Abused client

b (Rationale: Many theories exist concerning the motivation for violent behavior and abuse within families. Some of those theories propose that individuals are genetically predisposed to violence, while other theories discuss the influences of society and family structure. No definite causes of family violence have ever been agreed upon, but theories such as the psychopathology theory and the social learning theory lead into one another to help highlight some contributing factors to abusive behavior. )

A client who has been physically abused asks the nurse, "What makes people so violent toward others?" Which is the best response to this question? a "If women were more agreeable, there wouldn't be any violence." b "It is difficult to give one specific reason for violent behavior." c "Violence is inherited from a person's family." d "Hormones are the primary reason for violence in men."

a (Rationale: Elder abuse can occur when family are expected to care for the aging parent. This causes frustration, overextension, and sometimes is a financial burden. Stating that the abuser will use assistance from resources is a positive action toward behavior change. Stating that they will meet the needs of the client, that they are sorry, or that they need to change behavior are not demonstration of a positive change; it is simply lip service and a hallmark response by habitual abusers.)

A client who is a victim of elder abuse has been attending counseling sessions with their family. The nurse evaluates that an abusive family member has learned positive coping skills when which statement is made? a "Now that I know what my resources are, I think I can do a better job of caring for my parent." b "I will make sure that my parent's needs are met." c "I am sorry for the abuse; it won't happen again." d "I will need to change my behavior when my parent moves in with us."

d (Rationale: The client is demonstrating a desired outcome by stating, "I realize now that I am not responsible for the abuse and I do not deserve to be treated this way." The desired goal is for the client to verbalize awareness that they are not responsible for the abuse and that they do not deserve it. The other responses demonstrate negative outcomes. Desired outcomes would include the client openly communicating fears in regards to the abuse and demonstrating knowledge of available resources to those in abusive situations. )

A client who is a victim of intimate partner abuse attends a group therapy session. Which comment by the client indicates a desired outcome? a "I can't leave the situation. There is nowhere for me to go." b "I should have kept my mouth shut and none of this would have happened." c "I am not afraid to be alone with my significant other even though he is the reason I am here." d "I realize now that I am not responsible for the abuse and I do not deserve to be treated this way."

3 (The traditional and rigid gender roles described by the client are examples of role stereotyping. Impermeable boundaries, unbalanced power ratio and dysfundtional feeling tone are also common in abusive families)

A client with suspected abuse describes her husband as a good man who works hard and provides well for his family. She doesnt not work outside the home and states that she is proud to be a wife and mother just liker her own mother. The nurse interprets the family pattern described by the client as best illustrating which characteristic of abusive families? 1. tight, impermeable boundaries 2. unbalanced power ratio 3. role stereotyping 4. dysfunctional feeling tone

b (Rationale The nurse will expect an order for antibiotics to treat potential STIs. SSRIs might be indicated in weeks to come if the client develops symptoms of anxiety or depression following the​ rape; these are not evident at this time. The client is not complaining of pain at this time so the use of NSAIDs and narcotics is not indicated at this time.)

A college student is seen in the emergency department following an incident of date rape. The nurse documents that during her assessment of the​ student, the student describes the entire chain of events with a blank facial expression. She ends her comments by​ saying, open double quote"It​'s like it didn​'t happen to me at​ all." Which order will the nurse expect for this​ client? a SSRIs b Antibiotics c NSAIDs d Narcotics

b (Rationale: Encourage the nurse to talk to a professional. Nurses encourage the client to accept help in seeking an abuse-free living situation, but the decision ultimately lies with the client. Some individuals will not be ready to seek help, and while the nurse may disagree with this decision, he must refrain from judgment and be respectful of the client's decision. All nurses can do in these situations is offer assistance and resources, the victim will then know that help will be available if it is needed in the future. Trying to convince abused adults to leave their abuser does not empower the adult. Friends and coworkers should provide support without telling the nurse what to do. Encouraging the nurse to get a restraining order against the partner is inappropriate because a restraining order may actually increase the violent behavior of the partner. Involving the parents may complicate the situation and result in more abuse, which further isolates the nurse from family and friends. )

A nurse came to work with a black eye and a swollen lip. Coworkers have noticed that the partner calls the nurse at least 10 times during a 12-hour shift. The nurse has refused all invitations to go out with coworkers, saying that the partner will be there after work and doesn't like to wait. Which action taken by the coworkers would be most helpful? a Convince the nurse to leave the partner. b Encourage the nurse to talk to a professional. c Encourage the nurse to get a restraining order against the partner. d Enlist the parents' aid in getting the nurse away from the partner.

a,b,d,e (Rationale Some positive perspectives​ are: Families can be more open to get help and motivated to adopt new behaviors. The crisis can be a window of opportunity for​ change, and a trigger for relocating older adults. On the less pleasant​ side, the crisis can lead to the involvement of lawyers and the police.)

