PrepUs for Pediatrics Chapter 33
The responsibility of the nurse caring for a victim of child abuse in the emergency room would include which of the following?
Suggesting to the attending physician that the child be admitted for observation Nurses are responsible for seeing that abused children are protected from further abuse and that the abuse is reported.
The nursing student learning about child abuse correctly identifies which of the following as types of abuse in children? Select all that apply.
shaken baby syndrome neglect physical abuse sexual abuse Munchausen syndrome by proxy emotional/psychological abuse he different types of abuse in children are physical abuse, shaken baby syndrome, Munchausen syndrome by proxy, emotional abuse, neglect, and sexual abuse. SIDS (sudden infant death syndrome) is not a form of abuse.
A nurse is assigned to care for a child with trauma from abuse who has been admitted through the emergency department to the pediatric unit. What is a priority for the nurse to do when caring for this child?
Observe and document thoroughly and completely. When assessing a child who may have been abused or neglected, it is important to observe and document thoroughly and completely. The child should have a complete physical examination; the nurse should carefully describe and accurately document all bruises, blemishes, lacerations, areas of redness and irritation, and marks of any kind on the on child's body. It may be necessary to request that photographs be taken.
Which statement made by a new nurse demonstrates an understanding of the prevalence of sexual assault and related violence among the population?
"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." 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.
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 teenage 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?
Physical neglect 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.
In which age range are women most vulnerable for intimate partner violence?
16 to 24 years Women aged 24 and younger are the most vulnerable to intimate partner violence.
When initiating care for a client suspected of being a victim of human trafficking, what is the nurse's primary responsibility?
Building trust 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.
An obviously pregnant woman appears for her first prenatal visit. She reports a headache and generalized abdominal pain which has persisted over the past couple months. Which question should the nurse prioritize after determining the client is approximately 24 weeks' gestation, appears nervous, and is reluctant to have a full physical assessment?
"Do you feel safe at home?" Asking open-ended questions is always the best approach to get the client to open up and provide needed information. This woman may be in a situation with intimate partner violence or have a substance use disorder which would explain the nervousness, late start on prenatal care, and refusal to allow the nurse to see all of her body if she is trying to hide signs which would indicate either situation. The other questions are important, but are close-ended and would not be a priority if the woman and her unborn fetus were in danger
The nurse is completing the physical assessment of a 12-year-old child who has a series of bruises in various stages of healing. When asked about the bruises the child appears frightened and offers inconsistent accounts about how the child got the bruises. The nurse suspects abuse. Which initial action of the nurse is most appropriate?
Document the bruises and any statements made by the child relating to them. Nurses in each state have a legal requirement to report suspicions of child abuse or maltreatment. The nurse must document all findings. The medical record will be of importance in estabishing the findings. Once the findings are documented, the nurse will need to closely follow the agency policies regarding the reporting process. The nursing supervisor will need to also be involved but that will take place after the documentation has been completed. The child cannot be photographed without appropriate approvals. The child may indeed be asked to provide a more detailed reporting of the bruising, but it is not the role of the nurse to request it. The child's parents will also become a part of the investigation but the interviewing process does not come before the documentation of the findings.
Of the following children, which child is in the group of children who are most often victims of child abuse?
A 2-year-old girl The age group of children from birth to 4 years old has the highest number of victims of child abuse, with girls being abused more frequently than boys.
A female client shares that her partner often comes home in the evening after a couple of beers, and is jealous, tense and verbally abusive. He sometimes destroys things, such as breaking a vase of flowers. The client says this makes her feel embarrassed, but she tries to be submissive to her partner to calm him down. The nurse recognizes this interaction as which phase of a relationship with intimate partner violence?
Tension-building phase These behaviors are characteristic of the tension-building phase of the cycle of violence. During the honeymoon or remorseful phase the partner is loving and often brings gifts. In the violent phase there are direct attacks on the abused partner.
