UNIT 1 EXAM: Interpersonal Violence Exemplars (Intimate Partner Violence, Child Maltreatment, Human Trafficking)

What behavioral findings correspond to intimate partner violence in young adolescents? Select all that apply. 1.Sexually acting out 2.Attempting suicide 3.Pattern of substance abuse 4.Fear of certain people or places 5.Preoccupation with others or one's own genitals

2,3 *Rationale*: Adolescent undergoing intimate partner violence may attempt suicide or have patterns of substance abuse. The behavioral findings in children undergoing sexual abuse include sexually acting out, fear of certain people or places, and a preoccupation with genitalia.

What action should the nurse take if abuse of a 10-year-old child is suspected? 1.Report the suspicion to local authorities. 2.Elicit more information from the parents. 3.Refer the parents to a group therapy meeting. 4.Notify the healthcare provider of the suspicion

1 *Rationale*: A nurse is mandated by law to report suspected child abuse. Child protective services are notified to make appropriate investigations. Assessment is an ongoing process throughout treatment, but legally the nurse is bound to report suspected abuse. Referring the parents to a group therapy meeting is not the primary safety action at this time. The nurse must comply with state (Canada: provincial/territorial) law because all 50 states (Canada: 12 provinces and territories) require the nurse to be a mandated reporter. The healthcare provider can be notified, but this is not the priority action.

The nurse in the emergency department is caring for a young female victim of sexual assault. The client's physical assessment is complete, and physical evidence has been collected. The nurse notes that the client is withdrawn, confused, and at times physically immobile. How should the nurse interpret these behaviors? 1.Signs of depression 2.Reactions to a devastating event 3.Evidence that the client is a high suicide risk 4.Indicative of the need for hospital admission

2 *Rationale*: During the acute phase of the rape crisis, the client can display a wide range of emotional and somatic responses. The symptoms noted indicate an expected reaction. Options 1, 3, and 4 are incorrect interpretations.

The emergency department nurse is caring for a client who has been identified as a victim of physical abuse. In planning care for the client, which is the priority nursing action? 1.Adhering to the mandatory abuse-reporting laws 2.Notifying the caseworker of the family situation 3.Removing the client from any immediate danger 4.Obtaining treatment for the abusing family member

3 *Rationale*: Whenever an abused client remains in the abusive environment, priority must be placed on ascertaining whether the client is in any immediate danger. If so, emergency action must be taken to remove the client from the abusing situation. Options 1, 2, and 4 may be appropriate interventions but are not the priority.

1. Which statement made by a new mother should be explored further by the nurse? a. "I have three children, that's enough." b. "I think the baby cries just to make me angry." c. "I wish my husband could help more with the baby." d. "Babies are a blessing, but they are a lot of work."

b. "I think the baby cries just to make me angry."

While assessing an older adult during a regular health checkup, a nurse finds signs of elder abuse. Which physical findings would further confirm the nurse's suspicion? Select all that apply. 1.Presence of hyoid bone damage 2.Presence of cognitive impairment 3.Presence of burns from cigarettes 4.Presence of foreign bodies in the rectum 5.Presence of unexplained bruises on the wrist(s)

3,4,5 *Rationale*: A physical finding of abuse in older adults can be the presence of burns from cigarettes. The physical presence of foreign bodies in the rectum or urethra also indicates client abuse. Unexplained bruises on the wrist(s) may also be an indication of abuse in older adults. The presence of hyoid bone damage is an indication of intimate partner violence. The presence of cognitive impairment is a behavioral finding in older adult abuse.

The emergency department nurse is caring for an adult client who is a victim of family violence. Which priority information should be included in the discharge instructions? 1.Information regarding shelters 2.Instructions regarding calling the police 3.Instructions regarding self-defense classes 4.Explaining the importance of leaving the violent situation

1 *Rationale*: Tertiary prevention of family violence includes assisting the victim after the abuse has already occurred. The nurse should provide the client with information regarding where to obtain help, including a specific plan for removing the self from the abuser and information regarding escape, hotlines, and the location of shelters. An abused person is usually reluctant to call the police. Teaching the victim to fight back is not the appropriate action for the victim when dealing with a violent person. Explaining the importance of leaving the violent situation is important, but a specific plan is necessary.

