psych chapter 33
Which of the following is not considered a characteristic of violent families? a) Alcohol abuse b) Adequate support systems c) Social isolation d) Abuse of power and control
Adequate support systems Explanation: Having adequate support systems is not a characteristic of a violent family. Abuse of power and control, alcohol abuse, and social isolation are characteristics of violent families.
Which of the following is a warning indicator from a caregiver that may indicate elder abuse? a) Failure to keep medical appointments b) Blaming the elder for his or her illness or limitations c) Inability to manage finances d) Lack of toilet facilities
Blaming the elder for his or her illness or limitations Explanation: Blaming the elder for his or her illness or limitations is a warning indicator from a caregiver that may indicate elder abuse. Indicators of self-neglect are inability to manage finances, failure to keep medical appointments, and lack of toilet facilities.
Five common physical findings that indicate that a child has been abused are what? a) Bruises, burns, lacerations, missing teeth, and skeletal injuries b) Eye, head, and skeletal injuries; swollen glands; and breaks in skin c) Missing teeth, scars on genitalia, loose bones, broken legs, and burn marks d) Broken bones and finger joints, bruises, scars, and eye injuries
Bruises, burns, lacerations, missing teeth, and skeletal injuries Explanation: The most common indicators of physical abuse of a child are as follows: (1) bruises involving no breaks in skin integrity, (2) burns, usually due to immersion in hot water, contact with cigarettes, tying with a rope, or the application of a hot iron, (3) lacerations, abrasions, welts, and scars noted on the lips, eyes, face, and external genitalia, (4) missing or loosened teeth, and (5) skeletal injuries such as fractured bones, epiphyseal separation, or stiff, swollen, enlarged joints.
A 33-year-old woman has been treated for a periorbital hematoma and a broken nose that she suffered when her husband struck her. She does not know where he currently is, and she is scheduled for discharge. What action should the care team prioritize in this client's care? a) Educating the woman about the dynamics of domestic violence b) Teaching the woman improved coping and conflict-resolution skills c) Ensuring that the woman knows how to change her nasal dressings d) Ensuring that the woman goes to a safe place
Ensuring that the woman goes to a safe place Explanation: The woman's safety supersedes the importance of education and dressing changes, though all of these are appropriate interventions when conducted at the appropriate time.
The following are frequently experienced during the first phase of rape trauma syndrome: a) Depression, anxiety, resolution, and mental comfort. b) Fear, depression, anxiety, anger, and withdrawal. c) Resolving feelings, seeking support, crying, and difficulty sleeping. d) Fear, anxiety, disbelief, anger, and shock.
Fear, anxiety, disbelief, anger, and shock. Explanation: Depression and some form of resolution usually appear later in the reorganization phase. The first phase is characterized by more intense affective responses.
A client comes to the emergency department after being attacked and sexually assaulted. What is the most accurate nursing diagnosis for this client? a) Anxiety b) Fear c) Hopelessness d) Rape-trauma syndrome
Rape-trauma syndrome Explanation: The nursing diagnosis rape-trauma syndrome refers to both the acute and the long-term phases experienced by the victim of sexual assault. Specific nursing interventions can be planned based on this diagnosis. The rape victim may also experience fear, anxiety, and hopelessness; however, these are not specific diagnoses.
An emergency room nurse is assessing a 6-year-old female for possible signs of abuse. Which of the following is a priority intervention when dealing with child abuse or neglect? a) Social support b) Physiological needs c) Psychological needs d) Safety
Safety Explanation: The first part of treatment for child abuse or neglect is to ensure the child's safety and well-being.
A nurse is assessing a survivor of intimate partner violence. During the interview, the nurse determines that the survivor's partner is using power and control over the client through coercion and threats. Which client statement would lead the nurse to suspect this? a) "He acts like he's the master of his castle and I'm his servant." b) "He tells me that he'll tell child services I'm a bad mother." c) "He tells me who I can and cannot see." d) "He always tells me that the abuse never happened."
"He tells me that he'll tell child services I'm a bad mother." Explanation: The statement about telling child services that the client is a bad mother reflects coercion and threats. The statement about the abuse never happening reflects power and control through minimizing, denying, and blaming. The statement about whom the client can and cannot see reflects power and control through the use of isolation. The statement about the partner being the master of his castle reflects power and control through the use of the male privilege.
