The mother was abused as a child. Parents tend to parent the same way as their parents. Abuse, therefore, continues from generation to generation.

As the elementary school nurse is documenting student contact in the health room, which student is most concerning?

The student who repeatedly reports vague physical complaints and has nightmares. Having repeated trips to the health room with vague symptoms and history of nightmares indicates that something is greatly upsetting the child. This pattern of behavior could indicate various types of abuse. Further investigation with the child and collaboration with the teacher is necessary. Parental input is also required. The student who needs assistance in glucose testing needs additional instruction. The students experiencing fatigue and needing a rescue inhaler will need parental notification; possible follow-up by the health care provider is needed if symptoms do not improve.

Which action is most helpful in encouraging the expression of feelings in a pediatric client who is abused?

Using play to reduce stress It is most helpful to reduce stress in the client by means of play. Frequently, play can help the client work through the abuse and express feelings. Talking in a private space inhibits communication as the client may feel afraid of the stranger or afraid that he or she is going to get in trouble. Support groups are helpful in adolescent clients. Once the adolescent feels safe in the group, he or she can feel comfortable with recounting his or her experience. Physical caring behaviors can be appropriate depending upon the relationship with the client.

A school nurse is developing a plan of care for a child with suspected violence between the child's parents. The nurse monitors for which behaviors in the child?

aggressive behavior in school Children who have a parent who is violent may be identified because of behavior problems, noncompliance, and aggression in school. Developmental delays occur in children with other disorders. Development of tics or twitches occurs with Tourette syndrome. Compensating by overachieving is not typically related to violence in the home.

A child with acute bronchitis has just been hospitalized. The nurse overhears the child's mother say to the child that if he is not good, she will leave and not come back until he is ready to return home. What should the nurse suspect in this situation?

emotional abuse A child may be emotionally abused verbally or by unavailability of the caregiver, poor nurturing, threats involving leaving the child, or role reversal (in which the child must take on the role of parenting or is blamed for the parent's problems).

A 5-year-old child has frequent visits to the school nurse's office. Which assessment data should alert the nurse that this child may be a victim of physical neglect?

malnourished with frequent absences from school A neglected child may appear unwashed, thin, and malnourished or be dressed inappropriately, such as without mittens, a coat, or shoes in cold weather. Not requiring a child to attend school, deliberately keeping a child out of school without setting up a home school program, or allowing a child to go unsupervised after school may also be interpreted as neglect. Isolated from classmates with poor self-esteem may be a child who is emotionally neglected. Evidence of bruising on multiple parts of the body might indicate child abuse. Inappropriate knowledge of sexual terms and actions is more likely when a child is sexually abused.

The nursing student learning about child abuse correctly identifies which of the following as types of abuse in children? Select all that apply.

physical abuse shaken baby syndrome Munchausen syndrome by proxy emotional/psychological abuse neglect sexual abuse The different types of abuse in children are physical abuse, shaken baby syndrome, Munchausen syndrome by proxy, emotional abuse, neglect, and sexual abuse. SIDS (sudden infant death syndrome) is not a form of abuse.

In addition to physical examination, what is another important way that nurses know physical abuse is confirmed?

radiography Signs of child abuse can be further evaluated with technology. On radiography, bone fractures in various stages of healing may be noted. Spiral fractures of the long bones of a young child are not common, and their presence might indicate possible abuse. Children who have been harshly shaken may not show a clear picture of abuse, but computed tomography may demonstrate cerebral edema or cerebral hemorrhage.

A nurse who works with victims of sexual assault is conducting an in-service education program for a group of nurses working at a community mental health center. The nurse is describing the phases of recovery that a victim commonly goes through after a sexual assault. Place the behaviors listed below in the order that the victim experiences them. Use all options.

reports problems with anger and insomnia refuses to discuss the assault changes job or moves reports being able to trust others In the acute (disorganization) phase, the victim exhibits shock, fear, disbelief, anger, shame, guilt, feelings of uncleanliness, insomnia, nightmares, and sobbing. During the outward adjustment (denial) phase, the victim appears outwardly composed and returns to work or school but refuses to discuss the assault and denies need for counseling. During the reorganization phase, denial and suppression do not work, and the victim attempts to make life adjustments by moving or changing jobs, using emotional distancing to cope. in the last phase, integration and recovery, the victim begins to feel safe and starts to trust others. This survivor may become an advocate for other victims of sexual assault.

A parent is talking with the nurse and states that his spouse has a cocaine addiction. The parent goes on to state that the 2-year-old child is taken to the grandmother's house when the spouse uses cocaine, because this use only happens once in a while after the spouse has had a stressful day. The nurse is correct to identify that:

the parent is in a state of codependency. It is most correct to identify that the parent is codependent, supporting the spouse's addictive behavior. This usually involves making excuses for the addict's actions. There is nothing that states the other parent is a substance user. The parent states that the 2-year-old child is taken from the home, thus keeping the child safe. While many substance-using families are dysfunctional, more information is needed to confirm.

The generation-to-generation continuum of violence refers to the fact that:

violence is a learned behavior, and children who witness intimate partner violence are more likely to become abusers themselves. Violence is a learned behavior. Many abusers were abused themselves as children; however, not all children who were abused become abusers.