A 2.5-year-old child is admitted for treatment of injuries supposedly sustained in a fall down a flight of stairs. Child abuse is suspected. What statements might the nurse expect from a parent who engages in child abuse? Select all that apply. 1."Kids have to learn to be careful on the stairs." 2."Every time I turn around the kid is falling over something." 3."This child tends to be adventurous and doesn't understand about getting hurt on the stairs." 4."I can't understand it. This child didn't have a problem using the stairs without my help before this." 5."I try to keep an eye on my child, but little kids are always on the go and I just can't keep running after the kid

2,4 *Rationale*: Abusive parents often have a poor understanding of the expected growth and development of children and tend to blame the child. Toddlers generally need supervision and some assistance when climbing stairs, but abusive parents have little understanding of toddlers' abilities. Although "Kids have to learn to be careful on the stairs" is a true statement about toddlers, it is an unlikely response from an abusive parent because these people do not have an understanding of children's needs in relation to growth and development. "This child tends to be adventurous and doesn't understand about getting hurt on the stairs" is an unlikely response from an abusive parent because these people do not have an understanding of children's needs in relation to growth and development. Although "I try to keep an eye on my child, but little kids are always on the go and I just can't keep running after the kid" is a true statement about toddlers, it is an unlikely response from an abusive parent because these people usually do not have an understanding of children's needs in relation to growth and development.

A nurse in the emergency department is assessing a client who has been physically and sexually assaulted. What is the nurse's priority during assessment? 1.The family's feelings about the attack 2.The client's feelings of social isolation 3.The client's ability to cope with the situation 4.Disturbance in the client's thought processes

3 *Rationale*: The situation is so traumatic that the individual may be unable to use past coping behaviors to comprehend what has occurred. Assessing emotions that occur in response to news of the attack will occur later. The client should be the focus of care at this time. Social isolation is not an immediate concern. Coping skills, not thought processes, are challenged at this time.

A nurse educates the mother of a four-year-old child about sexual abuse. What behavioral finding explained by the nurse signifies that the child may be a victim of child abuse? 1.The child may attempt suicide. 2.The child may be verbally aggressive. 3.The child may have stress-related concerns. 4.The child may show fear of certain people or places

4 *Rationale*: A sexually abused child may show fear of certain people or places. Attempting suicide is observed in adolescents or adults who are being abused. Combative, verbally aggressive behavior can be appreciated in older adults who are sexually abused. Stress-related concerns are unrelated to sexual abuse.

2. Which problem is observed in children who regularly witness acts of violence in their family? Select all that apply. a. Phobias b. Low self-esteem c. Major depressive disorder d. Narcissistic personality disorder e. Posttraumatic stress disorder

a. Phobias b. Low self-esteem c. Major depressive disorder e. Posttraumatic stress disorder

5. The nurse is assisting a patient to identify safety issues that may occur now that she has left an abusive partner. What telephone numbers should be available to the patient? Select all that apply. a. The police department b. An abuse hotline c. A responsible friend or family member d. A domestic violence shelter e. The hospital emergency department

a. The police department b. An abuse hotline c. A responsible friend or family member d. A domestic violence shelter

6. Secondary effects of abuse often manifest as arrested development in children due to the fact that: a. Coping is easier than emotional growth b. Energy for development is diverted to coping c. Children cannot differentiate love from abuse d. Abuse fosters a sense of belonging, even if dysfunctional

b. Energy for development is diverted to coping

3. What situation associated with a caregiver presents the greatest risk that an older adult will experience abuse by that caregiver? a. The caregiver is a single male relative. b. The caregiver was neglected as a child. c. The caregiver is under the age of 30. d. The caregiver has little experience with the elderly.

b. The caregiver was neglected as a child.

4. What safety-related responsibility does the nurse have in any situation of suspected of abuse? a. Protect the patient from future abuse by the abuser. b. Inform the suspected abuser that the authorities have been notified. c. Arrange for counseling for all involved parties but especially the patient. d. Report suspected abuse to the proper authorities.

d. Report suspected abuse to the proper authorities.

What important intervention should be included in the nursing care provided immediately after a sexual assault? 1.Obtaining the assault history from the client 2.Informing the police before the client is examined 3.Having the client void a clean-catch urine specimen 4.Testing the client's urine for seminal alkaline phosphatase

1 *Rationale*: Obtaining the assault history from the client provides a basis for assessing trauma; in a client of childbearing age it also is necessary to assess the risk for pregnancy. Examination may precede reporting; the decision to report is mandated by law. Urination may wash away spermatic or bloody evidence. A test for seminal acid phosphate, not seminal alkaline phosphatase, is performed.

A 10-year-old referred for evaluation after drawing sexually explicit scenes says to the psychiatric nurse, "I just felt like it." Which response by the nurse is focused on assessing for abuse-related symptoms? 1."Well, a picture paints a thousand words." 2."You just felt like destroying your textbooks?" 3."Your parents and teachers are very concerned about your drawings." 4."I am concerned about you. Are you now or have you ever been abused?"

4 *Rationale*: The behaviors that this child engaged in are a warning signal of distress. The correct option is the only one that specifically addresses abuse. The remaining options are insensitive, not focused on the possible sexual abuse, or too indirect to be useful.

