Module - 3 abuse and violence quiz

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

The nurse is assessing a client who is a victim of intimate partner violence and recognizes a belief that is common among victims of abuse. Which belief would the nurse most likely identify? The client is inadequate in some way. The situation will never get better. The client can leave at any time. The client recognizes being a victim.

*Some victims believe that the abuse is caused by a personality flaw or inadequacy in themselves*. The victims rarely describe themselves as abused and believe if they can do as the abuser has asked, things will get better. Few believe they can leave.

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? emotional

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.

A nurse is caring for a young adult in the mental health clinic. The client tells the nurse that the client was physically neglected as a child. The nurse should assess the client for symptoms of what? Major depression

An important outcome of nursing intervention with survivors is appropriate treatment of any disorder resulting from abuse, such as *acute stress disorder, posttraumatic stress disorder, anxiety disorders, dissociative(분열성의) identity disorder, major depression*, or *substance abuse.*

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 members, adults, *children*, or spouses are implicated in 90% of the cases of elder abuse.

A young adult client female is assessed after being raped. The client reports being tied up and beaten while the perpetrator forced sexual intercourse. She recalls the perpetrator saying, "I will make you pay." What most accurately describes this category of rapist? anger retaliation

In this case, the most accurate description of this rapist is anger retaliation. In this category, the perpetrator wants to punish the victim and often causes substantial injury. The power assertive rapist desires to dominate and control the victim and may repeat with the same victim. The power reassurance rapist commits rape when the opportunity presents itself, such as when another crime is being committed. An anger excitement rapist acts out fantasies and can be strategic in carrying out the crime, for example, carries a rape kit.

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

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.

Which statement made by a new nurse demonstrates an understanding of the prevalence of sexual assault and related violence among the population? "The vast majority of victims of sexual assault and related violence are seen in the emergency room when they seek treatment." *"I've come to realize that I need to include questions related to sexual assault and related violence into the assessment of all my clients."* "It seems obvious that the greatest number of clients experiencing sexual abuse and related violence are the young and middle-aged adults." "The greatest need for thorough assessment regarding sexual assault and related violence is among those who are dependent and rely on the care of others."

Nurses will come in contact with sexual assault and related violence no matter what health care setting they work in and among all segments of the population. Nurses must be ready to ask the right questions and to act on the answers, because such action could be lifesaving.

*Which statement about intimate partner violence (IPV) is accurate?* *Knowledge deficits and biases of health care professionals limit its detection.*

The literature confirms that a significant factor in the underdetection of IPV rests with professional behavior. Health care practitioners often fail to identify and intervene with abused women. The underlying dynamics of poor screening practices are complex and include both biases and knowledge deficits.

A nurse is describing the cycle of violence to a group at a community clinic. The nurse determines that the attendees have understood the information when they identify which phase as usually lasting the longest?

Of the phases, the first phase, *tension building, is usually the longest*. Acute battering, in which there is the explosion of violence, and the honeymoon phase are not typically as long.

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

The nurse's responsibility in cases of suspected abuse is to report the allegations. It is not the nurse's responsibility to determine validity, encourage a written statement, or counsel the client on the dynamics of the abuse.

When initiating care for a client suspected of being a victim of human trafficking, what is the nurse's primary responsibility? Building trust Protecting privacy Supporting autonomy Remaining nonjudgmental

*Building trust is the top priority*. Although the other actions are appropriate, they are less achievable without first establishing a trusting relationship with the client.

Which statement is false regarding screening for intimate partner violence in women? *Women tend to fit a profile of abuse, and victims tend to share similar physical characteristics.* Screening should be routinely done at every visit. An older adult woman may be a victim of intimate partner violence. Although women who are abused may exhibit certain behavior patterns, all women should be screened for intimate partner violence.

Women do not typically fit a physical profile, and any woman can be a victim of intimate partner violence. Therefore, all women, even older adult women, should be screened at every visit.

A nurse is caring for a client who was raped at gunpoint. The client does not want any photos taken of the injuries. The client also does not want the police to be informed about the incident even though state laws require reporting life-threatening injuries. Which intervention should the nurse perform to document and report the findings of the case? Use direct quotes and specific language.

*The nurse should use direct quotes and specific language as much as possible when documenting.* The nurse should not obtain photos of the client without informed consent. The nurse should, however, document the refusal of the client to be photographed. *Documentation must include details as to the frequency and severity of abuse and the location, extent, and outcome of injuries, not just a description of the interventions taken*. The nurse is required by law to inform the police of any injuries that involve knives, firearms, or other deadly weapons or that present life-threatening injuries.