What behaviors would the school nurse observe when suspecting that a child is living with a family in which there is an addiction problem? Select all that apply
The child is a loner and avoids interaction with classmates. The child frequently comes into the nurse's office with vague complaints of a stomach ache. The child has missed a significant amount of school for "illness." Behaviors that may alert nurses and other health care personnel to an addiction problem in a child's family include the loner child who avoids interaction with classmates; the child failing in school or who has numerous episodes of unexcused absences or truancy; the child with frequent minor physical complaints, such as headaches or stomachaches; the child who steals or commits acts of violence; the aggressive child; and the child who abuses drugs or alcohol.
The public health nurse is providing immunizations to a family that includes three children. Which requires investigation for possible child neglect?
Two have an ear infection (in one of which the eardrum is ruptured) and one has scabies. The picture of the family is concerning, but actual neglect manifests when children have health issues and the family does not seek the medical care needed. All the children, although brought for immunizations, have medical issues. The eardrum being ruptured indicates that the child may have had this condition for some time. Further investigation is needed. Nutritional counseling and instruction on finding inexpensive age-appropriate clothing, or making sure that the family utilizes social services to assist with obtaining supportive services, may be indicated. Overall poor hygiene issues need to be addressed.
A 6-year-old child is playing. Which play scenarios witnessed by the nurse are indicative that the child is sexually abused? Select all that apply.
Using inappropriate adult language Playing with a boy and girl doll in a sexually graphic manner Arranging dolls in unnatural positions for play Children should have no knowledge of the particulars of sexual activity at age 6. If they do, it is inappropriate. Playing with dolls in a sexually graphic manner or placing the dolls in unnatural positions identifies that the child has been exposed to sexual activity. Using adult language also identifies inappropriate exposure. Common contact is saying that boys and girls love each other, or wanting to play house and having the girl have a baby. This can be reflective of what is happening in the house.
A 14-year-old girl is brought to the emergency department saying she was sexually assaulted. She tells the nurse that she feels guilty for having gone to a party where alcohol was being served. What is the nurse's best response?
"No one deserves to be raped, even going to a party with alcohol." The girl needs reassurance that even though she made a poor decision going to the party, she still did not deserve to be raped. Chastising her for making a bad decision is only going to make her feel more guilty. It is better not to say, "I understand how you feel" unless the nurse has been in the same situation. It is not sincere or helpful.
The nurse is teaching a group of nursing students about intimate partner violence. Which statement by the nurse is accurate?
"Power and control are central to the dynamic of intimate partner violence." Power and control of one partner over the other is the foundation of intimate partner violence. Erratic relationships and vulnerability are not central factors to the dynamic of intimate partner violence. Poor communications, emotional injury, learned helplessness, and social isolation are potential outcomes of being in a relationship where intimate partner violence is present.
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 child whose X-ray shows bone fractures in various stages of healing. A child who has a spiral fracture in the femur. A child whose CT scan shows an unexplained cerebral hemorrhage. 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. Anemia, nausea and vomiting are not typically associated with abuse.
The elementary school nurse is caring for four clients with physical injuries. Which child would require follow-up?
An 8-year-old with bruising noted on the inner aspect of the arms Bruising on soft tissue and particularly on the inner aspect of the arms is highly suspicious and would require immediate follow-up and, most likely, reporting. Bruising on the inner aspect of the arms indicates the child was in a defensive position at contact. The other options indicate areas of bruising on boney prominences in alignment with developmental age.
When beginning care for a victim of rape, the nurse asks the patient to "talk about what happened" to her. For which nursing diagnosis is the nurse using this approach?
Anxiety related to recent rape One need of any victim after a violent act is to talk about what happened because a person who can describe an incident can also begin to "put a fence around" or bring the event down from "something terrible has happened," a situation which leaves the person with a continuing high anxiety level, to "this specific thing has happened," a situation that allows the traumatic event to be examined and managed. Asking the victim to describe the incident to with an introduction such as "Most people find it helps to talk about what happened to them" helps the victim begin to put a fence around the incident. The nurse is not asking the patient to "talk about what happened" because of fear of maltreatment, disabling family coping related to the rape, or risk for violence related to poor self-control.