7. The use of a patient-centered interview technique works well for gathering information about abusive situations. It is a good use of clinical time to sit near the patient and: a. Establish trust and rapport b. Ask lots of questions c. Interrupt the patients' story to allow for decompression d. Utilize closed-ended questions

a. Establish trust and rapport

10. Perpetrators of domestic violence tend to: Select all that apply. a. Have relatively poor social skills and to have grown up with poor role models. b. Believe they, if male, should be dominant and in charge in relationships. c. Force their mates to work and expect them to handle the financial decisions. d. Be controlling and willing to use force to maintain their power in relationships. e. Prevent their mates from having relationships and activities outside the family.

a. Have relatively poor social skills and to have grown up with poor role models. b. Believe they, if male, should be dominant and in charge in relationships. d. Be controlling and willing to use force to maintain their power in relationships. e. Prevent their mates from having relationships and activities outside the family.

A young child in whom sexual abuse is suspected asks the nurse, "Did I do something bad?" What is the most therapeutic response by the nurse? 1."Do you think you did something bad?" 2."Who said that you did something bad?" 3."What do you mean by something bad?" 4."Are you worried that I think you did something bad?

3 *Rationale*: "What do you mean by something bad?" elicits further clarification of what the child means by "bad." The nurse must determine what the child means by the word "bad" before reflecting the term back to the child. "Who said that you did something bad?" is not helpful; it will do nothing to clarify the child's idea of what "bad" means or the child's feelings about what happened. Before the nurse can explore the child's concerns ("Do you think you did something bad?" or "Are you worried that I think you did something bad?"), the nurse must first understand the child's use of words and their meaning to the child.

A 15-year-old pregnant, unwed client tells the nurse, "My life was unbearable before I met Bobby. My mother beats me every day, and my dad has sexually abused me since I was 10 years old!" Which response is appropriate for the nurse to make? 1."Why didn't you just report your parents for this abuse?" 2."What are you saying? Your parents abused you, so you got pregnant?" 3."It seems that you needed Bobby's help to separate from your family." 4."Sounds like you decided to have a baby so you'd have someone for yourself."

3 *Rationale*: Adolescent pregnancy outside of marriage can arise from female low self-esteem, fears of inadequacy, and desperation to escape from an abusive and dysfunctional family. The most therapeutic communication technique is the one that uses restatement and repeats the main thought that the client expressed. This assures the client that the nurse is listening and is attempting to validate what the client has said. The remaining options are nontherapeutic because they reflect a knowledge deficit on the nurse's part, imply bias, are insensitive, or place responsibility on the adolescent.

A client comes to a trauma center reporting that she has been raped. She is disheveled, pale, and staring blankly. The nurse asks the client to describe what happened. What is the nurse's rationale for doing this? 1.It will help the nursing staff give legal advice and provide counseling. 2.Talking about the assault will help the client see how her behavior may have led to the event. 3.It will let the victim put the event in better perspective and help begin the resolution process. 4.Discussing the details will keep the victim from concealing the intimate happenings during the assault.

3 *Rationale*: Talking about what actually happened helps the client sort out the truth from confused thoughts and helps the client begin to accept what has happened as a part of her history. Legal counsel should come from a legal authority, not the nurse; the victim should be told of the legal services available. Sexual assaults are often planned. They are violent acts, and the perpetrators are responsible for their behavior. If the client does not want to discuss intimate details, this wish should be respected.

The nurse is caring for a female client in the emergency department who presents with a complaint of fatigue and shortness of breath. Which physical assessment findings, if noted by the nurse, warrant a need for follow-up? 1.Reddened sclera of the eyes 2.Dry flaking noted on the scalp 3.A reddish-purple mark on the neck 4.A scaly rash noted on the elbows and knees

3 *Rationale*: The client in this question should be screened for abuse. Battered women experience bruises, particularly around the eyes, red or purple marks on the neck, sprained or broken wrists, chronic fatigue, shortness of breath, muscle tension, involuntary shaking, changes in eating and sleeping, sexual dysfunction, and fertility issues. Mental health issues can also arise, including post-traumatic stress disorder, nightmares, anxiety, uncontrollable thoughts, depression, anxiety, low self-esteem, and alcohol and drug abuse. Reddened sclera, a dry rash on the elbows, and flaking of the scalp do not pose an indication of abuse.

Which assessment data would cause the nurse to suspect that a toddler-age client is experiencing physical abuse? 1.Abdominal distention 2.Bloody underclothing 3.Recurrent urinary tract infections 4.Bruises in various stages of healing

4 *Rationale*: Bruises in various stages of healing would cause the nurse to suspect the toddler-age client is being physically abused. Abdominal distension, a symptom of malnutrition, would cause the nurse to suspect physical neglect, not abuse. Bloody underclothing and recurrent urinary tract infection would cause the nurse to suspect sexual abuse

An 18-year-old woman is brought to the emergency department by her two roommates after being found unconscious in the bathroom. Laboratory tests are ordered. The nurse reviewing the findings notes that the urinalysis is positive for flunitrazepam. The nurse knows that flunitrazepam is often used for what? 1.As a date rape drug 2.To control symptoms of psychosis 3.To control symptoms of bipolar mania 4.To treat hangover symptoms after excessive alcohol consumption

1 *Rationale*: Flunitrazepam, illegal in the United States, has been used in date rapes; the victim is attacked after consuming a drink spiked with the drug. Flunitrazepam is not used to treat psychosis, mania, or hangover symptoms.