A 21-year-old woman has just given birth to her first child. Which of the following statements should signal the maternity nurse to the possibility of future abuse? a) "I don't even know where to begin with taking care of the baby." b) "I never really wanted this baby in the first place because the pregnancy was an accident." c) "I'm feeling pretty overwhelmed with everything and I need to get some help ASAP." d) "I don't tend to do very well with no sleep, so I'm pretty worried."
"I never really wanted this baby in the first place because the pregnancy was an accident." Explanation: Indifference or negativity surrounding the birth of a child has been identified as a potential precursor to child abuse. The other statements convey that the client is overwhelmed, which is not an unusual response to the birth of a child.
The emergency department nurse is assessing a female client with traumatic injuries. To assess whether or not the client's injuries have resulted from abuse, which question would be most appropriate for the nurse to ask the client? a) "It looks like someone has hurt you. Tell me about it." b) "Why do you think your husband has beaten you?" c) "Is your partner being mean to you?" d) "Can you describe the person who did this to you?"
"It looks like someone has hurt you. Tell me about it." Explanation: The nurse should say to the client, "It looks like someone has hurt you. Tell me about it." This is an open-ended statement and allows the client to verbalize her thoughts and feelings. Asking if the partner is being mean or asking why the client thinks the husband has beaten her already assumes that the client has been abused. Asking about the person who did this would be ineffective because survivors of violence are unlikely to disclose sensitive information unless they perceive the nurse to be trustworthy and nonjudgmental. Additionally, this question is a closed question that does not allow the client to verbalize her thoughts and feelings openly.
A nursing instructor teaching about sexual assault identifies a need for further instruction when one of the students makes which statement? a) "Fondling can be a type of sexual assault." b) "Sexual assault occurs about once every 2 minutes in the United States." c) "Sexual assault involves nonconsenting sexual activity." d) "Sexual assault is the same as rape."
"Sexual assault is the same as rape." Explanation: Sexual assault includes any form of non-consenting sexual activity ranging from fondling to penetration. Sexual assault occurs about once every two minutes. Sexual assault is a broader term than rape.
Approximately what percentage of women rape victims are raped by someone they know? a) 55% b) 35% c) 65% d) 45%
65% Explanation: Approximately two-thirds of women are raped by people they know, including spouses, boyfriends, friends, or acquaintances. Among young women, about 50% of rapes are date rapes.
The nurse is talking to a female client who is a survivor of intimate partner violence. The woman relates that her husband has been told that he has the characteristics of an antisocial personality disorder. The woman also informs the nurse that her husband has an extensive criminal record. The nurse interprets this information and suspects that the woman's husband would most likely demonstrate which behavior? a) Intermittent remorse for the violence and abuse that he commits b) Symptoms of depression along with harboring feelings of inadequacy c) Purposefully remaining socially isolated from people other than those in his family d) A risk for moderate to severe violence toward people within and outside of his family
A risk for moderate to severe violence toward people within and outside of his family Explanation: The woman's husband belongs to the group of perpetrators who are generally violent and engage in moderate to severe violence (both inside and outside of the home), tend to meet criteria for antisocial personality disorder, and are likely to have an extensive history of criminal behavior. These perpetrators become aggressive when they misinterpret neutral and positive emotional cues as negative, and when they are unable to identify expressions of fear. Another group of perpetrators, family-only perpetrators, engage in lower severity violent behaviors and exhibit the lowest levels of psychopathology. A third group of perpetrators, those with borderline personality disorder characteristics or dysphoria, engage in moderate to severe violence and demonstrate the highest levels of emotional volatility, dependency, and psychological distress. These perpetrators have a heightened sensitivity to emotional displays that predispose them to interpret social situations as threatening, and to respond with emotional dysregulation, verbal attacks, and physical violence.
Which of the following assessment findings should signal the nurse to the fact that a child may be experiencing child neglect rather than child abuse? a) A boy is brought to a clinic by his father who is nervous and unable to adequately explain how the boy broke his arm. b) A young child is admitted to hospital with hypothermia because he is inadequately dressed. c) A girl tells a social worker that she does not like it when her mother's boyfriend touches her "down there." d) A child exhibits multiple scars on his back and buttocks upon examination.
A young child is admitted to hospital with hypothermia because he is inadequately dressed. Explanation: Child neglect is the failure to provide for a child's basic physical, medical, or educational needs. Examples of child neglect include withholding adequate clothing. Injuries and sexual touching are examples of child abuse.
