Prep U Psychiatric-Mental Health Nursing Chapter 12: Abuse and Violence

The nurse can assess potential victims of domestic violence by asking which question?

"Has a past or current partner ever caused you to be afraid?"

Which statement made by a client raises the greatest concern that the client may be experiencing relationship violence?

"I don't know what else I can do to keep him from getting angry at me."

Which statement, made by a nurse who experienced sexual abuse as as a child, demonstrates being best prepared to work with sexual abuse and trauma survivors?

"I've been supported by health care professionals and now I want to support other survivors."

A nurse is presenting to a church group a program about domestic violence. During the presentation, a member of the audience asks the nurse to explain what "intergenerational transmission of violence" means because the person has seen that phrase used in the media. Which response by the nurse would be most appropriate?

"People who grow up in violent home situations tend to be involved in domestic violence situations as an adult."

A nurse is assessing a client in a community clinic who reports feeling anxious lately because she is considering leaving her marriage. The client describes a long history of partner abuse associated with this relationship. How should the nurse respond to this client?

"You have the right to be safe and respected."

A nurse is working in the emergency department. Which situation would lead the nurse to suspect possible abuse of a client? Select all that apply.

1. A 6-year-old is being seen for the 5th time for a urinary tract infection 2. A baby with contrecoup injuries to the brain 3. A 3-month-old with a fractured femur

After a series of admissions to the emergency department over the past several months, an 80-year-old client's malnutrition, vague history, and pattern of physical injuries lead the nurse to suspect elder abuse. Which aspect of the client's situation may contribute to elder abuse? Select all that apply.

1. The client is physically dependent on the client's son since losing mobility. 2. The client has no income or savings of the client's own. 3. The client's son describes the client as "needy, helpless, and pathetic."

The nurse is planning a community education session on elder abuse awareness. Which points should the nurse be sure to include? (Select all that apply.)

1. Withholding money for necessities is a form of abuse 2. Not helping you get medical attention you need is a form of abuse 3. It is abuse if you feel forced to have sex 4. It is abuse if your caregiver holds your arm too tight

A female client states that she has been receiving numerous text and phone messages from a co-worker. Which type of harrassment should be documented in the nurse's notes?

Cyberstalking

Which is the most commonly identified issue preventing people from leaving an abusive relationship?

Dependency

A nurse is working with a 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 would be most important for the nurse to do?

Inform the client that if leaving the abusive situation, there is a possibility the partner will attempt to fatally injure the client.

Which are forms of psychological abuse? Select all that apply.

Insulting Humiliating Destroying another's property

A client comes to the mental health clinic and reports feeling depressed for the last 3 months. The client also admits to having thoughts of suicide. When the nurse inquires about the client's relationships, the client tells the nurse that the client's spouse constantly belittles the client, telling the client often that the client is "stupid and fat." Which problem should the nurse assess for further?

Intimate partner violence

An 8-month-old infant has been brought to the emergency department unresponsive by the infant's teenage parent and the care team suspects shaken baby syndrome. When providing care for this infant, the nurse should prioritize which assessment?

Neurological assessment

Which would not be considered a risk factor for being a victim of elder abuse?

Older than 65 years

A nurse who provides care in a large, urban emergency department has worked with numerous victims of various forms of abuse as well as those who are abusers. The nurse recognizes that persons who commit abuse are most likely what?

Past victims of abuse themselves

In clients who do not completely recover from being victimized by rape, which mental illness is most likely to develop?

Post-traumatic distress syndrome

Which is a priority nursing intervention when child abuse or neglect is suspected?

Safety

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

Same frequency as in heterosexual couples

Which is not a risk factor for child sexual abuse?

The child is aged 10 years or younger.

Which would not increase the likelihood that an older adult will incur physical abuse?

The older adult is independent with activities of daily living.

Which three elements are necessary to legally define rape of a male, female, or mixed gendered person?

Use of force; vaginal, oral, or anal penetration; nonconsent of victim

Which is an inaccurate picture of the cycle of abuse that occurs over time?

Violent episodes are less frequent

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

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.

A nurse is seeing a 3-year-old child who is brought to a pediatric clinic by the mother with concerns about toilet training. The nurse notes the child has multiple bruises of various ages on the arms, trunk, and legs. The nurse should suspect:

physical abuse.

Which assessment question should the nurse ask of a client suspected of being ostracized by a school bully?

"Do you feel like a part of a group in school?"

When noted in an assessment of a child, the nurse should suspect child abuse if which common physical findings signaling abuse are present?

Bruises, burns, lacerations, missing teeth, and skeletal injuries

The nurse is legally obligated to report suspected child abuse to local authorities. Which information is essential?

Child's name, location, age, and suspected perpetrator

In violent families, which environment may be the most dangerous place for victims?

Home

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.

A client comes to the clinic for a prenatal visit. While the client is in the examining room, her estranged husband appears and insists on seeing the client. The client tells the nurse that they are in the process of getting a divorce and she does not want to be around him. "He's been following me to work and at my home everyday." What should the nurse suspect?

Stalking

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."

A nurse is working with a client who is a survivor of rape. The client asks the nurse, "It's been 6 months since it happened. Why can't I get back into doing the things I did before?" What is the nurse's best response?

