Abuse

Bullying: manifestations

-acute change in behavior -decreased participation in previously enjoyed activities -disliking school -increased absenteeism -decreased in academic performance -low self-esteem -loneliness -anxiety -depression -thoughts or plans for suicide -frequent somatic complaints

Bullying: clinical therapies

-allow child to express feelings -notify proper authorities -therapy for depression -ensure safety

Child abuse and youth violence: manifestations

-bruises or welts in unusual places or in several stages of healing, distinctive shapes -wary of physical contact with adults -behavioral extremes of withdrawal or aggression -burns (cigarette) -burns (immersion burns on hands, feet, buttocks) -rope burns -apprehensive when other children cry -fractures in multiple stages of healing, inconsistent with explanation -joint swelling or limited mobility -long-bone deformities -lacerations and abrasions to the mouth, lip, gums, eye, genitalia -human bite marks -signs of AHT -deformed or displaced nasal septum -bleeding or fluid drainage from the ears -broken, loose, or missing teeth -difficulty in respirations, tenderness or crepitus over ribs -abdominal pain or tenderness -recurrent UTIs -emotional and/or behavioral problems -increased absenteeism in school -severe injuries such as penetrating wounds or GSW

IPV: manifestations

-chronic fatigue -casual response to serious pain -vague complaints, aches, and injury or excessively emotional response to a relatively minor injury -frequent injuries -recurrent STDs -frequent ambulatory or ED visits -muscle tension -nightmares -facial lacerations -depression -injuries to chest, breasts, back, abdomen, genitalia -anorexia, other EDs -anxiety -bilateral injuries of arms or legs -symmetric injuries -drug or alcohol abuse -obvious patterns of belt buckles, bite marks, fist/hand marks -suicide attempts -poor self-esteem -burns (hands, feet, buttocks, distinctive patterns) -GI or stress ulcers -headaches

Sexual assault

-completed or attempted forced penetration of a victim -completed or attempted alcohol/drug-facilitated penetration of a victim -completed or attempted forced acts in which a victim is made to penetrate a perpetrator or someone else -completed or attempted alcohol/drug-facilitated acts in which a victim is made to penetrate a perpetrator or someone else -non-physically forced penetration, which occurs after a person is pressured verbally or through intimidation or misuse of authority to consent or acquiesce -unwanted sexual contact -non-contact unwanted sexual experiences

Elder abuse: manifestations

-constant hunger or malnutrition -listlessness -poor hygiene -social isolation -inappropriate dress for weather -chronic fatigue -unattended medical needs -poor skin integrity or decubiti -contractures -urine burns/excoriation -dehydration -fecal impaction -bruises and welts -withdrawal -burns -confusion -fractures -fear or suspicion of caretaker, family members, HCP -sprains or dislocations -lacerations or abrasions -evidence of oversedation -failure to meet financial obligations

Symptoms of shaken baby syndrome

-coup/contrecoup injury -retinal hemorrhages (bilateral or multilayered) -subdural hematoma -multiple occult long bone fractures in various stages of healing that suggest a pattern of abuse -lethargy -difficult feeding or sucking -lethargy -vomiting -seizures -bruises where baby was held and shaken

Risk factors for perpetration

-individual (e.g. parents' hx of maltreatment) -family (e.g. family disorganization, dissolution, and violence) -community -poverty -substance abuse (alcohol causing aggression, reducing inhibitions)

Mandatory reportable events

-infant abuse -child abuse -youth violence -elder abuse

Child abuse and youth violence: clinical therapies

-mandatory reporting -treat injuries -give abx per MD -therapy depending on developmental stage -ensure the safety and security of the child

Elder abuse: clinical therapies

-mandatory reporting -treat injuries -treat dehydration and malnutrition -treat depression -arrange for respite services -consider adult day care -ensure safety and security -refer perps to tx or therapy -arrange transfer of legal authority

Infant abuse: clinical therapies

-mandatory reporting -treat physical injuries -give abx per MD -ensure safety and security of child

