Giddens Ch 38 - Interpersonal Violence

When presenting a workshop on adolescent suicide, a community health nurse identifies which risk factors? Select all that apply. A. Victim of family violence B. Limited or strained family finances C. Member of a single-parent household D. Dependence on alcohol, drugs, or both E. Uncertainty related to sexual orientation F. Repeated demonstration of poor impulse control

A, D, E, F Being a victim of family violence of any kind increases the risk of suicide. Alcohol or drug abuse is a significant factor in adolescent suicide. A concern about sexual orientation or being accepted as homosexual is a risk factor for suicide, especially among adolescents. Poor impulse control can lead to an increased tendency toward risk taking, which is a factor in suicide, especially among adolescents. Although economic problems and absence of a parent can both stress a family and its members, there is no research to support that either is a major factor in adolescent suicide.

The emergency department nurse is conducting an interview and assisting with the physical examination of a female sexual assault victim. What is most important for the nurse to document on this client's record? A. Observations about the client's reaction to male staff members B. Statements by the client about the sexual assault and the rapist C. Information about the client's previous knowledge of the rapist D. Summary statement about the client's description of the assault and the rapist

B Statements by the client about the sexual assault and the rapist eliminate the nurse's subjectivity from the report. Observations about the client's reaction to male staff members is unrelated to the sexual assault itself and are subjective. Eliciting information about the client's previous knowledge of the rapist is not the responsibility of the nurse. A summary statement about the client's description of the sexual assault and the rapist may invite subjectivity.

A nurse in the emergency department is assessing a client who has been physically and sexually assaulted. What is the nurse's priority during assessment? A. The family's feelings about the attack B. The client's feelings of social isolation C. The client's ability to cope with the situation D. Disturbance in the client's thought processes

C The situation is so traumatic that the individual may be unable to use past coping behaviors to comprehend what has occurred. Assessing emotions that occur in response to news of the attack will occur later. The client should be the focus of care at this time. Social isolation is not an immediate concern. Coping skills, not thought processes, are challenged at this time.

Risk for assaultive behavior is highest in the mental health client who does what? A. Uses profane language B. Touches people excessively C. Exhibits a sudden withdrawal D. Experiences command hallucinations

D. Command hallucinations are dangerous because they may influence the client to engage in behaviors that are dangerous to self or others. Although profane language, excessive touching of others, and withdrawn behavior may all be cause for concern, none are as dangerous as command hallucinations.

A nurse is working with a child who was physically abused by a parent. What is the most important goal for this family? A. The child will live in a safe environment. B. The parents will use verbal discipline effectively. C. The family will feel comfortable in its relationship with the counselor. D. The parents will gain an understanding of their abusive behavior patterns.

A. The most important goal and top priority is to ensure the safety of the child. Once this is ensured, other goals can be identified and fulfilled, including the parents using verbal discipline effectively, the family feeling comfortable in its relationship with the counselor, and the parents gaining an understanding of their abusive behavior patterns.

A nurse determines that the information about falling down the stairs given by a parent suspected of child abuse contradicts the information given by the child. What should the nurse say to the parent? A. "Tell me again how your child fell down the stairs." B. "Your child says the stairs did not cause this injury." C. "Did you do anything to cause this injury to your child?" D. "Why don't you tell me what really happened to your child?"

A The nurse needs additional information to investigate the contradictory responses. The response "Your child says the stairs did not cause this injury" will put the parent on the defensive and may increase the child's risk for additional abuse. The response "Did you do anything to cause this injury to your child?" requires a yes or no response and will limit further discussion; it may also precipitate a defensive response. The response "Why don't you tell me what really happened to your child?" is judgmental, will interfere with further communication, and may precipitate a defensive response.