Which of the following would not be considered a protective factor for children who are abused? a) Solid intelligence b) Aggressiveness toward potential offenders c) Secure attachments d) Easy disposition
Aggressiveness toward potential offenders Explanation: Aggressiveness toward offenders is a direct defense. Protective factors are indirect actions used to minimize the psychic trauma experienced from the abuse.
The nurse can assess potential victims of domestic violence by ... a) "What did you do right before your partner hit you?" b) "Do you need the number of a women's shelter?" c) Asking questions such as "Has a past or current partner ever caused you to be afraid or hurt you?" d) "What is your history of physical injuries?"
Asking questions such as "Has a past or current partner ever caused you to be afraid or hurt you?" Explanation: In posing this question, nurses are sensitive to the client's reluctance to reveal abuse.
Which medication classification has been used successfully to treat PTSD? a) Antimanics b) Anticonvulsants c) Antipsychotics d) Antidepressants
Antidepressants Explanation: Antidepressants, such as Paxil and Zoloft, have been used to treat PTSD.
The nurse is assessing an elderly female in the emergency department. There are many bruises present on her body in varying stages of healing. After documenting the bruising in the assessment, what should the nurse do next? a) Notify the physician that abuse is suspected b) Ask the client when and how the bruises occurred c) Call the nursing supervisor immediately d) Follow the facility's policy and procedures for reporting abuse
Ask the client when and how the bruises occurred Explanation: The nurse should not assume the bruises were caused by abuse; the client's explanation is an important step in the assessment of potential abuse. A nurse must assess for abuse prior to getting the supervisor and physician involved. Reporting abuse would be initiated after a thorough assessment.
The school nurse is aware that a student has requested aspirin three times during the past week because his "back hurts." The nurse has noticed that he often wears long-sleeved sweaters and sweatshirts even in warm weather. The nurse suspects that the student may be the victim of physical abuse. The nurse is preparing to ask the child about his ongoing backache. Which of the following would the nurse anticipate being reported by the child if he was being abused? a) Child would give a far-fetched explanation not logically connected to his injuries. b) Child would give the same reason his sister would give were she asked to explain his injuries. c) Child would explain that his father is beating him on a regular basis. d) Child would carefully explain that his mother disciplines him because she loves him.
Child would give a far-fetched explanation not logically connected to his injuries. Explanation: When treating a child with injuries that are the result of physical abuse, professionals should suspect abuse when explanations are implausible and inconsistent with injuries, involved parties give different versions of the incident, or treatment seeking is delayed.
The nurse is legally obligated to report suspected child abuse to local authorities. Which of the following information is essential? a) Child's current school, grade, and teacher b) Therapist's name and client address c) Proof that the child has been recently abused d) Child's name, location, age, and suspected perpetrator
Child's name, location, age, and suspected perpetrator Explanation: Registered nurses are legally mandated to report child abuse. When reporting, the nurse must provide the child's name, location, age, and the suspected perpetrator. The nurse is not required to prove that abuse has occurred.
Which of the following is the most common trait found in abused wives who stay with their husbands? a) Dependency b) Jealousy c) Possessiveness d) Emotional immaturity
Dependency Explanation: Dependency is the most common trait seen in abused wives who stay with their husbands. Women often cite personal and financial dependency as reasons why they find leaving an abusive relationship extremely difficult.
A mental health nurse is interviewing a depressed child for suspected abuse. The mother states that the child is having disciplinary problems at school and stutters when approached. From the above behavioral indicators, the nurse would suspect which type of abuse? a) Sexual b) Physical c) Financial d) Emotional
Emotional Explanation: A behavioral profile of an emotionally abused child includes stuttering, enuresis, overeating, disciplinary problems, and failure to thrive. The scenario does not refer to physical, financial, or sexual abuse.
Which type of elder abuse involves harm of self-worth? a) Physical b) Emotional c) Neglect d) Abandonment
Emotional Explanation: The six types of elder abuse are physical (injury by hitting, kicking, pushing, slapping, burning, and so on), sexual (unconsented sexual act), emotional (harm of self-worth or emotional well-being), neglect (failure to meet the older adult's basic needs of shelter, food, and so on), abandonment (leaving an older adult alone and no longer providing care), and financial (illegally misusing money, property, or assets).
