Abuse

The nurse is providing care for a client who experienced several fractures as a result of intimate partner violence. Which intervention is the most appropriate to include when planning care for the client? A) Assist the client to devise a safety or escape plan B) Encourage the client to take charge of the situation C) Offer to contact outpatient services if the client promises not to return home after discharge D) Make it clear to the spouse that the couple needs to see a therapist

A) Assist the client to devise a safety or escape plan Rationale: A client who has been victimized by a partner should have a safety plan. This has the highest priority as the client's life is in danger. The client has no control over the partner, and suggesting that the couple needs to see a therapist may escalate the situation. Encouraging the client to take charge is too general a statement to be helpful; the client needs specific tools to develop a safety plan. It may not be safe and feasible for the client to leave the situation right away, and resources should not be withheld if a client is unable to promise not to return home.

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) Give the woman a list of emergency resources B) Report the husband to the police and social services C) Respect her views and document the marks D) Call the woman's husband and explain that abuse is illegal

A) 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 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) Go up the chain of command to the principal B) Remove the child from the school and initiate homeschooling C) Teach the child more effective coping strategies D) Move to a different town nearby

A) 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.

A client with a long history of experiencing domestic violence tells the nurse, "There is no way out for me; this situation will never change." What nursing diagnosis would be most appropriate? A) Powerlessness B) Risk for Other-Directed Violence C) Ineffective Health Maintenenance D) Chronic Low Self-Esteem

A) Powerlessness Rationale: Powerlessness is indicated when the client feels an inability to change the pattern or to leave the situation. The victim may experience health maintenance problems as a result of experiencing domestic violence; however, this is not the primary diagnosis. Some victims will experience self-esteem issues, which are secondary to their feeling of having little or no control over their lives. The client is not at high risk for other-directed violence but is rather at high risk to experience it.

Which diagnostic test might the healthcare team use to determine the full extent of an abuse victim's injuries if the victim complains of abdominal pain? A) Ultrasound B) X-ray C) MRI D) Blood test

A) Ultrasound Rationale: An ultrasound or CT scan of the abdomen can check for abdominal or organ injuries. An MRI of the spine will show spinal injuries. X-rays can detect fractured bones. Blood tests may be used to detect sexually transmitted diseases.

The nurse is discussing the different forms of abuse with a group of women in the community. Which info about emotional abuse should the nurse include in this discussion? SATA 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 cannot be seen E) It is inflicted accidentally

A, B, C, D 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 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? SATA A) Initiating a complete physical assessment B) Developing rapport C) Promoting a trusting relationship D) Encouraging the child to confront the abuser. E) Reporting the abuse

A, B, C, 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.

*Possible Exam Question* 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? SATA A Children learn about violence from observation B) The media expose children to many models of violence C) Early life stress leads to mood and anxiety disorders in the individuals who are abused D) The potentially abusive individual makes a conscious choice to abuse E) Some communities value the subordination of women

A, B, D 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.

An older adult client is brought into the ER after experiencing a fall. The nurse suspects elder abuse. Which assessment findings support the nurse's suspicions? SATA A) Poor hygiene B) Dehydration C) Intracranial trauma D) Fecal impaction E) Dislocations

A, B, D, E Rationale: The nurse suspecting elder abuse would assess for clinical manifestations associated with elder abuse. Some of those clinical manifestations are constant hunger or malnutrition, poor hygiene, social isolation, contractures, dehydration, fecal impaction, fractures, sprains, or dislocations. Intracranial trauma is not a typical clinical manifestation of elder abuse; however, it is a clinical manifestation of child abuse.

The nurse is assessing an older adult client who has been abused and neglected. The nurse should assess for which characteristic? SATA A) Trauma to sexual organs B) Chronic fatigue C) Withdrawn behavior D) Malnutrition E) Bruises and burns

A, C, 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 nurse is creating a plan of care for a neglected child. Which collaborative actions are appropriate nonpharmacologic treatments that should be included? SATA A) Reporting the abuse or neglect to the appropriate agency B) Pain medication for the child's injuries C) Family therapy for the parents D) Play therapy E) Providing a safe environment for the child

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 is caring for an 84yo 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 would be better for you if I share what you tell me with your caregiver." B) "I will not share anything you tell me with your caregiver." C) "It's necessary that I share what you tell me with your caregiver." D) "You shouldn't be so afraid of what your caregiver will do."

B) "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) Physical abuse B) Bullying C) Youth violence D) Sexual abuse

B) 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 client who has experienced domestic violence in the past has decided to stop participating in counseling. Which client statement would indicate that therapy has been effective? A) "Everyone knows what my problems are, and there is nothing I can do about it." B) "I am functioning fine now but I know that when problems come up again, I will ask for help." C) "My friends tell me that I have improved so this is a good time to stop." D) "It's so draining to deal with the same painful issues all the time."

B) I am functioning fine now but I know that when problems come up again, I will ask for help." Rationale: The client acknowledging that future problems will come up indicates that the client has gained insight into problems. The client's willingness to ask for help shows that the client is prepared to continue with counseling when new problems arise. Stating that the process is draining and painful suggests that little progress has been made and that the client is looking to avoid the pain. Stating that there is nothing than can be done is fatalistic. Basing termination of treatment on the statements of others places emphasis on others and not on self-evaluation

A 2yo child is brought into 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) Scraped and scabbed knees B) Welts or bruises in various stages of healing on the child's back C) Diaper rash D) A few bruises on shins

B) 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.