A 13-year-old who recently was suspended from school for consistently bullying other children is brought to the pediatric mental health clinic by his mother. The child is assessed by the psychiatrist and referred to a psychologist for psychologic testing. The day after the tests are completed, the mother returns to the clinic and asks the nurse for results of the tests. Which is the best response by the nurse? 1.Refer the mother to the psychiatrist. 2.Explain to the mother the results of the tests. 3.Suggest that the mother call the psychologist. 4.Teach the mother about the tests that were administered.

1 *Rationale*: It is the responsibility of the psychiatrist, who is the primary healthcare provider, to discuss the test results with the mother. Explaining to the mother the results of the tests is beyond the scope of the nurse's role. The mother should be referred to the psychiatrist, not the psychologist, because the psychiatrist is the leader of this health team. Teaching about the tests should have been done before, not after, the tests were administered.

The husband of a woman who has been sexually assaulted arrives at the hospital after being called by the police. After reassuring him about his wife's condition, the nurse should give priority to what? 1.Arranging for the rape counselor to meet with the wife 2.Discussing with him his own feelings about the situation 3.Helping him understand how his wife feels about the situation 4.Making him comfortable until the practitioner has finished examining his wife

2 *Rationale*: Partners may themselves feel angry and abused; these feelings should be quickly and openly discussed. Arranging for the rape counselor to meet with the wife should not be done yet; rape counselors work with the victim and partner together. The partner's feelings must be resolved before the partner can help the client, and the nurse may not fully know the wife's feelings. Making him comfortable until the practitioner has finished examining his wife may be reassuring, but it leaves the partner alone to deal with his feelings.

What health effects best describe a client who is the victim of abuse or negligence? Select all that apply. 1.Depression 2.Chronic fatigue 3.Involuntary shaking 4.Motivation to persevere 5.Interrupted sleeping patterns

1,2,3,5 *Rationale*: Clients who are victims of abuse or neglect are prone to certain health effects; these effects may be physical, such as bruises, broken bones, chronic fatigue, or involuntary shaking. The victim may also experience mental effects, such as nightmares, anxiety, post-traumatic stress disorder (PTSD), depression, interrupted sleep patterns, and low self-esteem. Motivation to persevere is not a direct effect and can be a positive characteristic.

A nurse on the pediatric unit is assigned to care for a 2-year-old child with a history of physical abuse. What does the nurse expect the child to do? 1.Smile readily at anyone who enters the room. 2.Be wary of physical contact initiated by anyone. 3.Begin to scream when the nurse nears the bedside. 4.Pay little attention to the nurse standing at the bedside

2 *Rationale*: This child will distrust any approach because approaches by adults commonly result in pain; abused children remain alert in an attempt to ward off an attack. This child will not be open to an approach by a stranger; basic trust of others does not develop in abused children. Abused children will usually not cry out; they learn not to expect comforting or soothing by others. This child will be acutely aware of anyone coming near; abused children try to defend themselves by keeping alert to the possibility of attack.

The emergency department nurse is performing an assessment on a child suspected of being sexually abused. Which assessment data obtained by the nurse most likely support this suspicion? 1.Poor hygiene 2.Difficulty walking 3.Fear of the parents 4.Bald spots on the scalp

2 *Rationale*: Abuse is the nonaccidental physical injury or the nonaccidental act of omission of care by a parent or person responsible for a child. It includes neglect and physical, sexual, or emotional maltreatment. Sexual abuse can involve incest, molestation, exhibitionism, pornography, prostitution, or pedophilia. Many times the findings associated with sexual abuse may not be easily apparent in the child. The most likely assessment findings in sexual abuse include difficulty walking or sitting; torn, stained, or bloody underclothing; pain, swelling, or itching of the genitals; and bruises, bleeding, or lacerations in the genital or anal area. Poor hygiene may indicate physical neglect. Fear of the parents and bald spots on the scalp most likely are associated with physical abuse.

A client comes to the emergency department after an assault and is extremely agitated, trembling, and hyperventilating. What is the priority nursing action for this client? 1.Begin to teach relaxation techniques. 2.Encourage the client to discuss the assault. 3.Remain with the client until the anxiety decreases. 4.Place the client in a quiet room alone to decrease stimulation.

