Old's maternity Ch 8

A woman has come to the emergency department with multiple bruises over her body and a small laceration over her upper lip. She says she fell down the stairs while doing her housework. Which observation would most likely cause the nurse to suspect that she has been a victim of battering? 1. The client is hesitant to provide details about how the injuries occurred. 2. The client was accompanied to the emergency department by her mother instead of her partner. 3. The client has sought care quickly after the incident. 4. The client does not seem to be in pain.

Answer: 1 Explanation: 1. Hesitation to provide detailed information about the injury and how it occurred is a common sign of abuse.

When a woman who has been raped is admitted to the emergency department, the nurse caring for the woman knows that which of the following is the priority nursing intervention? 1. Explaining exactly what will need to be done to preserve legal evidence 2. Assuring the woman that everything will be all right 3. Creating a safe, secure environment for her 4. Contacting family members

Answer: 3 Explanation: 3. The first priority in caring for a survivor of a sexual assault is to create a safe, secure environment.

The nurse working in the emergency department knows that many batterers have feelings of ambivalence. In what way might this be evident? 1. The abuser alternates episodes of unmerciful beatings with periods of remorse and loving attention. 2. The abuser has alternating periods of sadness and happiness. 3. The abuser has alternating periods of maturity and immaturity. 4. The abuser alternates letting the person he abuses be independent and then dependent.

Answer: 1 Explanation: 1. Extremes in behavior and overreacting are typical patterns.

The client has been a victim of a violent, sadistic rape. She is crying, and asks the nurse "Why would someone do something like that?" The nurse should explain that which of the following is the primary purpose of sadistic rape? 1. Take pleasure from the victim's struggle and pain 2. Express feelings of rage 3. Feel a sense of power or mastery 4. Relieve intolerable anxiety

Answer: 1 Explanation: 1. In sadistic rape, the assailant has an antisocial personality and delights in torture and mutilation. In this type of rape, the victim and assailant are generally strangers, and the assault is planned. Sadistic rapes cause the most injuries, including homicide.

The nurse is caring for an abused mother in the postpartum department. The client is afraid to go home, but has no money to do anything else. What can the nurse do to assist this individual and her baby? 1. Work with community services to have the client and her baby go to a safe place, complete paperwork to obtain financial assistance, and obtain some temporary assistance. 2. Explain that she will have to go home at this time, but provide her with paperwork to complete to obtain assistance. 3. Offer to have her partner come in and attend a counseling session with her. 4. Suggest that once she gets home, she should pursue getting a restraining order against her abuser.

Answer: 1 Explanation: 1. Nurses and medical personnel need to be alert to symptoms of battering, recognize these cues, and encourage women to seek assistance from community agencies. The most innovative and effective domestic violence programs in hospitals and urgent care facilities work collaboratively with domestic violence service agencies, develop a comprehensive community referral network, and work with multidisciplinary intervention teams.

The nurse at a shelter is counseling a group of battered women. What will the nurse will emphasize? 1. Battering will not stop or decrease if the woman becomes pregnant. 2. About 1 of every 5 women will experience abuse in her lifetime. 3. When these women go back to the situation after the abuser has cooled down, it will be better. 4. The battered woman can readily leave the situation.

Answer: 1 Explanation: 1. Pregnancy does not stop the abuser, and sometimes it increases the intensity of the abuse.

A home health nurse is making a home visit to a new mother who is diabetic and requires some follow-up to make sure her baby is doing well and that her diabetes is in control while she is breastfeeding. The client meets her at the door, crying, with bruises on her face and legs. The nurse knows the client has been in a questionable relationship. What is the first responsibility of the nurse for this client at this time? 1. Assist in getting the client and her baby to a safe situation. 2. Check her blood sugar and make sure it is within normal limits. 3. Ask her how she is doing with the breastfeeding. 4. Check the baby's heart rate and other vital signs.

Answer: 1 Explanation: 1. Providing the abused woman with information that empowers her in decision making and providing critical assistance in safety planning for her and her baby is the nurse's first responsibility.

What is the most important aspect of care for the nurse to remember when screening a woman for partner abuse? 1. Ensuring privacy and confidentiality 2. Conveying warmth and empathy 3. Asking specific, direct questions about abuse 4. Clarifying her myths about battering

Answer: 1 Explanation: 1. Screening for women experiencing domestic violence must be done privately, with only the nurse and the client present, in a safe and quiet place.

