"Chapter 41: Caring for Survivors of Violence" !

Which statement made by a client raises the greatest concern that the client may be experiencing relationship violence?

"I don't know what else I can do to keep him from getting angry at me."

Which statement, made by a nurse who experienced sexual abuse as as a child, demonstrates being best prepared to work with sexual abuse and trauma survivors?

"I've been supported by health care professionals and now I want to support other survivors."

A nurse is working with a client who is a survivor of rape. The client asks the nurse, "It's been 6 months since it happened. Why can't I get back into doing the things I did before?" What is the nurse's best response?

"It can take at least a year or more to get back to where you were before."

A client has been in a physically abusive relationship for more than a decade. Which statement best demonstrates that the client understands of how fear can influence a reluctance to leave such a relationship?

"My partner would hunt me down and kill me for sure."

The nurse is providing care to client who is currently in a sexually abusive relationship. To best manage the development of additional comorbid disorders, what question(s) should the nurse ask this client? Select all that apply.

"What community resources related to HIV and pregnancy are you aware of?" "What are the early symptoms of posttraumatic stress disorder (PTSD)?" "Do you have a safety and escape plan in place?"

A nurse is assessing a client in a community clinic who reports feeling anxious lately because she is considering leaving her marriage. The client describes a long history of partner abuse associated with this relationship. How should the nurse respond to this client?

"You have the right to be safe and respected."

The nurse is working with a client at the battered women's shelter who is in a violent and abusive relationship. The client is considering a separation and asks the nurse, "What do you think about that?" Which is the best response by the nurse?

"You may be in more physical danger after you leave him

The nurse is working at the battered women's shelter with a client who is in a violent and abusive relationship. The client is considering a separation and asks the nurse, "What do you think about that?" The best response by the nurse is,

"You may be in more physical danger after you leave him."

Approximately what percentage of women are victims of intimate partner violence (IPV)?

33%

Approximately what percentage of women rape victims are raped by someone they know?

65%

A nursing student learning about intimate partner violence (IPV) correctly identifies the percentage of deaths attributed to IPV to be what?

70% women and 30% men

A nurse is working in the emergency department. Which situation would lead the nurse to suspect possible abuse of a client? Select all that apply.

A 3-month-old with a fractured femur A baby with contrecoup injuries to the brain A 6-year-old is being seen for the 5th time for a urinary tract infection

A nurse is aware of the high incidence of intimate partner violence (IPV) and actively seeks opportunities to screen women for IPV. Which female client represents the best opportunity for assessing for IPV?

A client who is in the third trimester of pregnancy and who is having biweekly prenatal appointments at a clinic

Which type of elder abuse involves leaving an older adult and no longer providing care for the individual?

Abandonment

Which characteristics are found in violent families? Select all that apply.

Abuse of power and control Alcohol use disorder Social isolation

The nurse is assessing an elderly client in the emergency department. There are many bruises present on the client's body in varying stages of healing. After documenting the bruising in the assessment, what should the nurse do next?

Ask the client when and how the bruises occurred

When noted in an assessment of a child, the nurse should suspect child abuse if which common physical findings signaling abuse are present?

Bruises, burns, lacerations, missing teeth, and skeletal injuries

During an interview, a client reveals to the nurse, "I was sexually abused as a child." Based on this information, which finding would the nurse most likely anticipate being revealed during the assessment? Select all that apply.

Client has difficulty establishing interpersonal relationships Client has a history of substance abuse Client has difficulty establishing a mutually satisfying sexual relationship Client engages in self-harming behaviors

What are some types of behavior that the nurse would recognize as qualifying as psychological abuse? Select all that apply.

Criticizing Ridiculing Threatening a victim's dog

A female client states that she has been receiving numerous text and phone messages from a co-worker. Which type of harrassment should be documented in the nurse's notes?

Cyberstalking

According to the Bureau of Justice, 65% of women murdered by spouses or boyfriends were attempting to leave or had left the relationship. Which of the following is the most common trait found in abused wives who stay with their husbands?

Dependency

What assessment data, related to a 77 year old client, would be considered the highest risk for possible elder abuse?

Diagnosed with mild dementia

A 19-year-old college student has been date raped. She is in the emergency department undergoing a forensic examination and being assessed by the psychiatric emergency response team. The nurse notices that the client describes the series of events leading up to the rape with a blank facial expression, saying, "I feel like it didn't happen at all." Which of the following statements most accurately describes the client's response?

Dissociation as a defense mechanism to cope with the attack

Which type of elder abuse involves harm of self-worth?

Emotional

A client discloses to a nurse therapist that the client has been verbally abusive to the client's 6-year-old child and belittles the child routinely. Which form of abuse best describes the client's treatment of the child?

Emotional abuse

When interviewing an abused child, the nurse must first complete what?

Establish a safe environment

A client has been admitted to the medical unit from the emergency department after experiencing a violent assault. What action should the nurse prioritize when planning this client's care?

Establishing rapport with the client

A nurse is preparing a presentation for a senior center about elder abuse. When describing individuals associated with abusing older adults, which group would the nurse most likely identify? Select all that apply.

