Chapter 26: The abused child

10. In addition to providing privacy, which of the following would be most appropriate initially in situations involving suspected abuse? A) Allow the client to have a good cry over the situation. B) Tell the client, Injuries like these dont usually happen by accident. C) Call the police immediately so they can question the victim. D) Ask the abuser to describe his side of the story first.

10. B

11. When the nurse is alone with a client, the client says, It was all my fault. The house was so messy when he got home and I know he hates that. Which response would be most appropriate? A) It is not your fault. No one deserves to be hurt. B) What else did you do to make him so angry with you? C) You need to start to clean the house early in the day. D) Remember, he works hard and you need to meet his needs.

11. A

12. When developing a presentation for a local community organization on violence, the nurse is planning to include statistics on intimate partner abuse and its effects on children. In what percentage of the cases in which a parent is abused are the children battered also? A) 50% to 75% B) 25% to 50% C) 10% to 25% D) Less than 5%

12. A

14. Teaching for victims who are recovering from abusive situations must focus on ways to: A) Enhance their personal appearance and hairstyle B) Develop their creativity and work ethic C) Improve their communication skills and assertiveness D) Plan more nutritious meals to improve their own health

14. C

15. During a follow-up visit to the clinic, a victim of sexual assault reports that she has changed her job and moved to another town. She tells the nurse, I pretty much stay to myself at work and at home. The nurse interprets these findings to indicate that the client is in which phase of rape recovery? A) Disorganization B) Denial C) Reorganization D) Integration

15. C

16. A nurse is assessing a rape survivor for post-traumatic stress disorder. The nurse asks the woman, Do you feel as though you are reliving the trauma? The nurse is assessing for which of the following? A) Physical symptoms B) Intrusive thoughts C) Avoidance D) Hyperarousal

16. B

17. A group of students are preparing a class discussion about rape and sexual assault. Which of the following would the students include as being most accurate? (Select all that apply.) A) Most victims of rape tell someone about it. B) Few women falsely cry rape. C) Women have rape fantasies desiring to be raped. D) A rape victim feels vulnerable and betrayed afterwards. E) Medication and counseling can help a rape victim cope.

17. B, D, E

18. After teaching a class on date rape, the instructor determines that the teaching was successful when the class identifies which of the following as the most common date rape drug? A) Gamma hydroxybutyrate B) Liquid ecstasy C) Ketamine D) Rohypnol

18. D

19. A nurse is caring for a woman who was recently raped. The nurse would expect this woman to experience which of the following first? A) Denial B) Disorganization C) Reorganization D) Integration

19. B

1. The nurse is presenting a class at a local community health center on violence during pregnancy. Which of the following would the nurse include as a possible complication? A) hypertension of pregnancy B) Chorioamnionitis C)Placenta previa D)Postterm labor

1. B

13. The primary goal when working with victims of intimate partner violence is to: A) Convince them to leave the abuser soon B) Help them cope with their life as it is C) Empower them to regain control of their life D) Arrest the abuser so he or she cant abuse again

13. C

4. A battered pregnant woman reports to the nurse that her husband has stopped hitting her and promises never to hurt her again. Which of the following is an appropriate response? A) Thats great. I wish you both the best. B) The cycle of violence often repeats itself. C) He probably didnt mean to hurt you. D) You need to consider leaving him.

4. B

9. Which of the following would the nurse describe as a characteristic of the second phase of the cycle of violence? A) The batterer is contrite and attempts to apologize for the behavior. B) The physical battery is abrupt and unpredictable. C) Verbal assaults begin to escalate toward the victim. D) The victim accepts the anger as legitimately directed at her.

9. B

____ 7. Which is a child factor that may increase the risk for abuse? 1) Substance abuse 2) Lack of respite care 3) Developmental delay 4) History of divorce

ANS: 3 1 Substance abuse is a parental factor that may increase the risk for abuse. 2 A lack of respite care is a parental factor that may increase the risk for abuse. 3 A developmental delay is a child factor that may increase the risk for abuse. 4 A history of divorce is an environmental factor that may increase the risk for abuse.