3 *Rationale*: This client is in a severe state of anxiety. When a client is in a severe or panic state of anxiety, it is crucial for the nurse to remain with the client. The client in a severe state of anxiety would be unable to learn relaxation techniques. Discussing the assault at this point would increase the client's level of anxiety further. Placing the client in a quiet room alone may also increase the anxiety level.

A female victim of a sexual assault is being seen in the crisis center. The client states that she still feels "as though the rape just happened yesterday," even though it has been a few months since the incident. Which is the most appropriate nursing response? 1."You need to try to be realistic. The rape did not just occur." 2."It will take some time to get over these feelings about your rape." 3."Tell me more about the incident that causes you to feel like the rape just occurred." 4."What do you think that you can do to alleviate some of your fears about being raped again?"

3 The correct option allows the client to express her ideas and feelings more fully and portrays a nonhurried, nonjudgmental, supportive attitude on the part of the nurse. Clients need to be reassured that their feelings are normal and that they may express their concerns freely in a safe, caring environment. Option 1 immediately blocks communication. Option 2 places the client's feelings on hold. Option 4 places the problem solving totally on the client.

A nurse has learned that infants born to very young mothers are at risk for neglect or abuse, primarily because of what characteristic typical of adolescent mothers? 1.Did not plan for her pregnancy 2.Cannot anticipate her baby's needs 3.Is involved in seeking her own identity 4.Becomes resentful of the need to give constant care to the baby

3 *Rationale*: Adolescent parents are still involved in the developmental stage of resolving their own self-identity; they have not sequentially matured to intimacy and generativity, making nurturing of another difficult. Although adolescents usually do not plan for their pregnancies, it is not the primary reason that their infants are at risk for neglect or abuse. Although adolescents may have difficulty anticipating their infants' needs, it is not the primary reason that their infants are at risk for neglect or abuse. Although adolescents may resent the responsibilities involved in childrearing, it is not the primary reason that their infants are at risk for neglect or abuse. These issues could be problematic for a new mother of any age.

A nurse in the emergency department is assessing a young child with a head injury. The child is accompanied by a parent. Which observation should prompt the nurse to assess the child for abuse? 1.The child has Mongolian spots on the back. 2.The child belongs to a single-parent family. 3.The child has received care for injuries twice earlier. 4.The child and parent narrate the same story about the injury

3 *Rationale*: The nurse should assess the child for abuse if the child has received care for injuries on two earlier occasions. Frequent emergency visits for injuries should prompt the nurse to further investigate the case. Mongolian spots are normal variants of skin coloration obtained at birth and do not need further evaluation. A single-parent home does not indicate that the child is a victim of abuse. The nurse need not assess the child for abuse if both the parent and the child narrate the same story.

The nurse is caring for a pediatric client who is recovering from abuse and neglect. Place in order of priority the interventions that the nurse performs. All options must be used. 1.Clean and dress wounds. 2.Provide emotional support 3.Administer pain medications 4.Ensure environmental safety

3,1,4,2 *Rationale*: Interventions that may be performed by the nurse when caring for a client who is a victim of abuse or neglect include administering pain medications, providing wound care, using assistive devices to support sprains or fractures, educating the client and family about self-care, as well as education on support programs that provide awareness and emotional support. Also, ensuring that the victim is in a safe environment both in the hospital and when the victim is discharged is a priority. Administering pain medications, and cleaning and dressing wounds should be done first, followed by ensuring environmental safety and providing emotional support.

Which statement by the nurse indicates a need for further teaching concerning family violence? 1."Abusers use fear and intimidation." 2."Abusers usually have poor self-esteem." 3."Abusers often are jealous or self-centered." 4."Abusers are more often from low-income families."

4 *Rationale*: Personal characteristics of abusers include low self-esteem, immaturity, dependence, insecurity, and jealousy. Abusers often use fear and intimidation to the point at which their victims will do anything just to avoid further abuse. The statement that abuse occurs more often in lower socioeconomic groups is incorrect.

9. An appropriate expected outcome in individual therapy regarding the perpetrator of abuse would be: a. A decrease in family interaction so that there are fewer opportunities for abuse to occur. b. The perpetrator will recognize destructive patterns of behavior and learn alternate responses. c. The perpetrator will no longer live with the family but have supervised contact while undergoing intensive inpatient therapy. d. A triad of treatment modalities, including medication, counseling, and role-playing opportunities.

b. The perpetrator will recognize destructive patterns of behavior and learn alternate responses.