"It can take at least a year or more to get back to where you were before."

A nursing instructor teaching about sexual assault identifies a need for further instruction when one of the students makes which statement?

"It is not considered rape if it occurs with same-sex couples."

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."

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 tells me that he or she will tell child services I'm a bad parent."

The nurse is aware that fewer than half of rapes and sexual assaults are reported. Which are some of the reasons people do not report being sexually assaulted? Select all that apply.

1. The client is embarrassed of the assault. 2. They have a fear of being blamed for the incident. 3. The perpetrator may use coercion or threats to control the victim.

A 27-year-old has been brought to the emergency department by emergency medical services following a violent sexual assault that took place in the parking garage of the client's building. Which task would fall most clearly within the scope of practice of a forensic nurse?

Collecting specimens from the client for use as evidence

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 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

When interviewing an abused child, the nurse must first complete what?

Establish a safe environment

Which type of abuse includes name calling and belittling?

Psychological abuse

Which statement requires additional education regarding the truth about rape?

Rape is a crime of passion.

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

Which provides the most acceptable example of neglect according to the definition of the term?

Rejecting a 3-year-old who is crying and seeking affection after the child stumbles and falls

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

Stalking

Which feature would most likely predispose an adult to engage in family violence?

The adult was physically abused as a child

The nurse's suspicion that a child has been sexually abused is supported by what assessment data? Select all that apply.

The anal area is bruised The child reports "itching down there" The vulva appears edematous The urinalysis reports a bacterial infection

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.

A nurse is preparing to gather a health history of a client. Which questions can elicit disclosure if a client has been abused? Select all that apply.

1. "When there are arguments at home, have you ever been hurt or afraid?" 2. "It looks like someone has hurt you. Tell me about it." 3. "Some other women I have cared for have described problems like yours. If this is happening to you, can we talk about it."

During an interview, a client reveals to the nurse, "I was sexually abused as a child." Based on this information, which finding would the nurse most likely anticipate being revealed during the assessment? Select all that apply.

1. Client has difficulty establishing interpersonal relationships 2. Client has a history of substance abuse 3. Client has difficulty establishing a mutually satisfying sexual relationship 4. Client engages in self-harming behaviors

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.)

1. the client's father monitors contact with friends 2. has a family history of alcohol abuse 3. must go straight home after school each day

What percentage of women can expect to be a victim of an ongoing unwanted pursuit from stalking?

12-32%

Approximately what percentage of women rape victims are raped by someone they know?

65%

A nursing student learning about intimate partner violence (IPV) correctly identifies the percentage of deaths attributed to IPV to be what?

70% women and 30% men

Which assessment finding can help the nurse differentiate a child experiencing child neglect rather than child abuse?

A young child is admitted to the hospital with hypothermia because the child is inadequately

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

Which is not considered a characteristic of violent families?

Adequate support systems

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

Brushing her teeth

What are some types of behavior that the nurse would recognize as qualifying as psychological abuse? Select all that apply.

Criticizing Ridiculing Threatening a victim's dog

A nurse is preparing a presentation for a senior center about elder abuse. When describing individuals associated with abusing older adults, which group would the nurse most likely identify? Select all that apply.

Family member Adults Children Spouses

Nurses working with rape trauma victims need to be aware of their own attitudes about rape and sexual assault. Which rationale best explains why?

Giving back the survivor as much control as possible is important.

Which characteristic would a nurse least likely see in an abused individual?

High self-esteem

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

The nurse should consider which as a possible indicator of child neglect?

Malnourishment unrelated to illness

When health care professionals detect signs of elder abuse in clients, the law requires them to take which action?

Report the abuse to the state authorities.

During an interview, a 6-year-old child tells a nurse that the child is often left alone at home by the child's parents. Which action should the nurse take?

Report the child's information to the child protection agency.

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

Sadistic rapist

In a toddler, which injury is most likely the result of child abuse?

Several small, circular burns on the child's back

An older adult client has been attending a local day program for the elderly. The nurse who facilitates the program notices the client has multiple bruises on the arms, has scrapes to the hands and face, and is socially withdrawn. A referral to the client's family physician confirms the client has genital herpes. Which type of elder abuse should the nurse suspect?

Sexual abuse

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

Shaken baby syndrome

The majority of perpetrators of elder abuse include which population?

Spouse in the caregiver role

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

A nurse is giving a talk about child abuse to a local community group. When discussing risk factors for child abusers, which would the nurse identify as the most likely profile of the perpetrator of fatal child abuse?

Unemployed young woman who dropped out of high school

Nurses who work with children should be on alert for which physical signs of child abuse?

Unexplained cuts, bruises, burns, and scars

The nurse assesses a client who comes to the emergency room for vaginal bleeding and swelling. The client reports she had sexual intercourse with her boyfriend the previous night and states, "It was consensual, but sometimes he is rough." The client begins to cry and looks away. What should the nurse suspect?

intimate partner violence

The school health nurse is asked to see a child who has been coming to school with no lunch for the past week. The child tells the nurse, "I don't get a lunch this week, I have been wetting the bed." The nurse identifies that this child is experiencing which type of abuse?

neglect

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

ostracism

Which child has the greatest risk for being the target of bullying at school?

the child who wears hearing aids