abuse, neglect, role relationship

neglect assessment: physical findings

- FTT - poor hygiene - malnutrition - inappropriate clothing - constant hunger*** - bald patches on infant's head - lack of adequate supervision; abandonment

The best way to treat violent families is to offer families: A. A crisis intervention program. B. A multidisciplinary approach to treatment. C. A safe haven from the abuser. D. Legal counseling and court assistance.

B

An elderly woman who has been abused by her caregiver daughter tells the nurse, "You don't have to worry about me. My daughter cried and apologized. She promised me she will never hit me again." The nurse can assess that this is the stage in the cycle of violence known as A. tension building. B. acute battering. C. honeymoon. D. escalation.

C

report suspected cases of child abuse

- CPS - maintain an objective record - health hx., including accidental or environmental injuries - detailed description of physical exam (nutritional status, hygiene, G+D, cognitive and functional status) ** - environmental assessment of home - description of injuries (location, pictures, measurements) ** - verbal conversations with parents and child in QUOTES - description of behaviors, NOT interpretation - description of parent-child interactions ** = make sure to quote any subjective data - PRIORITY: is to remove child from abusive situation to prevent further injury

emotional abuse assessment: physical findings

- FTT - developmental lags - feeding problems - enuresis or sleep problems

physical abuse

- shaken baby syndrome - munchausen syndrome by proxy (MSBP)

Infants less than 1 year of age who present with apnea, seizures, lethargy, respiratory difficulty, coma, or death should be suspected of: A. Maltreatment. B. Physical abuse. C. Shaken baby syndrome. D. Child neglect.

C

What are some of the reasons for elder abuse in the United States? A.Personal problems of abusers B. Caregiver stress C. Impairment of the dependent elder D. All of the above

D

What leads certain individuals to cause violence or become violence prone? A. A personality disorder B. No internal sense of self-control C. The experience of shame and humiliation without the ability to feel guilty D. Persistent isolation, fear, and depression

C

Which form of abuse is least reported to authorities? A. Elder abuse B. Sexual abuse C. Child sexual abuse D. Child maltreatment

C

The school nurse is putting an ice pack on a black eye that a child received in a fight he started with another student.. The teacher has shared with the nurse that the boy with the black eye is one of the most aggressive children in school. The school nurse most needs to further assess this child and his family to determine which of the following things? A. If there is evidence of family violence B. How much television he is watching C. If the child has a learning disability D. How much sleep he is getting at night

A Rationale: Children who witness violence learn aggressive behavior. They also come to see violence as a choice for coping with frustration or anger. Child abuse and abuse of intimate partners both show a repeating pattern in families. While this child may be witnessing violence on television, it is more important to assess for family violence that the child might be experiencing or witnessing as it may involve life and death, whereas the television violence can be dealt with after the issue of whether there is family violence or not is dealt with.

Which statement made by an emergency department nurse indicates accurate knowledge of domestic violence? A. "Power and control are central to the dynamic of domestic violence." B. "Poor communication and social isolation are central to the dynamic of domestic violence." C. "Erratic relationships and vulnerability are central to the dynamic of domestic violence." D. "Emotional injury and learned helplessness are central to the dynamic of domestic violence."

ANS: A The nurse accurately states that power and control are central to the dynamic of domestic violence. Battering is defined as a pattern of coercive control founded on physical and/or sexual violence or threat of violence. The typical abuser is very possessive and perceives the victim as a possession.

A client who is in a severely abusive relationship is admitted to a psychiatric inpatient unit. The client fears for her life. A staff nurse asks, "Why doesn't she just leave him?" Which is the nursing supervisor's most appropriate reply? A. "These clients don't know life any other way, and change is not an option until they have improved insight." B. "These clients have limited KEY: Cognitive skills and few vocational abilities to be able to make it on their own." C. "These clients often have a lack of financial independence to support themselves and their children, and most have religious beliefs prohibiting divorce and separation." D. "These clients are paralyzed into inaction by a combination of physical threats and a sense of powerlessness."