A nurse case manager is working with a family that has been reported to authorities due to evidence of elder abuse. With which possible positive perspectives can the nurse view the crisis​ situation? Select all that apply. a Families can be more motivated to adopt new behaviors. b The crisis can be a trigger for relocating older adults. c The crisis can lead to the involvement of lawyers and the police. d Families can be more open to get help. e The crisis can be a window of opportunity for change.

b (People in gangs or associated with crimes often delay seeking medical attention. It is not that they​ don't recognize signs of infection or are waiting for the wound to heal by itself. While the wounds are​ visible, they are unlikely to be embarrassing.)

A nurse in the emergency department is bandaging the forearm of​ 26-year-old Marcus Hanson. He was stabbed in the arm more than a week​ ago, and the untreated wound is infected.​ "It was​ self-defense," explains Mr. Hanson. The nurse notices a gang tattoo on Mr.​ Hanson's biceps. What supposition can the nurse make about why Mr. Hanson delayed seeking​ treatment? a Forearm wounds often heal by themselves. b People in gangs or associated with crimes delay seeking medical attention. c Forearm wounds are visible and embarrassing. d People do not recognize signs of infection.

2,3,4,5 (The victim of abuse is usually compliant with the spouse and feels guilt, shame and some responsibility for the battering. Self-blame, substance abuse, and suicidal thoughts and attempts are possible dysfunctional coping methods used by abuse victime. The victim of abuse is not likely to demonstrate assertiveness.)

A nurse is assessing a client who is being abused. The nurse should assess the client for which characteristics? Select all that apply 1. assertiveness 2. self-blame 3. alcohol abuse 4. suicidal thoughts 5. guilt

a,c,d,e (Rationale ​Bruises, burns, and malnutrition are manifestations of physical elder abuse and neglect. Withdrawn behavior is a symptom of emotional elder abuse. Trauma to sexual organs is a symptom of sexual abuse of older adults. Chronic fatigue is not associated with elder abuse.)

A nurse is assessing an older adult client who was being abused and neglected. The nurse should assess the client for which​ characteristics? Select all that apply. a Withdrawn behavior b Chronic fatigue c Malnutrition d Bruises or burns e Trauma to sexual organs

1 (Rationale The nurse is checking for​ D, disability, when doing a neurological assessment. That is different from checking for B​ (breathing), C​ (circulation), and E​ (exposure).)

A nurse is assessing the victim of an automobile accident to check for possible injury to the brain and central nervous system. The client​'s family is relieved to learn that the client​'s neurological responses are normal. For which part of the ABCDE priority is the nurse​ checking? 1 D 2 B 3 E 4 C

b (Rationale The nurse should expect a stat order for a vasopressor like epinephrine. The reversal of shock will not be aided by an​ opioid, antibiotic, or mineral replacement.)

A nurse is checking the patency of the IV in a client who has suffered a major chest trauma. Since the vital signs are showing evidence of​ shock, the nurse expects the physician to order medication to treat that condition immediately. For which kind of medication should the nurse expect a stat​ order? a A mineral replacement like potassium b A vasopressor like epinephrine c An opioid like morphine d An antibiotic like amoxicillin

b (Rationale The nurse makes the individual feel less intimidated in reporting domestic abuse by asking a question that can be answered with "​sometimes, " instead of "yes " or "no. " The rest of the wording is optional.)

A nurse is conducting a nursing assessment interview of an individual with unexplained rib fractures. To check whether the person is a possible victim of domestic​ abuse, the nurse​ asks, open double quote"Has your partner ever struck you when feeling ​angry?close double quote" Which word in the nurse​'s phrasing of the question shows​ consideration? a Using the word "partner " b Using the word "ever " c Using the word "angry " d Using the word "struck "

a,c,e (Rationale The outcomes of children with similar risks of environmental exposure to violence include​ violence, depression, and nonproblematic behaviors. Outcomes do not include lethargy or hypertension.)

A nurse is looking at the professional literature about children with similar risks of environmental exposure to violence. Which outcomes would the nurse read​ about? Select all that apply. a Depression b Hypertension c Violence d Lethargy e Nonproblematic behaviors

a,b,c,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 is not a level of prevention.)

A nurse is preparing a community teaching presentation on prevention of abuse. Which levels of prevention should be included in the nurse​'s ​presentation? Select all that apply. a Community b Parental c Individual d Historical e Societal

c (Rationale ​X-rays are used to identify old and new fractures associated with physical abuse. STD and HIV testing and vaginal swabs are used in the evaluation of sexual abuse.)

A nurse is working in an emergency department and is being trained on diagnostic tests used for various cases of abuse. Which diagnostic tests should be included for​ physical, not​ sexual, abuse? a Vaginal swabs b STD testing c ​X-rays d HIV testing

c (Rationale The nurse could be stating that violence occurred across multiple generations or that it occurred with patterned frequency. That rules out unexpected and random violence. It also rules out​ self-abuse and nonviolent parents.)