A nurse suspects sexual child abuse in a preschooler who has come for a routine check-up. What physical findings lead to the nurse's suspicion? Select all that apply. 1.The nurse finds signs of immersion burns. 2.The nurse finds hematomas and bruises at various stages of resolution. 3.The nurse finds injuries and trauma inconsistent with reported cause. 4.The nurse finds that the preschooler has difficulty walking and sitting. 5.The nurse finds that the child has pain, itching, or unusual odor in genital area

4,5 *Rationale*: Physical findings of child sexual abuse in children include difficulty sitting and walking and pain, itching, or an unusual odor in the genital area. Signs of immersion burns, hematomas, bruises at various stages of resolution and injuries and trauma inconsistent with reported cause are the physical findings of sexual abuse in adolescents or older adults.

8. The abused person is often in a dependent position, relying on the abuser for basic needs. At particular risk are children and the elderly due to: a. The love they have for parents or children. b. Their limited options. c. The need to feel safe at home. d. Other relatives do not want them.

b. Their limited options.

During a support group session, a client says, "My husband hit me a lot, but when he threatened to start hitting our kids, I stabbed him. No jury will believe me because my husband can lie to anyone and be believed." If no one in the group responds, which statement is the therapeutic response by the nurse? 1."Abuse is a horribly difficult thing to experience. Can anyone in the group relate to what she's feeling?" 2."Yes. Everyone here was ill-used and abused, but what makes you think that this is a reason to stab someone?" 3."Everyone agrees that you couldn't let him hurt your children. But is there anything you would do differently?" 4."Your story is very much like every woman's here. The problem is getting a jury to see that you were justified in stabbing him."

1 *Rationale*: The therapeutic response is one that uses reflection and facilitates the client's feelings. In addition, a supportive response that encourages and supports other clients to connect or relate by responding to the client's statement is therapeutic. Comparing her experience to that of others and stating that her response to the abuse was not an appropriate option is insensitive and judgmental and will not promote communication.

The nurse should plan to take which action next after assessing a homeless pediatric client who is a victim of abuse? 1.Ask the mother who abused the child. 2.Report signs of abuse and document it. 3.Find out where the child sleeps at night. 4.Ask the child if he or she is scared of her mother or anyone else.

2 *Rationale*: Health care considerations for abused or neglected individuals are to treat them with compassion, respect, and dignity. Nurses are mandated reporters for domestic violence and abuse incidence, so a report should be done. Documentation of all injuries is also necessary for legal reasons. Asking the mother who abused the child and asking the child if he or she is scared of her mother or anyone else may cause fear and conflict. Finding out where the child sleeps at night may be helpful at some point of care but is not a next specific action.

The parents inform the nurse that their preschooler's teachers often complain about the child's bullying behavior in school. The parents are surprised, because they say the child is well behaved at home. What could be the reason for this inconsistency in the child's behavior? 1.The parents are lying about the child being well behaved. 2.The parents are inconsistent in their disciplining methods. 3.The child's parents do not spend enough time with the child. 4.The child is scared of the parents and displaces anger on others

4 *Rationale*: If the child is scared of the parents, the child will displace the anger that is experienced on others, especially peers and authority figures. The child is likely well behaved at home out of fear, but not out of respect for the parents. The parents are not lying about the child being well behaved at home if the child does behave in a disciplined manner out of fear. The parents may be very strict but not lack consistency in this scenario. Not spending enough time with the child does not result in aggressive behavior but may increase feelings of loneliness.

A woman who is frequently physically abused tells the nurse in the emergency department that it is her fault that her husband beats her. What is the most therapeutic response by the nurse? 1."Maybe it was your husband's fault, too." 2."I can't agree with that—no one should be beaten." 3."Tell me why you believe that you deserve to be beaten." 4."You say that it was your fault—help me understand that."

4 *Rationale*: Paraphrasing and clarifying are interviewing techniques that promote communication between the nurse and client and help the client hear and explore her words and gain insight into her behavior. "Maybe it was your husband's fault, too" is a declarative statement that is closed, will limit dialog, and is not therapeutic. When the nurse voices her opinion saying, "I can't agree with that—no one should be beaten", the nurse is shutting off communication with the client. Nurses are to be nonjudgmental and not offer an opinion, and should ask open-ended questions to facilitate communication with the client. Asking a "why" question is generally not therapeutic because most clients cannot respond to these questions with logical explanations

A child is seen in the school nurse's office with complaints of pain in his right forearm. In reviewing the child's record the nurse notes that he has a history of being physically abused by the mother. Which should be the initial intervention with this child? 1.Assess the child's physical status. 2.Ask the child how the injury occurred. 3.Report the case as suspected child abuse. 4.Observe the interactions between the child and his friends

1 *Rationale*: The initial intervention is to assess the child's physical status. The child should be initially assessed for injury to the right arm and for bruises, burns, scars, and any other signs of abuse. The nurse would next report the case as suspected child abuse to the appropriate authorities. Option 2 may or may not be appropriate, depending on the situation because the child may be fearful of telling the truth about how the injury occurred. Option 4, although appropriate for some situations, is not appropriate as the initial intervention.