A client at 16 weeks' gestation arrives at the prenatal clinic for a routine visit. During the examination the nurse notes bruises on the client's face and abdomen. There are no bruises on her legs and arms. Further assessment is required to confirm what? A. Domestic abuse B. Hydatidiform mole C. Excessive exercise D. Thrombocytopenic purpura

A. Domestic abuse is likely to intensify during pregnancy, and attacks are usually directed toward the pregnant woman's abdomen. A hydatidiform mole manifests as an unusually enlarged uterus for gestational age accompanied by hypertension, nausea and vomiting, and vaginal bleeding, not bruises on the face and abdomen. Excessive exercise may cause cardiovascular or pulmonary problems. It will not result in bruising. Thrombocytopenic purpura and other bleeding disorders manifest as bruises and petechiae on many areas of the body's surface, not just the face and abdomen.

A 7-year-old child sustains a fractured femur in a bicycle accident. The admission x-ray films reveal evidence of fractures of other long bones in various stages of healing. What does the nurse suspect as the cause of the fracture? A. Child abuse B. Vitamin D deficiency C. Osteogenesis imperfecta D. Inadequate calcium intake

A. Injuries in various stages of healing are the classic sign of child abuse. Vitamin D deficiency, osteogenesis imperfecta, and inadequate calcium intake may all be investigated after child abuse has been ruled out.

An 18-year-old woman is brought to the emergency department by her two roommates after being found unconscious in the bathroom. Laboratory tests are ordered. The nurse reviewing the findings notes that the urinalysis is positive for flunitrazepam. The nurse knows that flunitrazepam is often used for what? A. As a date rape drug B. To control symptoms of psychosis C. To control symptoms of bipolar mania D. To treat hangover symptoms after excessive alcohol consumption

A. Flunitrazepam, illegal in the United States, has been used in date rapes; the victim is attacked after consuming a drink spiked with the drug. Flunitrazepam is not used to treat psychosis, mania, or hangover symptoms.

A nurse is teaching staff members about the legal terminology used in child abuse. What definition of battery should the nurse include in the teaching? A. Maligning a person's character while threatening to do bodily harm B. A legal wrong committed by one person against property of another C. The application of force to another person without lawful justification D. Behaving in a way that a reasonable person with the same education would not

C. Battery means touching in an offensive manner or actually injuring another person. Battery refers to actual bodily harm rather than threats of physical or psychological harm. Battery refers to harm against persons, not property. Behaving in a way that a reasonable person with the same education would not is the definition of negligence.

A nurse is interviewing a mother accused of physical child abuse. When speaking with this mother, what does the nurse expect her to do? A. Attempt to rationally explain her behavior. B. Reveal the belief that her child needed to be disciplined. C. Offer a detailed explanation of how her child was injured. D. Ask how she can arrange to visit her child on the pediatric unit.

B An abusive parent often indicates that he or she was trying to improve the child's behavior with physical consequences for behavior the parent considered unacceptable. Such parents usually do not admit their behavior, so they do not have a need to rationalize it. These parents offer many vague explanations of how the child was injured; rarely is the explanation detailed. Asking how she can arrange to visit her child on the pediatric unit is an unusual request because the abusive parent usually does not ask to see the child.

What is the nurse's priority responsibility when abuse of an 8-year-old child is suspected? A. Treating the child's traumatic injuries B. Protecting the child from future abuse C. Confirming the child's suspected abuse D. Having the child examined by the healthcare provider

B Most injuries to abused children are not life threatening; protection takes priority. Treatment of major injuries is the responsibility of the medical staff, not the nurse. An accurate diagnosis of child abuse may take time and must be fully investigated. The nurse is often the first person to see the abused child and must establish protection before the healthcare provider arrives.

The husband of a woman who has been sexually assaulted arrives at the hospital after being called by the police. After reassuring him about his wife's condition, the nurse should give priority to what? A. Arranging for the rape counselor to meet with the wife B. Discussing with him his own feelings about the situation C. Helping him understand how his wife feels about the situation D. Making him comfortable until the practitioner has finished examining his wife

B Partners may themselves feel angry and abused; these feelings should be quickly and openly discussed. Arranging for the rape counselor to meet with the wife should not be done yet; rape counselors work with the victim and partner together. The partner's feelings must be resolved before the partner can help the client, and the nurse may not fully know the wife's feelings. Making him comfortable until the practitioner has finished examining his wife may be reassuring, but it leaves the partner alone to deal with his feelings.