ANS: D The nursing supervisor is accurate when stating that clients in severely abusive relationships are paralyzed into inaction by a combination of physical threats and a sense of powerlessness. Women often choose to stay with an abusive partner for some of the following reasons: for the children, for financial reasons, fear of retaliation, lack of a support network, religious reasons, and/or hopelessness.

The interventions common to treatment plans for abuse survivors include which of the following? (Select all that apply.) A. Remove the client from the home. B. Support the client in the decisions he/she makes. C. Encourage the client to pursue legal action. D. Establish trust and rapport. E. Identify areas of control.

B, D & E Rationale: B = This intervention empowers the client and enhances the client's current problem-solving ability. D = This intervention provides the client with an ally. E = This intervention empowers the client. A: You must enhance the client's current problem-solving ability without coercing the client or promoting your own agenda. Otherwise, clients continue to perceive themselves as powerless and dependent. C: If this is not the wish of the client, this is not an appropriate intervention. You must enhance the client's current problem-solving ability without coercing the client or promoting your own agenda.

Which of the following might cause the nurse to suspect elder abuse when making a home visit? A. The temperature in the house is 78°F. B. The client is wrapped in a large wool shawl. C. There are only peanut butter and jelly in the refrigerator. D. There is a bruise on the client's right leg that she says she got from bumping into a table.

C Rationale: A single bruise usually is not cause for concern, but a client who clearly has inadequate food might be suffering from abuse by family or caregivers. A & B: Sensitivity to hot or cold might dictate the methods the elderly use to feel comfortable.

What distinction can be made between abuse and neglect? A. Neglect occurs in the psychological domain; abuse occurs in the physical domain. B. Neglect is always physical; abuse can be verbal, physical, sexual, or emotional. C. Neglect is perpetrated against children; abuse victims can be children or adults. D. Neglect is a failure to provide; abuse is a failure to control aggression.

D Rationale: Neglect is failure to provide necessary care, and abuse is physical maltreatment

planning tx. for abuse

Health care providers must be aware of own feelings concerning abuse incidents: - when interviewing child must be nonjudgmental - acceptance and willingness to work with family **prevention of SBS - educate all parents, during the prenatal/postpartum period, on the danger of shaking infants - educate on coping mechanisms on caring for children with inconsolable crying

dysfunctional family

decision and behavior interfere with positive development during crisis or stress poor coping usually adapt to regain balance

mentally healthy families

live in harmony among themselves and society support and nurture members share feelings listen reliable rules

types of family

nuclear- 2 or more people living together related by blood, marriage or adoption extended- several nuclear families living together

elements of a family

roles, boundaries, rules, hierarchy, climate, equilibrium

family theory

systems theory- a system composed of an interconnected set of members each influences others in a predictable and recurring way.

warning signs of MSBP

the parent: - rarely leaves the child's bedside - takes on major responsibilities - welcomes ordinary and intrusive medical procedures* - appears disappointed when child shows improvement - exhibits considerable medical knowledge* - has hx. of "doctor shopping"*

emotional abuse

- psychologic maltreament - deliberate attempt to destroy or impair child's self-esteem or competence

outcomes for abuse

- the child or elder will experience no further harm or neglect (will be protected from further abuse) - the child will experience a reduction in fear and anxiety - the parents will exhibit positive interactions with the child (child/family will receive adequate support)

promoting a therapeutic environment for kids who reveal abuse

- acceptance - quiet place to talk - play therapy to allow child's self-expression - DON'T PROMISE NOT TO TELL - NO SECRETS - don't express shock or criticize their family - avoid using any leading statements that can distort their report aka don't put words their mouths - reassure them that they've done the right thing by telling - determine their immediate need for safety - explain in detail all routines and procedures in age-appropriate language (use their vocal to discuss body parts)

physical abuse assessment: physical findings

- cutaneous injuries - burns - fractures - head injuries - eye injuries: conjunctival hemorrhages in SBS***

sexual abuse assessment: possible physical findings

- difficulty walking or sitting - torn, stained, bloody underwear - gross evidence of trauma in the genital, oral or anal regions - pain, itching; STDs; genital discharge - pregnancy - eating d/o's - vague somatic complaints