The nurse is addressing a college class on the topic of domestic violence. Which information would the nurse be sure to convey to her students? 1. The American Nurses Association advocates client advocacy for all nurses to help identify and prevent violence against women. 2. The American Nurses Association has concluded that there is little nurses can do to eliminate violence. 3. The nurse who suspects abuse should ask the doctor to deal with it, per American Nurses Association guidelines. 4. The nurse who suspects abuse should ask the hospital's social work department to deal with it, per American Nurses Association guidelines.

Answer: 1 Explanation: 1. This is a true statement. Nurses can follow and become involved in legislative advocacy for issues related to domestic violence and other issues related to women's health through participation in their local and state chapters of the American Nurses Association.

The nurse suspects that a client has been physically abused, but the woman refuses to report the abuse to the police. Which statement by the client suggests to the nurse that the relationship might be in the "honeymoon period" of the cycle of violence? 1. "My boyfriend says he will never hurt me again." 2. "My boyfriend only drinks alcohol on the weekends." 3. "My boyfriend yells less than he used to." 4. "My boyfriend has frequent bouts of insomnia."

Answer: 1 Explanation: 1. This is an example of a statement made during the honeymoon period of the cycle of violence.

A nurse in the emergency department recognizes in the husband of a client one of which of the following common characteristics of batterers? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Emotionally immature 2. Tend to express their overwhelming feelings of inadequacy through violence 3. Feelings of insecurity and inferiority 4. A lack of respect in the community 5. Limited jealousy or possessiveness

Answer: 1, 2, 3 Explanation: 1. Batterers tend to be emotionally immature. 2. Because they tend to be emotionally immature and aggressive, batterers have a tendency to express their overwhelming feelings of inadequacy through violence. 3. Batterers are insecure, and feel inferior, often feeling that they are undeserving of their partner.

The nurse working in the emergency department of a hospital is caring for a woman whom the nurse suspects is the victim of domestic violence. The nurse knows that which of the following are contributing factors to domestic violence? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Experiencing or witnessing abuse as a child 2. Strong patriarchal family traditions 3. Linking masculinity to male honor 4. Low levels of marital conflict 5. Alcohol and drug abuse cause the violence

Answer: 1, 2, 3 Explanation: 1. Children who witness or experience abuse and battering are more likely to become batterers (men) or to be abused (women) in their own relationships. 2. Men raised in patriarchal families (those that encourage traditional gender roles) are more likely to engage in domestic violence. 3. Cultures that link definitions of manhood to dominance, toughness, or male honor are more likely to demonstrate violence against women.

The nurse working in the emergency department is admitting a woman who has been battered for a second time, and recognizes that the woman is again in the cycle of violence. The nurse knows that which of the following are characteristics of the phases of the cycle of violence? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Batterer demonstrates power and control 2. Active battering from some event 3. A loving, contrite period 4. Defeat and admission of guilt by the victim 5. Blame and punishment for inferiority

Answer: 1, 2, 3 Explanation: 1. In the tension-building phase in the cycle of violence, the batterer demonstrates power and control. 2. The acute battering incident is typically triggered by some external event or internal state of the batterer. 3. The tranquil phase in the cycle of violence is also sometimes called the honeymoon period. This phase may be characterized by extremely loving, kind, and contrite behaviors by the batterer.

The nurse is caring for a battered woman in the emergency department. Which nursing guidelines are used in the care of this client? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Letting the woman tell her story at her own pace 2. Anticipating ambivalence toward the batterer 3. Acknowledging the woman's feelings as reasonable 4. Letting the woman figure out how to identify specific problems on her own 5. Allowing her to believe in false beliefs if it makes her feel more secure

Answer: 1, 2, 3 Explanation: 1. The nurse should let the woman work through her story, problems, and situation at her own pace. 2. The nurse should anticipate ambivalence in the woman's love-hate relationship with the batterer. 3. The nurse should let the woman know that she is believed, and that her feelings are reasonable and normal.

The nurse is conducting a rape exam on a client in the emergency department after a sexual assault. What specimens will the nurse collect? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Swabs of body stains and secretions 2. Samples of pubic hair 3. Toenail scrapings 4. Samples of head hair 5. Sputum, for disease analysis

Answer: 1, 2, 4 Explanation: 1. The nurse will take swabs of body stains and secretions to analyze for semen or sperm. 2. The nurse will take pubic hair samples to analyze root structure and identify foreign hairs that might have been transferred from the rapist. 4. The nurse will take head hair samples to analyze root structure and identify foreign hairs that might have been transferred from the rapist.