A client is admitted to the mental health unit of the hospital because of agitation and unprovoked hostile verbal attacks toward others in the workplace. What is the priority nursing intervention for this client? A. Developing trust B. Maintaining safety C. Refocusing hostile energy D. Preventing hostile outbursts

B The client is potentially harmful to others, as evidenced by previous episodes of hostile behavior. Developing trust is impossible until the client's anger and agitation begin to subside. Although refocusing hostile energy is important, it is not the priority. Preventing hostile outbursts may not always be possible.

A nurse is working with a married woman who has come to the emergency department several times with injuries that appear to be related to domestic violence. While talking with the nurse manager, the nurse expresses disgust that the woman keeps returning to the situation. What is the best response by the nurse manager? A. "She must not have the financial resources to leave her husband." B. "Most women try to leave about six times before they are successful." C. "There's nothing the staff can do; people are free to choose their own lives." D. "These women should be told how stupid they are to stay in that kind of situation."

B. Nurses who work with victims of partner abuse need to be supportive and patient. It takes time and several attempts for most victims to leave abusive relationships. It may or may not be true that the client does not have the financial resources to leave her husband; there is not enough information to support this conclusion. The staff can encourage the woman to make plans for addressing various potential events and provide information about social services and telephone help lines. Shaming women in this position will simply make them less likely to seek help.

A nurse has learned that infants born to very young mothers are at risk for neglect or abuse, primarily because of what characteristic typical of adolescent mothers? A. Did not plan for her pregnancy B. Cannot anticipate her baby's needs C. Is involved in seeking her own identity D. Becomes resentful of the need to give constant care to the baby

C Adolescent parents are still involved in the developmental stage of resolving their own self-identity; they have not sequentially matured to intimacy and generativity, making nurturing of another difficult. Although adolescents usually do not plan for their pregnancies, it is not the primary reason that their infants are at risk for neglect or abuse. Although adolescents may have difficulty anticipating their infants' needs, it is not the primary reason that their infants are at risk for neglect or abuse. Although adolescents may resent the responsibilities involved in childrearing, it is not the primary reason that their infants are at risk for neglect or abuse. These issues could be problematic for a new mother of any age.

During a home visit, a nurse discovers that a child in the household has a disability and has been experiencing seizures. In addition, the child's parent is indifferent to the child's physical, emotional, or medical needs and seems to provoke seizure episodes by harsh verbal exchanges with the child. The nurse believes that an intervention by an appropriate community resource is indicated. Where should the nurse direct the referral? A. Outpatient clinic B. Hospital pediatric unit C. Child Protective Services D. Bureau of the handicapped

C All states have laws about obligatory reporting of child abuse to local authorities. This responsibility is delegated by the state to an appropriate local agency such as Child Protective Services. A staff member of the agency investigates allegations of child abuse, and recommendations are made to protect the child's welfare. The clinic treats the client medically, but other agencies handle child abuse and other social problems. The hospital probably will not admit the child unless an immediate medical incident requires it. The bureau of the handicapped is concerned with equipment and supplies required for the individual with a disability.

A healthcare provider prescribes losartan for a client. Which is the most important nursing action? A. Assess the client for hypokalemia. B. Ensure that the medication is ingested with food. C. Monitor the client's blood pressure during therapy. D. Teach that a missed dose can be doubled at the next scheduled time.

C Losartan is an antihypertensive. It blocks vasoconstrictor and aldosterone-producing effects of angiotensin II at receptor sites. A lowering of the client's blood pressure reflects a therapeutic response and should be monitored frequently. The client may be at risk for hyperkalemia, not hypokalemia. Losartan may be taken without regard to meals. Doubling a dose is unsafe. A missed dose can be taken as long as it is not close to the next scheduled dose.