Four types of abuse

-physical -psychologic -sexual -neglect

Nursing care

-promote safety -establish a therapeutic relationship -facilitate communication -promote empowerment

Sexual abuse: manifestations

-torn, stained, or bloody underwear -pain or itching in genital area -bruises or bleeding from external genitalia, vagina, rectum -poor peer relationships -withdrawal -STDs -unwilling to participate in physical activities -swollen or red cervix, vulva, perineum -wears long sleeves and several layers of clothing in hot weather -semen around the mouth or genitalia or on clothing -pregnancy -delinquency or running away -inappropriate sexual behavior or mannerisms -regressive behaviors

Sexual abuse: clinical therapies

-treat injuries -test for STDs -administer pregnancy test -DNA swabs to ID perp -treat for depression and suicidal behavior -therapy -educate on rights and ability to report to authorities -behavioral therapy for perps

IPV: clinical therapies

-treat physical injuries and physiologic conditions -treat depression -suggest substance abuse counseling for perpetrator and victim as needed -provide referrals for community services, support groups, shelters

Infant abuse: manifestations

-untreated diaper rash -lengthy time spent in soiled diapers -poor hygiene -frequent ear infections -poor eye contact, detachment -failure to thrive -sores, rashes, flea bites -multiple fractures in various stages of healing, inconsistent with explanations -AHT

Risk factors for victimization

-very young children -older adults (dementia,alzheimers) -individuals with special needs -gender (IPV more female victims) -poverty (largest risk factor and predictor of child abuse and neglect) -firearm in the home

The nurse is caring for a woman and notes several bruises on the​ woman's upper body. When the nurse asks about the​ marks, the woman replies that her husband has the right to punish her when she questions the​ husband's authority. Which response by the nurse is​ correct? A. Give the woman a list of emergency resources B. Report the husband to the police and social services C. Respect her views and document the marks D. Call the woman's husband and explain that abuse is illegal

A Rationale: Even though the wife permits the husband to hit her at his​ discretion, abuse is still illegal in the United States. The nurse cannot force the woman to leave her husband and cannot report the husband to the police or social services. The nurse can provide the woman with resources she needs in case she decides to leave. It is not appropriate for the nurse to call the husband and explain that abuse is illegal.

Which of the following pediatric clients would require prompt reporting to the authorities by the nurse? A. A 4-year-old who fell from a swing set with one fracture of the ulna and two healed fractures of the humerus on x-ray B. A 3-year-old with second degree burns on the upper chest and face after pulling a pot of hot water from the stove C. A 3-year-old who has a large hematoma on the forehead after falling from a slide D. A 2-year-old with swelling of the tongue and drooling after eating a plant in the yard

A Rationale: s/s of abuse and non-accidental trauma: -linear burns (immersion burns) -burns in the shape of common household items -cigarette burns -tears of the frenulum or gingiva -retinal hemorrhage on funduscopic exam -multiple fractures, bruises, or burns in various stages of healing -long bone fractures of the humerus or femur -subdural or epidural hematoma resulting from coup-countercoup injury -inconsistencies between the pattern of injury and the explanation given -delay between the time of the injury and time care is sought

The nurse is assessing an older adult client who has been abused and neglected. The nurse should assess for which characteristic? SATA A. Bruises and burns B. Withdrawn behavior C. Malnutrition D. Chronic fatigue E. Trauma to sexual organs

A, B, C, E Rationale: Bruises,​ burns, and malnutrition are manifestations of physical abuse and neglect of older adults. Withdrawn behavior is a symptom of emotional abuse of older adults. Trauma to sexual organs is a symptom of sexual abuse of older adults. Chronic fatigue is not associated with abuse of older adults.