The nurse suspects that a pregnant client might be experiencing abuse when the client does which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Gives an inappropriate explanation for the injuries 2. Hesitates in providing detailed information about the injury 3. Makes eye contact with the nurse while answering questions 4. Allows her partner to answer the nurse's questions 5. Frequently calls to change appointment times

Answer: 1, 2, 4, 5 Explanation: 1. Whenever a client gives an inappropriate explanation for injuries, such as being accident prone, the nurse should suspect abuse. 2. Clients experiencing abuse often hesitate in providing detailed information about an injury and how it occurred. 4. The client experiencing abuse may show signs of increased anxiety in the presence of the possible batterer, who frequently does most of the talking or hovers around the woman. 5. If a client has injuries sustained from abuse, she will often delay reporting of symptoms or seeking care for injuries.

When evaluating the care given a battered woman, the nurse analyzes care plan components to determine which of the following? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Compassionate, respectful care was delivered. 2. The woman has the necessary information to make decisions. 3. Medical records are deliberately vague. 4. Psychological care was given in the hospital. 5. The woman identifies culturally appropriate resources.

Answer: 1, 2, 5 Explanation: 1. One expected outcome of nursing care is that the woman receives compassionate, respectful, and individualized medical attention. 2. One expected outcome of nursing care is that the woman has the information she needs to make a decision about her future based on thoughtful consideration of alternatives. 5. Two expected outcomes of nursing care are that the woman is able to identify culturally appropriate community resources available to her and develops strategies for keeping herself, her children, and her family as safe as possible.

Vicarious trauma is a phenomenon nurses might experience. What are the signs indicating this problem that the nurse should be aware of? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Reduced sense of accomplishment 2. A positive effect on commitment to one's work 3. Questioning of personal belief systems 4. Balance of time for family, self, friends, and work 5. Frustration with the judicial system

Answer: 1, 3 Explanation: 1. Vicarious trauma refers to a gradual internal transformation that can negatively affect commitment to one's work, reduce any sense of accomplishment, and lead to a questioning of personal belief systems. 3. Vicarious trauma refers to a gradual internal transformation that can negatively affect commitment to one's work, reduce any sense of accomplishment, and lead to a questioning of personal belief systems.

The nurse is counseling a rape victim on her choices in pursuing legal action. The nurse will explain which of the following to the client? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Prosecution procedures are described as a second rape. 2. The prosecution will victimize her in court during testimony. 3. Publicity can intensify her feelings of humiliation. 4. Prosecution of the assailant is a community responsibility. 5. The client's sexual history will be publicized.

Answer: 1, 3, 4 Explanation: 1. Many sexual assault survivors who have gone through the judicial process refer to it as a second rape—and sometimes a more damaging one. 3. Publicity can intensify her feelings of humiliation. 4. Prosecution of the assailant is a community responsibility in which the prosecuting attorney will act on the victim's behalf.

The nurse has been talking to a woman about the reorganization phase following a rape. Which response would indicate that the client understands this phase? 1. "By using denial and suppression in this phase, I will eventually be able to accept what has happened to me." 2. "During this time, I won't talk much about the rape, because I am examining my inward feelings regarding the rape." 3. "During this time, I will repeatedly replay the role of the victim until I come to terms with the experience." 4. "My perception of a normal sexual relationship will be similar to my perception prior to the rape."

Answer: 3 Explanation: 3. During reorganization, a victim adjusts her self-concept to include the rape.

If a woman returns to an abusive situation, the nurse should encourage her to develop an exit, or safety, plan for herself and her children, if she has any. What should the plan include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Identify friends and family who know about the situation and will help her. 2. Call the police if violence begins. 3. Pack a change of clothes for herself and the children. 4. Have a plan for where she will go. 5. Have a planned escape route.

Answer: 1, 3, 4, 5 Explanation: 1. She should identify friends and family who know about the situation and will help her. Ask that she establish a code word for danger with those family and friends. 3. She should pack a change of clothes for herself and the children, including toilet articles and an extra set of car and house keys stored away from her house with a friend or neighbor. 4. She should have a plan for where she will go, regardless of the day or time. 5. She should have a planned escape route and emergency telephone numbers she can call.