A client has had repeated hospitalizations for aggressive, violent behavior. While on the mental health service, the client becomes very angry, starts screaming at the nurse, and pounds the table. What is the priority nursing assessment at this time? A. Range of expressed anger B. Extent of orientation to reality C. Degree of control over the behavior D. Determination of whether the anger is justified

C. Degree of control over the behavior is the most important assessment because it will influence the nurse's intervention. Depending on the extent of the client's control, the nurse may or may not need assistance. It is not the degree of anger but instead the behavior it precipitates that is important to assess. The extent of orientation to reality may or may not influence the ability to control behavior. Anger is always justifiable to the person; the determination of whether the anger is justified will not help the nurse address the client's behavior.

A married woman is brought to the emergency department of a local hospital. Her eyes are swollen shut, and she has a bruise on her neck. She reports that she is being beaten by her husband. How does the nurse expect the husband to behave when he arrives at the emergency department? A. Fearful B. Confused C. Charming D. Indifferent

C. Abusers are often extremely charming to mask their abusive tendencies and convince the abused mate and others that change is possible. After an abusive episode there is often a "honeymoon" period because the tensions of the abuser have been released. Abusers mask their fears by becoming angry and aggressive. Abusers are not confused; they are manipulative of others. Abusers are rarely indifferent; they tend to be opinionated and demanding.

The school nurse is conducting a teacher's in-service on signs that may indicate that a child is a victim of bullying. Which sign should the nurse include in the teaching session? A. The child wants to try out for the basketball team. B. The child asks for extra work to make better grades. C. The child is participating in several extracurricular activities after school. D. The child asks to go to the nurse's office frequently with vague complaints.

D Signs that may indicate a child is being bullied are similar to signs of other types of stress, including nonspecific ailments or complaints. Spending inordinate amounts of time in the school nurse's office with vague complaints is a sign that should be included in the teaching session. Withdrawal and deteriorating school performance are often signs of bullying. The child's wanting to participate on the basketball team, asking for extra work, and participating in extracurricular activities are not signs of withdrawal or deterioration in school performance.

A female client who physically abused her 9-year-old son is undergoing treatment to help her control her behavior. Which statement indicates that the client has developed a safe coping method to help her deescalate? A. "I promise that I won't get so angry when my son causes trouble again." B. "If my son gets straightened out, we shouldn't have these kinds of problems." C. "I think the root of the problem is when my husband comes home after drinking." D. "If I get angry at my son again, I'm going to need a pillow in the bedroom to punch."

D. Verbalization of the need to take out her anger on an inanimate object indicates the potential for increased impulse control; this is important in the prevention of further abuse. Promising not to get angry is unrealistic because all parents become angry with their children at some time or another. Placing the blame on the child or the spouse, rather than on the mother's own behavior, indicates a lack of progress toward controlling anger.

A nurse providing care in a hospital witnesses a client's spouse shaking the client vigorously because the client has had an episode of incontinence. Because of the suspicion of physical abuse, legally the nurse should discuss the concerns with which party? A. The client B. The client's spouse C. The client's primary healthcare provider D. Adult Protective Services

D. The nurse has a legal responsibility to report suspicions of abuse to the appropriate agency, which in this instance is Adult Protective Services. The client will not be able to understand the discussion. It is not the nurse's responsibility to directly challenge the spouse's behavior in this situation; the nurse may act as a client advocate by interrupting the spouse's behavior and providing immediate physical and emotional care. The nurse should then report suspicions of abuse to Adult Protective Services. Although the nurse may report suspicions about the spouse's behavior to the healthcare provider, the law requires that Adult Protective Services be notified.

A 6-year-old child has a fractured arm and multiple old injuries. Child maltreatment is suspected. What parental characteristic supports this suspicion? A. Inquiring about the time of discharge B. Displaying signs of guilt about the injuries C. Expressing concern about the child's health D. Offering inconsistent stories about the injuries

D. Typically, abusive parents resist questioning; however, when pressured to explain the injuries they offer a variety of stories in an attempt to cover up the real origin of the injuries. Abusive parents display little interest in the child's care or progress. Rather than guilt, battering parents tend to feel angry at the child for the injury. An abusive parent typically has difficulty showing concern for the child. The parent is unable to comfort the child, such as through touch, and gives little indication of realizing how the child feels.