The nurse is creating a plan of care for a neglected child. Which collaborate actions are appropriate non-pharmacologic treatments that should be included? SATA A. Reporting the abuse or neglect to the appropriate agency B. Play therapy C. Family therapy for the parents D. Pain medication for the child's injuries E. Providing a safe environment for the child

A, B, C, E Rationale: Nonpharmacologic treatment for abuse and neglect includes providing a safe environment for the​ child; behavioral,​ cognitive, group, or play​ therapy; family therapy for the​ parents; reporting suspected child abuse or neglect to the appropriate​ agencies; and behavioral therapy for those who are abusing or neglecting the child. Pain medication is a pharmacologic therapy.

The nurse is discussing the different etiologic causes of abuse and neglect with a colleague and strongly believes in the social learning theory. Which statement supports the​ nurse's belief?​ SATA A. Children learn about violence from observation B. The media exposes children to many models of violence C. Some communities value the subordination of women D. The potentially abusive individual makes a conscious choice to abuse E. Early life stress leads to mood and anxiety disorders in the individuals who are abused

A, B, D ​Rationale: According to the social learning theory of interpersonal​ violence, etiologic factors include learning about violence from observation​ and/or exposure to models of violence in the media. The social learning theory also recognizes that the potentially abusive person makes a conscious choice to abuse. Early life​ stress, leading to mood and anxiety disorders in the​ abused, is an etiologic factor in neurobiological​ theory, not social learning theory. The existence of communities that value the subordination of women is an etiologic factor of gender bias​ theory, not social learning theory.

The nurse is conducting an assessment interview. Which complaints by the client should the nurse consider might be associated with physical abuse? SATA A. Depression B. IBS C. UTI D. Chronic pelvic pain E. Headache

A, B, E ​Rationale: Complaints that might be associated with stress and physical abuse include​ headache, irritable bowel​ syndrome, and depression. Chronic pelvic pain and urinary tract infections can occur with sexual abuse but are not common with physical abuse.

The nurse in a​ long-term rehabilitation facility is helping an older adult client to recover from months of neglect. Which non-pharmacologic treatment should the nurse include in the care of the client after​ discharge? SATA A. Older adult abuse reported to appropriate agency B. Referral to a homeless shelter C. Adult day care D. Safe living environment E. Respite care for caregiver

A, C, D, E Rationale: Non-pharmacologic treatment of older adult abuse may include adult day​ care, a safe living​ environment, reporting abuse to the appropriate​ agency, and respite care for the caregiver. It does not include referral to a homeless​ shelter, which is an appropriate referral for a client who is homeless.

The pediatric nurse is training new staff about caring for children who are victims of abuse and neglect. Which is an appropriate nursing intervention the nurse should​ include? SATA A. Reporting the abuse B. Encouraging the child to confront the abuser C. Promoting a trusting relationship D. Developing rapport E. Initiating a complete physical assessment

A, C, D, E Rationale: Nursing interventions for child abuse and neglect include developing rapport with the​ child, promoting a trusting​ relationship, initiating a complete physical​ assessment, and reporting the abuse according to agency and state requirements for mandated reporters. Encouraging the child to confront the abuser is not a nursing intervention for child abuse and​ neglect; rather, the nurse will provide a​ safe, nonthreatening environment for the child.

Which of the following guidelines should the nurse implement when interviewing a client thought to be living in a domestic violence situation? SATA A. Assure the victim that they are not alone B. Allow the victim's partner to be present only during the exam C. Preserve any physical evidence, if applicable D. Approach the situation in a roundabout manner to avoid distressing the client E. Convey an attitude of concern and respect for the client

A, C, E Rationale: If the abuser is present, the nurse is not able to ask outright about the situation. If the nurse suspects abuse, she should talk to the client alone and assure the client of support or offers to help The nurse should be respectful and kind to the client who is in a potentially difficult and dangerous situation. D. A direct approach is much more effective when addressing clients who may be victims of abuse HCPs are often the first point of professional contact between the community and the victim of abuse or IPV. Nursing interventions may include assisting the victim to develop a safety plan or helping the victim to escape an abusive relationship.

