videbeck ch.12 prep u

A mental health nurse presenting an educational program on rape for high school students responds to the statement, "Women cry rape often times just to get even with the guy," by offering which answer? "Actually, fewer than 2% of all reported rapes are found to be false." "I'm not sure where you heard that but statistically it isn't true." "I don't believe that's true but even if it were it doesn't excuse the real rapes that occur." "If a man is falsely accused, the woman is prosecuted by the law."

"Actually, fewer than 2% of all reported rapes are found to be false." Explanation: Rape is an underreported crime due to feelings of guilt on the part of the victim. Only approximately 2% of all reported rape cases are false.

Which assessment question should the nurse ask of a client suspected of being ostracized by a school bully? "Do you feel like a part of a group in school?" "Do you smoke or use drugs?" "Can you go to the school principal with personal problems?" "Have you talked to your parents about your problems at school?"

"Do you feel like a part of a group in school?" Explanation: Ostracism, ignoring and excluding a target individual, has recently emerged as one of the more common and damaging forms of bullying. The victim experiences threats to belonging, self-esteem, meaningful existence, and sense of control. Ostracism may pose an even greater threat to children's adjustment than bullying. Those who bully are more likely to have poor grades and to use alcohol and tobacco. None of the remaining options are directly associated with the issue of ostracizing.

Which statement made by a client raises the greatest concern that the client may be experiencing relationship violence? "He was so much nicer when we started dating." "His father physically abused his mother for years." "He doesn't like it when I go out with my girlfriends." "I don't know what else I can do to keep him from getting angry at me."

"I don't know what else I can do to keep him from getting angry at me." Explanation: A warning sign of relationship violence is feeling that you must change your life or yourself so you won't anger him or her. The remaining statements, while troublesome, are not as clearly associated with behaviors of violence.

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? "Life is different for you now, you will gradually accept that." "It can take at least a year or more to get back to where you were before." "You are a victim. You need to give yourself some time." "Let's talk about what happened to you again. It can help."

"It can take at least a year or more to get back to where you were before." Explanation: It often takes one or more year for survivors of rape to regain previous levels of functioning. It is important to remind clients that it is possible to return to previous levels of functioning. Clients have many strengths that they don't realize. It is important for the nurse to avoid using the word "victim" and help the client identify as a survivor. The nurse should help the client focus on the present rather than dwell on horrific things from the past.

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 Friends

- Family member - Adults - Children - Spouses Explanation: Family members, adults, children, or spouses are implicated in 90% of the cases of elder abuse

What percentage of women can expect to be a victim of an ongoing unwanted pursuit from stalking? 5-10% 12-32% 40-48% 50-60%

12-32% Explanation: Women are 12-32% and men 17% who can expect to be victims of ongoing unwanted pursuit.

Approximately what percentage of women rape victims are raped by someone they know? 65% 35% 45% 55%

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.

Approximately what percentage of women rape victims are raped by someone they know? 65% 35% 45% 55%

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.

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 70% men and 30% women 50% women and 50% men 90% women and 10% men

70% women and 30% men Explanation: Approximately 70% of victims killed by IPV are women and 30% are men.

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 70% men and 30% women 50% women and 50% men 90% women and 10% men

70% women and 30% men Explanation: Approximately 70% of victims killed by IPV are women and 30% are men.

When noted in an assessment of a child, the nurse should suspect child abuse if which common physical findings signaling abuse are present? Eye, head, and skeletal injuries; swollen glands; and breaks in skin Broken bones and finger joints, bruises, scars, and eye injuries Bruises, burns, lacerations, missing teeth, and skeletal injuries Missing teeth, scars on genitalia, loose bones, broken legs, and burn marks

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.

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 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.

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? Jealousy Isolation Harassment Cyberstalking

Cyberstalking Explanation: Stalking is a pattern of repeated unwanted contact, attention, and harassment that often increases in frequency. Cyberstalking is the use of the Internet, e-mail, or other telecommunications technology to harass or stalk another person. The nurse should document the conversation in the nurse's notes.

