Chapter 16 Violence and Human Abuse

2. Which is a relationship risk factor for intimate partner violence? A) Emotional dependence and insecurity B) Belief in strict gender roles C) Desire for power and control D) Unhealthy family interactions

Ans: D Feedback: Individual risk factors for intimate partner violence include emotional dependence and insecurity, belief in strict gender roles, and desire for power and control. Relationship risk factors include unhealthy family relationships and interactions.

16. Which accurately defines femicide? A) A homicide of a female that occurs in the context of intimate partner violence B) Violence that targets people or groups of people on the basis of their gender C) A pattern of assaultive and coercive behaviors D) A suicide by a female that occurs in the context of intimate partner violence

Ans: A Feedback: Femicide is a homicide (not a suicide) of a female that occurs in the context of intimate partner violence (IPV). Gender-based violence is violence that targets people or groups of people on the basis of their gender. IPV is a pattern of assaultive and coercive behaviors that is perpetrated against an individual by one who is, was, or wishes to be in an intimate relationship with that individual and that may include inflicted physical injury, psychological abuse, sexual assault, progressive social isolation, deprivation, intimidation, and threats.

21. The nurse cares for a woman who is in her 39th week of gestation and who recently revealed that she is being physically abused by her partner. Which conditions associated with intimate partner violence (IPV) should the nurse look for in this client and in her child now and in the coming weeks? (Select all that apply.) A) Depression in the mother B) Low-birth weight infant C) Down syndrome in the infant D) Gestational diabetes in the mother E) Cleft palate in the infant

Ans: A, B Feedback: Depression before, during, and after birth has been strongly correlated with IPV. Researchers have also found that pregnant women who are assaulted by an intimate partner are at increased risk of giving birth to infants of reduced weight. Down syndrome is a genetic disorder and is not associated with IPV. Gestational diabetes is an endocrine disorder and would not be caused by IPV. A cleft palate is a congenital birth defect not associated with IPV.

12. The nurse suspect a 16-year-old client is being physically abused by her boyfriend. Compared with adolescent girls with no abuse history, this client is at significantly increased risk for: (Select all that apply.) A) Smoking cigarettes B) Anorexia C) Becoming pregnant D) Assaulting her siblings E) Theft

Ans: A, B, C Feedback: Adolescent girls who reported experiencing sexual or physical assault were significantly more likely to report smoking, attempt suicide, use cocaine, become pregnant, and engage in unhealthy eating habits, compared with adolescents with no abuse history. There is no evidence of an association of assaulting one's siblings or theft with exposure to violence.

15. Which instance would be considered child abuse and neglect according to the federal Child Abuse and Prevention and Treatment Act? A) A father leaving a child in the back seat of a car on a hot August day B) A mother not feeding a 5-year-old child all day C) A mother allowing her boyfriend to punch her daughter D) A caregiver smacking away a toddler's hand when she reaches for a hot stove E) A neighbor touching the private parts of a 12-year-old boy

Ans: A, B, C, E Feedback: The federal Child Abuse Prevention and Treatment Act (CAPTA) (42 U.S.C.A. §5106g), as amended by the Keeping Children and Families Safe Act of 2003 (U.S. Department of Health and Human Services, 2003), defines child abuse and neglect as the following: any recent act, or failure to act, on the part of a parent or caretaker that results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act that presents an imminent risk of serious harm. A caregiver smacking away a toddler's hand would not result in serious physical or emotional harm. All of the other answers would.

19. Which risk factors are associated with committing gun-related homicide? (Select all that apply.) A) Low income B) Lack of education C) Female gender D) Being a victim of discrimination E) Lack of employment opportunities

Ans: A, B, D, E Feedback: Factors that associated with committing gun-related homicides are as follows: low income, being a victim of discrimination, lack of education, and lack of employment opportunities. Most often, males are the victims as well as the perpetrators of homicides.