Nurses at an urban emergency department seek to develop a plan to help women involved in abusive relationships. *Which component is critical to the success of the plan?* *Access to community resources for referral*

Much of the support and treatment that will be needed for women in abusive relationships is needed in the community. *Having access to these resources is the most critical aspect to ensuring effective and sustainable support for women in abusive situations.* An IPV counselor in the emergency department will only be available for support when there is an acute situation for which the client has come to hospital. Such a component is effective but not a long-term option to support people in abusive relationships. A quality of life assessment tool is effective for assessment, but this is only the initial part of the plan. Written educational materials are important to enhance knowledge for women in abusive situations; however, *community support services are needed to ensure follow through and sustainability*.

Which child has the greatest risk for being the target of bullying at school? the child who wears hearing aids

*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.

On a follow-up visit, a client who was a victim of rape states having joined a rape survivor advocacy group. The nurse interprets this as indicating that the client is in which phase of rape recovery? integration and recovery

*During the disorganization phase, the victim typically experiences shock, fear, disbelief, anger, shame, guilt, and feelings of uncleanliness.* *During denial, the victim 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 victim attempts to make life adjustments by moving or changing jobs and uses emotional distancing to cope.* *During integration and recovery phase, the victim begins to feel safe and starts to trust others. The victim also may become an advocate for other rape survivors.*

When interviewing an abused child, the nurse must first complete what? Establish a safe environment

*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.

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

*Having contact with friends monitored by the father indicates there is an abuse of power and control in the home*. *Having to go straight home after school indicates the client is being forced into social isolation*. *In addition, there is a family history of alcohol abuse. These are all characteristics of violent families*. Adolescents commonly report feelings of being left out and experiencing social pressures to experiment with drugs and alcohol. These are not characteristics of violent families.

*Nurses at an emergency department seek to develop a plan to help clients who are victims of intimate partner violence. Which component is critical to the success of the plan?* avenues for referral

*Nurses assume their appropriate role in the effort to screen and treat victims of intimate partner violence through simple screening and having readily available information and avenues for referral.*

*A nurse is working on developing a safety plan with a client who is a survivor of violence. Which would the nurse address first?* *Recognizing the signs of danger*

*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.

Which statement made by a male client who has a history of perpetrating intimate partner violence reflects a known factor that is characteristic of this behavior? *"My classmates always called me a bully(불량배)."* "Sports like football and soccer are my life." "My mother was the disciplinarian(가르침이 엄한 사람) in our family." "It was just mom and me after dad died."

*Risk factors for intimate partner violence in men include taking aggression out on others while growing up as demonstrated by bullying.* A male-dominated family life is considered a relationship factor that may trigger such violence. A preference for sports, such as football and soccer, are not considered risk factors for intimate partner violence.

Which is a pattern of repeated unwanted contact, attention, and harassment that often increases in frequency? Stalking

*Stalking is a pattern of repeated unwanted contact, attention, and harassment that often increases in frequency.* Stalking is a crime of intimidation. Rape is the penetration of any bodily orifice by the penis, fingers, or an object. Incest involves sexual contact between family members. Physical abuse involves bodily harm.

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."

*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*.

The nurse is planning care for a victim of physical abuse. What interventions should the nurse implement when addressing the victim's need to regain a sense of control over one's life? Select all that apply. *Providing reinforcement of stress management strategies* *Arranging for consult with social services care team member* *Supporting autonomy by encouraging effective decision making* Encouraging discussions related to client's feelings of anger, depression and acceptance Encouraging social interaction with members of a survivors support group

Appropriate interventions to strengthen the victim's sense of control over life could include teaching coping strategies to manage stress, assisting with activities of daily living to improve lifestyle, and allowing the victim to make as many decisions as able. Interacting with others addresses the need to set realistic goals, whereas effective grieving is supported by discussing feelings.

A middle-aged client with young children has been the victim of intimate partner violence (IPV). When providing initial care to this family, the nurse should: *carefully assess the children for signs of trauma.* determine what initially caused the violence to begin. teach the client life skills for moving on from the relationship. reassure the client that this will never happen again.

Children are inevitable victims in an IPV situation and must be assessed and cared for accordingly. *The nurse must avoid false reassurance*. It is unnecessary, and often impossible, to identify specific causes for IPV. Relationship skills can be addressed in follow-up care.

An 11-year-old boy was raised in a home where his father beat his mother on a regular basis. 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.

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(두드러지다) in boys especially*. Children of mothers who are victims of intimate partner violence are at an increased risk for abuse. Exposure to intimate partner violence adversely affects a range of child functioning.

The nurse who has experience in caring for victims of intimate partner violence knows that goals for a victim may fall into which categories? Select all that apply.

Depending on when in the cycle of violence the nurse encounters a victim of intimate partner violence, goals may fall into three groups: *primary, secondary and tertiary*. *Primary* is aimed at *breaking the cycle of violence*, *secondary* focuses on *dealing with the victims and abusers in early stages with goal of preventing progression*, and *tertiary* is geared toward *helping victims of severe intimate partner violence recover and become productive members of society*.