A nurse is teaching a group of newly licensed nurses about risk factors for child maltreatment. Which of the following risk factors should the nurse include in the teaching? SATA A. A parent who has a history of alcohol use disorder B. A parent who frequently seeks help from others C. A parent who often acts on impulse D. A parent who perceives that their child is "perfect" E. A parent who believes in an authoritarian approach to raising their child

A, C, E Rationale: Risk factors for perpetration: -substance use/alcohol use -impulsive behavior -frequent use of harsh or physical punishment -parent viewing their child as "bad" -unrealistic ideas of how the child should behave -mandatory reporting is required here -must be reported within a time frame of 24 to 48 hours, depending on state guidelines -does not have to be proven to be reported

The nurse at a clinic notices bruises on the arms and legs of a frail older adult. The nurse suspects the bruises are caused by abuse. Which individual should the nurse consider as the possible​ perpetrator? SATA A. children visiting a parent B. prescriber of anticoagulants C. meals-on-wheels volunteers D. client's spouse E. caregiver living in home

A, D, E ​Rationale: Possible perpetrators include​ caregivers, spouses, and children. Possible perpetrators would not include the prescriber of anticoagulants or​ meals-on-wheels volunteers.

A nurse is assisting with planning an in-service for a group of elementary school teachers about identifying risk factors for maltreatment of children. Which of the following findings place a child at risk for maltreatment? SATA A. The child was born premature and has developmental delays B. The child's grandparents frequently provide care while the parents work C. The child's father, who is an educated executive, is often absent from family meals D. The child lives in a single-parent home

A, E Rationale: Risk factors for maltreatment: -prematurity -physical disabilities -developmental delays -chronic illnesses -single-parent homes

Child abuse/neglect

Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse, or exploitation An act or failure to act which presents an imminent risk of serious harm

Sexual abuse

Any sexual act that is perpetrated against someone's will including rape, attempted sexual acts, unwanted sexual contact, voyeurism, an sexual harassment Any type of sexual contact or behavior that occurs without the explicit consent of the recipient to include forced sexual intercourse, forcible sodomy, child molestation, incest, fondling, and attempted rape

Bullying

Any unwanted aggressive behavior(s) by another youth or group of youths, who are not siblings or current dating partners, involving an observed or perceived power imbalance that is repeated multiple times or is highly likely to be repeated

The nurse wishes to implement parental teaching about ways to prevent abuse or injuries in infants and very young children. Which should be the focus area of the nurse based on the leading cause of child abuse deaths in young​ children? A. Abdominal trauma B. Abusive head trauma C. Burn injuries D. Spinal fractures

B Rationale: Abusive head trauma​ (AHT) is the leading cause of death in children under the age of 5. It includes injuries sustained from shaken baby syndrome. Spinal​ fractures, abdominal​ trauma, and burn injuries are not the leading cause of death in young children.

A mom reports that her child has had multiple bruises over the last few​ weeks, but the child refuses to explain. The​ child's grades are​ dropping, and the child is afraid to go to school. Which type of abuse should the nurse​ suspect? A. Youth violence B. Bullying C. Physical abuse D. Sexual abuse

B Rationale: Bullying has been defined as repeated aggressive behavior by another person and frequently happens between schoolchildren. It can manifest with an unwillingness to go to school or poor academic grades.

A charge nurse is leading a peer group discussion about family and community violence. Which of the following statements by a member of the group indicates an understanding of the teaching? A. "Children older than 3 are at greater risk for abuse" B. "Substance use disorder does not increase the risk for violence" C. "Entering an intimate relationship increases the risk of violence" D. "Pregnancy increases the risk for IPV"

D Rationale: A. children under 3 are at a greater risk for abuse B. substance use does increase the risk for violence C. vulnerable persons are at increased risk for violence when they try to leave a relationship

A nurse is speaking with the parents of a child who has been the victim of bullying. Which of the following statements is true? A. Children who are victims of bullying are eager to confide in an adult B. Physical bullying is more common than verbal bullying C. Bullying is a normal part of childhood growth and development D. A physical disability is associated with a higher risk of bullying