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? Jealousy Isolation Harassment Cyberstalking

Cyberstalking Explanation: Stalking is a pattern of repeated unwanted contact, attention, and harassment that often increases in frequency. Cyberstalking is the use of the Internet, e-mail, or other telecommunications technology to harass or stalk another person. The nurse should document the conversation in the nurse's notes.

What assessment data, related to a 77 year old client, would be considered the highest risk for possible elder abuse? Lives with adult daughter Diagnosed with mild dementia Requires assistance with food preparation Widowed, female

Diagnosed with mild dementia Explanation: While the risk of elder abuse exists in all the options provided, such abuse is more likely when the elder client has chronic mental and/or physical health problems that limit there ability to express their concerns and/or describe their current living conditions.

When interviewing an abused child, the nurse must first complete what? Use vocabulary that the child uses Establish a safe environment Understand forensic implications for assessment Use anatomically correct dolls

Establish a safe environment Explanation: First, the nurse must establish a safe and supportive environment in which to conduct the evaluation. Second, the nurse needs to understand the forensic implication of assessment so that the interview format will be acceptable for disclosure in a court hearing. It is also important to use vocabulary that the child uses and to use anatomically correct dolls to obtain information about the abuse, but these are not the priority.

Nurses working with rape trauma victims need to be aware of their own attitudes about rape and sexual assault. Which rationale best explains why? Nurses can learn from the experiences of clients and thus help prevent becoming victims of assault themselves. The attitudes of individual nurses reflect on the overall profession. Nurses need to be able to sympathize with their clients. Giving back the survivor as much control as possible is important.

Giving back the survivor as much control as possible is important. Explanation: Knowing how to recognize when personal feelings are likely to interfere with optimal care is part of the nurse's professional responsibility. Giving back the survivor as much control possible is important by allowing the client to make decisions about who to call, what to do next, and what the client would like done in relation to the crime. The nurse's role in helping the survivor regain control is an essential part of recovery.

The nurse should consider which as a possible indicator of child neglect? Malnourishment unrelated to illness Helplessness Angry outbursts Hesitance to talk openly

Malnourishment unrelated to illness Explanation: Malnourishment is a possible indicator of neglect. Helplessness, hesitance to talk openly, and anger could be psychological or emotional indicators of abuse.

A nurse is working on developing a safety plan with a client who is a survivor of violence. Which would the nurse address first? Devising an escape route Recognizing the signs of danger Identifying a safe place to hide Identifying a signal to indicate it is safe to leave

Recognizing the signs of danger Explanation: One of the most important teaching goals is to help survivors develop a safety plan. The first step in developing such a plan is helping the survivor recognize the signs of danger. Changes in tone of voice, use of alcohol and other drugs, and increased criticism may indicate that the perpetrator is losing control. Detecting early warning signs helps survivors to escape before battering begins. The next step is to devise an escape route. This involves mapping the house and identifying where the battering usually occurs and what exits are available. The survivor needs to have a bag packed and hidden, but readily accessible, containing what is needed to get away. If children are involved, the adult survivor should make arrangements to get them out safely. That might include arranging a signal to indicate when it is safe for them to leave the house and to meet at a prearranged place. A safety plan for a child or dependent older adult might include safe places to hide and important telephone numbers, including 911, police and fire departments, and other family members and friends.

The nursing student learning about intimate partner violence correctly identifies its prevalence in same-sex couples as what? Twice as often as in heterosexual couples Same frequency as in heterosexual couples Half as frequent as in heterosexual couples Three times more frequent as in heterosexual couples

Same frequency as in heterosexual couples Explanation: Intimate partner violence in same-sex couples occurs with at least the same frequency as in heterosexual relationships, but people with same-sex partners may not be afforded the same support.

