32.A Abuse
The nurse is discussing the different etiologic causes of abuse and neglect with a colleague and strongly believes in the social learning theory. Which statement supports the nurse's belief? (Select all that apply.) A. The potentially abusive individual makes a conscious choice to abuse. B. Children learn about violence from observation. C. The media expose children to many models of violence. D. Early life stress leads to mood and anxiety disorders in the individuals who are abused. E. Some communities value the subordination of women.
A, B, C Rationale: According to the social learning theory of interpersonal violence, etiologic factors include learning about violence from observation and/or exposure to models of violence in the media. The social learning theory also recognizes that the potentially abusive person makes a conscious choice to abuse. Early life stress, leading to mood and anxiety disorders in the abused, is an etiologic factor in neurobiological theory, not social learning theory. The existence of communities that value the subordination of women is an etiologic factor of gender bias theory, not social learning theory.
The nurse is discussing the different forms of abuse with a group of women in the community. Which information about emotional abuse should the nurse include in this discussion? (Select all that apply.) A. It occurs because the caregiver failed to protect the victim. B. It is seldom measured. C. It occurs without the victim's consent. D. It is inflicted accidentally. E. It cannot be seen.
A, B, C, E Rationale: Emotional abuse is different from physical abuse because it cannot be seen and is seldom measured. Both emotional and physical abuse are inflicted without the victim's consent. Neither is inflicted accidentally. Abuse that happens when a caregiver fails to protect the victim can be physical abuse, emotional abuse, or both.
The nurse is assessing an older adult client who has been abused and neglected. The nurse should assess for which characteristic? (Select all that apply.) A. Bruises and burns B. Withdrawn behavior C. Chronic fatigue D. Malnutrition E. Trauma to sexual organs
A, B, D, E Rationale: Bruises, burns, and malnutrition are manifestations of physical abuse and neglect of older adults. Withdrawn behavior is a symptom of emotional abuse of older adults. Trauma to sexual organs is a symptom of sexual abuse of older adults. Chronic fatigue is not associated with abuse of older adults.
The pediatric nurse is training new staff about caring for children who are victims of abuse and neglect. Which is an appropriate nursing intervention the nurse should include? (Select all that apply.) A. Developing rapport B. Initiating a complete physical assessment C. Encouraging the child to confront the abuser D. Reporting the abuse E. Promoting a trusting relationship
A, B, D, E Rationale: Nursing interventions for child abuse and neglect include developing rapport with the child, promoting a trusting relationship, initiating a complete physical assessment, and reporting the abuse according to agency and state requirements for mandated reporters. Encouraging the child to confront the abuser is not a nursing intervention for child abuse and neglect; rather, the nurse will provide a safe, nonthreatening environment for the child.
The nurse at a clinic notices bruises on the arms and legs of a frail older adult. The nurse suspects the bruises are caused by abuse. Which individual should the nurse consider as the possible perpetrator? (Select all that apply.) A. Caregiver living in home B. Children visiting a parent C. Meals-on-wheels volunteers D. Prescriber of anticoagulants E. Client's spouse
A, B, E Rationale: Possible perpetrators include caregivers, spouses, and children. Possible perpetrators would not include the prescriber of anticoagulants or meals-on-wheels volunteers.
The nurse is creating a plan of care for a neglected child. Which collaborative actions are appropriate nonpharmacologic treatments that should be included? (Select all that apply.) A. Family therapy for the parents B. Pain medication for the child's injuries C. Providing a safe environment for the child D. Reporting the abuse or neglect to the appropriate agency E. Play therapy
A, C, D, E Rationale: Nonpharmacologic treatment for abuse and neglect includes providing a safe environment for the child; behavioral, cognitive, group, or play therapy; family therapy for the parents; reporting suspected child abuse or neglect to the appropriate agencies; and behavioral therapy for those who are abusing or neglecting the child. Pain medication is a pharmacologic therapy.
The nurse in a long-term rehabilitation facility is helping an older adult client to recover from months of neglect. Which nonpharmacologic treatment should the nurse include in the care of the client after discharge? (Select all that apply.) A. Safe living environment B. Referral to a homeless shelter C. Older adult abuse reported to appropriate agency D. Respite care for caregiver E. Adult day care
A, C, D, E Rationale: Nonpharmacologic treatment of older adult abuse may include adult day care, a safe living environment, reporting abuse to the appropriate agency, and respite care for the caregiver. It does not include referral to a homeless shelter, which is an appropriate referral for a client who is homeless.