neglect assessment: behavioral indicators

- dull, inactive infant - begging or stealing food - school attendance problems (arrives early/leaves late) - drug and etoh abuse - delinquency or reports of no caretaker

neglect

- failure of individual legally responsible for child's welfare to provide for the child's basic needs and adequate level of care *most common form of maltreatment* - physical - emotional

suspected cases of elder abuse

- failure to adhere to therapeutic regimens, which can pose threats to life (ulcerated conditions) - evidence of malnutrition, dehydration, elimination problems - bruises, swelling, lacerations, burns, bites - pressure ulcers - caregiver not allowing RN to be alone w/ elder

emotional abuse assessment: behavioral indicators

- habit d/o's - withdrawal - fearfullness - conduct problems - behavior extremes

characteristics of abused child

- hx. of behavioral issues - unusually bruises, welts, burns, fractures, bite marks - long sleeves or other concealing clothing - frequent injuries or "accidents" - tendency to avoid physical contact with adults - fearful attitude around parents

assessment

- interview child/caregivers - observe parent-child interactions - document each sore/bruise/burn and the stage of healing - do injury/symptoms fit accident or illness? - has there been a delay in seeking help? - suspect child abuse when injury doesn't match reported accident: further XRs are done if there is abuse suspicious (inconsistent)

sexual abuse assessment: behavioral indicators

- kids less than 5: regression, feeding/toileting disturbances, temper tantrums, requests for frequent underwear changes, seductive behaviors - kids 5-10: school problems*, night terrors, sleep problems, anxieties, withdrawal, refusal of physical activities, inappropriate behavior - teens: school problems, running away*, delinquency, promiscuity, drug/etoh abuse, eating d/o's, depression

risk factors for abusive behavior

- low family income - adults are victims of past abuse*** - believe punishment is the best discipline - poor impulse control - lack strong emotional attachment to kid - substance abuse - young maternal age - single parent household: lack of support/finances - socially isolated - low self-esteem - low tolerance for frustration

MSBP: munchausen syndrome by proxy

- medical child abuse or factitious d/o by proxy - caregiver deliberately fabricates or induces illness in a child - child maltreatment that may include physical, emotional and psychological abuse for the gratification of the caregiver

risk factors commonly identified in child abuse

- parental characteristics - characteristics of the child - environmental characteristics *interaction of these factors is thought to increase the risk of abuse in a particular family; multiple causes

interventions for abuse

- Protect the child/elder (remove from abusive situation to prevent further injury) - Minimize child's fear and anxiety - Foster positive parenting (therapeutic relationship - one of genuine concern/treatment, not one of accusation and punishment) - Provide interventions that promote parent's self-esteem and sense of trust - Referral to appropriate agencies (housing, childcare, Parents Anonymous)

indicators of MSBP

- unexplained, prolonged, or rare illness - discrepancies between hx. and clinical findings - illness that is unresponsive to tx. - symptoms that occur ONLY when parent is present - parent overly interested in health care team - parent overly attentive to child - resolution of symptoms after separation from perpetrator confirms the dx. - need to ask: is child's condition consistent with the reported hx.? does dx. evidence support the reported hx.?

potential for abuse

- unwanted pregnancy: relationship between mom and FOB - "you remind me of him" anger/negativity towards kid - unrealistic expectations of the child: toddlers have temper tantrums b/c of autonomy issues - failure to bond: premies, illness - temperament - problems during pregnancy and delivery, prematurity - illness, disability, developmental delay: 24/7 care = stress - resemblance to someone parent dislikes

physical abuse assessment: behavioral findings

- wariness of adults - fear of parents - suffers pain w/o crying - exhibits attention-seeking behavior - afraid to go home - aggressiveness/withdrawn - might protect parents***

The nurse is providing an educational session to new employees, and the topic is abuse of the older client. The nurse helps the employees identify that which client is most typical of a victim of abuse? 1. A 75-year-old man with moderate hypertension. 2. A 68-year-old man with newly diagnosed cataracts 3. A 90-year-old woman with advanced Parkinson's disease 4. A 70-year-old woman with early diagnosed Lyme disease

3 Rationale: Elder abuse includes physical, sexual, or psychological abuse, misuse of property, and violation of rights. The typical abuse victim is a woman of advanced age with few social contacts and at least one physical or mental impairment that limits her ability to perform activities of daily living. In addition, the client usually lives alone or with the abuser and depends on the abuser for care.