A 3-year-old who has been seen in the emergency department for various fall-related injuries is being treated for apparent blindness in the left eye as a result of retinal hemorrhage. The nurse should suspect that which form of child abuse is part of the cause of the child's condition? Shaken baby syndrome Munchausen's syndrome by proxy Ineffective supervision Child neglect

Shaken baby syndrome Explanation: Despite its name, shaken baby syndrome has been documented in children up to 5 years of age. The physical findings usually include bruising from being grabbed firmly along with major head injury, such as subdural hematoma or cerebral edema. Nonfatal consequences include blindness due to retinal hemorrhage.

The majority of perpetrators of elder abuse include which population? Spouses Adult children Siblings Grandchildren

Spouses Explanation: Most cases of elder abuse occur when one older spouse is taking care of another.

Which feature would most likely predispose an adult to engage in family violence? The adult was physically abused as a child The adult has been experiencing financial problems The adult experiences chronic mild depression The adult is used to being in control

The adult was physically abused as a child Explanation: The tendency for adults to raise their children in the same way that they were raised perpetuates the cycle of family violence. Adults who were victims of abuse as children frequently abuse their own children.

The nurse's suspicion that a child has been sexually abused is supported by what assessment data? Select all that apply. The anal area is bruised The child reports "itching down there" The vulva appears edematous The urinalysis reports a bacterial infection There are frequent ear infections

The anal area is bruised The child reports "itching down there" The vulva appears edematous The 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. Ear infections are common among children.

Which is not a risk factor for child sexual abuse? The child is aged 10 years or younger. The child suffers from developmental delays. The child lives in a home where substance abuse occurs. The child has primary caretaker who is mentally ill.

The child is aged 10 years or younger. Explanation: Children at high risk for sexual abuse include those who • Are aged 3 years or younger • Suffer from a developmental delay • Live in a home where substance abuse occurs • Have adolescent parents or a single parent • Are in foster care • Have primary caretakers who were sexually abused themselves • Have primary caretakers who are mentally ill or have a developmental delay

Which statement is true regarding children being raised in a home where they have witnessed intimate partner violence? They are at increased risk for being abused. They have higher rates of schizophrenia. It has little impact on child functioning. Female children are more likely to experience depression.

They are at increased risk for being abused. Explanation: Children being raised in a home where they have witnessed intimate partner violence demonstrate higher levels of depression and lower levels of self-esteem; these effects are pronounced in boys especially. Children of battered women are at an increased risk for abuse. Exposure to intimate partner violence adversely affects a range of child functioning.

Which three elements are necessary to legally define rape of a male, female, or mixed gendered person? Use of force; vaginal, oral, or anal penetration; nonconsent of victim Use of force, consent of victim, oral penetration Use of gun or weapon, nonconsent of victim, victim unaware of assault Nonconsent of victim, bruising or swelling of perineum, lack of duress

Use of force; vaginal, oral, or anal penetration; non-consent 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 • Non-consent by the victim

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? neglect physical emotional abandonment

abandonment Explanation: Although abandonment can cause neglect and lead to physical and emotional abuse, abandonment is the primary type of abuse that this person is experiencing. The older person is calling for help because the caregiver has not been present for days. Neglect is the failure to meet basic needs of shelter and food. Physical abuse is causing injury by hitting, kicking, or pushing. Emotional abuse is injuring the person's self-worth and emotional well-being.

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 child exhibiting reluctance to play with other children parent encouraging the child to help with household chores parent limiting the amount of time the child watches television

child crying and appearing sad Explanation: Children who witness intimate partner violence are often overlooked as abuse victims. Witnessing violence puts children at risk for developing depression which can be demonstrated by crying and appearing sad. Reluctance to play with other children could have many causes however does not indicate intimate partner violence in the home. Helping with household chores and limiting television time are not indications that the child is exposed to intimate partner violence in the home.