The nurse is conducting an assessment interview. Which complaints by the client should the nurse consider might be associated with physical abuse? (Select all that apply.) A. Depression B. Urinary tract infection C. Irritable bowel syndrome D. Chronic pelvic pain E. Headache
A, C, E Rationale: Complaints that might be associated with stress and physical abuse include headache, irritable bowel syndrome, and depression. Chronic pelvic pain and urinary tract infections can occur with sexual abuse but are not common with physical abuse.
The home care nurse is talking to an entire family about caring for their oldest member, an 88-year-old client with multiple health issues. The rest of the family includes a 48-year-old, a 28-year-old, an 18-year-old, and an 8-year-old. Which individual is in an age group that is less likely to report or admit being the victims of violence? (Select all that apply.) A. 8-year-old B. 48-year-old C. 18-year-old D. 88-year-old E. 28-year-old
A, D Rationale: Children (such as the 8-year-old) and older adults (such as the 88-year-old) are less likely to report or admit to being the victims of violence. This is not true of adults (such as the 18-, 28-, and 48-year-olds).
Which action is an example of a collaborative intervention by a nurse working with older adult who has experienced abuse? A. Referring the client to a social worker case manager B. Sharing information about services C. Exploring options for help D. Completing mandatory reports to authorities
A. Referring the client to a social worker case manager Rationale: A collaborative intervention would be referring the client to a social worker case manager. Independent interventions include completing mandatory reports to authorities, exploring options for help, and sharing information about services.
A client who was a victim of intimate partner violence (IPV) is aware that recovery from this type of relationship can be a long and difficult process. Which main goal should the nurse identify for the victim to heal and move on in life? A. Regaining a sense of empowerment and safety B. Resolving grief over any losses C. Getting back into work and home routines D. Getting through the shock and confusion of the act
A. Regaining a sense of empowerment and safety Rationale: The main goal for a victim is to regain a sense of empowerment and safety. The victim needs to move from being a victim to be a survivor. A sense of security and safety is vital to this transition. Getting back to work and home routines, resolving grief over any losses, and getting through the shock and confusion are all important, but not the ultimate goals.
A 2-year-old child is brought to the pediatric clinic with an upper respiratory infection. After assessing the child, the nurse suspects that this child may be a victim of child abuse. Which finding strongly supports the nurse's suspicion? A. Welts or bruises in various stages of healing on the child's back B. Scraped and scabbed knees C. A few bruises on shins D. Diaper rash
A. Welts or bruises in various stages of healing on the child's back Rationale: The assessment findings in children who are physically abused include bruises and welts in various stages of healing, which are found in areas where one does not normally see bruising from being a child; whip marks on the back, legs, or buttocks; abdominal pain or tenderness; and broken bones or fractures in various stages of healing. Bruises on the lower legs, scraped and scabbed knees, and diaper rash are normal findings for children at this age, who are trying and exploring new things and may still be in diapers. Untreated diaper rash may be a sign of neglect.
The nurse is preparing a community teaching presentation on prevention of abuse. Which level of prevention should the nurse include? (Select all that apply.) A. Historical B. Parental C. Societal D. Individual E. Community
B, C, D, E Rationale: The nurse knows that the levels of prevention should include: individual, community, societal, and parental. Historical information may be used to examine trending information but it is not a level of prevention.
The nurse wishes to implement parental teaching about ways to prevent abuse or injuries in infants and very young children. Which should be the focus area of the nurse based on the leading cause of child abuse deaths in young children? A. Abdominal trauma B. Abusive head trauma C. Burn injuries D. Spinal fractures
B. Abusive head trauma Rationale: Abusive head trauma (AHT) is the leading cause of death in children under the age of 5. It includes injuries sustained from shaken baby syndrome. Spinal fractures, abdominal trauma, and burn injuries are not the leading cause of death in young children.