A client at 36 weeks' gestation presents in the emergency department with a broken arm. The client states, "I fell while cooking dinner." During the assessment, the nurse notes no prenatal care for this pregnancy, as well as bruises in multiple stages of healing on the client's abdomen, arms, and chest. What action will the nurse perform next?
Ask the client how she acquired the bruises First, the nurse will ask how the client acquired the multiple bruises. This will provide information on possible violence. The nurse would also notify the health care provider and document the findings. Information would be provided based on the finding of intimate partner violence.
The nurse visits the foster home of a newborn with failure to thrive syndrome. Which observation indicates a successful outcome for this child's care?
Child eagerly takes a bottle and is gaining weight. A successful outcome for the care of a child with failure to thrive syndrome would be that the child shows interest in bottle feedings and begins to gain weight. The child crying and having bruises over the legs could indicate physical abuse or another medical problem. The mother not visiting the child indicates ongoing psychological issues with the mother bonding with the child. The father bringing toys does not indicate that the care of the child has been successful. The father's bonding with the child cannot be determined by this action of bringing toys.
A nursing instructor is discussing child maltreatment. What response by the student shows an understanding of what is included in the description of child maltreatment? Select all that apply
Intentional psychological maltreatment Intentional physical maltreatment Sexual maltreatment Negligence by someone responsible for the care of a child "Child maltreatment" means any intentional act of physical, psychological, or sexual maltreatment, including acts of negligence, committed by a person responsible for the care of the child.
The nurse has documented the following on the medical record of four children. When caring for the client assignment, for which child would the nurse initiate additional abuse screening?
Linear abrasions on ankles and wrists Linear abrasions at the ankles and wrists suggest a restraint was used to tie the child to a bed. Scald burns to the chest often happen from accidental spills of coffee.
The nurse is caring for a pediatric client with the injury pictured. When asking the caregivers about the way in which the client received these injuries, which communication manner is essential?
Nonjudgmental manner The most essential communication manner is a nonjudgmental one. The caregivers may feel that the nurse is accusing them of abuse if the manner is direct and unexpected. Easing into the discussion is a way to obtain all assessment documentation and not just focus on the area of injury, but it remains essential to have a nonjudgmental attitude. Joking with the caregiver in this situation is not appropriate.
A nurse working in the emergency department who suspects child abuse should do which of the following?
Report it to the authorities. State laws require health care personnel to report suspected child abuse. This law overrides the concern for confidentiality. Laws also have been enacted that will protect the nurse who reports from reprisal by a caregiver (eg, being sued for slander). If a nurse does not report suspected child abuse, the penalty can be loss of his or her nursing license.
The elementary school teacher invites the nurse into the classroom to observe a pupil's interaction when completing an assignment. Which characteristic alerts the school nurse that the child may be the victim of emotional abuse?
The child is fretful and worried about the project. When completing group work there can be many dynamics in the classroom; however, the child should not be fretful and worried about the project. This indicates that something else is the cause of the worry. The teacher and school nurse work together to help the child as needed.
A teenage client has been undergoing individual psychotherapy following a sexual assault a few days ago. The nurse would determine that the early stage of therapy is successful when the client meets which outcome?
The client is able to describe what happened and express feelings In the early stage right after the rape occurs, it is critical that the client be able to describe what happened and verbalize feelings related to the event. The decision on whether or not to press legal charges does not mean that the client is coping with the situation. Nightmares usually begin soon after the event and may continue for a long time. Returning to school and participating in activities is healthy for the victim, but again it does not demonstrate successful therapy has occurred.
A 1-year-old is a victim of child abuse. Which of the following factors obtained on history is most apt to be associated with the risk of Munchausen syndrome by proxy physical abuse in children?
The mother was abused as a child. Parents tend to parent the same way as their parents. Abuse, therefore, continues from generation to generation.