2. Which approach would be most appropriate when counseling a woman who is a suspected victim of violence? A) Offer her a pamphlet about the local battered womens shelter. B) Call her at home to ask her some questions about her marriage. C) Wait until she comes in a few more times to make a better assessment. D) Ask, Have you ever been physically hurt by your partner?

2. D

20. A group of nurses are researching information about risk factors for intimate partner violence in men. Which of the following would the nurses expect to find related to the individual person? (Select all that apply.) A) Dysfunctional family system B) Low academic achievement C) Victim of childhood violence D) Heavy alcohol consumption E) economic stress

20. B, C, D

21. A nurse is working with a victim of intimate partner violence and helping her develop a safety plan. Which of the following would the nurse suggest that the woman take with her? (Select all that apply.) A) Drivers license B) Social security number C) Cash D) Phone cards E) Health insurance cards

21. A, B, C, E

22. A nurse is presenting a discussion on sexual violence at a local community college. When describing the incidence of sexual violence, the nurse would identify that a woman has which chance of experiencing a sexual assault in her lifetime? A) One in three B) One in six C) Two in 15 D) Three in 20

22. B

23. After teaching a class on sexual violence, the instructor determines that the teaching was successful when the class identifies which of the following as a type of sexual violence. (Select all that apply.) A) Female genital cutting B) Bondage C) Infanticide D) Human trafficking E) Rape

23. A, B, C, D, E

24. A nurse is reading a journal article about sexual abuse. Which age range would the nurse expect to find as the peak age for such abuse? A) 710 years B) 812 years C) 1418 years D) 1822 years

24. B

25. After teaching a group of students about sexual abuse and violence, the instructor determines that the teaching was successful when the students describe incest as involving which of the following? A) Sexual exploitation by blood or surrogate relatives B) Sexual abuse of individuals over age 18 C) Violent aggressive assault on a person D) Consent between perpetrator and victim.

25. A

____ 4. Which clinical manifestation noted during a physical examination causes the nurse to suspect physical abuse? 1) Traumatic alopecia 2) Extremity fractures 3) Unilateral ecchymosis of the eye 4) Weight below the 10th percentile

ANS: 1 1 Traumatic hair loss (alopecia), in which hair is pulled from the scalp, is a clinical manifestation that causes the nurse to suspect physical abuse. 2 Spinal, not extremity, fractures are a clinical manifestation of physical abuse. 3 Bilateral, not unilateral, ecchymosis of the eye is a clinical manifestation of physical abuse. 4 Weight below the fifth, not the 10th, percentile is indicative of physical neglect.

3. When describing an episode, the victim reports that she attempted to calm her partner down to keep things from escalating. This behavior reflects which phase of the cycle of violence? A)Battering B)Honeymoon C)Tension-building D)Reconciliation

3. C

____ 10. Which is a component of constructing patient-centered goals when planning care for a school-aged patient who is being abused? 1) Family-centered 2) Past-oriented 3) Measurable 4) Based on medical principles

ANS: 3 1 Planning for child-centered, not family-centered, goals is a component of patient-centered nursing care for a child who is being abused. 2 Planning for future-centered, not past-centered, goals is a component of patient-centered nursing care for a child who is being abused. 3 Planning goals that are measureable is a component of patient-centered nursing care for a child who is being abused. 4 Goals included in a nursing plan of care should be focused on nursing, not medical, principles.

____ 9. Which is a priority nursing action when providing care to a school-aged child who is experiencing abuse? 1) Meeting the child's immediate psychological needs 2) Planning for the child's long-term physical needs 3) Earning the trust of the child's parents 4) Engaging the child in play to encourage expression of anxiety

ANS: 1 1 The priority nursing action when providing care to a school-aged child who is experiencing abuse is to meet the child's immediate physical and psychological needs. 2 Although planning for the child's long-term physical needs is important, the priority is to meet the child's immediate physical and psychological needs. 3 Although earning the trust of the child's parents is important, the priority is to meet the child's immediate physical and psychological needs. 4 Although engaging the child in play to encourage the expression of anxiety is important, the priority is to meet the child's immediate physical and psychological needs.

5. Which of the following nursing actions would be least helpful for a client who is a victim of violence? A) Assist the client to project her anger. B) Provide information about a safe home and crisis line. C) Teach her about the cycle of violence. D) Discuss her legal and personal rights.

