health Chapt 9 Violence and Abuse(nclex)

When screening a patient about intimate partner violence, which types of questions should the nurse employ? a) Direct or indirect questions b) Direct questions, like "Does your partner harm you?" c) Indirect questions, like "Do you feel safe in your home?" d) Neither direct nor indirect questions

Direct or indirect questions Correct Explanation: When interviewing a patient about intimate partner violence, direct questioning and indirect questioning elicit the same answers. Either direct or indirect questions can be used.

Which of the following is TRUE regarding intimate partner violence? a) Women who are in an abusive relationship experience less abuse while they are pregnant. b) One in four women will be a victim of violence. c) Even though women seldom blame themselves for the abuse, they often cannot leave the relationship. d) Abusers often have outward signs that they are abusers or have a mental illness.

One in four women will be a victim of violence. Explanation: Approximately 20% to 30% of women will be a victim of violence. Women experience an increase in violence during pregnancy. Abusers often have no outward signs that they are abusers or have a mental illness. Women usually blame themselves and feel they cannot leave the relationship.

The nurse is assisting a woman who is a victim of intimate partner violence in preparing a plan for leaving the relationship. Which of the following instructions would the nurse include? Select all that apply. a) "Set up a specific plan for leaving and then practice it." b) "Get some phone cards that you can use to make the necessary calls." c) "Be sure to have some type of identification, like a photo ID or driver's license." d) "Don't worry about your clothes; just get yourself out right away." e) "Take the deed to the house or your apartment lease with you."

• "Be sure to have some type of identification, like a photo ID or driver's license." • "Take the deed to the house or your apartment lease with you." • "Set up a specific plan for leaving and then practice it." Explanation: When leaving an abusive relationship, a victim should take with her a driver's license or photo ID, the deed to the house or apartment lease, and a change of clothes for herself and her children. She should develop a game plan for leaving and then rehearse it. The woman should not use phone cards because they can leave a trail the abuser can follow.

Which of the following would be considered child abuse? Select all that apply. a) A caregiver intentionally is demeaning to a child. b) A caregiver allows siblings to talk inappropriately to each other. c) A caregiver lets a child participate in school activities and the child gets injured. d) A caregiver neglects a child's physical needs.

• A caregiver intentionally is demeaning to a child. • A caregiver neglects a child's physical needs. Explanation: The term child abuse has come to mean any intentional act of physical, emotional, or sexual abuse, including acts of negligence, committed by a person responsible for the care of the child.

A patient who has been seen in the clinic multiple times for counseling recently admitted to being abused by her husband over a period of five years. Today she states, "He has been so sweet to me the last six days that I think this time he has really changed. He even brought me flowers yesterday and said he loves me." How should the nurse respond to this? a) Over a period of time the honeymoon phase ends and abuse becomes accelerated and thus more dangerous. b) I certainly would not be sucked into that. c) It seems as if he really loves you. d) That was a very sweet gesture.

Over a period of time the honeymoon phase ends and abuse becomes accelerated and thus more dangerous. Correct Explanation: The cycle of abuse can cover a long period of time. Abuse in relationships typically becomes accelerated over time and thus more dangerous. The woman needs to know that this is normal behavior for an abuser: his actions are not going to change and this time will be no different from all the other times.

A nurse is performing a routine physical for a 7-year-old girl who is thin, unwashed, and dressed in rags. Although it is winter time, she has no coat with her. Her teenaged brother in the waiting room, however, is dressed in trendy clothes and looks healthy and well-fed. Which of the following should the nurse most strongly suspect regarding this girl? a) Physical maltreatment b) Sexual maltreatment c) Psychological maltreatment d) Physical neglect

Physical neglect Correct Explanation: Physical neglect is a more subtle form of maltreatment than physical maltreatment, but it can be just as damaging to a child's welfare. A neglected child may appear unwashed, thin, and malnourished or be dressed inappropriately, such as without mittens, a coat, or shoes in cold weather. In some families, no one has a warm coat to wear or receive enough food because there is no money for these things; that is different from the family in which parents do have these things, but the children or one particular child does not. There is no evidence in this scenario of physical, sexual, or psychological maltreatment, although they could be present.

The generation-to-generation continuum of violence refers to the fact that a) Children who grow up in abusive homes almost always become abusers themselves unless they have professional intervention b) Violence is a learned behavior, and children who witness abuse are more likely to become abusers themselves c) Children who grow up in an abusive home are less likely to be abusers themselves because they see first hand the devastation that violence can cause d) Violence is an innate behavior, and children become abusers because of external factors in their environment more often than in their family

Violence is a learned behavior, and children who witness abuse are more likely to become abusers themselves Explanation: Violence is a learned behavior. Many abusers were abused themselves as children; however, not all children who were abused become abusers.

The nurse is interviewing the caregiver of a 5-year-old child who has been admitted with bruises on the abdomen and thighs as well as additional bruises in various stages of healing. Which of the following statements made by the caregiver might alert the health care team to the possibility of child abuse? a) "When he is in trouble I make him go to his room." b) "His brother just plays too rough with him." c) "He just learned to ride his bicycle." d) "My child goes to daycare after school."

"His brother just plays too rough with him." Correct Explanation: When a child is brought to a physician or hospital because of physical injuries, family caregivers may attribute the injury to some action of the child's that is not in keeping with the child's age or level of development. The caregiver may also attribute the injury to an action of a sibling. When the child's symptoms do not match the injury that the caregiver describes, be alert for possible abuse. The other statements might be normal situations for a 5-year-old and would not necessarily alert the nurse to a possibility of child abuse.

A woman has just confided in the nurse that her partner slapped and kicked her that morning. What is the best response by the nurse? a) "Oh my goodness, I cannot believe that happened to you. You poor thing, I feel terrible for you." b) "It's very brave of you to tell me all this. Help is available if you choose it." c) "Maybe he didn't mean to do it. Have you talked with him about it?" d) "Is this the first and only time he has done anything?"