The nurse is caring for a 16-year-old boy with a history of being sexually abused. The nurse might expect this adolescent to ... a) Experience nightmares and flashbacks b) Have no ill effects due to his age c) Reject his mother for not protecting him d) Want to confront the perpetrator
Experience nightmares and flashbacks Explanation: Nightmares and flashbacks are common in people who were abused as children regardless of their current age. Answer B, C, and D are inappropriate responses.
Which of the following characteristics would a nurse least likely see in an abused individual? a) Isolation b) Guilt c) Entrapment d) High self-esteem
High self-esteem Explanation: Abused individuals often demonstrate a pattern of learned helplessness, manifest characteristics of low self-esteem and shame, and often experience feelings of increased dependence, isolation, guilt, and entrapment.
In many cases, family members tolerate abusive and violent behavior from relatives that they would never accept from strangers. In violent families, which normal safe haven may be the most dangerous place for victims? a) Church b) School c) Home d) Work
Home Explanation: In violent families, the home, which is normally a safe haven of love and protection, may be the most dangerous place for victims.
In violent families, which normal safe haven may be the most dangerous place for victims? a) Home b) Church c) Work d) School
Home Explanation: In violent families, the home, which is normally a safe haven of love and protection, may be the most dangerous place for victims.
A frightened young woman calls the emergency department and tearfully tells the nurse, "I've been raped! Please help me!" Before telling the client what to do, the nurse would need to know if a) If she has insurance, if she could get to the hospital by herself, and if pregnancy is a possibility b) If the client knew her assailant, knew her location, and had notified the police c) If the client was injured, was in a safe place, and had transportation available d) If she had bathed, douched, or changed clothes
If the client was injured, was in a safe place, and had transportation available Explanation: If the client is injured, she may need immediate medical attention; if she is in a safe place, she can talk to the nurse on the phone. All other questions can wait until the client's safety is ensured.
A client comes to the mental health clinic and reports feeling depressed for the last 3 months. She also admits to having thoughts of suicide. When the nurse asks her how her home life is, the client says that her husband constantly belittles her and tells her that she is stupid and fat. What problem should the nurse suspect? a) Normal marital challenges b) Intimate partner violence (IPV) c) Bipolar disorder d) Sexual abuse
Intimate partner violence (IPV) Explanation: Intimate partner violence (IPV) is a significant public health problem. It involves psychological, physical, or sexual harm perpetrated by a current spouse or partner.
Which of the following would not be an indicator of physical abuse of an elder? a) Dislocations or sprains b) Frequent ER visits with unexplained trauma c) Bruises d) Intimidation of the elderly person
Intimidation of the elderly person Explanation: Intimidation constitutes psychological abuse, not physical abuse. Bruises, frequent ER visits with unexplained trauma, and dislocations or sprains could be indicative of elder abuse.
The nurse is caring for a young adult in the mental health clinic. The client tells the nurse that he was physically neglected as a child. The nurse should assess the client for symptoms of which of the following? a) Schizophrenia b) Major depression c) Panic disorder d) Narcissistic personality disorder
Major depression Explanation: The nurse should assess the client for symptoms of major depression. Other mental health consequences associated with violence include anxiety disorders (posttraumatic stress disorder), alcohol addiction, and other disorders.
Which of the following is a possible indicator of neglect? a) Malnourishment not related to a known illness b) Hesitance to talk openly c) Anger d) Helplessness
Malnourishment not related to a known illness Explanation: Malnourishment is a possible indicator of neglect. Helplessness, hesitance to talk openly, and anger are psychological or emotional indicators of abuse.
A group of nursing students is reviewing information about intimate partner violence (IPV). The group demonstrates understanding of this topic when they identify which of the following? a) IPV in same-sex couples occurs less frequently as compared with heterosexual relationships. b) Men may not consider behaviors such as slapping or shoving as abuse. c) The reactions to IPV are similar in male and female victims. d) Men are more likely to be seriously injured even though more women are typically victims.
Men may not consider behaviors such as slapping or shoving as abuse. Explanation: Men are sometimes hesitant to report victimization or may not consider behaviors such as shoving or slapping "abuse." Nearly one in four women and one in nine men are victims of IPV at some point in their lives. Women are much more likely than men to be seriously injured as a result of IPV and to require medical treatment. IPV in same-sex couples occurs with at least the same frequency as in heterosexual relationships, but individuals with same-sex partners may not be afforded the same support. The reaction to IPV may differ by gender.
