Chapter 9: Violence and Abuse

A client is receiving treatment for injuries sustained during a fight with a partner. The nurse observes the partner visit the client daily in the hospital and appears very solicitous and contrite. The client states, "My partner always apologizes and brings gifts after a fight." Which response by the nurse is appropriate?

"Although your partner seems sorry, often an abuser will continue to repeat the behavior in the future."

A nurse is screening a client for intimate partner violence using indirect questions. Which question would the nurse most likely ask?

"Clients with your injuries are often abused. Is anything like this happening now?"

During a prenatal assessment, the nurse observes that the client is quiet and withdrawn.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?"

The nurse gave a presentation about intimate partner violence (IPV) to a local community group. The nurse determines more teaching is needed when a member makes which statement?

"For the victim's safety, the victim has to learn to be careful to not set off the abuser."

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."

A victim of rape is prescribed emergency contraception. After teaching the client about this therapy, the nurse determines that the teaching was effective based on which client statement?

"It contains high doses of a typical birth control pill."

A 16-year-old pregnant client presents to the office for the third time this week. While completing the client's admission, the nurse screens for intimate partner violence. The client responds, "I have already told you twice this week I am not being abused. Why do you keep asking me these questions?" Which response by the nurse is best?

"It is protocol to screen all clients for intimate partner violence at every visit."

The nurse is caring for a client who has been a victim of intimate partner violence (IPV) for a few years. The client states, "My partner has been so sweet to me the last few days by telling me how special I am and bringing me flowers. I believe my partner is sorry and will not do this again." How will the nurse respond?

"It may seem better now, but over time, IPV typically becomes accelerated and more dangerous."

The nurse suspects a client is a victim of intimate partner violence (IPV). Which statement by the client supports the nurse's suspicion?

"My spouse refuses to let me go out to find a job."

After teaching a class about intimate partner violence to a group of young adults, the nurse determines that additional teaching is needed based on which statement by the group?

"People who are battered typically come from lower socioeconomic groups."

The triage nurse receives a phone call from a client stating, "I was just raped and I need help. What should I do?" Which response by the nurse is a priority?

"Tell me if you are in a safe location away from the assailant now."

The nurse suspects a pregnant client is a victim of intimate partner violence (IPV). When the nurse asks the client if her partner abuses her, the client responds, "Oh no, my partner does not hit me." Which response by the nurse is most appropriate?

"There are many types of intimate partner violence beyond physical abuse."

A client states "My spouse loves me. My spouse did not mean to hit me. My spouse felt so bad, I received flowers to show me how sorry my spouse was for hitting me. I know this will not happen again." How will the nurse respond?

"This is a common action of abusers. It does not mean you will not be hit again."

In which age range are women most vulnerable for intimate partner violence?

16 to 24 years

The nurse is caring for a client who was raped 3 hours ago. Which intervention is a priority for the nurse to perform?

Administer prescribed emergency contraceptive pills.

A nurse is caring for a pregnant woman who has multiple bruises in varying stages across her body. Which is the priority nursing action?

Ask if anyone at home has hit or hurt her.

Which initial interview technique would be least effective in gathering information from a suspected abuse victim?

Ask the client to strip down and show you where she has been hurt.

The nurse is assessing a client whose partner is present. The nurse notes the partner swears and yells, makes lavish promises, and threatens to hit the client. Which nursing intervention is a priority?

Ask the partner to leave the room.

A client has been admitted to the inpatient psychiatric facility with a diagnosis of posttraumatic stress disorder after a history of violence by a partner. During the admission process, which action is a priority for the nurse to complete?

Assess the client for suicide risk.

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

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

Building trust

The nurse is asked to provide information for a task force addressing child abuse (child mistreatment) in the community. Which prevention tactics are suggested? Select all that apply.

Develop and teach high school courses on parenting and normal child growth and development. Promote activities that encourage self-esteem in young adults. Role-model for caregivers various behaviors with children that are compassionate, loving, and caring. Educate those who were abused as children, and offer them professional help to break the pattern of violence. Help parents and caregivers find local support in their community.

The emergency room nurse is caring for a client who was raped a few hours ago. Which intervention(s) will the nurse perform? Select all that apply.

Ensure a forensic examination is performed. Send specimens for sexually transmitted infection (STI) testing. Take the client to an isolated location for assessment. Refer the client for psychological counseling. Document the findings in the client's medical record.