Among women who have been sexually assaulted, which of the following are the most frequently diagnosed sexually transmitted infections (STIs)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Bacterial vaginosis 2. HIV 3. Chlamydia 4. Syphilis 5. Gonorrhea

Answer: 1, 3, 5 Explanation: 1. Among women who have been sexually assaulted, trichomoniasis, bacterial vaginosis, gonorrhea, and chlamydia are the most frequently diagnosed sexually transmitted infections (STIs). 3. Among women who have been sexually assaulted, trichomoniasis, bacterial vaginosis, gonorrhea, and chlamydia are the most frequently diagnosed sexually transmitted infections (STIs). 5. Among women who have been sexually assaulted, trichomoniasis, bacterial vaginosis, gonorrhea, and chlamydia are the most frequently diagnosed sexually transmitted infections (STIs).

When a woman seeks care for an injury, the nurse should be alert to which clues of abuse? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Defensive injuries 2. Immediate reporting of symptoms or seeking care for injuries 3. Lack of eye contact 4. Providing too much detailed information about the injury 5. Vague complaints without accompanying pathology

Answer: 1, 3, 5 Explanation: 1. Defensive injuries may be a sign of abuse. 3. Lack of eye contact may be a sign of abuse. 5. Vague complaints without accompanying pathology may be a sign of abuse.

A client comes to the reproductive health clinic and reports that she woke up in a strange room this morning, her perineal area is sore, and she can't clearly remember what happened the previous evening. The client says that she is afraid that she was a victim of a drug-facilitated sexual assault. Which statement should the nurse include when discussing this possibility with the client? 1. "Drinking alcohol can lead to uninhibited sexual behavior, which is not the same as rape." 2. "Some men use drugs mixed into a drink to subdue a potential victim prior to a rape." 3. "It is rare that a woman doesn't remember what happened if she is actually raped." 4. "We need to check for forensic evidence of rape before we can be sure what happened."

Answer: 2 Explanation: 2. Drug-facilitated sexual assault occurs when a drug such as Rohypnol, which dissolves easily and is odorless, is slipped into the drink of an unsuspecting woman.

The nurse is presenting a session on intimate partner violence. Which statement by a client indicates a need for further education? 1. "My daughter is not to blame for the violence in her marriage." 2. "Everyone experiences anger and hitting in a relationship." 3. "Abusers can be either husbands or boyfriends or girlfriends." 4. "The 'honeymoon period' follows an episode of violence."

Answer: 2 Explanation: 2. Violence is not a normal part of intimate relationships. Domestic violence, also called intimate partner violence (IPV), is defined as a pattern of coercive behaviors and methods used to gain and maintain power and control by one individual over another in an adult intimate relationship. This statement indicates that the client has likely been a victim of domestic violence.

In educating a group of women at a community center, the nurse talks about the myths surrounding sexual assault. What topics would the nurse include? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Older women are less likely to be sexually assaulted. 2. Rape is universal, and all societies have rape. 3. Women who party and do drugs set themselves up for sexual assault. 4. If the woman just relaxes, it will be over, and she might even like it. 5. Women lie about rape as an act of revenge.

Answer: 2, 4, 5 Explanation: 2. Rape is not universal to all societies, and not all men rape women. 4. Rape is an act of violence in which the perpetrator uses sex as a weapon to control, intimidate, and violate the victim. 5. While false allegations of rape do occur, they are the exception, not the rule.

The nurse is planning a community education presentation on battering. Which statement about battering should the nurse include? 1. Battering occurs in a small percentage of the population. 2. Battering is mainly a lower-class, blue collar problem. 3. Battered women are at greatest risk for severe violence when they leave the batterer. 4. If the batterer stops drinking, the violence usually stops.

Answer: 3 Explanation: 3. Battered women are at greatest risk for injury or domestic homicide when they leave the abuser.

The nurse in the emergency department is caring for a pregnant woman who presents with bruised breasts and abdomen. When asked how this happened, she states she fell down the stairs. The husband stays very close to his wife and does most of the talking. Of what is the nurse aware? 1. The client likely did fall down the stairs. 2. The husband is being attentive and trying to help her feel better. 3. The husband could have battered her and possibly caused her to fall down the stairs. 4. This client is safe to return home after her wrist is fixed.

Answer: 3 Explanation: 3. Battering may occur for the first time during pregnancy or may escalate in intensity if the woman is already being abused. The injury is frequently aimed at the breasts, abdomen, or vagina.