A child is admitted to the hospital with physical injuries. Which assessment findings would indicate that the child is a victim of abuse? SATA A) Confusion B) Missing teeth C) Apprehension when other children cry D) Abrasions to the mouth, lips, and genitalia E) Dehydration

B, C, D Rationale: Clinical manifestations of child abuse include abrasions to the mouth, lips, and genitalia; missing teeth; and apprehension when other children cry. Dehydration and confusion are manifestations of elder abuse.

The nurse in a long-term rehabilitation facility is helping an older adult client to recover from months of neglect. Which non-pharmacologic therapy should the nurse include in the care of the client after discharge? SATA A) Referral to a homeless shelter B) Adult day care C) Respite care for caregiver D) Older adult abuse reported to appropriate agency E) Safe living environment

B, 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 preparing a community teaching presentation on prevention of abuse. Which level of prevention should the nurse include? SATA A) Historical B) Community C) Individual D) Societal E) Parental

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 is conducting an assessment interview. Which complaints by the client should the nurse consider might be associated with physical abuse? SATA A) UTI B) Depression C) Chronic Pelvic pain D) Irritable Bowel Syndrome E) Headache

B, D, 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 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) Spinal fractures B) Abdominal trauma C) Abusive head trauma D) Burn injuries

C) 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.

*Probable exam question* The nurse is completing a morning assessment on an older adult Asian client. Assessment findings reveal circular red welts over the client's upper back with several bruised areas. Which nursing action is the most appropriate? A) Contact adult protective services B) Call the HCP immediately C) Assess the client's cultural traditions D) Contact the client's family

C) Assess the client's cultural traditions Rationale: The most appropriate action for the nurse at this time is to assess the client's cultural traditions. The practice of cupping is generally practiced by many Asian cultures, as well as individuals who participate in holistic healing. Cupping is the act of placing a glass cup on the skin, and then using heat to create suction; often this is performed to promote blood flow and overall healing. The result of the procedure can be circular red welts or even dark bruising, which are often found along the individual's back. This treatment is not abusive in nature, but rather a form of healing.

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) Call the police to report the crime committed against the child B) Tell the child that the babysitter will be made to pay for what the person did C) Develop a trusting relationship with the child by doing exactly what is promised D) Ask the child's parent to leave the room to conduct a thorough examination

C) 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.

Which of the following is a common element of abuse experienced by a victim? A) Accidental injury B) Feelings of control C) Humiliation D) Manipulation

C) Humiliation Rationale: Common elements of abuse include humiliation, intimidation, and physical injury. Injury associated with abuse is not accidental. Feelings of control and use of manipulation tactics are related to the perpetrator, not the victim.

A client who was a victim of intimate partner violence 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) Getting through the shock and confusion of the act B) Getting back into work and home routines C) Regaining a sense of empowerment and safety D) Resolving grief over any losses

C) 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 pediatric nurse is caring for an 8-month-old client. While making rounds, the nurse enters the room and finds the infant's father violently shaking the infant. The father attempts to make it appear as though the infant was choking. Upon further assessment, the nurse notes bruised areas on the infant's arms and legs. What is a priority action for the nurse to take? A) Discuss what the nurse witnessed with the infant's mother B) Discuss what the nurse witnessed with the other nurses C) Report what the nurse witnessed and assessed to the authorities D) Call security to remove the father from the room

C) Report what the nurse witnessed and assessed to the authorities Rationale: Because of mandatory reporting laws, nurses must report all suspected cases of child abuse to the appropriate authorities. It would not be appropriate at this time to discuss the findings with the infant's mother or with other nurses. The nurse should also not call security to remove the father from the room until after the abuse has been reported.

The home care nurse is talking to an entire family about caring for their oldest member, an 88yo with multiple health issues. The rest of the family includes a 48yo, a 28yo, an 18yo, and an 8yo. Which individual is in an age group that is less likely to report or admit being the victims of violence? SATA A) 18yo B) 28yo C) 8yo D) 88yo E) 48yo

C, 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).

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? SATA A) Prescriber of anticoagulants B) Meals on Wheels Volunteers C) Children visiting a parent D) Client's spouse E) Caregiver living in the home

C, D, 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 providing care for a 2yo client. When assessing the client's risk for abuse, which factors increase this client's risk? SATA A) The child has bruises on the knees and shins B) The child's parent's are married C) The child is less than 3yo D) The child is deaf E) The child's parents are unemployed and receive medical assistance

C, D, E -< 3yo - disability - poverty Rationale: Risk factors for child abuse include poverty, age less than 3 years, and child disability or condition that requires a great deal of care. Marriage of the parents and bruises on the knees and shins are not risk factors for abuse.

Which action is an example of a collaborative intervention by a nurse working with an older adult who has experienced abuse? A) Completing mandatory reports to authorities B) Sharing information about services C) Exploring options for help D) referring the client to a social worker case manager

D) 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 young pre-teen boy is brought to the ER 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) Neglect C) Emotional abuse D) Sexual abuse

D) 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.