When assessing a 6-year-old child believed to be a victim of emotional abuse, the possibility is supported when the child is ... observed to be anxious and rejecting adult attention. showing signs of developmental delays. attending day care 5 days a week. parented by a single parent.

observed to be anxious and rejecting adult attention. Explanation: While anxiety can be a sign of many different problems, an anxious child who rejects the attention of an adult may raise a red flag encouraging the nurse to assess further and possibly making a report. 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.

A school health nurse is seeing an 11-year-old child who is refusing to attend school for the past 3 weeks. On assessment, the child describes a recent school experience where the child has been deliberately isolated from social groups. The child tells the nurse this began after an argument with their "best friend." The child is describing: ostracism terrorism neglect child abuse

ostracism Explanation: In this case, the child is experiencing ostracism. Ostracism refers to ignoring or excluding a target individual and is a damaging form of bullying. The child's adjustment is clearly being threatened as the child is no longer able to attend school. Terrorism refers to community violence that takes place on a larger scale. Neglect refers to the malicious or ignorant withholding meeting a child's needs for their well-being. This is the abuse of a child by a parent or primary caregiver. Child abuse refers to the various forms of abuse rendered on a child by an adult in the role of caregiver.

The nurse is assessing a victim who is brought into the hospital after being found badly beaten and raped by an unknown person. Which healthcare professional should the nurse contact to collect evidence of the assault? healthcare provider on call client's primary care provider sexual assault nurse examiner charge nurse of the emergency room

sexual assault nurse examiner Explanation: Examination for sexual abuse may require referral to a trained registered nurse in sexual assault, known as a SANE (sexual assault nurse examiner). This person is specially trained in protecting evidence. The healthcare provider on call and the client's primary care provider are not the appropriate professionals to contact to collect evidence from a rape. The charge nurse would not be appropriate either.

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? attend group therapy sessions submit to random drug testing spend time in solitary confinement attend Alcoholics Anonymous meetings

submit to random drug testing Explanation: Intervention programs may require abusers to undergo substance abuse treatment concurrently, so clients are required to remain sober and to submit to random drug testing. Treatment centers will use a variety of approaches however none are specifically identified such as group therapy, solitary confinement, or attending Alcoholics Anonymous meetings.

Which child has the greatest risk for being the target of bullying at school? the child who just transferred to the school the child who wears hearing aids the child who recently immigrated to America the child who is short for his or her age

the child who wears hearing aids Explanation: Children with special physical health-care needs are bullied more often, and children with a chronic emotional, behavioral, or developmental problem are more likely to be a victim of bullying. While any child may be a target for bullying, none on the other children have the obvious risk factor that a special needs child brings about.

A nurse is interviewing a client who is a survivor of abuse. The client is telling the nurse about how the violence occurred. Which statement would the nurse interpret as reflecting phase 3 of the cycle of violence? "He threw me against the wall and started punching my face." "He yells at me for not having dinner waiting for him when he comes home." "He calls me stupid and incompetent, asking himself why he ever married me." "He tells me that he is sorry and that he will never hit me again."

"He tells me that he is sorry and that he will never hit me again." Explanation: During phase 3 of the cycle, the perpetrator becomes kind, contrite, and loving, begging for forgiveness and promising never to inflict abuse again. The actual violence occurs in phase 2. Yelling at the client for not having dinner ready and calling her stupid and incompetent reflect phase 1, or tension building.

An emergency department nurse is assessing a 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? "Is your partner being mean to you?" "Why do you think your spouse has beaten you?" "It looks like someone has hurt you. Tell me about it." "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 thoughts and feelings. Asking whether the partner is being mean or asking why the client thinks the spouse has done this beating 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 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? "My partner always tells me that the abuse never happened." "My partner tells me who I can and cannot see." "My partner tells me that he or she will tell child services I'm a bad parent." "My partner acts like the master of the castle and I'm the servant."

"My partner tells me that he or she will tell child services I'm a bad parent." Explanation: The statement about telling child services that the client is a bad parent 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 the castle reflects power and control through the use of privilege.