D Rationale: Bullying refers to repetitive, intentional infliction of physical, psychological, or emotional abuse by one or more individuals upon another individual deemed less physically or psychologically powerful than the bully. Bullying is not a normal part of childhood growth and development. Children generally want to conform to their peer group, beginning in middle childhood, and some may be unable to do so, preventing peer identification. This increases the risk of being bullied, particularly in children with disabilities or unusual physical characteristics. Long-term effects of bullying: -sleep disturbances -adjustment disorders -anxiety -depression -feelings of insecurity -psychosomatic complaints -poor academic performance A. victims of bullying are frequently ashamed of being perceived as weak or afraid to confide in an adult because of concerns about reprisal B. the most common type of bullying is verbal aggression including: -intimidating remarks -obscenities -yelling -derogatory remarks Verbal bullying increases as children reach high school, as physical bullying decreases

A nurse is caring for a 7-month-old infant with intracranial hemorrhage due to child abuse. The nurse knows what which of the following statements is true? A. Epidural hemorrhage is most likely to occur as a result of abusive head trauma B. An infant with abusive head trauma is unlikely to have concomitant spinal injury C. A skull fracture is indicative of abusive head trauma in infants with intracranial hemorrhage D. Children with abusive head trauma have fractures in other bones unrelated to the skull in up to 50% of cases

D Rationale: Studies have shown that children who are victims of AHT have skeletal fractures in 20-50% of cases. The fractures are most likely to occur in ribs and long bones, and metaphyseal fractures are also more likely in this population. S/S shaken baby: -intracranial bleeding -retinal hemorrhage -irritability -poor feeding -vomiting -unresponsiveness -pending death A. Epidural hemorrhage is more likely to be the result of unintentional head trauma. Subdural hemorrhage is unlikely to be accidental and is highly associated with AHT in children. B. Infants have greater spinal elasticity and other characteristics that make them more likely to have spinal injuries in cases of AHT. This occurs in up to 80% of infants with AHT. C. Although skull fractures occur frequently in children with AHT, they occur commonly in children who experience unintentional head injuries.

A nurse is caring for a school-age child who reports being physically abused by his guardian. Which of the following statements should the nurse make? A. "I promise I won't tell anyone about this" B. "Let's discuss this with your guardian" C. "Your guardian is wrong of doing this to you" D. "It is not your fault that this happened"

D Rationale: Talking to children who reveal maltreatment: -provide a place to talk in private -do not act shocked or criticize the person who committed the maltreatment -tell the child that you are required to report the maltreatment to authorities -avoid the use of leading statements, which can distort the events that occurred -reassure the child that they have not done anything wrong -inform the child what will happen when you report the occurrence -assess the child's immediate need for safety

Elder abuse

The intentional physical, emotional, or sexual mistreatment or neglect of an individual 65 years of age and older

Psychologic abuse

Verbal or emotional abuse or excessive demands and expectations in which the individuals may experience behavioral, emotional, affective, and other mental disturbances

Developing a safety plan

1. practice how to get out safely 2. keep purse or wallet and keys easily accessible at all times 3. have a contact person and number available who can be notified to call police 4. teach children to call police or 911 5. have a code word to indicate a violent situation so that friends, family, or children know to call police 6. move to a low-risk area in the event of an argument 7. use judgment, and if the situation is serious, give the partner what is being demanded to calm them down

A nurse is caring for a client in the ER who has multiple bruises on her face and arm, a black eye, and a broken nose The client says that the injuries were from falling down the stairs. The nurse suspects that the client may have been physically assaulted. Which of the following should the nurse do next? A. Ask the client directly about the possibility of physical abuse B. Tell the client that it is difficult to believe that such injuries resulted from a fall C. Ask the client what she did to make someone beat her so badly D. Discuss with the client what she can do to de-escalate the situation next time