"It's very brave of you to tell me all this. Help is available if you choose it." Correct Explanation: When talking with a woman who is a victim of intimate partner violence, it is important not to uses expressions of emotionality or judgement such as, "Oh my goodness" or "I feel terrible for you." It is also important to validate the victim's story and tell her you believe what happened. Encouraging her to say more while informing her that help is available is the best therapeutic answer.

The nurse is caring for a group of children on the pediatric unit. The nurse should collect further data and explore the possibility of child abuse in which of the following situations? a) A 7-year-old with a spiral fracture of the humerus, which the caregiver reports was caused when the child was hit with a bat swung by a Little League teammate b) A 6-year-old with a greenstick fracture of the wrist, which the caregiver reports was caused when the child fell while ice-skating c) A 9-year-old with a compound fracture of the tibia, which the caregiver reports was caused when the child attempted a flip on a skateboard d) A 10-year-old with a simple fracture of the femur, which the caregiver reports was caused when the child fell down a set of stairs

A 7-year-old with a spiral fracture of the humerus, which the caregiver reports was caused when the child was hit with a bat swung by a Little League teammate Explanation: The bones most commonly fractured in childhood are the clavicle, femur, tibia, humerus, wrist, and fingers. The classification of a fracture reflects the kind of bone injury sustained. A spiral fracture, which twists around the bone, is frequently associated with child abuse, and is caused by a wrenching force. A greenstick fracture is one kind of incomplete fracture common in children due to incomplete ossification. When a broken bone penetrates the skin, the fracture is called compound, or open. A simple, or closed, fracture is a single break in the bone without penetration of the skin.

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) A risk for moderate to severe violence with people both within and outside his family b) Symptoms of depression along with harboring feelings of inadequacy c) Intermittent remorse for the violence and abuse that he commits d) Purposefully remain socially isolated from people other than those in his family

A risk for moderate to severe violence with people both within and outside his family Correct 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 predisposes them to interpret social situations as threatening and to respond with emotional dysregulation, verbal attacks, and physical violence.

A nurse is performing a physical examination of a pregnant woman. As she is examining her, she notices a bruise on her abdomen. Which of the following should the nurse do? a) Ask the client to account for the bruise b) Make a note in the patient's chart regarding the finding and plan to observe for other signs of abuse in the future c) Assume that the bruise is from intimate partner violence and call the police while the patient is still with you d) Assume that the bruise is from an accident and not worry about it

Ask the client to account for the bruise Correct Explanation: As many as 20% to 30% of women seen in emergency departments are there because they have been maltreated by their intimate partner. Common injuries suffered include burns, lacerations, bruises, and head injuries. Asking all women at physical examinations to account for any bruise they have helps detect physical maltreatment. The nurse should not assume that the bruise is just the result of an accident or that it is the result of intimate partner violence; she should question the client to learn more. Depending on how the client responds, it may be appropriate to make a note in the patient's chart or to take some other action to help protect the client.

A nurse is assessing a boy who was recently found to have been molested by a neighbor. Which of the following characteristics is most likely in a pedophile? a) Emotional fixation at a childhood level b) Physically abusive c) Homosexual d) Violent

Emotional fixation at a childhood level Explanation: Molestation is a vague term that includes "indecent liberties" such as oral-genital contact, genital fondling and viewing, or masturbation. A pedophile is an adult who seeks out prepubescent children (Tanner stage 0-1, usually under age 12 years) for sexual gratification, whereas a hebephile seeks out pubescent children (Tanner stage 1-4, usually age 11 to 15). In contrast to a rapist, whose crime is violent, both pedophiles and hebephiles may be very gentle and limit the involvement to molestation. The relationship may involve people with either homosexual or heterosexual orientations. Rehabilitation of pedophiles/hebephiles is difficult because they are fixated emotionally at a childhood level (seeing themselves as children, they do not perceive relationships with children as wrong).

The nursing instructor is discussing violence and abuse that is seen in women with a student. She realizes that the student needs further instruction when the student states which of the following? a) Nurses only come in contact with violence in the ER. b) Nurses will come in contact with violence no matter what health care setting they work. c) Nurses will come in contact with sexual abuse no matter what health care setting they work. d) Violence against women is on the rise in the United States.

Nurses only come in contact with violence in the ER. Correct Explanation: All the statements are true except for the one that says nurses will only come in contact with violence in the ER. They will see both violence and sexual abuse in all settings.

In caring for a child who has been admitted after being sexually abused, which of the following interventions would be included in the child's plan of care? a) Test the urine for glucose upon admission b) Observe for signs of anxiety c) Encourage frequent family visits d) Weigh on the same scale each day

Observe for signs of anxiety Correct Explanation: The child who has been sexually abused may exhibit anxiety, acts of aggression or hostility, or have physical complaints regarding various aches and pains, gastrointestinal upsets, changes in bowel and bladder habits (including enuresis), or nightmares. In cases of incest it is important that the perpetrator not be allowed to visit the child. Weighing the child and testing urine for glucose are not indicated for a child who has been sexually abused.

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) Suicide risk b) Hydration status c) Nutritional status d) Sleep patterns

Suicide risk Explanation: Although physiologic areas such as nutrition, hydration, and sleep are important areas to assess, for clients with posttraumatic stress disorder, depression is a common symptom. Thus, a thorough assessment of suicide intent is critical.

If the following data was collected on a group of children, which of the following would most likely be evaluated as possibly related to child abuse? Select all that apply. a) A child whose blood work shows evidence of anemia. b) A child who has chronic nausea and diarrhea. c) A child whose X-ray shows bone fractures in various stages of healing. d) A child whose CT scan shows a cerebral hemorrhage. e) A child who has a spiral fracture in the femur.

• A child whose X-ray shows bone fractures in various stages of healing. • A child whose CT scan shows a cerebral hemorrhage. • A child who has a spiral fracture in the femur. Correct Explanation: Signs or possible evidence of child abuse can be further evaluated by the use of technology. On a radiograph, bone fractures in various stages of healing may be noted. Spiral fractures of the long bones of a young child are not common, and their presence might indicate possible abuse. Children who have been harshly shaken may not show a clear picture of abuse, but computed tomography may demonstrate cerebral edema or cerebral hemorrhage.