When assessing a 6-year-old child believed to be a victim of emotional abuse, the possibility is supported when the child is a) Parented by a single parent b) Showing signs of developmental delays c) Attending day care 5 days a week d) Observed stuttering during the interview
Observed stuttering during the interview Explanation: While stuttering may not be related to emotional abuse, it is a characteristic viewed as being a possible red flag. Developmental delays are not necessarily an indicator of emotional abuse, nor is attending day care on a regular basis. Being raised by a single parent is also not necessarily an indicator of emotional abuse.
Which of the following would not be considered a risk factors for being a victim of elder abuse? a) Female b) Older than 65 years c) Financial dependency d) Impaired cognitive function
Older than 65 years Explanation: Age alone is not a risk factor, the vulnerabilities of being female, cognitively impaired, and financially dependent increase the risks of being abused.
A college program aimed at teaching female students about ways to keep themselves safe from attack or rape while walking on campus would be considered which type of prevention? a) Primary prevention b) Tertiary prevention c) Rehabilitative prevention d) Secondary prevention
Primary prevention Explanation: Education aimed at preventing health problems or crises is considered primary prevention.
Which of the following is a priority intervention in the treatment of the client diagnosed with PTSD? a) Promoting the client's self-esteem b) Establishing social support c) Assisting the client to cope with stress and emotions d) Promoting the client's safety
Promoting the client's safety Explanation: Promoting the client's safety is the priority intervention for the client diagnosed with PTSD. The nurse continually must assess the client's potential for self-harm or suicide and take action immediately.
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? a) Sexual abuse b) Sodomy c) Physical abuse d) Psychological abuse
Psychological abuse Explanation: Name calling and belittling are examples of psychological abuse. Physical abuse ranges from shoving and pushing to severe battering and choking. Sexual abuse includes assaults during sexual relations, such as pulling hair, slapping, hitting, and rape. Sodomy is anal intercourse.
Which antidepressant has been the most helpful to victims of rape in managing symptoms through recovery? a) Olanzapine b) SSRIs c) TCAs d) MAOIs
SSRIs Explanation: Biochemical treatment with antidepressants (especially selective serotonin reuptake inhibitors) and antianxiety medications helps reduce symptoms of PTSD, depression, and anxiety.
An emergency room nurse is assessing a 6-year-old female for possible signs of abuse. Which of the following is a priority intervention when dealing with child abuse or neglect? a) Social support b) Psychological needs c) Physiological needs d) Safety
Safety Explanation: The first part of treatment for child abuse or neglect is to ensure the child's safety and well-being.
Supported by recent research findings, the nurse-manager of a busy community-based walk-in clinic best prepares a new nurse to identify victims of domestic violence by ... a) Providing the new nurse with the opportunity and resources to become familiar with effective assessment techniques b) Scheduling the nurse to attend a seminar that focuses on the management of abused clients c) Making experienced nursing staff available to the new nurse to act as a mentor when an assessment of such a client is required d) Assigning the new nurse to shadow an experienced nurse who is caring for a potential abuse victim
Scheduling the nurse to attend a seminar that focuses on the management of abused clients Explanation: Research has shown that educational programs are necessary to help nurses feel better equipped to identify potential victims and be more comfortable in asking about domestic violence. The other provided options are not necessarily inappropriate but none represents the best option for this scenario.
In a toddler, which injury is most likely the result of child abuse? a) A hematoma on the occipital region of the head b) A small, isolated bruise on the right lower extremity c) Several small, circular burns on the child's back d) A 1-inch forehead laceration
Several small, circular burns on the child's back Explanation: Small circular burns on a child's back are no accident and may be from cigarettes. Toddlers are injury prone because of their developmental stage, and falls are frequent because of their unsteady gait; head injuries are not uncommon. A small area of ecchymosis is not suspicious in this age group.
Mrs. Jacobs has been attending a local day program. Her counselor there notices that she has been coming in with bruises and scrapes and is increasingly depressed. On physical examination, Mrs. Jacobs is diagnosed with genital herpes. Which type of elder abuse do you suspect? a) Financial abuse b) Psychological abuse c) Sexual abuse d) Physical neglect
Sexual abuse Explanation: The physical bruising and presence of genital herpes indicate abuse that is sexual in nature. Older adults are increasingly the victims of abuse (e.g., physical, sexual, psychological, or neglect).