A Rationale: -many pts are hesitant to talk about it and need encouragement -ask directly -use sensitive, empathetic, and compassionate approach -do not treat the pt like they are lying -do not blame the victim -offer encouragement, reinforcement, and suggestions or identification of resources for the protection of the pt

A nurse manager is reviewing the admission history of four adult clients. The nurse is required to report which of the following situations to an outside agency? A. An older adult client who is dependent on caregivers and was admitted for the treatment of burns on the buttocks B. A young adult client who was admitted for asthma and has track marks that might indicate IV substance use C. A young adult client who was admitted for acute glomerulonephritis following a viral infection D. An emancipated minor who has acute appendicitis and wants to leave the facility without treatment

A Rationale: Physical manifestations of older adult abuse can include burns to the buttocks and soles of the feet, vaginal and anal bruises, skeletal fractures, welts, lacerations, and bruises at different stages of healing Manifestations of elder neglect: -pressure sores -dehydration -malnutrition -contractures -body odor -lethargy Manifestations of emotional abuse: -threats -humiliation -intimidation -isolation Behavioral manifestations of abuse: -anger -aggression -depressio -physical or cognitive impairment -listlessness -withdrawal -Mandatory reporting required here -Drug use is not a mandatory reporting event -Glomerulonephritis is not a mandatory reportable event -An emancipated minor has the authority to make decisions about health care

A client who was a victim of intimate partner violence​ (IPV) is aware that recovery from this type of relationship can be a long and difficult process. Which main goal should the nurse identify for the victim to heal and move on in​ life? A. Regaining a sense of empowerment and safety B. Getting through the shock and confusion of the act C. Getting back into work and home routines D. Resolving grief over any losses

A Rationale: The main goal for a victim is to regain a sense of empowerment and safety. The victim needs to move from being a victim to be a survivor. A sense of security and safety is vital to this transition. Getting back to work and home​ routines, resolving grief over any​ losses, and getting through the shock and confusion are all​ important, but not the ultimate goals.

A young​ pre-teen boy is brought to the emergency department by ambulance because the mother found rectal bleeding after leaving the child with a relative. Which situation should the nurse​ suspect? A. Sexual abuse B. Neglect C. Physical abuse D. Emotional abuse

A Rationale: Victims of sexual abuse may have bleeding from the rectum or external genitalia. Sexual abuse does occur in boys and it can happen at the hands of a relative.​ Neglect, physical​ abuse, and emotional abuse do not cause rectal bleeding.

The nurse is discussing the different forms of abuse with a group of women in the community. Which information about emotional abuse should the nurse include in this​ discussion? SATA A. It cannot be seen B. It occurs because the caregiver failed to protect the victim C. It is seldom measured D. It occurs without the victim's consent E. It is inflicted accidentally

A, B, C, D ​Rationale: Emotional abuse is different from physical abuse because it cannot be seen and is seldom measured. Both emotional and physical abuse are inflicted without the​ victim's consent. Neither is inflicted accidentally. Abuse that happens when a caregiver fails to protect the victim can be physical​ abuse, emotional​ abuse, or both.

Intimidation

Abusing pets, swearing, breaking things, displaying weapons, damaging property

A nurse knows that parents who do not use a child safety seat when transporting the child are engaging in which of the following? A. Sexual abuse B. Child neglect C. Emotional abuse D. Physical abuse

B Rationale: Child neglect is the most common type of child abuse. It is a failure to provide for the basic physical, medical, emotional, or educational needs of the child. Physical neglect occurs when a caretaker does not provide food, clothing, hygiene, shelter, or protection from harm. Failure to provide love, security, and emotional support characterize emotional neglect. Educational neglect is characterized by failure to ensure school attendance, appropriate homeschooling, or enrollment in school. Medical neglect is a delay in seeking medical care or refusal of care that results in a risk of damage or in actual damage to the child. Neglect includes both actual harm and the potential for harm, such as leaving a young child unattended for several hours alone in a home or failure to use a child seat, even if there is no injury. In child abuse or neglect, the nurse should protect the child from further abuse, advocate for the child, and support the family.