The nurse is performing a physical examination of a 5-year-old boy. Which of the following findings would most strongly indicate maltreatment of the child? (Select all that apply.) a) Burns on the dorsal surface of the hand b) A scab on the child's elbow c) Linear lesions across the chest and abdomen d) A curved laceration on the back e) Cuts and bruises on the hands f) A bruise on the child's knee

• Cuts and bruises on the hands • Burns on the dorsal surface of the hand • A curved laceration on the back • Linear lesions across the chest and abdomen Explanation: Several injuries in children clearly signal probable child maltreatment. Children who are maltreated have a higher incidence of hand injury. Children who are beaten with electrical cords, belts, or clotheslines have peculiar circular and linear lesions. Children who are beaten with a belt buckle may have additional curved lacerations from the imprint of the buckle; few other objects produce such contusions. When children burn their hand by accident, they usually burn the palm; burns from maltreatment are often on the dorsal surface. However, it is normal for preschoolers who actively play to have bruises on multiple bony spots (shin, elbows, knees, etc.).

A community health nurse is speaking at a local Chamber of Commerce luncheon on women's issues related to abuse. Some of the myths about violence that she needs to address are which of the following? (Check all that apply.) a) Women provoke their partners to abuse them. b) Battering of women occur only in lower socioeconomic classes. c) Violence occurs to only a small percentage of women. d) Women stay in the abused relationship because they feel they have no options. e) Substance abuse causes the violence.

• Women provoke their partners to abuse them. • Battering of women occur only in lower socioeconomic classes. • Violence occurs to only a small percentage of women. • Substance abuse causes the violence. Correct Explanation: Common nyths about violence that the nurse needs to denounce refute include that battering of women occurs in lower socioeconomic classes, that substance abuse causes the violence, that violence occurs to only a small percentage of women, and that women provoke their partners to abuse them. The statement that women stay in an abused relationship because they feel they have no options is factual.

The nurse who has experience in caring for women who have been abused knows that goals for a patient of abuse may fall into which of the following categories? (Check all that apply.) a) primary prevention b) secondary prevention c) tertiary prevention d) none of the above

• primary prevention • secondary prevention • tertiary prevention Explanation: Depending on when in the cycle of violence the nurse encounters the abused woman, goals may fall into three groups: primary, secondary and tertiary. Primary is aimed at breaking the cycle of abuse, secondary focuses on dealing with the victims and abusers in early stges with goal of preventing progression and tertiary is geared toward helping severely abused women recover and become productive members of society.

It is important for a nurse working in pediatrics to understand problems that children face when they have grown up around abuse. Studies indicate that children who witness intimate partner violence are at risk for developing which of the following? (Check all that apply.) a) psychiatric disorders b) school failures c) failure to thrive syndrome d) developmental problems e) violence against others f) low self-esteem

• psychiatric disorders • developmental problems • school failures • violence against others • low self-esteem Explanation: Children who witness initmate partner violence are at risk for developing psychiatric problems, developmental problems, school failure, violence against others, and low self-esteem. It has not been proven that these children will suffer from failure-to-thrive syndrome.

The nurse who works in a woman's health clinic correctly identifies two key objectives for 2020 National Health Goals that addresses violence against women as which of the following? (Check two.) a) reduce the annual rate of rape or attempted rape b) increase the rate of women's consumed calories c) increase the rate of women's depression d) reduce the rate of physical assault by current or former intimate partners

• reduce the annual rate of rape or attempted rape • reduce the rate of physical assault by current or former intimate partners Correct Explanation: The two objectives are to reduce the rate of physical assault by current or former intimate partners and to reduce the annual rate of rape or attempted rape. It would be desirable to decrease the rate of depression in women as well as decrease their caloric intake due to the high incidence of obesity, but this is not a goal of 2020 National Health Goals.

The nurse is aware of three different phases in the cycle of violence. Which of the following is not one of those phases? a) A battering incident. b) A "honeymoon" phase. c) A tension-building phase. d) A hopeless stage.

A hopeless stage. Correct Explanation: Women abused by their intimate partners appear hopeless. They often exhibit behaviors that demonstrate depression and ambivalence toward their abuser. However, hopelessness is not part of the cycle of violence. With the cycle of violence there is often a pattern: a tension-building phase, a battering incident, and a "honeymoon" phase.

When providing care to a victim of abuse, which of the following would the nurse do? a) Make the decisions for the woman. b) Provide an overview of the procedures to be done. c) Allow the woman to participate in her care. d) Take the lead in providing the interventions quickly.

Allow the woman to participate in her care. Correct Explanation: Active participation in care is critical because it promotes feelings of control. The victim should be allowed to actively participate in her care and decision making. The nurse should offer step-by-step explanations of procedures to alleviate her fears and to demonstrate a caring attitude. The nurse should let the woman set the pace of the nursing interventions.

Which type of elder abuse involves harm of self-worth? a) Neglect b) Abandonment c) Physical d) Emotional

Emotional Correct 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).

Which of the following is FALSE regarding emergency contraception (EC)? a) EC works by preventing fertilization, ovulation, or implantation. b) EC is most effective if it is taken within 12 hours of rape. c) EC will disrupt an established pregnancy if taken within 72 hours. d) EC simply contains the same hormones that are found in birth control pills.

EC will disrupt an established pregnancy if taken within 72 hours. Explanation: Emergency contraception will not disrupt an established pregnancy.

A nursing student studying sexual violence makes the following statement in class, "A man who has sex with his wife even though she did not want it cannot be charged with sexual abuse." Is this statement true or false? a) True b) False

False

Which of the following situations should the nurse investigate further for suspected intimate partner violence? a) The patient states "I let my husband control our finances, I am really bad with money." b) The significant other has not attended any prenatal visits with the patient c) The patient is experiencing labor pain and the significant other has not left her side d) The patient consistently looks at the significant other before answering any questions

The patient consistently looks at the significant other before answering any questions

Homicide from intimate partner violence is the number-one cause of death in pregnant women. a) False b) True

True Correct Explanation: The rate of this is so high during pregnancy, homicide from intimate partner violence is the number-one cause of death in pregnant women, a finding that probably occurs because stress can be a trigger to violence, and pregnancy, with all that an expected new child entails (another mouth to feed, body to clothe, or dependent to protect), can increase stress.