5. A

6. When describing the cycle of violence to a community group, the nurse explains that the first phase usually is: A) Somehow triggered by the victims behavior B) Characterized by tension-building and minor battery C) Associated with loss of physical and emotional control D) Like a honeymoon that lulls the victim

6. B

7. Which of the following statements would be most appropriate to empower victims of violence to take action? A) Give your partner more time to come around. B) Remember children do best in two-parent families. C) Change your behavior so as not to trigger the violence. D) You are a good person and you deserve better than this.

7. D

8. When a nurse suspects that a client may have been abused, the first action should be to: A) Ask the client about the injuries and if they are related to abuse. B) Encourage the client to leave the batterer immediately. C) Set up an appointment with a domestic violence counselor. D) Ask the suspected abuser about the victims injuries

8. A

____ 16. Which circumstance requires the nurse to obtain assistance from local law enforcement when providing care to a child who is being abused? 1) For a child who is at risk for further abuse 2) For a child who is emotionally abused 3) For any child who is sexually abused 4) For any child who is physically neglected

ANS: 1 1 If the nurse believes that a child is at risk for further abuse, then it is a requirement to obtain assistance from local law enforcement. 2 The nurse is not required to obtain assistance from local law enforcement for a child who is emotionally abused. The nurse should report this to child protective services. 3 The nurse is not required to obtain assistance from local law enforcement for a child who is sexually abused. The nurse should report this to child protective services. 4 The nurse is not required to obtained assistance from local law enforcement for a child who is physically neglected. The nurse should report this to child protective services.

____ 15. Which is a nursing responsibility when providing care to a child who is being abused? 1) Filing a report with child protective services 2) Taking photographs of the child's injuries on a personal cell phone 3) Determining who is abusing the child 4) Washing a child who is being sexually abused upon arrival to the department

ANS: 1 1 The nurse is responsible for filing a report with child protective services within 24 hours of encountering a child suspected of being the victim of abuse. 2 Although photographs are often required for documentation purposes if a child is being abused, the photographs should not be taken with a personal cell phone. 3 It is not the nurse's responsibility to determine who is abusing the child. 4 The nurse should not wash a child who is suspected of being the victim of sexual abuse until after the collection of evidence occurs.

____ 18. Which factors associated with sexual abuse should the nurse include in an educational session regarding this topic? (Select all that apply.) 1) Anyone can be an abuser. 2) The middle daughter is often the victim. 3) Male victims are less likely to report the abuse. 4) Pedophiles often choose to work closely with children. 5) The perpetrator is typically someone the family does not know.

ANS: 1,3,4 1. This is correct. Anyone (e.g., father, mother, sibling, member of the extended family) can be an abuser. 2. This is incorrect. The eldest daughter, not the middle daughter, is most often the victim of sexual abuse. 3. This is correct. Male victims of sexual abuse are less likely to report it because of the social stigma. 4. This is correct. Pedophiles often choose to work in an environment where kids are typically found. 5. This is incorrect. The perpetrator of sexual abuse is typically someone who is known by the family

____ 12. The licensed practical nurse (LPN) notes annular ecchymosis on a school-aged child's back. The LPN is not sure if this is due to abuse or a cultural practice. Which is the priority action by the LPN? 1) Contacting child protective services 2) Asking the registered nurse to assist with the assessment 3) Instructing the parent to proceed to the waiting room for the remainder of the examination 4) Initiating a child life specialist consult for a more in-depth assessment of the current situation

ANS: 2 1 Although all cases of suspected child abuse should be reported by the LPN, this is not the priority action based on the current scenario. 2 An LPN who is unsure whether marks left on a child's skin are the result of abuse or a cultural care practice should seek assistance from a more experienced member of the health-care team, such as a registered nurse. This is the priority action when providing care. 3 The parent of a school-aged child should not be asked to proceed to the waiting room during the examination process. The priority nursing action is to determine the cause of the marks. 4 Although a child life specialist may be needed during the care of a child who is being abused, this is not the priority action in this situation. The priority nursing action is to determine the cause of the marks.