Exploitation of children is considered which type of abuse? a) Emotional abuse b) Neglect c) Physical abuse d) Sexual abuse
Sexual abuse Explanation: Sexual abuse can involve exploitation, such as making, promoting, or selling pornography involving minors and coercion of minors to participate in obscene acts. Physical abuse includes burning, biting, or cutting a child. Neglect is malicious or ignorant withholding of physical, emotional, or educational necessities for the child's well-being. Emotional abuse includes verbal assaults, such as blaming, name-calling, and using sarcasm.
A female client has been admitted to the inpatient psychiatric facility with a diagnosis of posttraumatic stress disorder after a history of violence by her boyfriend. During the initial assessment interview, which assessment would be the priority? a) Nutritional status b) Hydration status c) Suicide risk d) Sleep patterns
Suicide risk Explanation: Although physiologic areas such as nutrition, hydration, and sleep are important areas to assess, a thorough assessment of suicide intent would be the priority since depression is a common symptom in clients with posttraumatic stress disorder.
The nurse uses the following as an example of neglect: a) When an adult does not intervene when a 10-year-old child is being bullied by older peers b) Correcting a child for copying homework in front of the entire class c) Telling a 3 year old to stop crying like a baby when he stumbles and falls d) Disciplining a 6-year-old child for "sassing" by putting tape on his mouth
Telling a 3 year old to stop crying like a baby when he stumbles and falls Explanation: Neglect is an act of omission and refers to a parent's or other person's failure to meet a dependent's basic needs, such as providing appropriate emotional care. Telling a 3 year old to stop crying like a baby when he stumbles and falls is an example of neglect.
Which of the following behaviors would first alert the school nurse or teacher to suspect sexual abuse in a 7-year-old child? a) Learning problems and shyness b) Withdrawn behavior and enuresis c) Extreme friendliness to peers d) Telling sexually explicit stories to peers
Telling sexually explicit stories to peers Explanation: Children who have sexual knowledge not expected at their age have often been sexually abused.
A parent brings a preschooler to the emergency department for treatment of a dislocated shoulder, which allegedly happened when the child fell down the stairs. Which action should make the nurse suspect that the child was abused? a) The child cries uncontrollably throughout the examination. b) The child does not make eye contact with the nurse. c) The child does not cry when the shoulder is examined. d) The child pulls away from contact with the physician.
The child does not cry when the shoulder is examined. Explanation: A characteristic behavior of abused children is lack of crying when they undergo a painful procedure or are examined by a health care professional. Therefore, the nurse should suspect child abuse. Crying throughout the examination, pulling away from the physician, and not making eye contact with the nurse are normal behaviors for preschoolers.
Nurses who work with children should be alert for which of the following physical signs of child abuse? a) Excessive crying, temper tantrums, and talkativeness b) Poor appetite, hypoactivity, and listlessness c) Unexplained cuts, bruises, burns, and scars d) Stomach aches, skin rashes, and obesity
Unexplained cuts, bruises, burns, and scars Explanation: Cuts, bruises, burns, and scars are common indicators of physical abuse in children. The other choices include symptoms that are common in children (crying, temper tantrums, poor appetite) and may occur with specific physical illnesses (e.g., stomach aches, skin rashes) but are not necessarily indicators that abuse has occurred.
The nurse is interviewing the parents of an injured child in the emergency room. Which sign is the strongest indicator that child abuse may be a problem? a) The mother and father tell different stories regarding what happened. b) The injury is not consistent with the history or the child's age. c) The parents are argumentative and demanding with emergency department personnel. d) The family is poor.
The injury is not consistent with the history or the child's age. Explanation: When the child's injuries are inconsistent with the history given or impossible because of the child's age and developmental stage, the emergency department nurse should be suspicious that child abuse is occurring. The parents may tell different stories because their perception may be different regarding what happened; if they change their story when different health care workers ask the same question, this is a clue that child abuse may be a problem. Child abuse occurs in all socioeconomic groups. Parents may argue and be demanding because of the stress of having an injured child.
The nurse is caring for a family in which the elderly mother has been a victim of abuse and neglect by her son age 48 years. Which of the following would be most important for the nurse to keep in mind before interviewing the family? a) A top nursing priority would be to legally remove the son from the home. b) The nurse must allow the older adult mother to decide if she wants to leave the situation or not. c) Placement for the older adult woman in a nursing home within the community is crucial. d) The main focus of the nurse's actions should be on improving the elderly mother's self-esteem.