Which of the following is FALSE regarding screening for intimate partner violence in women? a) An elderly female may be a victim of intimate partner violence. b) Screening should be routinely done at every visit. c) Although women who are abused may exhibit certain behavior patterns, all women should be screened for intimate partner violence. d) Women tend to fit a profile of abuse, and victims tend to share similar physical characteristics.

Women tend to fit a profile of abuse, and victims tend to share similar physical characteristics. Correct Explanation: Women do not typically fit a physical profile, and any woman can be a victim of abuse. Therefore, all women, even elderly women, should be screened at every visit.

A patient with multiple bruises comes to the clinic for treatment. She appears withdrawn and quiet when the nurse approaches her. Her husband accompanies her to the exam room and begins to answer all the questions the nurse asks the patient. What should the nurse suspect? a) The patient must be a quiet person. b) an abusive relationship c) nothing d) a loving relationship

an abusive relationship Correct Explanation: One major indicator of abuse is the hovering behavior of the male partner during a visit. The patient also has multiple bruises and is very quiet. Something is definitely going on and this scenario does not indicate a loving relationship.

A young woman is seen in the ER with multiple bruises and two black eyes. She states that she tripped and fell down a flight of stairs and feels embarrassed. The nurse suspects abuse, but no abuse is reported because the physician states, "She is married to a prominent lawyer who is a good friend of mine and I know he would never do this." What is wrong with this scenario? a) It should be investigated as abusers come from all walks of life. b) The physician knows best. c) The nurse should not get involved after what the physician said. d) Nothing, the patient probably did fall down the steps.

It should be investigated as abusers come from all walks of life. Correct Explanation: All of the options are definitely wrong except for the one that says abusers come from all walks of life and they often feel insecure, powerless, helpless feelings that are not in line with the macho image they would like to project. In this case the physician neglected his duty to report, as did the nurse.

Which of the following is not linked to domestic violence in pregnancy? a) Placental abruption b) Psychological disorders c) Delayed prenatal care d) Substance abuse e) Post-term deliveries

Post-term deliveries

The nurse working in the obstetrics clinic has been trained to pick up on warning signs of abuse during pregnancy. These include which of the following?(Select all that apply.) a) poor attendance at prenatal visits b) difficulty with physical exams c) weight fluctuations d) unrealistic fears e) noncompliance with treatment f) more weight gain than recommended

• poor attendance at prenatal visits • unrealistic fears • weight fluctuations • difficulty with physical exams • noncompliance with treatment Explanation: Signs of abuse can emerge during pregnancy. They may include poor attendance at prenatal visits, unrealistic fears, weight fluctuations, difficulty with physical exams, and noncompliance with treatment. Gaining more weight than recommended is not an indicator of abuse.

As part of a local college awareness program, a nurse is interviewing several of the participants about their views on rape. Which statement would lead the nurse to determine that teaching about rape is necessary?

"A woman can avoid being raped. If she doesn't want it to happen, then it won't." Correct Explanation: Women can be forced and overpowered by most men. The majority of women who are raped never tell anyone about it, and almost two thirds of victims never report it to the police. No victim invites sexual assault, and what she wears is irrelevant. It can take several years for a woman to recover from rape. Medications can help initially, but counseling is necessary.

The nursing student is studying violence and abuse against the older woman. While researching it, she learns that laws require health care professionals to report elder or vulnerable person abuse. How many states currently have these laws? a) 32 b) 52 c) 50 d) 40

50 Correct Explanation: All fifty states have laws requiring health care professionals to report elder or vulnerable person abuse.

What is the leading cause of death in pregnant women? a) Intimate partner violence b) Amniotic fluid embolism c) Pulmonary embolism d) Undiagnosed cardiac condition

Intimate partner violence Explanation: Homicide as a result of partner abuse is the number one killer of pregnant women.

When a pregnant patient is abused during her pregnancy what complication is likely to occur after delivery due to the abuse? a) low birth weight b) post-partum depression c) edema d) schizophrenia

post-partum depression Correct Explanation: Several studies have confirmed the relationship between abuse and poor mental health, especially depression. For the pregnant woman, this most often manifests itself as post-partum depression.

The nursing instructor is teaching about violence and informs the students that its three cycles and include which of the following? (Check three.) a) courting phase b) tension-building phase c) pre-honeymoon phase d) honeymoon phase e) acute battering phase

• tension-building phase • honeymoon phase • acute battering phase Correct Explanation: In an abusive relationship, the cycle of violence comprises 3 distinct phases: the tension building phase, the acute battering phase, and the honeymoon phase.

Nurses at an urban emergency department seek to develop a plan to help women involved in abusive relationships. Which of the following components is critical to the success of the plan? a) Avenues for referral b) An intimate partner violence (IPV) counselor c) Educational materials d) A quality of life assessment tool

Avenues for referral Correct Explanation: Nurses assume their appropriate role in the effort to screen and treat victims of IPV through simple screening and having readily available information and avenues for referral.

A first year nursing student is learning how to differentiate between the two types of violence against women: intimate partner violence and sexual abuse. She learns that intimate partner violence includes which of the following? a) dating, cohabitating, or marital relationships b) stranger off the street c) neighbor d) working associate

dating, cohabitating, or marital relationships Correct Explanation: Intimate partner violence includes individuals who are currently in dating, cohabitating, or marital relationships, or those who have been in such relationships in the past.

A 16-year-old girl is seen in an emergency room following a rape. The management of a rape victim should be directed primarily toward a) assessing for sources of infection resulting from the rape. b) decreasing guilt and increasing self-esteem. c) relieving physical discomfort and pain. d) teaching the child how to prevent further attacks.

decreasing guilt and increasing self-esteem. Explanation: Rape is a demeaning event in a person's life. Helping maintain self-esteem in the face of this is important.