Which assessment data should a school nurse recognize as signs of physical neglect? A. The child is often absent from school and seems apathetic and tired. B. The child is very insecure and has poor self-esteem. C. The child has multiple bruises on various body parts. D. The child has sophisticated knowledge of sexual behaviors.

A Rationale: The RN should recognize that a child who is often absent from school and seems apathetic and tired might be a vidicm of neglect. Other indicators of neglect are stealing food or money, lacking medical or dental care, being consistently dirty, lacking sufficient clothing, or stating that there is no one home to provide care.

Which type of abuse is described as the failure to meet the basic needs of children by those persons responsible for their health and well-being? A. Physical abuse B. Physical neglect C. Emotional abuse and neglect D. Nonassaultive abuse

A

A kindergarten student is frequently violent toward other children. A school nurse notices bruises and burns on the child's face and arms. What other symptom should indicate to the nurse that the child might have been physically abused? A. The child shrinks at the approach of adults. B. The child begs or steals food or money. C. The child is frequently absent from school. D. The child is delayed in physical and emotional development.

A Rationale: The nurse should determine that a child who shrinks at the approach of adults in addition to having bruises and burns might be a victim of abuse. Whether or not the adult intended to harm the child, maltreatment should be considered.

Which statement made by a parent of a child diagnosed with Tourette's syndrome would be assessed as a risk factor for family violence? A. "My husband lost his job, and it seems all our savings are going to pay for our son's expensive medication and all the other things he needs." B. "Our son is really a good little boy, but he needs to be disciplined both at home and in school." C. "We shouldn't be, but we are ashamed of our son's disorder and his inability to control the tics in public." D. "We have become active in the support group but still find the suggestions extremely difficult to put into practice."

A Rationale: Job loss, financial problems, and a child who is "different" and has special needs should alert the nurse to the risk for family violence, because all these factors contribute to a crisis situation.

Your peer, who works in the emergency department, asks you to identify characteristics of the typical perpetrator of child abuse. Which of the following statements should you include in your response? A. "Perpetrators often present as pleasant, concerned individuals." B. "Abusers often have a long history of violent, criminal behavior." C. "Be alert to family members who appear agitated or almost out of control." D. "As you interact with the perpetrators, it will become obvious they are mentally ill."

A Rationale: Making the assumption that the perpetrator will announce undercurrents of criminal behavior in some way runs counter to the facts concerning sexual and physical abusers. B: This is false; in addition, this history is seldom available to you in the emergency department. C: Agitated family members are commonplace in the emergency department. Perpetrators may appear in control or out of control. Their level of control will not assist you in identifying them as perpetrators. D: Fewer than 10% of all cases involve an abuser who is mentally ill. The vast majority seem totally normal and are often charming, persuasive, and rational.

Self-awareness is essential in caring for the survivors of rape or violence. Possible outcomes from an absence of self-awareness include which of the following? (Select all that apply.) A. The client may feel obligated to defend the perpetrator. B. The nurse may assume the perpetrator was a stranger. C. The nurse may "normalize" behavior the client perceives as violent. D. The nurse may convey to the client that the client is not responsible for the violence. E. The perpetrator's safety may be jeopardized.

A, B, C & D Rationale: D: As members of society, nurses are affected by misperceptions and myths. The nurse who is unaware of her thoughts and feelings may blame the victim for provoking the attack with attire or behavior. B: The nurse may assume the perpetrator was a stranger. As members of society, nurses are affected by misperceptions and myths. This assumption may result in unsafe plans for the client's aftercare. C: The nurse may "normalize" behavior the client perceives as violent. The client may not be communicating clearly or appropriately, and the nurse may misinterpret that a controlled, emotionless account of the violence means the event was nonthreatening or insignificant. A: The client may feel obligated to defend the perpetrator. The nurse's communicated rage toward a perpetrator of incest or rape may result in the victim defending the perpetrator from the nurse. - E: If the nurse does not inquire about the perpetrator's identity or the client's immediate plan for safety, the client may harm the perpetrator. Furthermore, the client would have to contend with the legal system as a consequence of taking violent action against the perpetrator.