A client at 34 weeks' gestation comes to the clinic with her partner and reports neck and back pain. During the assessment, the nurse notes multiple contusions in various stages of healing on the client's torso and weight gain of 3 lb (1.36 kg) during the course of the pregnancy. Which action will the nurse take next?

Have the client's partner leave the room during the examination.

A pregnant client with multiple bruises in various stages of healing comes to the clinic for treatment. She appears withdrawn and quiet when the nurse approaches her. Her partner accompanies her to the exam room and begins to answer for the client. There is minimal eye contact from the client to the nurse. Which action will the nurse complete next?

Have the client's partner leave the room.

The nurse is caring for a client who is seeking care after being raped. What is the primary reason the nurse does not leave the client alone during the emergency room stay?

Promotes the client's sense of safety

A client has recently been treated in the emergency department for trauma to the head as a result of intimate partner violence (IPV). The client states to the nurse the desire to go back home to the partner upon discharge. Which action will the nurse take first?

Provide the client with components of an IPV safety plan.

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.

A client who is a rape survivor has appeared to cope very well. However, at a routine visit several months later, the client describes a new onset of nightmares and flashbacks. Which action by the nurse is most appropriate for this client?

Refer the client to a psychologist for psychotherapy treatment.

The nurse notices the caregiver of a 6-year-old child yell at, belittle, and call the child "stupid" and "ignorant" on multiple occasions. Which action will the nurse take first?

Report the abuse to the client's health care provider.

A client who is a victim of intimate partner violence fails to report the violence primarily because of which reason?

The client feels responsible for causing the incident.

During a prenatal examination the nurse observes bruises on the client's arms and a black eye. When asked about the bruises, the client states, "It was an accident. My spouse just had a bad day at work, and I was late getting dinner prepared. But my spouse is being so kind now; my spouse brought me flowers yesterday. My spouse is looking for a new job, so it will not happen again." This client is in which phase of the cycle of violence?

The honeymoon phase

An 11-year-old boy was raised in a home where his father beat his mother on a regular basis. Which statement is true regarding children being raised in a home where they have witnessed intimate partner violence?

They are at increased risk for being abused.

A nurse is conducting an awareness session on sexual abuse, and she is explaining the psychological profile of an average abuser. Which trait is often displayed by abusers?

They exhibit antisocial behaviors.

A nurse is caring for a client who was raped at gunpoint. The client does not want any photos taken of the injuries. The client also does not want the police to be informed about the incident even though state laws require reporting life-threatening injuries. Which intervention should the nurse perform to document and report the findings of the case?

Use direct quotes and specific language.

A nurse is conducting a discussion group at a local women's health center about violence and women. The nurse would include that women are at a higher risk for violence at which time?

during pregnancy

The nurse is aware of three different phases in the cycle of violence. Which is not one of those phases?

hopeless stage

The nurse is assessing a client who was a previous victim of rape. The nurse believes the client is in the integration and recovery phase following the rape. Which action will the nurse recommend to the client for continued recovery?

joining a rape survivor group

The nurse is conducting a class on rape prevention for a group of young adults and is describing the various types of date rape drugs. Which drug would the nurse describe as causing a separation in perception and sensation?

ketamine

A nurse is working in a local community health care facility where many clients are victims of intimate partner violence. For which sign(s) will the nurse assess to determine if a client is a victim? Select all that apply.

mental health disorders such as depression, anxiety, or substance use disorder injuries on the face, head, and neck reported history of the injury inconsistent with the presenting problem

The nurse is talking to a client who is a survivor of intimate partner violence. The client states that the spouse has the characteristics of antisocial personality disorder. The client also informs the nurse that the spouse has an extensive criminal record. The nurse interprets this information and suspects that the client's spouse would demonstrate which behavior?

moderate to severe violence with people both within and outside the family

A group of nursing students are preparing a talk on violence against women and how to prevent it. They want to list characteristics of perpetrators of intimate partner violence and should include which characteristics? Select all that apply.

substance and/or alcohol use disorder negative affect (hostility and depression) history of childhood abuse current unemployment history of antisocial behavior

The nursing instructor is teaching about violence and informs the students about which of its distinct phases? Select all that apply.

tension-building phase acute battering phase honeymoon phase

Nurses sometimes have difficulty assessing clients for intimate partner violence. Which screening protocol is most thorough when assessing for violence?

the SAVE model