A nurse determines that the information about falling down the stairs given by a parent suspected of child abuse contradicts the information given by the child. What should the nurse say to the parent? 1."Tell me again how your child fell down the stairs." 2."Your child says the stairs did not cause this injury." 3."Did you do anything to cause this injury to your child?" 4."Why don't you tell me what really happened to your child?"

1 *Rationale*: The nurse needs additional information to investigate the contradictory responses. The response "Your child says the stairs did not cause this injury" will put the parent on the defensive and may increase the child's risk for additional abuse. The response "Did you do anything to cause this injury to your child?" requires a yes or no response and will limit further discussion; it may also precipitate a defensive response. The response "Why don't you tell me what really happened to your child?" is judgmental, will interfere with further communication, and may precipitate a defensive response.

The school nurse is conducting a teacher's in-service on signs that may indicate that a child is a victim of bullying. Which sign should the nurse include in the teaching session? 1.The child wants to try out for the basketball team. 2.The child asks for extra work to make better grades. 3.The child is participating in several extracurricular activities after school. 4.The child asks to go to the nurse's office frequently with vague complaints

4 *Rationale*: Signs that may indicate a child is being bullied are similar to signs of other types of stress, including nonspecific ailments or complaints. Spending inordinate amounts of time in the school nurse's office with vague complaints is a sign that should be included in the teaching session. Withdrawal and deteriorating school performance are often signs of bullying. The child's wanting to participate on the basketball team, asking for extra work, and participating in extracurricular activities are not signs of withdrawal or deterioration in school performance.

A nurse providing care in a hospital witnesses a client's spouse shaking the client vigorously because the client has had an episode of incontinence. Because of the suspicion of physical abuse, legally the nurse should discuss the concerns with which party? 1.The client 2.The client's spouse 3.The client's primary healthcare provider 4.Adult Protective Services

4 *Rationale*: The nurse has a legal responsibility to report suspicions of abuse to the appropriate agency, which in this instance is Adult Protective Services. The client will not be able to understand the discussion. It is not the nurse's responsibility to directly challenge the spouse's behavior in this situation; the nurse may act as a client advocate by interrupting the spouse's behavior and providing immediate physical and emotional care. The nurse should then report suspicions of abuse to Adult Protective Services. Although the nurse may report suspicions about the spouse's behavior to the healthcare provider, the law requires that Adult Protective Services be notified.

A 6-year-old child has a fractured arm and multiple old injuries. Child maltreatment is suspected. What parental characteristic supports this suspicion? 1.Inquiring about the time of discharge 2.Displaying signs of guilt about the injuries 3.Expressing concern about the child's health 4.Offering inconsistent stories about the injuries

4 *Rationale*: Typically, abusive parents resist questioning; however, when pressured to explain the injuries they offer a variety of stories in an attempt to cover up the real origin of the injuries. Abusive parents display little interest in the child's care or progress. Rather than guilt, battering parents tend to feel angry at the child for the injury. An abusive parent typically has difficulty showing concern for the child. The parent is unable to comfort the child, such as through touch, and gives little indication of realizing how the child feels.

The primary nurse calls the pediatric nurse practitioner to examine the genital area of a 5-year-old girl in whom sexual abuse by her father is suspected. How can the primary nurse be most supportive to the child? 1.By describing the procedure and staying with the child during the examination 2.By explaining that the nurse wants to see if there is "anything wrong down there" 3.By asking whether she prefers the nurse or the mother to stay with her during the examination 4.By helping the mother explain the examination and the findings in terms that the child will understand

1 *Rationale*: Describing the procedure and staying with the child during the examination provides reassurance and support for the child. Using the phrase "anything wrong down there" could cause the child to have negative feelings about herself. Asking the child to decide whether she prefers the nurse or the mother is not therapeutic and may be threatening. Depending on the mother's involvement, explaining the examination and the findings may threaten rather than support the child.

Which warning signals should the nurse observe in a child suspected to be a victim of abuse? Select all that apply. 1.The child doesn't want to be touched by anyone. 2.The child sleeps for an average of 15 hours a day. 3.The child frequently visits the emergency department. 4.The child suffers from fever and tenderness in the abdomen. 5.The child looks at the caregiver before answering any question

1,3,5 *Rationale*: The child may become scared if touched. The physical abuse may cause injuries and the child may visit the emergency department frequently. An abused child may look at the caregiver before answering any question due to fear. The child sleeping for an average of 15 hours a day does not indicate abuse. Fever and tenderness in the abdomen are not signs of abuse; it could indicate an organic cause

A nurse is interviewing a mother accused of physical child abuse. When speaking with this mother, what does the nurse expect her to do? 1.Attempt to rationally explain her behavior. 2.Reveal the belief that her child needed to be disciplined. 3.Offer a detailed explanation of how her child was injured. 4.Ask how she can arrange to visit her child on the pediatric unit

2 *Rationale*: An abusive parent often indicates that he or she was trying to improve the child's behavior with physical consequences for behavior the parent considered unacceptable. Such parents usually do not admit their behavior, so they do not have a need to rationalize it. These parents offer many vague explanations of how the child was injured; rarely is the explanation detailed. Asking how she can arrange to visit her child on the pediatric unit is an unusual request because the abusive parent usually does not ask to see the child.