Risk factors for intrafamily physical and sexual abuse include which of the following? (Select all that apply.) A. Family's immigrant or refugee status B. Continuous socioeconomic functioning below the poverty level C. Family's primary language other than community's dominant language D. Breadwinner's active military status E. Residence in low-income housing `

A, C & D Rationale: Abrupt relocation to an unfamiliar place contributes to individual and family perception of isolation, a common dynamic in families of abuse. Inability to communicate in the dominant language contributes to isolation, a common dynamic in families of abuse. If the breadwinner is absent from the household, the remaining parent has fewer resources and may experience isolation. The multiple moves that military families experience decrease social connections. Such isolation is a common dynamic in families of abuse. Support systems available to these families may offer assistance for more universally experienced stressors and may not actively seek out families at risk for abuse. B: Impoverishment by itself is not a risk factor. Physical and sexual abuse occur at all socioeconomic levels.

A kindergarten student is frequently violent toward other children. A school nurse notices bruises and burns on the child's face and arms. What other symptom should indicate to the nurse that the child might have been physically abused? A. The child shrinks at the approach of adults. B. The child begs or steals food or money. C. The child is frequently absent from school. D. The child is delayed in physical and emotional development.

ANS: A The nurse should determine that a child who shrinks at the approach of adults in addition to having bruises and burns might be a victim of abuse. Whether or not the adult intended to harm the child, maltreatment should be considered.

When planning care for women in abusive relationships, which of the following information is important for the nurse to consider? (Select all that apply.) A. It often takes several attempts before a woman leaves an abusive situation. B. Substance abuse is a common factor in abusive relationships. C. Until children reach school age, they are usually not affected by parental discord. D. Women in abusive relationships usually feel isolated and unsupported. E. Economic factors rarely play a role in the decision to stay in abusive relationships.

ANS: A, B, D When planning care for women who have been victims of domestic abuse, the nurse should be aware that it often takes several attempts before a woman leaves an abusive situation, that substance abuse is a common factor in abusive relationships, and that women in abusive relationships usually feel isolated and unsupported. Children can be affected by domestic violence from infancy, and economic factors often play a role in the victim's decision to stay.

A woman describes a history of physical and emotional abuse in intimate relationships. Which additional factor should a nurse suspect? A. The woman may be exhibiting a controlled response pattern. B. The woman may have a history of childhood neglect. C. The woman may be exhibiting codependent characteristics. D. The woman might be a victim of incest.

ANS: D The nurse should suspect that this client might be a victim of incest. Women in abusive relationships often grew up in abusive homes.

Jan, age 5, is sent to the school nurses's office with an upset stomach. She has vomited and soiled her blouse. When the nurse removes her blouse, she notices that Jan has numerous bruises on her arms and torso, in various stages of healing. She also notices some small scars. Jan's abdomen protrudes on her small, thin frame. From the objective physical assessment, the nurse suspects that: A. Jan is experiencing physical and sexual abuse B. Jan is experiencing physical abuse and neglect C. Jan is experiencing emotional neglect D. Jan is experiencing sexual and emotional abuse

B

During an assessment in the emergency room, in the family's presence, you develop concerns about caregiver abuse. Your state requires you to report cases of suspected abuse. The family members repeat their explanation of the client's injuries. What do you say to them? A. You do not discuss your obligation to report with the family. B. "I am required by law to report suspected abuse." C. "Some state officials will be calling you in the next few days. Tell them what you told me." D. "I believe what you are telling me. Another health care provider may report this as suspected abuse, but I will not report this."