The nurse must allow the older adult mother to decide if she wants to leave the situation or not. Explanation: Removing children and older adults from their families or caregivers often is necessary to ensure immediate safety. If the home of an abused or neglected child or older adult cannot be made safe, the nurse must facilitate other professionals involved in placing the child or older adult in a foster home or nursing home. Still, intervening in cases of elder abuse is not a clear-cut issue. When an older adult's decision making is not impaired (competence is the legal term), he or she must be allowed an appropriate degree of autonomy in deciding how to manage the problem, even if the choice is to remain in the abusive situation. Forcing someone to do something against his or her wishes is in itself a form of victimization and denies autonomous decision making.
To preserve evidence from a possible rape with no report of oral sex, the female victim should avoid all of the following except ... a) Brushing her teeth b) Douching c) The victim should avoid all of these activities prior to physical examination d) Shower
The victim should avoid all of these activities prior to physical examination Explanation: To preserve possible evidence, the physical examination should occur before the women has showered, brushed her teeth, douched, changed her clothes, or had anything to drink.
A 22-year-old female college student was drugged last night with GHB at a party and subsequently raped. Which of the following responses would suggest that the woman is at risk of silent rape syndrome? a) The woman experiences intense shame and humiliation after the assault. b) The woman tells her mother what happened and swears her to secrecy. c) The woman has resolved that she will tell no one about the assault. d) The woman presents to a clinic asking for STD testing the following morning.
The woman has resolved that she will tell no one about the assault. Explanation: The defining characteristic of silent rape syndrome is that the victim fails to disclose information about the rape to anyone. Shame and humiliation are not uncommon immediate responses to rape.
The nurse is working in the emergency department with a woman who was raped 1 hour ago. In planning care, it is important for the nurse to remember which of the following? a) Angry feelings need to be set aside until physical care is completed. b) The nurse will need to make decisions for this client. c) Evidence collection according to procedures is the priority. d) The woman may feel threatened by some of the procedures.
The woman may feel threatened by some of the procedures. Explanation: Many of the examination procedures, such as a pelvic exam, may cause the woman to feel violated again.
Three elements that are necessary to legally define rape of a male or female are ... a) Use of force, consent of victim, oral penetration b) Use of force; vaginal, oral, or anal penetration; nonconsent of victim c) Use of gun or weapon, nonconsent of victim, victim unaware of assault d) Nonconsent of victim, bruising or swelling of perineum, lack of duress
Use of force; vaginal, oral, or anal penetration; nonconsent of victim Explanation: Three essential elements are necessary to legally define rape of a man or woman: • Use of force, threat, intimidation, or duress • Vaginal, oral, or anal penetration • Nonconsent by the victim
A nurse who provides care in a large, urban emergency department has worked with numerous victims of various forms of abuse as well as those who are abusers. The nurse recognizes that persons who commit abuse are typically what? a) Victims themselves of abuse b) Over 50 years of age c) Of lower socioeconomic class d) Delusional and/or psychotic
Victims themselves of abuse Explanation: While persons who commit abuse are by no means a homogeneous group, they do tend to be victims of abuse themselves. They are not necessarily poor, acutely ill, or elderly.
Which of the following is an inaccurate picture of the cycle of abuse that occurs over time? a) Violent episodes are less frequent b) Severity of the injuries worsen c) The period of remorse disappears d) Violent episodes are more frequent
Violent episodes are less frequent Explanation: Over time, the violent episodes are more frequent, the period of remorse disappears altogether, and the level of violence and severity of injuries worsen.
The loss of employment is most likely to trigger abusive behavior toward others by the client who a) Is used to being in control b) Experiences chronic mild depression c) Was physically beaten as a child d) Was experiencing financial problems before the loss of employment
Was physically beaten as a child Explanation: The loss of employment is most likely to trigger abusive behavior toward others by the client who was physically beaten as a child.
Rape trauma syndrome is a two-phase process that all rape survivors experience. It includes a) a phase of psychosis followed by a phase of recovery. b) an acute phase of symptom exaggeration and a short-term phase of reintegration. c) exacerbation of symptoms, and a successful recovery phase. d) an acute phase of disorganization and a long-term process of reorganization.
an acute phase of disorganization and a long-term process of reorganization. Explanation: The acute phase involves a variety of signs of distress and attempts to cope. Reorganization involves the victim's attempts at regaining normalcy in life.
If recovery from the rape does not occur, the victim may develop ... a) delirium. b) anxiety disorders. c) post-traumatic distress syndrome. d) borderline personality disorder
post-traumatic distress syndrome. Explanation: PTSD can result at least 1 month after an identifiable traumatic event. Symptoms include generalized anxiety, intrusive thoughts or images of the trauma, flashbacks, nightmares, and other sleep disturbances.