A nurse triaging clients in the pediatric emergency room knows that which of the follow injuries in a 2-year-old is most concerning for child abuse? A. Nursemaid's elbow B. Humerus fracture C. Splatter burns on the arms D. Fracture of the femur

B Rationale: Manifestations: -immersion burns -fractures of long bones -retinal hemorrhages -demarcated immersion burns -humerus/femur fx -cigarette burns -injuries that do not match the explanation -a splatter burn can indicate that the child pulled a hot pot of water off of the stove

A child's parent expresses suspicion that their child has been subjected to sexual abuse by the babysitter. Which approach is most appropriate for the nurse to take? A. Tell the child that the babysitter will be made to pay for what the person did B. Develop a trusting relationship with the child by doing exactly what is promised C. Call the police to report the crime committed against the child D. Ask the child's parents to leave the room to conduct a thorough examination

B ​Rationale: The priority when caring for a child who is the victim of violence is always safety. Because the child is in a safe​ environment, the most appropriate action for the nurse is to develop a trusting relationship by doing exactly what is promised for the child. It is not appropriate to ask the parent to leave the​ room, as the parent leaving may increase the​ client's anxiety. The nurse should not make negative comments about the abuser and must follow established protocols for mandatory reporting.

The nurse is preparing a community teaching presentation on prevention of abuse. Which level of prevention should the nurse include? SATA A. Historical B. Individual C. Societal D. Parental E. Community

B, C, D, E Rationale: The nurse knows that the levels of prevention should​ include: individual,​ community, societal, and parental. Historical information may be used to examine trending information but it is not a level of prevention.

A nurse is collecting data from a preschooler for suspected physical abuse. The nurse should identify that which of the following is an expected finding of physical abuse? SATA A. Bruising on bilateral knees B. Bruising on bilateral hands C. Spiral fracture of the right forearm D. Abrasion to the left knee E. Reddened welt across back

B, C, E Rationale: Manifestations of abuse: -"glove" or "stocking" burns from immersion into boiling water -spiral fractures from forceful twisting -welt indicates belt strike -unexplained burns, bites, bruises, broken bones -wounds or bruising on the face, chest, arms, abdomen, back, buttocks, genitalia -fearful reaction to parents or protests and cries when it is time to go home

The home care nurse is talking to an entire family about caring for their oldest​ member, an​ 88-year-old client with multiple health issues. The rest of the family includes a​ 48-year-old, a​ 28-year-old, an​ 18-year-old, and an​ 8-year-old. Which individual is in an age group that is less likely to report or admit being the victims of​ violence? SATA A. 28 y/o B. 88 y/o C. 18 y/o D. 48 y/o E. 8 y/o

B, E ​Rationale: Children​ (such as the​ 8-year-old) and older adults​ (such as the​ 88-year-old) are less likely to report or admit to being the victims of violence. This is not true of adults​ (such as the​ 18-, 28-, and​ 48-year-olds).

Cyber-bullying

Bullying through the use of technology such as text messages, email, cell phone apps, chat rooms, and social media

Which action is an example of a collaborative intervention by a nurse working with an older adult who has experienced abuse? A. Completing mandatory reports to authorities B. Exploring options for help C. Referring the client to a social worker case manager D. Sharing information about services

C Rationale: A collaborative intervention would be referring the client to a social worker case manager. Independent interventions include completing mandatory reports to​ authorities, exploring options for​ help, and sharing information about services.

A parent comes in to speak with the pediatric nurse about bullying that the child has been dealing with at school. The teacher has not been able to control the responsible​ student, and the parent asks for advice. Which advice by the nurse is most​ appropriate? A. Move to a different town nearby B. Remove the child from the school and initiate home schooling C. Go up the chain of command to the principal D. Teach the child more effective coping strategies

C Rationale: The nurse should advise the parent to go up the chain of command to the principal and school board if necessary. If those steps​ don't resolve the​ problem, the nurse can then brainstorm the best steps with the parent. This may mean changing schools or moving to a different town. Coping strategies are important for children and adults dealing with bullying or​ abuse, but this does not appropriately answer the question.