B Rationale: It is best to be honest and direct. A: It is best to be honest and direct rather than give them reason for mistrust because of your omission. C: You do not know what state officials will do, but you can be honest and direct regarding your responsibility. D: This response suggests you either will not report the incident or will not accept responsibility for doing so. The ethical principle of fidelity maintains you should be truthful, and the law requires you to report suspected abuse.

A child has been seen six times in the clinic in the last month because of "severe vomiting." The child's physical exam is normal, electrolytes are within normal limits, and the child is gaining weight appropriately. The mother expresses to the nurse that she is very concerned about her child's health. Based on this information, the child should be further evaluated for which of the following conditions? A. Physical abuse B. Munchausen syndrome by proxy C. Physical neglect D. Sexual abuse

B Rationale: Munchausen syndrome by proxy is a type of child abuse involving fabrication of signs and symptoms of a health condition in a child. Vomiting is one of the most commonly fabricated symptoms. Since the child has no signs of illness, is gaining weight, and has normal electrolyte values, suspicion should be raised. While the child might not be a victim of MSBP, further evaluation should occur to confirm the diagnosis or to rule it out.

When there is reason to suspect that a child is being abused, the nurse must initially A. call the local police to report it. B. follow agency policy for reporting. C. confront the parent or parents. D. interrogate the child to obtain proof.

B Rationale: Nurses are mandated reporters of child abuse. They must follow the rules set forth by the state regarding the steps to take to report child abuse.

To best assure the safety of a 3-year-old child whose parent admits to finding it difficult to control their anger, the most appropriate short-term goal would be for the parent to A. understand the impact of violence on the child within 2 days. B. begin attending anger management training sessions within 2 weeks. C. state a willingness to attend a support group for physical abusers within 1 week. D. show remorse for their anger management issues within 2 days.

B Rationale: Perpetrators of violence need help learning how to manage anger. A structured group is an excellent way to provide this teaching.

The nurse discusses the care of an elderly client with her 38 year old son who lives with her. When the nurse mentions noting bruises on the client's arms, the son becomes angry and says that it is difficult to manage care for the mother who is confused and lonely. It is the responsibility of the nurse: A. To teach the son how to be more supportive of his mother B. Report the possible abuse to the Department of Elder Abuse C. Assist the son to identify resources in the community D. Continue to monitor the client.

B Rationale: The most important step is to report the suspected abuse. In many states the nurse is legally responsible to alert the authorities about cases of suspected elder abuse. A: Secondary prevention would be supporting the son to be more supportive of the mother. Primary prevention is to alert the local Elder Abuse Hotline. C: Secondary prevention would entail helping the son identify resources in the community. Primary prevention is to alert the local Elder Abuse Hotline. D: To continue to monitor for additional bruises would put the client at high risk for continued maltreatment.

The nurse is working with a 2-year-old client. Which of the following is most indicative of abuse in a toddler? A. The toddler cries when the nurse does the assessment. B. The toddler is extremely compliant with the nurse during the initial assessment. C. The child tries to push the nurse away during the assessment. D. The nurse observes that the child has multiple-bottle caries.

B Rationale: The toddler who is indiscriminately friendly with unfamiliar adults is demonstrating behavior inconsistent with his developmental stage. This is a clinical manifestation of abuse. A & C: Toddlers in general are fearful of strangers, and would not openly accept the nurse initially. It is developmentally appropriate for the child to cry and to push the nurse away during the assessment. D: Multiple-bottle caries might be indicative of neglect, but is not indicative of abuse.

Which statement reflects a fact about family violence? A. Ninety-five percent of abuse victims are women. B. The victim's behavior is often the cause of the violence. C. Violence occurs in families of all backgrounds. D. Alcohol and stress are the major causes of abuse.

C

Which child is at LOWEST risk for abuse? A. A 3-month-old who has colic and teenaged parents. B. A 4-year-old who has cerebral palsy and retarded parents. C. A 2-year-old who has leukemia and two working parents. D. A 5-year-old who has ADHD and a father who was abused as a child.

C Rationale: Although the child in option C has a serious physical disorder, she is at lower risk than the child in option A, whose inconsolable crying can be frustrating; B: the child in option B, who will not be as independent as other children his age and who has parents who may not understand his needs; D: or the child in option D, whose hyperactivity can be annoying, especially to a parent who himself has been abused.