Family member Adults Children Spouses

Which of the following are biologic indicators of posttraumatic stress disorder (PTSD)?

Flashbacks

Nurses working with rape trauma victims need to be aware of their own attitudes about rape and sexual assault. Which rationale best explains why?

Giving back the survivor as much control as possible is important.

The mental health nurse should discuss an emergency plan for leaving abusive situations will when the woman is able to do which of the following? Select all that apply.

Identifies safe places to go Keep emergency money available Makes a spare car key Compile a list of important phone numbers

A nurse manager is working with the nursing staff of a busy community-based walk-in clinic that provides care to a large number of survivors of domestic violence. When helping the staff provide care, which information would be most important for the nurse manager to convey to the staff?

Importance of measuring the clients' progress in small steps

The nurse at a university health services clinic has been asked to meet with a freshman class about warning signs of relationship violence. The nurse points out which danger sign the students should be alert for in a date?

Is excessively jealous

The nurse is planning a community education session on elder abuse awareness. Which points should the nurse be sure to include? (Select all that apply.)

It is abuse if you feel forced to have sex Withholding money for necessities is a form of abuse Not helping you get medical attention you need is a form of abuse It is abuse if your caregiver holds your arm too tight

A nurse is assessing a survivor of abuse. Which assessment would be most important for the nurse to complete first?

Lethality assessment

A pregnant woman comes to the clinic for a routine visit. Upon examination the nurse notices bruises on the client's upper arms and neck. The client reports that her husband has been abusive to her. The nurse is concerned because abuse during pregnancy can lead to which condition? Select all that apply.

Low birth weight Low maternal weight gain Infections Anemia Miscarriage

The nurse is involved in a community education program for new parents and plans to include information on child abuse. The nurse will teach the parents that the most common form of child abuse is what?

Neglect

The school health nurse is asked to see a child who has been coming to school with no lunch for the past week. The child tells the nurse, "I don't get a lunch this week, I have been wetting the bed." The nurse identifies that this child is experiencing which type of abuse?

Neglect

Which are common behavioral and emotional responses to abuse? Select all that apply.

One third of abusive men are likely to have come from violent homes. Women who grew up in violent homes are 50% more likely to expect or accept violence in their own relationships. Dependency on the abuser is a common trait found in victims of domestic violence. It is critical for the nurse to demonstrate acceptance after hearing about the abuse so that the victim may begin to gain self-acceptance.

An elderly client with dementia lives with their daughter but attends a day center during the day. The nurse notices the client is unkempt and smells of urine. Upon examining the client, the nurse notes bruising on the arms and back. From these observations, which type of abuse does the nurse suspect?

Physical abuse

A client has just presented at the emergency department after being raped. What initial action by the nurse would be most appropriate?

Provide emotional support

The community health nurse meets with the family members of an older adult client. The nurse includes which in the plan of care as a preventive measure to guard against elder abuse?

Provide the primary caregiver with additional resources to meet the client's needs

Intimate partner violence is the mistreatment or misuse of one person by another in the context of an emotionally intimate relationship. Which type of abuse includes name calling and belittling?

Psychological abuse

A client comes to the emergency department after being attacked and sexually assaulted. What is the most accurate nursing diagnosis for this client?

Rape-trauma syndrome

A nurse is caring for a client who arrived at the emergency room with injuries following a physical assault with a baseball bat. The client tells you that their significant other is responsible for the injuries. Place the following nursing actions in order from the highest importance to the lowest importance. All options must be used.

Remove the significant other from the room with the client. Conduct an assessment of the client. Notify the physician of the client's injuries and situation. Notify the police of the assault. Call a meeting of the interdisciplinary team

During the nurse's assessment of a new client on a medical unit, the client confides in the nurse that the client's spouse often "slaps me around" after the client has been drinking. What action should the nurse take in response to this statement?

Report the client's statement promptly to the appropriate authorities.

The nursing student learning about intimate partner violence correctly identifies its prevalence in same-sex couples as what?

Same frequency as in heterosexual couples

Which assessment finding should cause the nurse the greatest concern regarding the possible abuse of an older adult client?

Sends money every month to each adult child

In a toddler, which injury is most likely the result of child abuse?

Several small, circular burns on the child's back

Which are common characteristics of violent families regardless of the type of abuse that exists? Select all that apply.

Social isolation Intergenerational transmission Abuse of power and control Alcohol and other drug abuse

A client comes to the clinic for a prenatal visit. While the client is in the examining room, her estranged husband appears and insists on seeing the client. The client tells the nurse that they are in the process of getting a divorce and she does not want to be around him. "He's been following me to work and at my home everyday." What should the nurse suspect?

Stalking

Which are common reasons why abused women remain with the abusive partner? Select all that apply.

The abused person has low self-esteem and defines her success as a person by the ability to make the relationship work. The abused person is afraid that the abuser will kill her if she tries to leave. The abused person believes that she is unable to function without her husband. The abused person is personally and financially dependent on the abuser.