Which of the following would the nurse identify as indicating emotional abuse? Select all that apply. a) Throwing things at a victim b) Threatening to hit the victim c) Forcing the victim to perform a degrading act d) Calling the victim names e) Controlling how the family's money is spent f) Not allowing the victim to seek care for an injury

• Threatening to hit the victim • Forcing the victim to perform a degrading act • Calling the victim names Correct Explanation: Calling the victim names; promising, swearing, or threatening to hit the victim; and forcing the victim to perform degrading or humiliating acts are examples of emotional abuse. Throwing things at the victim is an example of physical abuse. Controlling the finances and spending is an example of financial abuse. Interfering with a victim's access to health care for injuries is an example of physical abuse.

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? a) "He threw me against the wall and started punching my face." b) "He calls me stupid and incompetent, asking himself why he ever married me." c) "He yells at me for not having dinner waiting for him when he came home." d) "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." Correct Explanation: During phase 3 of the cycle, the perpetrator becomes kind, contrite, and loving, begging for forgiveness and promising never to inflict abuse again until the next time. 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.

A nurse is presenting a program to a church group about domestic violence. During the presentation, a member of the audience asks the nurse to explain what "intergenerational transmission of violence" means because he has seen that phrase used in the media. Which of the following responses by the nurse would be most appropriate? a) "Recent research has identified a gene that is responsible for transmission of a risk for violent behavior that is passed on from generation to generation." b) "People who are violent are that way because of the various neurochemical imbalances in their brains." c) "People who grow up in violent home situations tend to be involved in domestic violence situations as an adult." d) "Domestic violence seems to skip every other generation when it is traced in families."

"People who grow up in violent home situations tend to be involved in domestic violence situations as an adult." Correct Explanation: Violent families create an atmosphere of tension, fear, intimidation, and tremendous confusion about intimate relationships. Children in violent homes often learn violent behavior as an approved and legitimate way to solve problems, especially within intimate relationships. Social learning or intergenerational transmission of violence theory posits that children who witness violence in their homes often perpetuate violent behavior in their families as adults. Moreover, children who grow up in violent homes learn to accept violence and expect it in their own adult relationships. Neurochemical imbalances, genetics, or skipping generations are unrelated to this theory.

A nurse is giving a talk on violence against women to a community group and informs the attendees that violence is growing in the United States today. The nurse informs them of which alarming statistic? a) Fewer then 1/3 of all U.S. women will experience some form of physical violence in their lifetimes. b) 1/3 to 1/2 of all U.S. women will experience some form of physical violence in their lifetimes. c) 1/2 to 3/4 of all U.S. women will experience some form of physical violence in their lifetimes. d) 1/4 to 1/3 of all U.S. women will experience some form of physical violence in their lifetimes.

1/3 to 1/2 of all U.S. women will experience some form of physical violence in their lifetimes. Explanation: Statistics prove that violence against women is increasing; 1/3 to 1/2 of all U.S. women will experience some form of physical violence in their lifetimes.

When teaching a group of students about the cycle of violence, which behavior would the nurse describe as eventually disappearing as the violence becomes accelerated over time? a) Apologies for the pain and abuse b) Denial of the seriousness of the injuries c) Excessive hostility and friction d) Loss of control

Apologies for the pain and abuse Correct Explanation: As the violence increases in frequency and severity over time, the honeymoon phase gradually shortens and eventually disappears altogether. The abuser no longer feels the need to apologize and indulge in a honeymoon phase as the woman becomes increasingly disempowered by the relationship.

A pregnant client and her husband are at their first prenatal visit. While performing the admission history, the nurse notes several new and old bruises on the woman's neck and body. She is silent and withdrawn. The husband answers all the questions. Based on these observations, the nurse suspects intimate partner violence. Which of the following is the most appropriate nursing intervention at this time? a) Ask the husband to wait in the lobby while the client is being examined. b) Ask the couple if they would like to see a social worker. c) Ask the woman if she would like her husband to wait outside in the lobby. d) Ask the husband if he feels the client has been depressed throughout the pregnancy.

Ask the husband to wait in the lobby while the client is being examined. Correct Explanation: Abusers commonly isolate their partners to maintain control. Pregnancy and birth are trigger points for intimate partner abuse, because they may cause abusers to experience a sense of loss of control. The health care visit may be the only opportunity a victim has to communicate her problems to others. It is important to assess the woman apart from the potential abuser to further explore the suspicions. Asking the potential abuser to wait in another room helps the nurse achieve this goal. It is not appropriate to direct questions toward the husband; by doing so, the nurse may imply a lack of support for the woman. It is not appropriate to consult a social worker at this stage and may encourage further abuse if the abuser suspects that the woman may have disclosed this type of information. Asking the woman if she would like the spouse to wait outside may shut down the opportunity out of her fear of being disloyal.

A nurse is assigned to care for a hospitalized 14 year old with gastroenteritis. The teen tells the nurse that a brother ran away about 2 months ago and hasn't been heard from since, a sister has a substance abuse problem, and both parents are fighting. What type of situation is this family displaying? a) Impaired parenting b) Child neglect c) Dysfunctional dynamics d) Child abuse

Dysfunctional dynamics Correct Explanation: A dysfunctional family that cannot resolve and work through stresses in a positive, socially acceptable manner. Families often face multiple pressures at the same time; this dynamic creates additional stress and adds to the risk of dysfunctional coping.

A nurse is assessing a boy who was recently found to have been molested by a neighbor. Which of the following characteristics is most likely in a pedophile? a) Violent b) Emotional fixation at a childhood level c) Physically abusive d) Homosexual

Emotional fixation at a childhood level Correct Explanation: Molestation is a vague term that includes "indecent liberties" such as oral-genital contact, genital fondling and viewing, or masturbation. A pedophile is an adult who seeks out prepubescent children (Tanner stage 0-1, usually under age 12 years) for sexual gratification, whereas a hebephile seeks out pubescent children (Tanner stage 1-4, usually age 11 to 15). In contrast to a rapist, whose crime is violent, both pedophiles and hebephiles may be very gentle and limit the involvement to molestation. The relationship may involve people with either homosexual or heterosexual orientations. Rehabilitation of pedophiles/hebephiles is difficult because they are fixated emotionally at a childhood level (seeing themselves as children, they do not perceive relationships with children as wrong).