A nurse is working in a community hospital situated in an area with a history of grievous assaults on women, including rape. The nurse discovers that most rape victims come to the hospital but leave without seeking medical treatment. Which intervention should the nurse perform to ensure that rape victims get legal and medical aid? Let them wait in waiting rooms to collect their thoughts before approaching them. Treat them as any other client to make them feel more comfortable. Focus on treating them rather than on collecting evidence. *Ensure that the appropriate law enforcement agencies are apprised of the incident.*

For every rape victim who turns up, the nurse should ensure that the appropriate law enforcement agencies are apprised(알리다) of the incident. Victims should not be made to wait long hours in the waiting room, as they may leave if no one attends to them. *Victims of rape should be treated with more sensitivity than other clients.* Although the primary job of a nurse is to medically care for the rape victim, a nurse should also pay due attention to collecting evidence to substantiate the victim's claim in a court of law.

A nurse is preparing a presentation for a local community group about intimate partner violence. Which statement would be most appropriate for the nurse to include in the presentation? Intimate partner violence primarily affects young, unmarried women. Until the 1990s, society tended to legitimize a man's control over a woman. Intimate partner violence in homosexual relationships may go unreported for fear of harassment. Children who witness intimate partner violence against a parent are less likely to become abusers.

Intimate partner violence 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. Intimate partner violence affects people at nearly every stage of their lives and may occur in old or young, beautiful or unattractive, married or single individuals. 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 abusers themselves.

The psychiatric nurse recognizes that a male rape victim is less likely to report the crime due to which reason? The belief that his masculinity will be in question

It is a common misconception that males cannot be sexually abused, that only "sissies(여자같은) and weaklings allow abuse," leading to the possibility that his masculinity is at stake if he is identified as a victim.

A nurse is performing a physical examination of a pregnant woman. During examination, the nurse notices a bruise on the client's abdomen. Which action should the nurse take? *Ask the client to account for the bruise.* Assume that the bruise is from an accident and not worry about it. Make a note in the client's chart regarding the finding, and plan to observe for other signs of intimate partner violence in the future. Assume that the bruise is from intimate partner violence, and call the police while the client is still in the room.

Many 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 client's chart or to take some other action to help protect the client.

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."

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 type of rapist derives *erotic gratification* from the victim's suffering? Sadistic rapist

Sadistic rapists derive erotic gratification from the victim's suffering. *Power rapists often attack people their own age and use intimidation and minimal physical force to control their victims*. *Their assaults are premeditated*. Anger rapists use &extreme force and restraint that results in physical injury to the victim*. There is not a type of rapist called premeditated.

When a pregnant client is victim of intimate partner violence during pregnancy, what complication is likely to occur after birth due to the abuse? edema postpartum depression low birth weight schizophrenia

Several studies have confirmed the relationship between intimate partner violence and poor mental health, especially depression. For the pregnant woman, this most often manifests itself as *postpartum depression*.

A 33-year-old client has been treated for a periorbital hematoma and a broken nose that the client suffered when the client's spouse struck the client. The client does not know where the spouse currently is, and the client is scheduled for discharge. What action should the care team prioritize in this client's care? Ensuring that the client goes to a safe place

The client's safety supersedes the importance of education and dressing changes, though all of these are appropriate interventions when conducted at the appropriate time.

The nurse is receiving shift hand-off and is assigned a client who was recently raped. When developing a plan of care, which consideration is most important? Victims of rape can find talking about the experience to be therapeutic.

The nurse is correct to begin a therapeutic conversation. Talking about what happened often helps victims cope. Victims usually do not like to be alone after the incident. Often, the victim's usual sexual partner is unable to provide strong support after a rape situation because he or she has difficulty dealing with the situation. Most victims are willing to return for examinations and testing.

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? "It looks like someone has hurt you. Tell me about it."

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*.

When caring for victim of intimate partner violence, the nurse uses the ABCDES framework to provide interventions. Which components are part of this framework? Select all that apply.

Use of the ABCDES framework provides direction: *reassuring the victim that he or she is not alone;* *informing the victim of the belief that violence is not acceptable in any situation;* *ensuring the victim that information reported is confidential;* *documenting information factually and accurately;* *educating the victim about the cycle of violence and its escalation;* and *ensuring the victim's safety by providing the victim with resources and a plan of action to carry out when the client decides to leave.* Expressing an opinion that there may be a reason for the violence is never appropriate nor is documenting the nurse's own perception of what happened.

A client has just confided in the nurse about being slapped and kicked by the partner that morning. What is the best response by the nurse? "It's very brave of you to tell me all this. Help is available if you choose it."

When talking with a woman who is a victim of intimate partner violence, *it is important not to use 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 the victim you believe what happened. Encouraging the victim to say more while informing the victim that help is available is the best therapeutic answer.