Which behavior would first alert the school nurse or teacher to suspect sexual abuse in a 7-year-old child?

The child tells sexually explicit stories to peers.

The nurse is collecting assessment data on a client who is suspected to be a victim of violence. Which assessment data would support the suspicion that the client is a victim of abuse? Select all that apply.

The client has few friends. There is a large amount of alcohol use in the home. The client reports that the client's father was abusive during childhood.

The nurse is aware that fewer than half of rapes and sexual assaults are reported. Which are some of the reasons people do not report being sexually assaulted? Select all that apply.

The client is embarrassed of the assault. They have a fear of being blamed for the incident. The perpetrator may use coercion or threats to control the victim.

A nurse is screening a new client for intimate partner violence (IPV). What aspect of this woman's current circumstances is the most significant risk factor?

The client's family lives on less than $1,000 per month.

After a series of admissions to the emergency department over the past several months, an 80-year-old client's malnutrition, vague history, and pattern of physical injuries lead the nurse to suspect elder abuse. Which aspect of the client's situation may contribute to elder abuse? Select all that apply.

The client's son describes the client as "needy, helpless, and pathetic." The client is physically dependent on the client's son since losing mobility. The client has no income or savings of the client's own.

The nurse is interviewing the parents of an injured child in the emergency department. Which sign would alert the nurse as the strongest indicator that child abuse may be a problem?

The injury is not consistent with the history or the child's age.

The pediatric nurse is caring for a 15-month-old child recently admitted to the hospital for a fractured femur. Which data obtained during the assessment would raise the nurse's suspicion that the child has suffered physical abuse?

The injury occurred several days before the parents sought treatment

Which would not increase the likelihood that an older adult will incur physical abuse?

The older adult is independent with activities of daily living.

A person found guilty of physically abusing a domestic partner is offered participation in a rehabilitation program as part of the sentencing process. What information should the nurse provide the individual in order to make an informed decision about accepting the offer? Select all that apply.

The program will likely last between 36 weeks and 5 years. If alcohol is a factor, sobriety during the entire period of the program is mandatory. When applicable, random drug testing is a criteria of the program's acceptance.

A female college student comes to the counseling center and tells the nurse she is afraid of her boyfriend. She states, "He is so jealous and overprotective; he wants to know where I am and who I'm with every minute." The nurse recognizes this as which of the following?

The tension-building phase of the violence cycle

A college student comes to the counseling center and tells the nurse that they fear their partner. The student states, "My partner is so jealous and overprotective. My partner wants to know where I am and who I'm with every minute." Which statement is most likely true regarding this situation?

This is characteristic of the tension-building phase of the violence cycle.

The nurse provides care to individuals who have been sexually assaulted during their childhood. Which characteristic is most commonly noted by the nurse during an assessment of such clients?

Unusually aggressive

The cycle of violence or abuse is a reason often cited for why women have difficulty leaving abusive relationships. Which of the following is an inaccurate picture of the cycle of abuse that occurs over time?

Violent episodes are less frequent

The nurse in the emergency room is assessing a client who was brought in by the police for evaluation after receiving a call from a neighbor. The client reports to the nurse that the person who has been cooking and helping around the house has not been home for days. Which type of abuse does the nurse suspect based on the client's statement?

abandonment

The nurse is concerned that a client may be experiencing emotional abuse. The nurse observes an interaction between the client and a family member. Which assessment findings related to the actions of the family member toward the client led the nurse to make this clinical determination? Select all that apply.

calling the client names putting the client down making the client feel guilty

The nurse asks the parent of a school-age child about intimate partner violence in the home. Which assessment finding caused the nurse to complete this assessment?

child crying and appearing sad

The nurse is teaching a victim of intimate violence how to create a safety plan. Which should be included when the nurse is assiting the client in devising an escape? Select all that apply.

identify a prearranged place for children to meet configure a list telephone numbers needed in case of emergency map the house for an escape route prepare and hide an escape bag

Which are forms of psychological abuse? Select all that apply.

isolating a person from family Humiliating Insulting

When the school nurse is assessing an adolescent who reports trouble sleeping, which characteristics of the client indicate there may be violence in the home? (Select all that apply.)

must go straight home after school each day has a family history of alcohol abuse the client's father monitors contact with friends

The nurse is planning care for a client who is a victim of violence. Which of the following should the nurse identify as goals for this client's plan of care? Select all that apply.

restore health ensure safety stop the violence prevent injury

The nurse is caring for a client who is a victim of intimate violence. The client has pressed charges and the perpetrator is involuntarily remanded to a treatment center for 5 years. The client asks the nurse about the requirements of the treatment center that will help prevent ongoing substance abuse. Which of the following required actions does the nurse include in the correct response?

submit to random drug testing

The nurse suspects that a client is a victim of intimate partner violence. What should the nurse consider when caring for this client? Select all that apply.

support can be accessed safely availability of support

A client who has been victimized repeatedly by a spouse is angry and verbally lashing out on the nurse. Based on the client's behavior, which technique would the nurse use with this client?

use "I feel" statements