Which of the following are biologic indicators of posttraumatic stress disorder (PTSD)? a) A feeling of unreality about oneself b) Auditory hallucinations c) Memory difficulties d) Flashbacks

Flashbacks Explanation: Biologic indicators, such as elevated pulse and blood pressure, sleep and appetite disturbances, exaggerated startle responses, flashbacks, and nightmares, may suggest PTSD or depression. Signs and symptoms of dissociation include memory difficulties, a feeling of unreality about oneself or events, a feeling that a familiar place is strange and unfamiliar, auditory and visual hallucinations, and evidence of having done things without remembering them.

A caregiver who works in the hospital brings his 9-year-old son to the emergency room with a spiral fracture of the tibia. The caregiver reports that the injury occurred when the boy's 5-year-old sister hit him with wooden bat. The injury is inconsistent with an impact and with the sister's strength. Which of the following would be appropriate for the nurse to do in this situation? a) Let the hospital administrator know so that the hospital can take any necessary action. b) Leave the treatment area and call the police. c) Leave the treatment area and call the social services department in the hospital. d) Tell the caregiver that the story is not plausible and ask what really happened.

Leave the treatment area and call the social services department in the hospital. Correct Explanation: Abusive parents can be found at all socioeconomic levels. When a child is brought to a physician or hospital with abuse injuries, family caregivers may attribute the injury to an action of a sibling. Whenever the child's symptoms do not match the injury the caregiver describes, be alert for possible abuse. State laws require health care personnel to report suspected child abuse. This requirement overrides the concern for confidentiality. Laws have been enacted that protect the nurse who reports suspected child abuse from reprisal by a caregiver (e.g., being sued for slander) even if it is found that the child's situation is not a result of abuse. If the nurse does not report suspected child abuse, the penalty can be the loss of the nursing license. Do not accuse the caregiver before a complete investigation takes place.

A pregnant client discloses to the nurse that she has been abused by her husband for the past 4 years. Which of the following is true regarding violence against pregnant women? a) Partner abuse may increase during pregnancy. b) Partner abuse in pregnant women is rare. c) Alcohol and substance abuse always cause abusive behavior. d) It occurs most frequently in lower socioeconomic and minority groups.

Partner abuse may increase during pregnancy. Correct Explanation: Pregnancy and birth are trigger points for intimate partner abuse (IPA), because the abuser may experience a sense of loss of control. During pregnancy, the mother and fetus take priority, and the abuser attempts to maintain or regain control by abusing the woman. IPA occurs in families of all social, economic, educational, racial, and religious backgrounds. Many women experience IPA; it is a common problem. Substance abuse and violence against women are two separate problems. Substance abuse is a disease, but violence is a learned behavior. Alcohol and drugs do not always lead to abuse.

A patient who is abused fails to report the abuse MAINLY because of which of the following reasons? a) She feels lucky to be alive. b) She feels responsible for causing the incident. c) She does not want anyone to know. d) She thinks it will not happen again.

She feels responsible for causing the incident. Explanation: The honeymoon phase prevents many women from reporting abuse. The victim wants to believe tht her partner can really change and she feels responsible, at least in part, for causing the incident and feels responsible for her partner's well-being.

The nurse is assisting with a physical exam on a child who has been admitted with a diagnosis of possible child abuse. Which of the following findings might alert the nurse to this possibility that the child may have been abused? a) The child has bruises on the knees and elbows. b) The child has a fractured bone. c) The child is hyperactive and angry. d) The child has a burn that has not been treated.

The child has a burn that has not been treated. Correct Explanation: Burns are a common type of injury seen in the abused child. Although burns may be accidental in young children, certain types of burns are highly suspicious. Cigarette burns, or burns from immersion of a hand in hot liquid, from a hot register (as evidenced by the grid pattern), from a steam iron, or from a curling iron are common abuse injuries. Caregivers have been known to immerse the buttocks of a child in hot water if they thought the child was uncooperative in toilet training. Children often injure themselves and may have fractured bones or bruises on knees and elbows that are not from child abuse. Hyperactivity and anger are not physical signs of child abuse; they are emotional signs.

Up to 75% of girls who are raped know their attacker. a) True b) False

True

The nurse has learned that the number one factor that will motivate a woman to escape an abusive relationship is which of the following? a) fear of harm to her unborn child b) fear of death c) fear of harm to herself d) fear of harm to other family members

fear of harm to her unborn child Correct Explanation: Frequently, the fear of harm to her unborn child will motivate a woman to escape an abusive relationship.

What are the best ways to prevent abuse in a community? Select all that apply. a) Role-model for caregivers caring behaviors with children b) Promote activities that encourage self-esteem in young adults c) Help parents and caregivers find local support in their community d) Develop and teach high school courses on parenting and normal child growth and development e) Educate those who were abused as children and offer them professional help to break the pattern of violence

• Develop and teach high school courses on parenting and normal child growth and development • Promote activities that encourage self-esteem in young adults • Role-model for caregivers caring behaviors with children • Educate those who were abused as children and offer them professional help to break the pattern of violence • Help parents and caregivers find local support in their community Explanation: All of the above are ways to reduce the risk of abuse in a community.

The nurse who counsels women who suffer from abuse understands that abuse can come in different forms that include which of the following? (Check all that apply.) a) financial abuse b) sexual abuse c) spiritual abuse d) physical abuse e) emotional abuse

• financial abuse • sexual abuse • physical abuse • emotional abuse Correct Explanation: Abusers may use whatever it takes to controp a situation-from emotional abuse to physical assault. The different types of abuse include emotional, physical, financial, and sexual. Although a person could put down someone's religion and/or keep them from worshipping, there is not a distinct abuse labeled as spiritual abuse at this time.

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 tells me that he'll tell child services I'm a bad mother." b) "He always tells me that the abuse never happened." c) "He acts like he's the master of his castle and I'm his servant." d) "He tells me who I can and cannot see."