When a client reveals to the nurse that he or she was a victim of childhood sexual abuse, the nurse assesses for indications of which of the following? Select all that apply. a) Client has a history of substance abuse b) Client has difficulty establishing a mutually satisfying sexual relationship c) Client has difficulty establishing interpersonal relationships d) Client engages in self-harming behaviors e) Client exhibits antisocial tendencies
• 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 Explanation: Losing the ability to trust people is a common characteristic of the adult survivor of childhood sexual abuse. Substance abuse is a common characteristic of the adult survivor of childhood sexual abuse. Other characteristics include having difficulty establishing interpersonal relationships and finding mutually satisfying sexual relationships. Also, survivors may engage in self-harm.
Which of the following are forms of psychological abuse? Select all that apply. a) Incest b) Rape c) Insulting d) Humiliating e) Destroying another's property
• Destroying another's property • Insulting • Humiliating Explanation: Psychological abuse includes behaviors such as criticizing, insulting, humiliating, or ridiculing someone in private or in public. It can also involve actions such as destroying another's property, threatening or harming pets, controlling or monitoring spending and activities, or isolating a person from family and friends. Rape and incest are forms of sexual assault.
Which of the following are implicated in the majority of elder abuse cases? Select all that apply. a) Spouses b) Friends c) Adults d) Children e) Family member
• Family member • Adults • Children • Spouses Explanation: Family members, adults, children, or spouses are implicated in 90% of the cases of elder abuse.
The psychiatric nurse assesses for a child's potential risk factors for sexual abuse when (Select all that apply.) a) Observing for signs of child neglect b) Evaluating the child for developmental delays c) Determining whether either parent has ever been sexually abused d) Questioning parents and child about school attendance e) Questioning the parents concerning their possible substance abuse
• Questioning the parents concerning their possible substance abuse • Evaluating the child for developmental delays • Determining whether either parent has ever been sexually abused • Questioning parents and child about school attendance Explanation: The psychiatric nurse assesses for a child's potential risk factors for sexual abuse when questioning the parents concerning their possible substance abuse, evaluating the child for developmental delays, determining whether either parent has ever been sexually abused, and questioning parents and child about school attendance.
The nurse's suspicion that a child has been sexually abused is supported when the assessment data includes (Select all that apply.) a) The vulva appears edematous b) The child reports "itching down there" c) The anal area is bruised d) Urinalysis reports a bacterial infection e) The child attends day care 3 days a week
• The anal area is bruised • The child reports "itching down there" • The vulva appears edematous • Urinalysis reports a bacterial infection Explanation: The nurse's suspicion that a child has been sexually abused is supported when the assessment data includes a bruised anal area, itching reported by the child, an edematous vulva, and a urinary infection.
After a series of admissions to the emergency department over the past several months, an 80-year-old woman's malnutrition, vague history, and pattern of physical injuries lead the nurse to suspect elder abuse. Which of the following aspects of the woman's situation may contribute to elder abuse? Select all that apply. a) The woman is physically dependent on her son since she lost her mobility. b) The woman describes herself and her son as "not well-off, but not terribly poor either." c) The woman's son describes her as "needy, helpless, and pathetic." d) The woman and her son are recent immigrants to the United States. e) The woman has no income or savings of her own.
• The woman is physically dependent on her son since she lost her mobility. • The woman has no income or savings of her own. • The woman's son describes her as "needy, helpless, and pathetic." Explanation: Physical and financial dependence and personality conflicts with caregivers and children are known to contribute to elder abuse. Low socioeconomic status and recent immigration are not identified as causative factors.
Which of the following are risk factors for those who are more likely to abuse an older adult? Select all that apply. a) Lack of social support b) History of intergenerational conflict c) Financial dependence d) Use of drugs e) Cognitive disability
• Use of drugs • Lack of social support • Financial dependence Explanation: High risk factors for those who are more likely to abuse older adults include using drugs or alcohol, high levels of stress, lack of social support, high emotional or financial dependence on the older adult, lack of training in taking care of older adults, and depression. Risk factors for elder abuse include older age, impairment in activities of daily living, cognitive disability or other mental illness, dependency on the caregiver, isolation, stressful events, and a history of intergenerational conflict between the older adult and the caregiver.