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." "Relationship counseling can be very helpful." "I wonder if your perceptions of the relationship are accurate." "I am here to help you through every step of this process."

"You have the right to be safe and respected." Explanation: When working with someone who is a victim of partner abuse, it is important that the nurse assertively support the client's decision. The affirmation of the client's decision can help to improve the client's self-confidence as she begin the process of leaving her partner. It is important the nurse refrain from recommending couple's counseling, imply doubt about the client's situation, or take charge and do everything for the client.

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. putting the client down calling the client names making all the decisions making the client feel guilty limiting contact with others

- putting the client down - calling the client names - making the client feel guilty Explanation: Behaviors that suggest that someone is experiencing emotional abuse include putting the person down, name-calling, and making the person feel guilty. Making all the decision is a behavior associated with male privilege. Limiting contact with others demonstrates the use of isolation.

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 6-year-old is being seen for the 5th time for a urinary tract infection A baby with contrecoup injuries to the brain A 3-month-old with a fractured femur A 15-month-old with shortness of breath after peanut ingestion A 3-year-old with a deep finger laceration

A 6-year-old is being seen for the 5th time for a urinary tract infection A baby with contrecoup injuries to the brain A 3-month-old with a fractured femur Explanation: Re-occurring urinary tract infections signal the possibility of sexual abuse of the child. The nurse must assess for further signs of abuse both with parents present and without. A fracture of the femur in a 3-month-old is uncommon given the infant's age and level of development. Contrecoup injuries of the brain in a baby should generate suspicion that the baby has been shaken. A 15-month-old with an allergic reaction to a peanut ingestion and a 3-year-old with a deep finger laceration should not signal abuse to the assessor. The problems are commonly seen in the pediatric emergency room.

When noted in an assessment of a child, the nurse should suspect child abuse if which common physical findings signaling abuse are present? Eye, head, and skeletal injuries; swollen glands; and breaks in skin Broken bones and finger joints, bruises, scars, and eye injuries Bruises, burns, lacerations, missing teeth, and skeletal injuries Missing teeth, scars on genitalia, loose bones, broken legs, and burn marks

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.

When attempting to preserve evidence from a possible rape with no report of oral sex, the female victim should be instructed that which self-care activities are permitted? Brushing her teeth Douching Showering Changing clothes

Brushing her teeth 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.If there is no report of oral sex, then rinsing the mouth or drinking fluids can be permitted immediately.

A 27-year-old has been brought to the emergency department by emergency medical services following a violent sexual assault that took place in the parking garage of the client's building. Which task would fall most clearly within the scope of practice of a forensic nurse? Providing reassurance to the client that the care team and the police will prioritize the client's care Collecting specimens from the client for use as evidence Assisting with diagnostic tests to determine the extent of the client's injuries Asking the client to describe the perpetrator in detail and documenting the client's statement

Collecting specimens from the client for use as evidence Explanation: While a forensic nurse would certainly attempt to reassure a client such as this one, a priority forensic nursing task would be collecting specimens for use as evidence. This would supersede assisting with diagnostics, which falls within the scope of any registered nurse. The police, not a nurse, would be responsible for taking the client's statement.

Which is the most commonly identified issue preventing people from leaving an abusive relationship? Dependency Emotional immaturity Jealousy Possessiveness

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.

What assessment data, related to a 77 year old client, would be considered the highest risk for possible elder abuse? Lives with adult daughter Diagnosed with mild dementia Requires assistance with food preparation Widowed, female

Diagnosed with mild dementia Explanation: While the risk of elder abuse exists in all the options provided, such abuse is more likely when the elder client has chronic mental and/or physical health problems that limit there ability to express their concerns and/or describe their current living conditions.

A mental health nurse is interviewing a child for suspected abuse. The parent states that the child is having disciplinary problems at school and stutters when approached. From the listed behavioral indicators, the nurse would suspect which type of abuse? Physical Financial Emotional Sexual

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.