OB week 13 chpt 9

The nurse is assessing a client who is a victim of intimate partner violence and recognizes a belief that is common among victims of abuse. Which belief would the nurse most likely identify? a. The client is inadequate in some way. b. The situation will never get better. c. The client recognizes being a victim. d. The client can leave at any time.

a. The client is inadequate in some way. Some victims believe that the abuse is caused by a personality flaw or inadequacy in themselves. The victims rarely describe themselves as abused and believe if they can do as the abuser has asked, things will get better. Few believe they can leave.

The nurse is working with a perpetrator of intimate partner violence. The nurse educates the perpetrator that the behavior can be changed with intervention based on the understanding that it is: a. a learned behavior. b. caused by a disease. c. an inherited behavior. d. caused by a psychiatric condition.

a. a learned behavior. Violence is a learned behavior that, without intervention, is self-perpetuating.

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? a. during pregnancy b. on paydays c. during winter d. if they leave the abuser

a. during pregnancy Women are at a higher risk for violence during pregnancy. Recent research findings indicate that having children does not protect women. They are more vulnerable during this time, and the abusers take advantage of it.

A client comes to the clinic for an evaluation of several injuries that are suspicious. While assessing the client, the nurse identifies factors related to the client's partner that could indicate an increased risk for intimate partner violence. Which factors might the nurse identify? Select all that apply. a. young age b. older adult c. depression d. good paying job e. apparent poverty f. talk of heavy weekend drinking

a. young age c. depression e. apparent poverty f. talk of heavy weekend drinking Rationale:There are several recognized risk factors for intimate partner violence. Individual factors include young age, heavy drinking, personality disorders, depression, low academic achievement, witnessing and experiencing violence as a child, and low income.

The nurse has just finished a presentation about intimate partner violence at a local group meeting and realizes more teaching is needed when one person comments: a. "It's not just men against women anymore; it can be anyone against whomever they are intimate with." b. "That was interesting, but it will never happen here. It only happens in the poor side of town." c. "Drugs and alcohol can really make the situation much worse." d. "I've heard getting pregnant can make the situation worse."

b. "That was interesting, but it will never happen here. It only happens in the poor side of town." It is a myth that battering occurs only in the lower socioeconomic classes. Violence occurs in all socioeconomic classes. The other statements are true.

When teaching a group of young adults about the cycle of violence, the nurse would describe which behavior as eventually disappearing as the violence becomes accelerated over time? a. denial of the seriousness of the injuries b. apologies for the pain and abuse c. loss of control d. excessive hostility and friction

b. apologies for the pain and abuse As the violence increases in frequency and severity over time, the honeymoon phase gradually shortens and eventually disappears altogether. The abuser no longer feels the need to apologize and indulge in a honeymoon phase as the victim becomes increasingly disempowered by the relationship.

A client who is a rape survivor has appeared to cope very well. However, at a routine visit several months later, the client describes nightmares and flashbacks. The nurse would suspect which condition? a. crisis avoidance b. posttraumatic stress disorder c. overwhelming guilt d. continued recovery

b. posttraumatic stress disorder The woman is experiencing signs and symptoms of post-traumatic stress disorder (PTSD), which are experienced by a significant proportion of rape victims. Symptoms can include nightmares, flashbacks, increased emotional arousal, and irritability. These clients should be referred for counseling.

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. a. assault b. and insomnia c. trust others d.changes job or moves

1) and insomnia 2) assault 3) Changes job or moves 4) 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.

When establishing a rapport with the client who is a victim of intimate partner violence, it is important that a nurse remain nonjudgmental, be alert for subtle clues of abuse, and avoid classifying the client as: a. a chronic complainer. b. accident-prone. c. attention-seeking. d. a hypochondriac.

a. a chronic complainer. Routine screening for intimate partner violence is the first way to detect abuse. The nurse should build rapport by showing an interest in the concerns of the client, listening, and creating an atmosphere of openness. The nurse should communicate support through a nonjudgmental attitude, or by telling the client that no one deserves to be abused. Rather than overlooking abused clients as "chronic complainers" astute nurses need to be vigilant for subtle clues of intimate partner violence.

A client comes to the clinic reporting neck and back pain. The partner appears anxious and overprotective. Based on this visit and previous visits, the nurse suspects possible intimate partner violence. How might the nurse handle this examination? a. Ignore the partner's actions. b. Isolate the client to ensure privacy before questioning about possible intimate partner violence. c. Ask the client questions about violence in front of the partner. d. Question the partner about his or her actions.

b. Isolate the client to ensure privacy before questioning about possible intimate partner violence. If intimate partner violence is detected, immediately isolate the client to provide privacy and to prevent potential retaliation from the abuser. The nurse should not ignore the partner. Asking about violence in front of the potential perpetrator may trigger an abusive episode during the interview or at home. Asking the partner about his or her actions may also raise the risk for potential retaliation.