When working with families in which there is child abuse, spousal abuse, or elder abuse; which of the following nursing diagnoses (in addition to risk for violence), would the nurse most likely and most often include in the care plans for family members? A. Impaired home maintenance B. Risk for suicide C. Social isolation D. Disturbed personal identity

C Rationale: Social isolation is a common characteristic of violent families. There are legal and social consequences for violent behavior, so the violence in the family becomes the family secret. Secrecy is one factor that accounts for the under-reporting of family violence. The abuser often discourages family members from having friends or socializing outside the family. The abuser's wife may not be allowed to work outside the home. Social isolation occurs in child abuse, intimate partner abuse, and in elder abuse.

Nurse Sunshine suspects that a child, age 4, is being neglected physically. To best assess the child's nutritional status, the nurse should ask the parents which question? A. "Has your child always been so thin?" B. "Is your child a picky eater?" C. "What did your child eat for breakfast?" D. "Do you think your child eats enough?"

C Rationale: The nurse should obtain objective information about the child's nutritional intake, such as by asking about what the child ate for a specific meal. The other options ask for subjective replies that would be open to interpretation.

Which of the following observations is indicative of physical mistreatment? A. Withdrawing from soft touch B. Downcast eyes C. Dislocated shoulder D. Agitation

C Rationale: This is the only listed physical sign. A dislocated shoulder can occur with a violent jerk on the arm.

There are several biopsychosocial theories associated with causation of rape and intrafamily abuse. However, the nurse knows that: A. Inability to control impulses is a consistent finding. B. The greatest predictor for intrafamily abuse is the perpetrator's history of abuse as a child. C. None of the contributing factors consistently results in or is predictive of rape or intrafamily abuse. D. Stranger rape has a sexual connotation, while dynamics associated with family abuse relate to power and control.

C Rationale: lthough a genetic predisposition may make certain behaviors more likely, it does not make them inevitable. A: According to social learning theory, perpetrators are not out of control, as is commonly assumed. They may be enraged or cool and calculating, but in either case they have made a choice. B: Most people who were sexually abused as children do not go on to sexually abuse others. D: With rape, the issue is not one of sex but one of force, domination, and humiliation.

What are the goals of treating abuse? A. Maximize client's safety B. Support the client C. Empower the client to take control D. All of the above

D

Primary prevention of elder mistreatment is a healthcare goal. The nurse recognizes that one of the risk factors often present in elder mistreatment situations is: A. Home care dependency. B. Elder abandonment. C. Caregiver independence. D. Elder dependency.

D Rationale: One of the primary characteristics in elders who have been mistreated is dependency on others for performance of activities of daily living. Dependence can lead to caregiver strain and then mistreatment. Home care is not a risk factor for mistreatment. Caregiver independence is not related to mistreatment of the elderly. Elders who have minimal family support can feel abandoned.

While weighing a 12-month-old in the clinic, the nurse notes six nickel-sized bruises on the child's buttocks. The bruises range in color from purple to greenish-yellow. The nurse also notes a looped cord mark on the child's thigh. It is most important that the nurse: A. Do nothing, since these findings are normal for a child who is learning to walk. B. Document the assessment findings in detail. C. Inform the parents that she thinks the child has been abused. D. Report suspected child abuse to the appropriate authority.

D Rationale: The multiple bruising on the buttocks and the looped cord mark are symptoms highly suspicious of physical abuse. In addition, bruises in different stages of healing might be indicative of non-accidental trauma. A: A child who is learning to walk might have multiple bruises on the front of the legs, but should not have multiple bruises on his buttocks, nor should he have looped cord marks. B: While detailed charting of the findings is essential and required, it is most imperative that suspected child abuse be reported to the appropriate authority in order to protect the child from further injury. C: If the parents are informed of the nurse's suspicion, they might leave before further evaluation can be performed.

nursing diagnoses

Risk for injury/trauma Fear Anxiety Risk for post-trauma syndrome Altered parenting