8. Which statements by a caregiver would indicate the presence of risk factors for violence and should cause the nurse to have significant concern for the safety of children? (Select all that apply.) A) "My boyfriend says that one day he'll put a bullet through my head if I don't stop nagging him." B) "My 3-year-old daughter cries when my partner and I argue." C) "My husband sometimes makes our son come into our bedroom and watch as he hits me." D) "The last time we fought, he threatened to go pull out his shotgun." E) "My husband got upset with how much our daughter was texting and took her phone away from her for a month."

Ans: A, C, D Feedback: Risk factors that indicate significant concern for the safety of the children are as follows: (1) threats to kill the caretaker, children, and/or self or fears on the part of the caretaker for the children's safety; (2) a child was physically injured in an incident in which the caretaker was the target; (3) a child was coerced to participate in or witness the abuse of the caretaker; (4) a weapon was used or threats to use a weapon were made, and the caretaker believed that there was intention and ability to cause harm. A toddler crying because of an argument and a father taking away a daughter's phone for a month are not causes for significant concern regarding the safety of the children.

11. After examining a young woman, the nurse asks her questions about some bruises on her back. The client confides that her husband has started hitting her when they argue. The nurse makes recommendations about getting help; the client dismisses them and states, "It's just a few bruises. I think I can handle it." Which long-term consequences of exposure to violence, according to Healthy People 2020, should the nurse discuss with this client? (Select all that apply.) A) Premature death B) Breast cancer C) Disability D) Lost productivity E) Obesity

Ans: A, C, D Feedback: Healthy People 2020 emphasizes a need to prevent violence and the sequelae known to result from exposure to violence recognizing that violence leads to the following: premature death, disability, poor mental health, high medical costs, and lost productivity. Breast cancer and obesity are not known as long-term consequences of exposure to violence.

6. The nurse is completing a lethality assessment with a female client. Which are appropriate lethality risk questions? (Select all that apply.) A) Is there a gun in your house? B) Are you using drugs or drinking excessively? C) Has your partner ever been arrested? D) What is the worst thing your partner has ever done to you? E) Do you feel that the partner is capable of hurting you?

Ans: A, C, D, E Feedback: Appropriate questions to ask a client to assess for lethality risks associated with intimate partner violence include the following: (1) Is there a gun in the house? (2) Is the woman's partner unemployed? (3) What is the worst thing the partner has ever done to the victim? (4) Does the victim feel that the partner is capable of hurting her, of carrying out his threats? (5) Has the woman's partner ever been arrested? (6) Is the woman's partner (not the woman herself) using drugs or drinking excessively?

1. Which most accurately defines gender-based violence? A) A homicide of a female that occurs in the context of intimate partner violence B) Violence that targets people or groups of people on the basis of their gender C) A pattern of assaultive and coercive behaviors perpetrated against an individual by one who is, was, or wishes to be in an intimate relationship with the victim D) A type of violence typically committed by one gender but not the other

Ans: B Feedback: Gender-based violence is violence that targets people or groups of people on the basis of their gender. Femicide is the homicide of a female that occurs in the context of intimate partner violence (IPV). IPV is a pattern of assaultive and coercive behaviors perpetrated against an individual by one who is, was, or wishes to be in an intimate relationship with that individual and that may include inflicted physical injury, psychological abuse, sexual assault, progressive social isolation, deprivation, intimidation, and threats. Gender-based violence is based on the gender of the victim, not that of the perpetrator.

20. The nurse assesses a new client and performs a standard screening for intimate partner violence. Which is the most appropriate question to ask first? A) "Are you in danger now?" B) "It's normal for couples to disagree about things. What happens when you and your partner disagree?" C) "Do you ever think about hurting yourself, cutting, stopping eating, or purging food?" D) "Have you ever thought about or been granted a restraining order?"

Ans: B Feedback: The most appropriate question to ask first is, "It's normal for couples to disagree about things. What happens when you and your partner disagree?" This question is open-ended and allows the client to share information about behavior that she may not even recognize as abuse. The other questions listed are more appropriate to ask as follow-up questions, once the woman has stated that she is being abused.