A nurse is assigned to care for a 7-year-old who has been admitted with infected circular burns to both arms, which resemble cigarette burns. The child states to the nurse, "If I did better in school, this would not happen." What does the nurse understand is most likely the issue with the abusive parents?
The parents have inadequate parenting skills. Commonly, abusive parents have inadequate parenting skills. If they have unrealistic expectations of the child, they may not respond appropriately to the child's behavior.
As the elementary school nurse is documenting student contact in the health room, which student is most concerning?
The student who repeatedly reports vague physical complaints and has nightmares. Having repeated trips to the health room with vague symptoms and history of nightmares indicates that something is greatly upsetting the child. This pattern of behavior could indicate various types of abuse. Further investigation with the child and collaboration with the teacher is necessary. Parental input is also required. The student who needs assistance in glucose testing needs additional instruction. The students experiencing fatigue and needing a rescue inhaler will need parental notification; possible follow-up by the health care provider is needed if symptoms do not improve.
The nurse manager is educating staff about the mandate of health care workers to report suspected child abuse. A staff member asks, "What if you are not certain that it is an abuse situation. What should the nurse do?" The nurse manager is most correct when providing which answer?
"Feel comfortable about reporting your suspicion as the law protects you." It is important that nurses understand that they must report suspicion of abuse without fear of retaliation. Laws have been enacted that protect the nurse who reports suspected child abuse from reprisal by a caregiver. The nurse does not have to confirm the abuse through family confession to file a report. It is appropriate to collaborate with another professional, but ultimately the nurse needs to report the suspicion
During a routine well-child visit, the mother of a preadolescent patient asks the nurse to explain signs of sexual abuse. The mother is concerned because an older male neighbor has been making comments and overtly admiring the child when playing outdoors. What signs of sexual abuse should the nurse tell the mother to look out for? Select all that apply.
Child reports abdominal pain. Child has a change in school performance. Child demonstrates anxiety or trouble sleeping. Child does not want to be left alone with a certain adult.
The nurse is caring for a client believed to be a victim of human trafficking. What action is most important for the nurse to perform?
Gain the client's trust. It is most important for the nurse to gain the trust of the victim. This will allow the nurse to obtain the most information to appropriately help the client. The nurse may notify the authorities and test for pregnancy if the client is a victim. The client will be assessed, but it isn't the priority.
The nurse is caring for a woman with injuries as a result of intimate partner violence. What is the nurse's responsibility in providing appropriate care to this client?
Inform the client about risk factors and determine the immediate level of danger. The nurse's role is to inform, educate, identify resources, and to empower the client to take action. The nurse cannot take action on the part of the client or tell the client what she needs to do.
The nurse is caring for a client who is seeking care after being raped. What is the primary reason the nurse does not leave the client alone during the emergency room stay?
Promotes the client's sense of safety The nurse's first responsibility is to provide the client a safe environment both physically and emotionally. Staying with the client will help promote a sense of safety. Although the other options may result from the nurse's presence, the primary goal is safety.
Which action is most helpful in encouraging the expression of feelings in a pediatric client who is abused?
Using play to reduce stress It is most helpful to reduce stress in the client by means of play. Frequently, play can help the client work through the abuse and express feelings. Talking in a private space inhibits communication as the client may feel afraid of the stranger or afraid that he or she is going to get in trouble. Support groups are helpful in adolescent clients. Once the adolescent feels safe in the group, he or she can feel comfortable with recounting his or her experience. Physical caring behaviors can be appropriate depending upon the relationship with the client.
A school nurse is developing a plan of care for a child with suspected violence between the child's parents. The nurse monitors for which behaviors in the child?
aggressive behavior in school Children who have a parent who is violent may be identified because of behavior problems, noncompliance, and aggression in school. Developmental delays occur in children with other disorders. Development of tics or twitches occurs with Tourette's syndrome. Compensating by overachieving is not typically related to violence in the home.