____ 3. Which child factor that contributes to abuse should the nurse assess for when abuse is suspected? 1) Low self-esteem 2) Temperament that is demanding 3) Stress that is chronic in nature 4) Poverty-level socioeconomic status

ANS: 2 1 Low self-esteem is a parental, not a child, factor that often contributes to abuse. The nurse should assess the parent for low self-esteem to determine the risk for child abuse. 2 A child's temperament, especially if demanding, is a risk factor for abuse. The nurse should assess the child's temperament to determine the risk for child abuse. 3 Chronic stress is an environmental, not a child, factor that often contributes to abuse. The nurse should assess the family's environment for chronic stress to determine the risk for child abuse. 4 Poverty is an environmental, not a child, factor that often contributes to abuse. The nurse should assess the family's socioeconomic status to determine the risk for child abuse.

____ 11. The nurse is providing care for a child of Asian descent who is experiencing an exacerbation of asthma. The nurse notes bruising on the child's back in the shape of a Christmas tree. Which question exhibits therapeutic communication when conducting the health history assessment on the basis of the current data? 1) "Why are you subjecting your child to this treatment?" 2) "Do you use spooning when caring for your child's breathing issues?" 3) "Have you ever been accused of abusing or neglecting your child?" 4) "Do you require a medical translator during the interview process?"

ANS: 2 1 This question is accusatory and judgmental and does not exhibit therapeutic communication by the nurse when conducting a health history assessment. 2 Many parents of Asian descent may implement cultural care practices in the treatment of chronic conditions such as asthma. Spooning, or coin rubbing, is an example of a practice that is not painful to the child and has cultural significance. This must be explored during the health history assessment to differentiate child abuse from cultural care practices. 3 This question is likely to put the parents on the offensive and is not open-ended, which decreases the likelihood of therapeutic communication during the health history assessment. 4 Although it is appropriate to determine the need for a medical translator, this question does not exhibit therapeutic communication by the nurse when conducting a health history assessment.

____ 8. Which pediatric patient is at increased risk for child abuse, necessitating a focused nursing assessment? 1) A 3-year-old child who is toilet-trained 2) A 1-year-old child who was born at 41 weeks' gestation 3) A 9-month-old child, born prematurely, who is diagnosed with reflux 4) A 10-year-old child who is active in sports and recently made the honor roll

ANS: 3 1 A 3-year-old patient who is toilet-trained does not have any risk factors associated with an increased risk for abuse. 2 A 1-year-old child born at 41 weeks' gestation does not have any risk factors associated with an increased risk for abuse. A history of prematurity, not postmaturity, is a risk factor for child abuse. 3 Both prematurity and a chronic condition such as gastroesophageal reflux are risk factors that increase a child's risk for abuse. 4 A 10-year-old child who is active in sports and recently made the honor roll does not have any risk factors associated with an increased risk for abuse

____ 2. Which is the most common form of child abuse around the world that the nurse should assess for when caring for children? 1) Physical 2) Emotional 3) Neglect 4) Sexual

ANS: 3 1 Although physical abuse is a form of child abuse, this is not the most prevalent form around the world. 2 Although emotional abuse is a form of a child abuse, this is not the most prevalent form around the world. 3 Neglect is the most prevalent form of child abuse seen around the world. There are two types, physical neglect and emotional neglect. 4 Although sexual abuse is a form of child abuse, this is not the most prevalent form around the world.

____ 17. Which are clinical manifestations of sexual abuse that the nurse should include when assisting with the assessment process? (Select all that apply.) 1) Radar gaze 2) Poor hygiene 3) Vaginal discharge 4) Positive chlamydia culture 5) Ecchymosis located on the inner thighs

ANS: 3,4,5 1. This is incorrect. Although a radar gaze is a clinical manifestation associated with abuse, it is not specific to sexual abuse. 2. This is incorrect. Poor hygiene is a manifestation associated with neglect, not sexual abuse. 3. This is correct. Vaginal discharge is a clinical manifestation associated with sexual abuse. 4. This is correct. A positive chlamydia culture, a sexually transmitted infection, is a clinical manifestation associated with sexual abuse. 5. This is correct. Ecchymosis, or bruising, located on the inner thighs is a clinical manifestation associated with sexual abuse

____ 20. Which individuals are mandatory reporters of child abuse? (Select all that apply.) 1) Parents 2) Grandparents 3) Childcare providers 4) Commercial film developers 5) Child protective services employees

ANS: 3,4,5 1. This is incorrect. Parents are not mandatory reporters of child abuse. 2. This is incorrect. Grandparents are not mandatory reporters of child abuse. 3. This is correct. Childcare providers are mandatory reporters of child abuse. 4. This is correct. Commercial film developers are mandatory reporters of child abuse. 5. This is correct. Child protective services employees are mandatory reporters of child abuse.