"He tells me that he'll tell child services I'm a bad mother." Correct 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 nurse is interacting with a new mother, whose infant is 6 weeks old. The mother appears exhausted and anxious. Which of the following statements by the mother most indicates a potential risk for maltreatment of the child? a) "She cries quite a bit. I sure will be glad when this phase is over!" b) "She cries a lot. I haven't gotten much sleep lately. But when she's calm, she's such a sweetheart." c) "She cries all the time. I don't know what to do with her. She's just a bad baby, I guess." d) "She cries a lot at night. Is there something I'm doing wrong?"

"She cries all the time. I don't know what to do with her. She's just a bad baby, I guess." Correct Explanation: Parents may be identified as being able to maltreat children during health maintenance visits. By the time a baby is brought to a health care agency for an initial health maintenance visit, you should be able to see positive parent-child interaction has begun. Listen for parents who say the baby is "nothing but trouble," "cries all the time," or "is bad." Ask new parents how it feels to be a new parent. "I'm exhausted but enjoying it" is a different answer from "it takes too much time" or "it's not much fun."

Which of the following would the nurse include when preparing a presentation for a local community group about intimate partner abuse? a) Children who witness abuse of a parent are less likely to become batterers. b) Abuse in homosexual relationships may go unreported for fear of harassment. c) Until the 1990s, society tended to legitimize a man's control over a woman. d) Abuse primarily affects young, unmarried women.

Abuse in homosexual relationships may go unreported for fear of harassment. Correct Explanation: Abuse occurs in both heterosexual and homosexual relationships, but violence within homosexual relationships may go unreported for fear of harassment or ridicule. Few statistics are available on its incidence in homosexual relationships. Abuse affects women at nearly every stage of their lives and may occur in old or young, beautiful or unattractive, married or single women. Until the 1970s, society tended to legitimize a man's power and control over a woman. Children who witness one parent abusing another are more likely to become delinquents or batterers themselves.

A nurse suspects that a 6-year-old girl is being sexually maltreated by her father, based on some comments made by the girl. Which of the following methods would be most effective in confirming the nurse's suspicion? a) Assess the girl for unexplained fractured bones b) Ask the girl's mother what she knows of the father's activities c) Check for any sexual perpetrators listed in the area under Megan's law d) Ask the girl to draw a picture of what happened

Ask the girl to draw a picture of what happened Correct Explanation: Incest is sexual activity between family members. Asking the child to draw a picture of what happened may be an effective way of revealing sexual maltreatment. Incest results in a destructive relationship because it causes a great deal of guilt and loss of self-esteem in both the abusing and the maltreated person. Other members of the family are likely to suspect the maltreatment is occurring but are helpless to do anything about it; this leads to guilt and feelings of worthlessness on their part for not being able to protect the victim. Thus, the child's mother may not reveal anything when questioned by the nurse due to guilt or fear. Sexual maltreatment does not always involve physical maltreatment, such as would result in fractures. The father may not be listed as a sexual perpetrator.

When implementing an intervention for a woman in an abusive situation, what is the primary goal? a) For the woman to be removed from her abusive relationship b) For the woman to be able to stand up to her abuser c) For the woman to be able to care for herself d) For the woman to regain a sense of control in her life

For the woman to regain a sense of control in her life Correct Explanation: The primary goal when working with women who are victims of abuse is for them to regain a sense of control in their lives. Control over the victim's life is the primary way an abuser maintains domination in an abusive relationship.

A nurse is working with a female client who is anticipating the possibility of leaving an abusive relationship. In helping the client make the decision to leave or to stay in the abusive situation, which of the following would be most important for the nurse to do? a) Ensure that the client can effectively describe the behaviors inherent in each phase of the cycle of domestic violence b) Inform the client that if she leaves the abusive situation, there is a possibility her partner will attempt to murder her c) Suggest that the client legally change her name and move out of state so she will be safe from future harm d) Assist the client in finding a new apartment and a new job so she will be safe after she leaves her current situation

Inform the client that if she leaves the abusive situation, there is a possibility her partner will attempt to murder her Explanation: Survivors must understand the cycle of violence and the danger of homicide that increases as violence escalates or the survivor attempts to leave the relationship. Although survivors also need information about resources, such as shelters for battered women, legal services, government benefits, and support networks, the nurse needs to first discuss the possibility of the perpetrator's reaction and the possibility of extreme violence leading to death.

On a follow-up visit, a woman who was a victim of rape states that she has joined a rape survivor advocacy group. The nurse interprets this as indicating that the woman is in which phase of rape recovery? a) Reorganization b) Denial c) Integration and recovery d) Disorganization

Integration and recovery Correct Explanation: During the disorganization phase, the woman typically experiences shock, fear, disbelief, anger, shame, guilt, and feelings of uncleanliness. During denial, the woman appears outwardly composed and returns to work or school but refuses to discuss the assault and denies the need for counseling. During the reorganization phase, the woman attempts to make life adjustments by moving or changing jobs and uses emotional distancing to cope. During integration and recovery, the woman begins to feel safe and starts to trust others. She also may become an advocate for other rape victims.

The nurse is conducting a class on rape prevention for a group of young adult women and is describing the various types of date rape drugs. Which drug would the nurse describe as causing a separation in perception and sensation? a) Ketamine b) Diazepam c) Rohypnol d) Gamma hydroxybutyrate (GHB)

Ketamine Explanation: Ketamine acts on the central nervous system to separate perception and sensation. Rohypnol produces memory loss for up to 8 hours. GHB produces euphoria, an out-of-body high, sleepiness, increased sex drive, and memory loss. It may cause unconsciousness, depression, and coma. Diazepam is an antianxiety agent that causes sedation, lethargy, mild drowsiness, confusion, and disorientation.

A mother brings her 10-year-old daughter in and tells the nurse that she believes the child has a brain tumor and quickly runs through a list of some classic symptoms associated with brain cancer. On examination and after performing routine blood work, however, the nurse finds nothing wrong with the child. The child says that she feels fine. When the nurse reviews the patient's chart, she finds that this is the sixth time the mother has brought the girl in for various serious conditions in the past 6 months. Which of the following situations does the nurse suspect? a) Physical neglect b) Psychological maltreatment c) Failure to thrive d) Munchausen syndrome by proxy

Munchausen syndrome by proxy Correct Explanation: Munchausen syndrome by proxy refers to a parent who repeatedly brings a child to a health care facility and reports symptoms of illness when, in fact, the child is well. For example, a parent might report symptoms such as seizures, excessive sleepiness, or abdominal pain in a child. Because of these symptoms, the child is submitted to needless diagnostic procedures or therapeutic regimens. There is no evidence of psychological maltreatment, physical neglect, or failure to thrive in this case.