A nurse is working with a child who has been psychologically neglected by the parents. The nurse would anticipate which complication for this child?
developmental delay and mental health issues Children who experience psychological neglect have issues with developmental delays, plus mental health issues such as depression, anxiety, self harm, aggression, psychosomatic complaints, and bedwetting. It is not typical for them to have intellectual disability or social isolation or speech disorders. Rocking behaviors and loss of muscle tone are found in children with failure to thrive.
A 5-year-old child has frequent visits to the school nurse's office. Which assessment data should alert the nurse that this child may be a victim of physical neglect?
malnourished with frequent absences from school A neglected child may appear unwashed, thin, and malnourished or be dressed inappropriately, such as without mittens, a coat, or shoes in cold weather. Not requiring a child to attend school, deliberately keeping a child out of school without setting up a home school program, or allowing a child to go unsupervised after school may also be interpreted as neglect. Isolated from classmates with poor self-esteem may be a child who is emotionally neglected. Evidence of bruising on multiple parts of the body might indicate child abuse. Inappropriate knowledge of sexual terms and actions is more likely when a child is sexually abused
The generation-to-generation continuum of violence refers to the fact that:
violence is a learned behavior, and children who witness intimate partner violence are more likely to become abusers themselves. Violence is a learned behavior. Many abusers were abused themselves as children; however, not all children who were abused become abusers.
When interacting with a pediatric client and family, which would prompt further investigation for potential child abuse? Select all that apply.
A caregiver intentionally is demeaning to a child. A caregiver neglecting a child's physical needs. A caregiver punching the child's arm when the child does not follow instructions. 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 caregiver with poor parenting skills who allows a child to talk inappropriately is not considered being abusive. There is no abuse in allowing a child to participate in school activities or live at a homeless shelter.
During a prenatal assessment, the nurse observes that the client is quiet and withdrawn. The client keeps asking if her partner can come into the examination room, because the partner does not like to be kept waiting. Which question would be most important for the nurse to ask before the partner comes into the examination room
"Do you feel safe in your home?" Client safety is the priority. Asking if the client feels safe, before the partner is present, is important. Also, the client may be reluctant to answer this question is the partner is present. Feeling safe is a higher priority than gathering specifics about the relationship, such as what occurs when they argue. The other questions can be asked with the partner present, with the client's permission.
A family nurse practitioner is speaking to a community group about family abuse and informs the group that such abuse can take various forms, including which of the following? Select all that apply.
child abuse spouse abuse other family member abuse substance abuse Abuse in the family can take various forms. Parents or caregivers may abuse a child, spouse, other family members, or substances. Although mismanagement of money will affect a family, it is not considered a type of abuse.
Which clinical symptoms are documented as being indications of sexual abuse? Select all that apply.
Gastrointestinal upset Changes in bowel and bladder habits Behaviors of aggression and hostility Each case is unique; however, common characteristics indicating sexual abuse are gastrointestinal upset, changes in bowel and bladder habits, and behaviors in aggression and hostility. A decreased performance in academics and a lack of participation in extracurricular activities are most commonly seen in victims of sexual abuse.
The nurse is caring for a child who has unusal bruises and marks that do not match the child's developmental age. When completing an admission assessment, which other information does the nurse identify as a potential factor in child abuse?
Long-term unemployment without supplemental income
The generation-to-generation continuum of violence refers to the fact that
violence is a learned behavior, and children who witness intimate partner violence are more likely to become abusers themselves. Violence is a learned behavior. Many abusers were abused themselves as children; however, not all children who were abused become abusers.
During a prenatal assessment, the nurse observes that the client is quiet and withdrawn. The client keeps asking if her partner can come into the examination room, because the partner does not like to be kept waiting. Which question would be most important for the nurse to ask before the partner comes into the examination room?
"Do you feel safe in your home?" Client safety is the priority. Asking if the client feels safe, before the partner is present, is important. Also, the client may be reluctant to answer this question is the partner is present. Feeling safe is a higher priority than gathering specifics about the relationship, such as what occurs when they argue. The other questions can be asked with the partner present, with the client's permission.