Physical abuse

Causing or attempting to cause physical pain or injury to another by physical means such as hitting, punching, burning, kicking, or striking with an object

Corrupting emotional/psychological abuse

Characterized by encouraging or reinforcing deviant, destructive, sexually exploitive, or antisocial behavior -Parent encouraging drug and alcohol use in their child is an example of this

Isolation

Cutting off contacts, not allowing visitors, taking mail, denying access to the phone or assistive devices

A​ 2-year-old child is brought to the pediatric clinic with an upper respiratory infection. After assessing the​ child, the nurse suspects that this child may be a victim of child abuse. Which finding strongly supports the​ nurse's suspicion? A. Diaper rash B. Scraped and scabbed knees C. A few bruises on shins D. Welts or bruises in various stages of healing on the child's back

D Rationale: The assessment findings in children who are physically abused include bruises and welts in various stages of​ healing, which are found in areas where one does not normally see bruising from being a​ child; whip marks on the​ back, legs, or​ buttocks; abdominal pain or​ tenderness; and broken bones or fractures in various stages of healing. Bruises on the lower​ legs, scraped and scabbed​ knees, and diaper rash are normal findings for children at this​ age, who are trying and exploring new things and may still be in diapers. Untreated diaper rash may be a sign of neglect.

The nurse is caring for an​ 84-year-old client who has been hospitalized for malnutrition. The nurse suspects that older adult abuse may be responsible for the​ client's condition, but when the nurse asks about the care the client receives from the​ caregiver, the client admits feeling afraid of what will happen if the caregiver finds out about the complaining. Which response by the nurse is​ correct? A. "It would be better for you if I share what you tell me with your caregiver" B. "You shouldn't be so afraid of what your caregiver will do" C. "It's necessary that I share what you tell me with your caregiver" D. "I will not share anything you tell me with your caregiver"

D Rationale: The nurse would respond to the​ client's concerns by stating that the nurse will not share anything the client says with the caregiver. Assuring the client of confidentiality will help promote a trusting​ relationship, which is an essential nursing intervention. The nurse would not tell the client that it would be better for the client if the nurse shares the information with the​ caregiver, because this may make the client feel unsafe. The nurse would not tell the client that​ it's necessary for the nurse to share the information with the caregiver because this is untrue. The nurse would not tell the client not to be afraid of the caregiver because this statement is judgmental and would not promote a trusting relationship between the nurse and the client.

Neglect

Failing to provide basic human needs such as food, clothing, or shelter as well as medical treatments and medications Exposing someone to dangerous environments, abandonment, or forcing the individual out of the home

Using privilege

Forcing a servant/master relationship, perpetuating the belief that it is the abuser's right to be served

Emotional abuse

Instilling guilt, humiliating, yelling, degrading, insulting, demeaning, denying, naming, withholding affection, creating a siege mentality

Coercion and threats

Making or carrying out threats to harm, leave, commit suicide; the other partner to drop charges, commit crimes

Using children

Making partner feel guilty about the children; using children as messengers; harassing during visitation exchanges; threatening to take children away

Youth violence

Occurs in minors and may continue into young adulthood May include being a victim of violence, a violent offender, or a witness to violence

Levels of prevention

PICS -parental -individual -community -societal

Abusive head trauma (AHT)

Shaken baby syndrome Leading cause of child abuse deaths in children under 5 years of age Babies less than a year old are at the greatest risk for AHT

Economic abuse

Taking money, taking over titles, taking over home, giving away assets, misuse of powers of attorney, spending assets, stealing

Intimate partner violence

The act of inflicting sexual, emotional, or physical harm on a current or previous partner or spouse four main types: -physical violence -sexual violence -threats of both physical and/or sexual violence -emotional abuse