The victim of rape ask about emergency contraception. The nurse would educate the client that the drug should be taken within which time frame to ensure maximum effectiveness? a. 48 hours after the rape b. 24 hours after the rape c. 36 hours after the rape d. 12 hours after the rape

d. 12 hours after the rape Emergency contraception is most effective if it is taken within 12 hours of the rape; it becomes less effective with every 12 hours of delay thereafter. It must be taken within 72 to 120 hours of the unprotected intercourse to prevent ovulation, fertilization, or implantation. It will not disrupt an established pregnancy.

A nurse is developing a plan of care for a victim of abuse. Which action would be most appropriate for the nurse to include in the plan? a. Make the decisions for the client. b. Provide an overview of the procedures to be done. c. Take the lead in providing the interventions quickly. d. Allow the client to participate in the care.

d. Allow the client to participate in the care. Active participation in care is critical because it promotes feelings of control. The victim should be allowed to actively participate in care and decision making. The nurse should offer step-by-step explanations of procedures to alleviate fears and to demonstrate a caring attitude. The nurse should let the client set the pace of the nursing interventions.

To properly assist a victim of intimate partner violence, which action would be most appropriate for the nurse to do? a. Discuss the details with the victim. b. Summarize the details of the incident. c. Confront the abuser about the details. d. Document the details.

d. Document the details. Accurate documentation is critical because this evidence may support the client's case in court. Documentation must include details about the frequency and severity of violence; location, extent, and outcome of injuries; and any treatments or interventions. Documentation should always use direct quotes, and be very specific.

On a follow-up visit, a client who was a victim of rape states having joined a rape survivor advocacy group. The nurse interprets this as indicating that the client is in which phase of rape recovery? a. disorganization b. integration and recovery c. denial d. reorganization

b. integration and recovery

A nurse is describing the cycle of violence to a group at a community clinic. The nurse determines that the attendees have understood the information when they identify which phase as usually lasting the longest? a. honeymoon b. tension building c. explosion of violence d. acute battering

b. tension building Of the phases, the first phase, tension building, is usually the longest. Acute battering, in which there is the explosion of violence, and the honeymoon phase are not typically as long.

As part of a local college awareness program, a nurse is interviewing several of the participants about their views on rape. Which statement would lead the nurse to determine that teaching about rape is necessary? a. "A woman can avoid being raped. If she doesn't want it to happen, then it won't." b. "Most victims of rape never report the episode to the police or tell anyone about it." c. "Women who are raped may require several years to recover emotionally and physically." d. "What a woman wears has no effect on whether or not she will be raped."

a. "A woman can avoid being raped. If she doesn't want it to happen, then it won't." Women can be forced and overpowered by most men. The majority of women who are raped never tell anyone about it, and almost two thirds of victims never report it to the police. No victim invites sexual assault, and what she wears is irrelevant. It can take several years for a woman to recover from rape. Medications can help initially, but counseling is necessary.

A nurse has experienced success by utilizing the SAVE model to evaluate clients for possible intimate partner violence. Which action would be least appropriate for the nurse to address? a. screening all clients for violence b. validating that the client is the cause c. asking for evidence of the abuse d. educating the client concerning the community resources available

b. validating that the client is the cause The SAVE model includes: Screen all clients for violence by asking simple questions; Ask direct questions in a nonjudgmental way; Validate the client by ensuring belief of the story and not blaming the client for what happened; Evaluate and educate the client as to the available resources.

A nurse is reviewing the medical record of a client. Which information would the nurse identify as indicating emotional abuse? Select all that apply. a. controlling how the family's money is spent b. not allowing the victim to seek care for an injury c. calling the victim names d. threatening to hit the victim e. forcing the victim to perform a degrading act f. throwing things at a victim

c. calling the victim names d. threatening to hit the victim e. forcing the victim to perform a degrading act Calling the victim names; promising, swearing, or threatening to hit the victim; and forcing the victim to perform degrading or humiliating acts are examples of emotional abuse. Throwing things at the victim is an example of physical abuse. Controlling the finances and spending is an example of financial abuse. Interfering with a victim's access to health care for injuries is an example of physical abuse.

A nurse working with victims of intimate partner violence recognizes that one of the best interventions is to: a. send the victim directly to a shelter for safety. b. file charges against the abuser immediately. c. strengthen the victim's sense of control over life. d. confront the abuser.

c. strengthen the victim's sense of control over life. The goal of intervention is to enable the victim to gain control of her life. Providing reassurance and support to the victim of intimate partner violence is key. Appropriate actions can help victims to express their thoughts and feelings in constructive ways, manage stress, and move on with their lives. These victims need to understand that they are in control, and strengthening this understanding will greatly improve their chances of making changes.