A nurse is discussing concerns about possible child abuse with the nursing supervisor. Which statement by the nurse requires correction by the supervisor?
"HIPAA prevents nurses from disclosing confidential information from parents." The fact that the information was given in a confidential interview does not free a nurse from this responsibility (it is an exception under the confidentiality rules of the Health Insurance Portability and Accountability Act [HIPAA]) (Fraser, Matthews, Walsh, et al., 2010). Therefore, the nursing supervisor would need to correct this misinformation. The other comments are correct. All health care institutions and agencies have protocols on how the reporting of child maltreatment should be managed. It is important to learn the protocol required by your particular agency, community, and state. 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 symptoms does the nurse identify as potential clinical manifestations resulting from physical abuse in the home? Select all that apply
Behavioral issues Poor attendance in school Bedwetting Feelings of guilt The child who lives in a home where domestic violence occurs many times has a variety of behaviors such as poor attendance in school, feelings of guilt related to not being able to protect the abused, behavioral issues and bedwetting. These symptoms and others manifested are referred to as symptoms associated with post-traumatic stress disorder. High academic standards and an outgoing personality are not associated with manifestations from physical abuse.
Which symptoms does the nurse identify as potential clinical manifestations resulting from physical abuse in the home? Select all that apply.
Feelings of guilt Poor attendance in school Behavioral issues Bedwetting The child who lives in a home where domestic violence occurs many times has a variety of behaviors such as poor attendance in school, feelings of guilt related to not being able to protect the abused, behavioral issues and bedwetting. These symptoms and others manifested are referred to as symptoms associated with post-traumatic stress disorder. High academic standards and an outgoing personality are not associated with manifestations from physical abuse.
The nurse is working with a client who is in a relationship with a man who controls her activities, calls her names, and occasionally hits her. What are the goals in the treatment of this client? Select all that apply.
Maximize the client's safety Empower the client to take control Provide support to the client The goal is to provide support, to empower the woman, and to maximize her safety. Hospitalization might keep her safe in the short-term, but is not a solution. It is not the nurse's place to involve the police in the client's situation. It is beyond the nurse's scope of practice as well as a HIPAA violation.
The parents bring their 4-week-old infant to the emergency room unresponsive. The parents indicate that the infant was shaken. Which diagnostic test is anticipated?
Magnetic resonance imaging The nurse anticipates that the health care provider will prescribe magnetic resonance imaging (MRI) to assess the infant's brain. Common injuries form shaken baby syndrome are edema to the brainstem, retinal hemorrhages, and brain hemorrhages.
The nurse is caring for a client in an abusive situation. In developing a plan of care, which factors does the nurse consider? Select all that apply.
Substance use is a common factor in abusive relationships. It often takes several attempts before a woman leaves an abusive situation. Women in abusive relationships usually feel isolated and unsupported. Factors that need to be considered include the following: It often takes several attempts before a woman leaves an abusive situation; women in abusive relationships usually feel isolated and unsupported; and substance use is a common factor in abusive relationships. Economic factors are often a factor because the partner/abuser usually controls the financial resources. Toddlers and preschoolers can be affected by parental discord and intimate partner violence (physical, emotional, verbal) that takes place in the household.
The nurse is visiting the home of a family with a previous history of physical neglect. Which observation indicates that interventions have not been successful?
The father allows the children to stay home from school whenever they desire. Not requiring a child to attend school may be interpreted as neglect. Following a vegetarian diet, encouraging participating in sports, and concern about immunization discomfort do not indicate that interventions to address physical neglect have not been successful.
During a prenatal examination the nurse observes bruises on a woman's arms and a black eye. When asked about the bruises, the client states, "It was an accident. My husband just had a bad day at work, and I was late getting his dinner. But he is being so kind now; he brought me flowers yesterday. He is looking for a new job, so it won't happen again." This client is in which phase of the cycle of violence?