17. Intimate partner violence is a pattern of assaultive and coercive behaviors. This definition includes: (Select all that apply.) A) Emotional injury B) Sexual assault C) Progressive social interaction D) Physical injury E) Deprivation

Ans: B, D, E Feedback: Intimate partner violence (IPV) is a pattern of assaultive and coercive behaviors that is perpetrated against an individual by one who is, was, or wishes to be in an intimate relationship with that individual and that may include inflicted physical injury, psychological abuse, sexual assault, progressive social isolation (not interaction), deprivation, intimidation, and threats. Emotional injury is not included in IPV.

9. A nurse is preparing to make a mandatory report of intimate partner violence (IPV) with regard to the caregiver of a pediatric client. Which actions are appropriate? (Select all that apply.) A) Tell the child about the possibility of filing a mandatory report B) Determine whether it will be safe to inform the child about the report C) Ask about the child's incidence of using drugs D) Ask the victim whether she has a plan to keep herself and the child safe E) Ask the victim if she would like to file a report at the same time as you file yours

Ans: B, D, E Feedback: The nurse should take the following actions when making a mandatory report of IPV: (1) Talk with the adult victim (not the child) about the possibility of filing a mandatory report. (2) Consider the safety concerns of filing. (3) Determine whether it will be safe to inform the children about the report. (4) Share concerns of safety with the Child Protective Agency. (5) Ask about the perpetrator's behaviors with questions such as the following: What is the worst thing he or she has done? Does he or she own a gun? Has he or she been arrested? Does he or she use drugs (not does the child use drugs)? Do you think he or she is capable of hurting you or your children? (6) Address safety planning with the nonoffending victim. (7) Consider filing in concert with the adult victim.

4. Preventing intimate partner violence (IPV) and recurrence of violence requires targeting efforts at all three levels of prevention: primary, secondary, and tertiary. Which is a secondary prevention strategy? A) Creating and broadcasting a public service announcement that raises awareness about IPV B) Putting up posters around the health provider's office that give tips on what to do if one is in an abusive relationship C) Screening a woman for evidence of abuse who has several risk factors for IPV D) Providing a woman who is being abused by her husband the number to an abuse hotline so that she can get help leaving him

Ans: C Feedback: Primary prevention includes screening and prevention efforts that target the general population. Secondary prevention occurs through generalized screening and inquiry with high-risk populations. Tertiary prevention involves caring for victims affected by or currently experiencing violence. Creating and broadcasting a public service announcement and putting up posters are examples of primary prevention, as they are aimed at the general public. Screening a woman for evidence of abuse who has several risk factors for IPV is an example of secondary prevention. Providing help to a woman who is being abused is an example of tertiary prevention.

10. Who is in the best position to recognize both children being victimized and children perpetrating violence? A) Pediatric primary care provider B) Parent C) School nurse D) Next door neighboR

Ans: C Feedback: School nurses play a pivotal role in recognizing both children who are being victimized and those who are perpetrating violence, as they are in daily contact with the children. The parents of the children might know whether their own child is a victim or a perpetrator, but they likely would know the other children involved. The child's primary care provider and next door neighbor are not as likely to know of violence experienced or perpetrated by children as the school nurse is, due to the nurse's more frequent contact with the children and location in the school setting.

18. An injury prevention objective of Healthy People 2020 is: A) Prevention of drug-related deaths B) Identification of improper chemical storage in homes C) Decreased incidents of homicide, child maltreatment, and physical assaults D) Elimination of alcohol possession by adolescents on school property

Ans: C Feedback: The injury prevention objectives of Healthy People 2020 include the following: (a) prevention and reduction of firearm-related (not drug-related) deaths; (b) identification of improper firearm (not chemical) storage in homes; (c) surveillance of external causes of injury in emergency departments; (d) decreased incidents of homicide, child maltreatment, and physical assaults; (e) prevention and reduction of sexual assaults; and (f) elimination of weapon (not alcohol) possession by adolescents on school property.