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? a. "The medication will cause me to have an abortion." b. "I need to take 3 doses over the next several days." c. "I can wait until tomorrow morning to start taking it." d. "It contains high doses of a typical birth control pill"

d. "It contains high doses of a typical birth control pill" Emergency contraceptive pills involve high doses of the same oral contraceptives that millions of women take every day. The emergency regimen consists of one dose taken within 72 to 120 hours of the unprotected intercourse. Emergency contraception works by preventing ovulation, fertilization, or implantation. It does not disrupt an established pregnancy and should not be confused with mifepristone (RU-486), a drug approved by the Food and Drug Administration for abortion in the first 49 days of gestation. Emergency contraception is most effective if is taken within 12 hours of the rape; it becomes less effective with every 12 hours of delay thereafter.

The nurse is assessing a woman who underwent a female circumcision for cultural reasons when she was 9 years old. The nurse observes that the prepuce and a portion of the clitoris have been removed. The nurse identifies this as which type of female genital cutting procedure? a. type III b. type II c. type IV d. type I

d. type I With a type I procedure, the prepuce with or without a part or all of the clitoris is excised. With a type II procedure, the clitoris and part or all of the labia minora are excised. With a type III procedure, all or part of the external genitalia is excised and the vagina is stitched or narrowed. A type IV procedure includes the following: the clitoris or labia is pricked, pierced, or incised, the clitoris and/or labia are stretched, the clitoris and surrounding tissues are cauterized, the vaginal orifice is scraped or cut, corrosive substances are introduced into the vagina, and herbs are inserted to narrow it.

The nurse is assisting a victim of intimate partner violence in preparing a plan for leaving the relationship. Which instructions would the nurse include? Select all that apply. a. "Take the deed to the house or your apartment lease with you." b. "Get some phone cards that you can use to make the necessary calls." c. "Set up a specific plan for leaving and then practice it." d. "Be sure to have some type of identification, like a photo ID or driver's license." e. "Don't worry about your clothes; just get yourself out right away."

a. "Take the deed to the house or your apartment lease with you." c. "Set up a specific plan for leaving and then practice it." d. "Be sure to have some type of identification, like a photo ID or driver's license." When leaving an abusive relationship, a victim should take a driver's license or photo ID, the deed to the house or apartment lease, and a change of clothes for oneself and one's children. The victim should develop a game plan for leaving and then rehearse it. The victim should not use phone cards because they can leave a trail the abuser can follow.

A nurse has just finished a presentation about intimate partner violence at a local group meeting. The nurse determines that more teaching is needed based on which group statement? a. "That was interesting. It's scary because it can happen anywhere, even here." b. "It's only women that get hurt. Men are the ones doing all the hurting." c. "I've heard getting pregnant can make the situation worse." d. "Drugs and alcohol can really make the situation much worse."

b. "It's only women that get hurt. Men are the ones doing all the hurting." Violence occurs in all socioeconomic classes and all genders. Although women are victims of violence more frequently than men, the prevalence of violence among men nonetheless represents a significant public health concern. One out of every 4 men has experienced rape, physical violence, and/or stalking by an intimate partner in their lifetime. Alcohol and drugs can make the situation worse. . Pregnancy is a time of unique vulnerability to intimate partner violence (IPV) victimization because of changes in women's physical, social, emotional, and economic needs during pregnancy. Although the true prevalence of violence during pregnancy is unclear, research suggests it is substantial and often continues into the postpartum period.

When caring for victim of intimate partner violence, the nurse uses the ABCDES framework to provide interventions. Which components are part of this framework? Select all that apply. a. clear documentation of the nurse's perception of the abuse b. maintenance of confidentiality of the information reported c. plan of action and resources for safety for when the victim decides to leave d. expression of the belief that there may be a reason for the violence e. reassurance that the victim is not alone in this situation f. education about the cycle of violence and its escalation

b. maintenance of confidentiality of the information reported c. plan of action and resources for safety for when the victim decides to leave e. reassurance that the victim is not alone in this situation f. education about the cycle of violence and its escalation Use of the ABCDES framework provides direction: reassuring the victim that he or she is not alone; informing the victim of the belief that violence is not acceptable in any situation; ensuring the victim that information reported is confidential; documenting information factually and accurately; educating the victim about the cycle of violence and its escalation; and ensuring the victim's safety by providing the victim with resources and a plan of action to carry out when the client decides to leave. Expressing an opinion that there may be a reason for the violence is never appropriate nor is documenting the nurse's own perception of what happened.