A child's parent expresses suspicion that their child has been subjected to sexual abuse by the babysitter. Which approach is most appropriate for the nurse to take? A. Ask the child's parent to leave the room to conduct a thorough examination. B. Develop a trusting relationship with the child by doing exactly what is promised. C. Tell the child that the babysitter will be made to pay for what the person did. D. Call the police to report the crime committed against the child.
B. Develop a trusting relationship with the child by doing exactly what is promised. Rationale: The priority when caring for a child who is the victim of violence is always safety. Because the child is in a safe environment, the most appropriate action for the nurse is to develop a trusting relationship by doing exactly what is promised for the child. It is not appropriate to ask the parent to leave the room, as the parent leaving may increase the client's anxiety. The nurse should not make negative comments about the abuser and must follow established protocols for mandatory reporting.
The nurse is caring for a woman and notes several bruises on the woman's upper body. When the nurse asks about the marks, the woman replies that her husband has the right to punish her when she questions the husband's authority. Which response by the nurse is correct? A. Report the husband to the police and social services. B. Give the woman a list of emergency resources. C. Respect her views and document the marks. D. Call the woman's husband and explain that abuse is illegal.
B. Give the woman a list of emergency resources. Rationale: Even though the wife permits the husband to hit her at his discretion, abuse is still illegal in the United States. The nurse cannot force the woman to leave her husband and cannot report the husband to the police or social services. The nurse can provide the woman with resources she needs in case she decides to leave. It is not appropriate for the nurse to call the husband and explain that abuse is illegal.
A young pre-teen boy is brought to the emergency department by ambulance because the mother found rectal bleeding after leaving the child with a relative. Which situation should the nurse suspect? A. Physical abuse B. Sexual abuse C. Neglect D. Emotional abuse
B. Sexual abuse Rationale: Victims of sexual abuse may have bleeding from the rectum or external genitalia. Sexual abuse does occur in boys and it can happen at the hands of a relative. Neglect, physical abuse, and emotional abuse do not cause rectal bleeding.
The nurse is caring for an 84-year-old client who has been hospitalized for malnutrition. The nurse suspects that older adult abuse may be responsible for the client's condition, but when the nurse asks about the care the client receives from the caregiver, the client admits feeling afraid of what will happen if the caregiver finds out about the complaining. Which response by the nurse is correct? A. "It's necessary that I share what you tell me with your caregiver." B. "It would be better for you if I share what you tell me with your caregiver." C. "I will not share anything you tell me with your caregiver." D. "You shouldn't be so afraid of what your caregiver will do."
C. "I will not share anything you tell me with your caregiver." Rationale: The nurse would respond to the client's concerns by stating that the nurse will not share anything the client says with the caregiver. Assuring the client of confidentiality will help promote a trusting relationship, which is an essential nursing intervention. The nurse would not tell the client that it would be better for the client if the nurse shares the information with the caregiver, because this may make the client feel unsafe. The nurse would not tell the client that it's necessary for the nurse to share the information with the caregiver because this is untrue. The nurse would not tell the client not to be afraid of the caregiver because this statement is judgmental and would not promote a trusting relationship between the nurse and the client.
A mom reports that her child has had multiple bruises over the last few weeks, but the child refuses to explain. The child's grades are dropping, and the child is afraid to go to school. Which type of abuse should the nurse suspect? A. Sexual abuse B. Youth violence C. Physical abuse D. Bullying
D. Bullying Rationale: Bullying has been defined as repeated aggressive behavior by another person and frequently happens between schoolchildren. It can manifest with an unwillingness to go to school or poor academic grades.
A parent comes in to speak with the pediatric nurse about bullying that the child has been dealing with at school. The teacher has not been able to control the responsible student, and the parent asks for advice. Which advice by the nurse is most appropriate? A. Remove the child from the school and initiate home schooling. B. Teach the child more effective coping strategies. C. Move to a different town nearby. D. Go up the chain of command to the principal.
D. Go up the chain of command to the principal. Rationale: The nurse should advise the parent to go up the chain of command to the principal and school board if necessary. If those steps don't resolve the problem, the nurse can then brainstorm the best steps with the parent. This may mean changing schools or moving to a different town. Coping strategies are important for children and adults dealing with bullying or abuse, but this does not appropriately answer the question.