5. Pediatric providers face special issues in screening for intimate partner violence (IPV) in a caregiver who is accompanying a child. Which are appropriate strategies for addressing this screening issue? (Select all that apply.) A) Asking the mother directly, with the child present B) Asking the child directly, while the mother is out of the room C) Asking the mother indirectly, with a written questionnaire or computer survey D) Screening for the safety and dangerousness of the situation before deciding whether to ask the mother E) Informing parents about mandatory reporting law after asking questions

Ans: C, D Feedback: Appropriate strategies include the following: asking mothers indirectly (written questionnaire, computer survey), asking mothers directly, without (not with) the child present; informing parents about mandatory reporting laws before (not after) asking questions; screening for safety and dangerousness of the situation; and being aware of resources and referrals. It would not be appropriate to ask the child about IPV that the mother may have experienced.

13. A 50-year-old woman recently underwent a divorce and has two teenaged children. She has an associate's degree from her local community college and earns an annual salary of $22,000. Which risk factors place this woman at risk for intimate partner violence (IPV)? (Select all that apply.) A) Age of 50 years B) Education at associate's degree level C) Recent divorce D) Having two teenaged children E) Annual salary of $22,000

Ans: C, E Feedback: Risk factors include age less than 45 years, low income, lack of employment, recent separation or divorce, education at the high school (not associate's degree) level or less, and having young (not teenaged) children.

14. The nurse helps a client who is a victim of intimate partner violence (IPV) with safety planning. The client worries about what to do if her partner becomes violent again. A safety suggestion for the when the client is at home is for her to go to the: A) Kitchen because it is well-lit B) Bathroom because it is a small space C) Basement because there are places to hide D) Living room because there are windows

Ans: D Feedback: Components for safety planning include a crisis/"disaster" plan, a place to go, how to get there, and other considerations. Safety planning involves discussing measures that the client may not have considered. For example, if an argument occurs at home, the woman should stay away from (1) the kitchen because sharp instruments are there and (2) the bathroom because the space is small and contains many hard surfaces. She should go to a room with a window or door, carry her cell phone, with 911 set to speed dial, and tell family members and neighbors. The basement is not appropriate because it is less likely to have windows or doors.

7. Preventing intimate partner violence (IPV) and recurrence of violence requires targeting efforts at all three levels of prevention: primary, secondary, and tertiary. Which is a tertiary prevention strategy? A) Adding a question to the standard health history form that asks whether the client is currently experiencing abuse B) Putting up posters around the health provider's office that give tips on what to do if one is in an abusive relationship C) Screening a woman for evidence of abuse who has several risk factors for IPV D) Providing a woman who is being abused by her husband the number to an abuse hotline so that she can get help leaving him

Ans: D Feedback: Primary prevention includes screening and prevention efforts that target the general population. Secondary prevention occurs through generalized screening and inquiry with high-risk populations. Tertiary prevention involves caring for victims affected by or currently experiencing violence. Adding a question to the standard health history form and putting up posters are examples of primary prevention, as they are aimed at the general public. Screening a woman for evidence of abuse who has several risk factors for IPV is an example of secondary prevention. Providing help to a woman who is being abused is an example of tertiary prevention.

3. Which is a societal risk factor for intimate partner violence? A) Experiencing poor parenting B) Marital instability C) Unwillingness of neighbors to intervene when violence is witnessed D) Traditional gender roles

Ans: D Feedback: Traditional gender roles is a societal risk factor, as it is primarily determined by the society one lives in, rather than by individual characteristics, relationship dynamics, or even local community factors. Experiencing poor parenting is an individual risk factor. Marital instability is a relationship factor. Unwillingness of neighbors to intervene when violence is witnessed is a community factor.