A recently married 22-year-old woman is brought to the trauma center by the police. She has been robbed, beaten, and sexually assaulted. The client, although anxious and tearful, appears to be in control. The primary healthcare provider prescribes 0.25 mg of alprazolam for agitation. The nurse will administer this medication when what event occurs? 1.The client's crying increases. 2.The client requests something to calm her. 3.The nurse determines a need to reduce her anxiety. 4.The primary healthcare provider is getting ready to perform a vaginal examination

2 *Rationale*: Because a sexual assault is a threat to the sense of control over one's life, some control should be given back to the client as soon as possible. Crying is a typical way to express emotions; the client should be told that medication is available if desired. The nurse determining a need to reduce the client's anxiety or administering the medication when the primary healthcare provider is getting ready to do a vaginal examination takes control away from the client; the client may view these actions as an additional assault on the body, which increases feelings of vulnerability and anxiety and does not restore control.

A nurse is caring for a 5-year-old child who is a victim of physical abuse. Which interventions are appropriate while talking to the child to help reveal the abuse? Select all that apply. 1.Asking about the family's social or legal problems, if any 2.Discussing the body parts using words the child will understand 3.Telling the child that it is not the child's fault and no one is going to blame the child 4.Telling the child that reporting the abuse to the nurse is the right thing to do 5.Allowing the child to talk in the presence of the family members to minimize fear

2,3,4 *Rationale*: While asking the preschooler to reveal abuse, the nurse should discuss the body parts using words that the child will understand. The nurse should tell the child that it is not the child's fault and no one is going blame the child. The child should also be told that it is a good thing to report about the incident to the nurse, as it is required by law that the nurse report the incident. The nurse should limit the interview to the child's physical and mental health concerns and not ask about the family's social or legal problems. Physical abuse can also be caused by parents; therefore a private time and place should be provided for the abused child to talk.

Child maltreatment is suspected in a 3-year-old girl admitted to the hospital with many poorly explained injuries. Which statement by the mother further supports this suspicion? 1."When I get angry, I take her for a walk." 2."I have no problems with any of my other children." 3."When she misbehaves, I send her to her room alone." 4."I make her stand in the corner when she doesn't eat her dinner."

2 *Rationale*: Identification of one child in the family as being different by the parents or siblings, coupled with other signs of abuse, should prompt suspicions of physical abuse and warrant further investigation. Taking a walk is helpful for both the mother and the child and does not indicate abuse. Sending a child to his or her room alone is an acceptable punishment for misbehavior. Although making a child stand in the corner is demeaning, it is not physical abuse.

A nurse is working with a married woman who has come to the emergency department several times with injuries that appear to be related to domestic violence. While talking with the nurse manager, the nurse expresses disgust that the woman keeps returning to the situation. What is the best response by the nurse manager? 1."She must not have the financial resources to leave her husband." 2."Most women try to leave about six times before they are successful." 3."There's nothing the staff can do; people are free to choose their own lives." 4."These women should be told how stupid they are to stay in that kind of situation."

2 *Rationale*: Nurses who work with victims of partner abuse need to be supportive and patient. It takes time and several attempts for most victims to leave abusive relationships. It may or may not be true that the client does not have the financial resources to leave her husband; there is not enough information to support this conclusion. The staff can encourage the woman to make plans for addressing various potential events and provide information about social services and telephone help lines. Shaming women in this position will simply make them less likely to seek help.

A nurse is assessing a toddler and the dynamics of the child's family, in which abuse is suspected. What behaviors are expected? Select all that apply. 1.The child cringes when approached. 2.The child has unexplained healed injuries. 3.The parents are overly affectionate toward the child. 4.The child lies still while surveying the environment. 5.The parents give detailed accounts of the child's injuries

1,2,4 *Rationale*: The child cringes when approached because past experiences with adults have resulted in pain rather than comfort. Evidence of past injuries may exist, but the parents do not discuss it, because this would be an admission of child abuse. Abused children are always on the alert for potential abuse. Lying motionless is an attempt to avoid attention; also, in the past the abused child's attempts to resist abuse have often precipitated more abuse. Abusive parents are unable to provide any emotional support and will not exhibit overly affectionate behavior. Because abusive parents try to hide the fact of abuse, explanations about injuries are usually fabricated, inconsistent, and vague.