A nurse is providing care to a older adult victim of intimate partner violence. When approaching this client, the nurse must ensure to avoid which type of behavior? a. nonjudgmental b. accepting c. critical d. consultative

c. critical It is very important that the nurse listen carefully and nonjudgmentally. Judging or criticizing the victim for decisions might lead to the impression that the victim deserves the abuse or is to blame. The nurse should build trust and a sense of rapport with the victim and help build the victim's confidence so he or she can take the necessary steps to leave the situation.

A nurse is assessing a victim of rape. The victim tells the nurse, "It felt like I was outside my body looking down and watching the whole thing." The nurse suspects that the client received which substance? a. ketamine b. diazepam c. gamma hydroxybutyrate d. rohypnol

c. gamma hydroxybutyrate Date rape drugs are also known as "club drugs" because they are often used at dance clubs, fraternity parties, and all-night raves. The most common is rohypnol (also known as "roofies," "forget pills," "mind erasers," and the "drop drug"). This drug is 10 times as strong as diazepam. The effects can be felt within 30 minutes and produces memory loss for up to 8 hours. Gamma hydroxybutyrate (GHB) called "liquid ecstasy" or "easy lay") produces euphoria, an out-of-body high, sleepiness, increased sex drive, and memory loss. GHB takes effects in about 15 minutes and can last 3 to 4 hours. It may cause unconsciousness, depression, and coma. The third date rape drug, ketamine (known as "Special K," "vitamin K," or "super acid"), and acts on the central nervous system very quickly to separate perception and sensation. Diazepam does not cause an out-of-body experience.

A nurse is preparing a presentation for a local community group about intimate partner violence. Which statement would be most appropriate for the nurse to include in the presentation? a. Intimate partner violence primarily affects young, unmarried women. b. Children who witness intimate partner violence against a parent are less likely to become abusers. c. Until the 1990s, society tended to legitimize a man's control over a woman. d. Intimate partner violence in LBGTI relationships may go unreported for fear of harassment.

d. Intimate partner violence in LBGTI relationships may go unreported for fear of harassment. Intimate partner violence occurs in both heterosexual and LGBTI relationships, but violence within LBGTI relationships may go unreported for fear of harassment or ridicule. Little is known about the national prevalence of IPV, sexual violence, and stalking among the LGBTI community in the United States. However, research indicates that rates of IPV among LGBTI individuals are equal to or greater than rates among heterosexual individuals. Risk factors are also similar to those of heterosexual individuals, as are needs related to help with leaving and the recovery process. Moreover, there is as much IPV in the LGBTI population as in heterosexual relationships with the added psychological abuse of "outing," when one partner threatens to disclose the other's sexual preference in an effort to maintain power and control. Intimate partner violence affects people at nearly every stage of their lives and may occur in old or young, beautiful or unattractive, married or single individuals. Until the 1970s, society tended to legitimize a man's power and control over a woman. Children who witness one parent abusing another are more likely to become delinquents or abusers themselves.

While interviewing a client, the client tells the nurse, "Our budget is tight. My spouse controls how all the money is spent. And I am not allowed to get a job either." The nurse suspects that the client may be experiencing which type of abuse? a. emotional b. sexual c. physical d. financial

d. financial Based on the client's statements, financial abuse would be suspected. Physical abuse would be indicated by actual physical assault or injuries, such as hitting, grabbing, throwing things, and kicking or punching. Emotional abuse would be indicated by threatening to hit, humiliating the victim, isolating the client from family and friends, or controlling the victim's every move. Sexual abuse would involve forcing the client to have intercourse against his or her will or forcing the client to do something he or she finds degrading and humiliating.

A young female immigrant has come to the clinic for medical care. On examination, the nurse discovers she underwent female genital cutting as a young girl. The nurse recognizes this practice is primarily based on: a. her choice. b. her religion. c. punishment. d. her culture.

d. her culture. The exact origins of female genital cutting are not known. It is not mandated by any religion and predates both Christianity and Islam. In some cultures, it is associated with feminine beauty and often signifies a rite of passage from childhood to adulthood. FGC is performed to decrease a woman's sexual desires and to ensure her chastity until marriage and receipt of a dowry from the prospective groom. Ultimately, the reality of being ostracized by the community and the possibility of being ineligible to marry create enormous social pressure to have FGC performed, pressure that exceeds the physical and emotional damage of this practice.

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? a. diazepam b. rohypnol c. gamma hydroxybutyrate (GHB) d. ketamine

d. ketamine Ketamine acts on the central nervous system to separate perception and sensation. Rohypnol produces memory loss for up to 8 hours. GHB produces euphoria, an out-of-body high, sleepiness, increased sex drive, and memory loss. It may cause unconsciousness, depression, and coma. Diazepam is an antianxiety agent that causes sedation, lethargy, mild drowsiness, confusion, and disorientation.