The emergency department nurse is admitting a client who has been sexually assaulted. The nurse is explaining how the physical evidence will be collected. Which statement by the client indicates that teaching has been effective? 1. "All the evidence will be kept in a locked cupboard until the police arrive." 2. "You collect urine samples to make sure the rapist did not get me pregnant." 3. "The evidence you collect might be able to identify the rapist." 4. "Blood samples are taken to help identify whether the rapist had HIV."

Answer: 3 Explanation: 3. DNA can be obtained from collected evidence to identify the rapist.

A woman is seen in the prenatal clinic. The nurse notices that the woman has a swollen eye and a bruise on her cheek. Which statement is most appropriate for the nurse to make? 1. "You must leave your partner before you are injured again." 2. "It is important that you refrain from doing things that anger your partner." 3. "Women who are abused often have injuries like yours." 4. "I am required by law to notify the police department of your injuries."

Answer: 3 Explanation: 3. This is an appropriate statement to make.

A woman with multiple bruises on her face and arms is seen in the emergency department. Her significant other is with her. When asked about her injuries, the woman states, "I ran into a door." Which action by the nurse is of highest priority? 1. Take the woman's vital signs. 2. Document the location of the bruises. 3. Assess for additional bruising. 4. Interview the woman in private.

Answer: 4 Explanation: 4. Screening for women experiencing domestic violence must be done privately, with only yourself and the client present, in a safe and quiet place.

The client with limited English language skills has a black eye, and bruises across her face and arms. The client's husband has been acting as an interpreter for her, and answers all of the questions the nurse asks, often without talking to his wife first. The nurse suspects the client has been a victim of domestic abuse. What should the nurse do next? 1. Ask the husband whether he has beaten his wife. 2. Ask the husband to have a female friend come in with his wife. 3. Provide written materials in English for the client to read at home. 4. Ask the husband to step out of the room, and obtain an interpreter.

Answer: 4 Explanation: 4. Screening for women experiencing domestic violence must be done privately. An interpreter should also be provided as necessary.

A woman who has been abused for a number of years asks the nurse for assistance in leaving the relationship. What response by the nurse is most appropriate? 1. Comment that she should have left long ago. 2. Remind the client that that fault was not likely all attributable to her abuser. 3. Encourage her to be sure with her decision, as her abuser will be difficult to deal with. 4. Assist the client to develop a safety plan.

Answer: 4 Explanation: 4. The nurse should provide women who have been abused with information that empowers them in decision making and provide critical assistance in safety planning for women and their children.

A client arrives at the emergency department stating that she was raped, but she felt so "dirty" that she went home and showered. She states that she has on clean clothes but has her other clothes in a bag. What will the nurse tell the client? 1. "I understand why you felt dirty, but you know you should not have taken a shower." 2. "We will probably never find out who raped you because you destroyed evidence." 3. "Do you want an emergency contraceptive pill?" 4. "I understand that was important to you. We will see what we can get from your clothes, and give them to the authorities."

Answer: 4 Explanation: 4. This is the correct statement. This is not the time to tell her what she did wrong, as she is psychologically upset. The ability to collect evidence that is comprehensive, appropriate, and reliable contributes to successful prosecution of perpetrators of sexual assault.

The nurse is interviewing a client who has admitted to being a victim of domestic violence. What is the most typical description of how the domestic violence developed in a relationship? 1. "He changed overnight. Everything was fine, and all of a sudden he flipped out and beat me up; he nearly killed me." 2. "It was severe from the beginning. As soon as we got married, he began hitting me and threatening to kill me." 3. "We've both always dated other people. I thought that was understood. He was as emotionally abusive in the beginning as he is now." 4. "I don't know when it started, really. It was gradual. First, just yelling, blaming, and shoving. Then the beatings started; and now they're more frequent."

Answer: 4 Explanation: 4. Typically, these forms of abuse begin slowly and subtly after some form of commitment, such as engagement, onset of a sexual relationship, marriage, pregnancy, or first childbirth.

The nurse is teaching an in-service educational presentation about working with battered women. The nurse should explain that it is often frustrating for nurses to work with battered women for which reasons? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. There is little the nurse can really do to help. 2. Healthcare policies and practices are not supportive of abused women. 3. Both husband and wife must agree to therapy. 4. These women might return to the abusive situation. 5. Women often believe that they are the cause of the abuse.

Answer: 4, 5 Explanation: 4. Women often believe that escape is futile, or escape and then return when the crisis is over. 5. Women are often convinced by the abusers that it is their own behavior that causes the abuse.