The honeymoon phase Being kind, showing love, and bringing gifts after an episode of abuse is characteristic of the honeymoon stage of the cycle of violence. The tension-building phase is when the tension begins to increase due to activities such as being late or the abuser having a bad day or being intoxicated. The acute explosion phase is the violent act as anger or tension is released. The resolution and reorganization phase occurs when the abused partner leaves the situation.
A 16-year-old girl is seen in an emergency department following a rape. The management of a rape victim should be directed primarily toward:
decreasing guilt and increasing self-esteem. Rape is a demeaning event in a person's life. Helping maintain self-esteem in the face of this is important.
A child with acute bronchitis has just been hospitalized. The nurse overhears the child's mother say to the child that if he is not good, she will leave and not come back until he is ready to return home. What should the nurse suspect in this situation?
emotional abuse A child may be emotionally abused verbally or by unavailability of the caregiver, poor nurturing, threats involving leaving the child, or role reversal (in which the child must take on the role of parenting or is blamed for the parent's problems).
Which statement by a parent of a 4-year-old child is most likely to suggest child abuse?
"He doesn't ever help me clean house." "Role reversal," or a child taking care of a parent, is frequently seen with child abuse.
A client has been seen and treated in the emergency room several times for injuries that are deemed suspicious. The client is reluctant to participate in a screening process. How best can the nurse provide reassurance to this client?
Being nonjudgmental During the screening process the victim is most likely to be uncomfortable and not want to participate. Victims are concerned about being judged by the interviewer, provoking more violence, and being disappointed by the provider's response to the disclosure. The nurse can best help the victim participate in screening by ensuring confidentiality and being nonjudgmental. There is no guarantee the nurse can assure the woman of help. At best, the nurse can provide information of agencies and services. Having the client be honest about the injuries can cause much distress for the client who may feel it will only lead to more injuries after the partner realizes details have been disclosed. Helping the client find community resources to develop a plan of protection is best done with the social worker and community agencies rather than the emergency room nurse. The nurse should make a referral to the social worker to help with this situation.
The nurse is caring for a child who has been referred to the health care facility by a school nurse, who suspects the child may have been living in a home where domestic violence has occurred. Which symptom reported by a family member might indicate this possibility?
Child has not been sleeping well and has been wetting the bed Children affected by domestic violence may show signs and symptoms that result from the violent situation. These symptoms may be referred to as symptoms of posttraumatic stress disorder and may include inability to sleep, bedwetting, temper tantrums, withdrawal, and feelings of guilt for not being able to protect himself or herself. The school-age child may have academic problems, frequent absences, behavior issues, or self-isolation. The older child will often use drugs or alcohol; get into legal trouble, many times by committing a crime against another person; or attempt suicide.
A 17-year old pregnant teenager is living with her 20-year old partner in a rural area with no public transportation. The clinic nurse wants to have a visiting nurse come to the home to monitor the pregnancy, but the partner refuses, stating, "We don't need people in our house...I will make sure she gets the care she needs." At the next appointment, the nurse learns he took away the client's phone and only allows her to call her mother once a week. The nurse recognizes these behaviors as which component of intimate partner violence?
Coercive tactics Coercive tactics includes behaviors such as limiting social interactions and controlling behaviors. These are a recognized form of abuse, even without evidence of physical injury. Emotional abuse includes verbal assault, humiliation, intimidation, or any other treatment which may diminish the sense of identity, dignity, and self-worth of another person. Stalking aggression would be following or tracking another person's movement or activity. Physical violence results in bruises, fractures, and other injuries to the body.
A nurse is working with the burn clinic at a local hospital. Which types of burns would the nurse address with the health care provider and social worker? Select all that apply.
Linear pattern burns Small, round burns Hand burns with a pattern The health care provider and social worker are alerted to certain style of burns associated with child abuse. Cigarette burns (small round) and burns from hand immersion into hot liquid or onto a hot register, curling iron, or steam iron are pattern burns from objects and commonly seen with child abuse. Some burns are accidental, such as those suffered in house fires or as a sunburn while swimming.