____ 19. Which factors associated with Munchausen syndrome by proxy should the nurse include in an educational session regarding this topic? (Select all that apply.) 1) The child is usually under the age of 10 years. 2) The child often displays symptoms during the hospitalization. 3) The child has had multiple hospitalizations in the medical history. 4) The perpetrator is usually the father with some knowledge of health care. 5) The claimed history is not supported by evidence found by health-care providers.

ANS: 3,5 1. This is incorrect. The child is often younger than 6, not 10, years of age. 2. This is incorrect. The child often does not display symptoms of illness during a hospitalization. 3. This is correct. The child typically has multiple hospitalizations in the medical history. 4. This is incorrect. The perpetrator is typically the mother, not the father, with some knowledge of health care. 5. This is correct. The claimed history of illness is typically not supported by evidence found by health-care providers.

____ 6. Which environmental influence should the nurse include when assessing a child's risk for abuse? 1) A history of cruelty to animals 2) A lack of follow-through for medical follow-up 3) The use of multiple health-care providers 4) The family frequently relocates to different geographical locations.

ANS: 4 1 A history of cruelty to animals is a parental, not an environmental, factor contributing to abuse. 2 A lack of follow-through for medical follow-up is a parental, not an environmental, factor contributing to abuse. 3 The use of multiple health-care providers is a parental, not an environmental, factor contributing to abuse. 4 Frequent relocations to different geographical locations is an environmental factor contributing to abuse

____ 13. The nurse suspects that a child is being sexually abused. Which nursing action is appropriate? 1) Using a personal cell phone to collect images for documentation 2) Asking a novice nurse to assist in the data collection 3) Reviewing institutional policy regarding reporting abuse to authorities 4) Bathing the child after the collection of evidence

ANS: 4 1 A personal cell phone should not be used to collect images for documentation purposes from a child who is being sexually abused. 2 The nurse should ask a more experienced nurse, not a novice nurse, to assist in data collection if uncomfortable with the process. 3 The pediatric nurse should be familiar with institutional policy regarding reporting abuse to the authorities. This is not the most appropriate nursing action. 4 A child who is sexually abused should not be bathed or washed until after the collection of evidence. This is an appropriate nursing action

____ 1. Which health-care provider is mandated by law to report suspected child abuse? 1) Baptist priest 2) Day-care provider 3) Basketball coach 4) Registered nurse

ANS: 4 1 Although clergy, such as a Baptist priest, is mandated to report suspected child abuse, this individual is not a health-care provider. 2 Although a day-care provider is mandated to report suspected child abuse, this individual is not a health-care provider. 3 Although a basketball coach is mandated to report suspected child abuse, this individual is not a health-care provider. 4 All persons involved with the care of the child will be held responsible in assessing and reporting any actual or suspected symptoms or signs of child abuse. These include nurses, physicians, social workers, and anyone involved with the care of the child.

____ 14. Which is a behavioral indicator of abuse when providing care to a pediatric patient? 1) Ecchymosis 2) Rash 3) Vaginal discharge 4) Radar gaze

ANS: 4 1 Ecchymosis, or bruising, is a physical indicator of abuse. 2 A rash is a physical indicator of abuse. 3 Vaginal discharge is a physical indicator of abuse. 4 A radar gaze, when the child is constantly surveying the environment for the onslaught of further abuse, is a behavioral indicator of abuse.

____ 5. Which percentage of reported cases of child abuse in the United States reflects child neglect? 1) 12% 2) 16% 3) 24% 4) 52%

ANS: 4 1 The rate of reported cases of sexual abuse, not neglect, is 12%. 2 The rate of reported cases of other types of abuse, not neglect, is 16%. 3 The rate of reported cases of physical abuse, not neglect, is 24%. 4 The rate of reported cases of child neglect is 52% in the United States