The responsibility of the nurse caring for a victim of child abuse in the emergency room would include which of the following? a) Suggesting to the attending physician that the child be admitted for observation b) Prohibiting parents from visiting until more facts are obtained c) Asking the child what was happening that led to the abuse d) Prohibiting the babysitter from staying to offer support

Suggesting to the attending physician that the child be admitted for observation Explanation: Nurses are responsible for seeing that abused children are protected from further abuse and that the abuse is reported.

Question: Place the three phases of intimate partner violence in the order in which they occur. Acute violence phase Honeymoon phase Tension-building phase

Tension-building phase Acute violence phase Honeymoon phase Correct Explanation: Tension building, the first phase, is seen as a building up of anger, arguments, and verbal fighting. The acute violence phase is the next phase, wherein physical harm comes to the victim. This can be a result of internal factors in the abuser or an external crisis. The honeymoon phase is the final phase in the cycle; during this phase, the relationship regains a feeling of calm and tranquility. This phase is filled with exchanges of love and passion.

Nurses sometimes have difficulty assessing women for violence. Which of the following refers to the screen protocol to use to be the most thorough? a) The SBAR model b) The RACE model c) The SAVE model d) The FACE model

The SAVE model Explanation: The SAVE model is a screening protocol that nurses can use when assessing women for violence. It stands for screen, ask, validate and evaluate. The SBAR is a reporting tool used by nurses when handing off patients. The FACE model is a pain scale used to evaluate pain in children. The RACE model is used when there is a fire.

A young mother brings her 6-month-old in for an examination, appearing listless and inattentive of her child. She sets the child in the floor and reads and sends text messages on her phone. The child appears underweight and lethargic. Which finding would confirm the nurse's suspicion that this child is experiencing failure to thrive? a) The child cries when the nurse picks her up b) The child rests her head on the nurse's shoulder and cuddles with her after the examination c) The child is below the fifth percentile for weight and height d) The child resists when the nurse takes her vital signs

The child is below the fifth percentile for weight and height Explanation: Failure to thrive is a unique syndrome in which an infant falls below the 5th percentile for weight and height on a standard growth chart or is falling in percentiles on a growth chart. Such a child would more likely exhibit a lack of resistance to the examiner's manipulation and a lack of cuddling or conforming to being held. Crying when being picked up by a stranger is normal for an infant, and not a sign of failure to thrive.

If a nurse fails to report child maltreatment, she can face a fine, jail time, or loss of nursing licensure. a) False b) True

True Correct Explanation: State laws typically identify two levels of responsibility for reporting child maltreatment: mandatory reporters and permissive reporters. Nurses are included in the mandatory category in most states; this means they must report suspected child maltreatment when they identify it. Failure to do so can result in a fine, jail time, or loss of nursing licensure.

Which of the following is an example of Screening using the SAVE model? a) The nurse states "I believe you and I'm here to help." b) The nurse provides the patient with a 24/7 abuse hotline number c) The patient states "My sister lives near here and says I can stay with her." d) The nurse asks "Do you feel you are in control of your life?"

The nurse asks "Do you feel you are in control of your life?"

Walter is an 11-year-old boy who was raised in a home where his father beat his mother on a regular basis. Which of the following statements is true regarding children being raised in a home where they have witnessed intimate partner violence? a) Female children are more likely to experience depression b) They are at increase risk for being abused c) They have higher rates of schizophrenia d) It has little impact on child functioning

They are at increase risk for being abused Correct Explanation: They demonstrate higher levels of depression and lower levels of self-esteem; these effects are pronounced in boys especially (Reynolds, et al., 2001). Children of battered women are at an increased risk for abuse. Exposure to IPV adversely affects a range of child functioning.

The generation-to-generation continuum of violence refers to the fact that a) Children who grow up in abusive homes almost always become abusers themselves unless they have professional intervention b) Violence is a learned behavior, and children who witness abuse are more likely to become abusers themselves c) Violence is an innate behavior, and children become abusers because of external factors in their environment more often than in their family d) Children who grow up in an abusive home are less likely to be abusers themselves because they see first hand the devastation that violence can cause

Violence is a learned behavior, and children who witness abuse are more likely to become abusers themselves Correct Explanation: Violence is a learned behavior. Many abusers were abused themselves as children; however, not all children who were abused become abusers.

A young woman who has recently been married asks a nurse at the clinic for something to calm her nerves and help her sleep. When assessing the patient the nurse suspects that the husband is abusing the patient. This is confirmed when the patient states, "My husband will not let me look for a job and when I need money he will not give it to me." This patient is suffering from which type of abuse? a) sexual b) physical c) emotional d) financial

financial Correct Explanation: Financial abuse includes preventing a woman from getting a job, sabotaging a current job, controlling how all money is spent, or failing to contribute financially.

The nurse working in an OB clinic realizes that a pregnant patient who has been abused before can expect to be abused during her pregnancy. What is the strongest predictor that a pregnant woman will be abused during her pregnancy? a) prior abuse b) other children in the home c) history of financial abuse d) history of sexual abuse

prior abuse Correct Explanation: The strongest predictor of abuse during pregnancy is prior abuse. For women who have been abused before, beating and violence during pregnancy are "business as usual."

A 5-year-old girl is being admitted with a possible diagnosis of child abuse. The child has bruises in various places on her body that the caregiver attributes to the child recently beginning to play soccer. Bruises associated with child abuse would likely be found in which of the following areas of the body? a) knees b) thighs c) elbows d) forehead

thighs Correct Explanation: Bruises that occur in areas of soft tissue, such as the abdomen, buttocks, genitalia, thighs, and mouth, may be suspect of child abuse.