A pediatric nurse is conducting a health history on a newly admitted child. The nurse includes the fact that the child​'s family has been involved in a cycle of violence. What meaning could the nurse be​ conveying? a The child has​ self-abusive behaviors. b The child​'s parents have never committed violent acts. c Violence has occurred across multiple generations. d Violence occurs unexpectedly and randomly in the child​'s family.

2 (Truancy and running away are common symptoms for young children and adolescents. The stress of the abuse interferes with school success leading to the avoidance of school. Running away is an effort to escape the abuse and or lack of support at home. Rather than an inability to play or a lack of play, play is likely to be aggressive with sexual overtones. Children tend to act out anger rather than control it. Head banging is behavior typically seen in very young children who are abused)

A preadolescent child is suspected of being sexually abused because he demonstrates the self destructive behaviors of self mutilation and attempted suicide. Which common behavior should the nurse also expect to assess? 1. inability to play 2. truancy or running away 3. head banging 4. overcontrol of anger

a,b,c,e (Rationale The CDC found that parents can decrease the risk of violence by showing an interest in their child​'s ​experiences, such as​ homework, sports, and grades. Parents can also participate in such cultural or religious practices as attending worship services. Financial success was not found by the CDC to be a protective factor.)

A public health nurse is the guest speaker at a PTA meeting. The nurse describes how parents​' activities can decrease the risk of violence in their family. Which actions supported by CDC research will the nurse​ include? Select all that apply. a Showing interest in the child​'s homework b Rewarding good report cards c Watching the child​'s sports team play d Achieving financial success e Regularly attending worship services together

c (Graffiti, empty beer​ cans, and discarded trash items can be signs of a​ low-income environment. That setting is a predisposing factor for violence. By​ itself, the setting does not precipitate or cause violence. It is not protective or reactive.)

A public health nurse is visiting the home of Hazel​ Harrington, a​ 90-year-old woman with diabetes. Looking out the​ window, the nurse sees​ graffiti, empty beer​ cans, and discarded trash items. Which kind of environmental factor for violence would the nurse become aware​ of? a Precipitating factor b Protective factor c Predisposing factor d Reactive factor

a,b,c (Rationale A history of bullying​ (either as victim or​ perpetrator) is a behavioral factor that could predispose to violence. Depression is a psychological factor that could predispose to violence. Family members​' involvement in substance abuse is not a behavioral or psychological factor. Living in a​ low-income community is not a behavioral or psychological factor.)

A school nurse is talking to a​ fifth-grade class about recognizing behavioral and psychological factors in themselves and their classmates that predispose them to violence. What characteristics should the nurse​ describe? Select all that apply. a Depression b History of being bullied c History of bullying others d Having siblings who are heroin addicts e Living in a​ low-income community

3 (The mothers feelings are the priority here. Addressing the mothers feelings and asking for her view of the situation is most important in building a relationship with the family. Ignoring the mothers feelings will hinder the relationship. Defending the school nurse and the school puts the clients mother on the defensive and stifles communication)

A third grade child is referred to the mental health clinic by the school nurse because he is fearful, anxious, and socially isolated. After meeting with the client, the nurse talks to the mother, who says, "It is that school nurse again. she has done nothing but try to make trouble for our family since my son started school. And now you are in on it." The nurse should respond by saying: 1. "The school nurse is concerned about your son and is only doing her job" 2. "You do not need to feel singled out. We see a number of children who go to your sons school" 3. "You sound pretty angry with the school nurse. Tell me what has happened" 4. "Let me tell you why your son was referred, and then you can tell me about your concerns"

1 (The dolls and toys in a play therapy room are useful props to help the child remember situations and re-experience the feelings, acting out the experience with the toys rather than putting the feelings into words. Role playing without props commonly is more difficult for a child. Although drawing itself can be therapeutic, having the abuse see the pictures is usually threatening to for the child. Reporting abuse to authorities is mandatory but dos not help the child express feelings)

A young child who has been sexually abuse has difficulty putting feelings into words. Which approach should the nurse employ with the child? 1. engaging in play therapy 2. role playing 3. giving the childs drawings to the abuser 4. reporting the abuse to a prosecuter

3 (dealing with physical pain associated with mutilation is viewed easier than dealing with the intense anger and emotional pain. The client fears an aggressive outburst when anger and emotional pain increase. Self mutilation seems easier and safer. Additionally self mutilation may occur if the client feels unreal or numb or is dissociating. Here the mutilation proves to the client that he or she is alive and capable of feeling. The client may want to be less sexually attractive, but this aspect usually is not related to self mutilation. Binging and purging is commonly done in addition to, not instead of, self mutilation. Although a few clients report and occasional high with self mutilation, usually the experience is just relief from anger and rage)

Adolescents and adults who were sexually abused as children commonly mutilate themselves. The nurse interprets this behavior as: 1. the need to make themselves less sexually attractive 2, an alternative to binging and purging 3. use of physical pain to avoid dealing with emotional pain 4. an alternative to getting high on drugs

4 (The safety of other children is primary concern. It is critical to know whether other children are at risk for being sexually abused by the same perpetrator. Asking about other forms of abuse, how long the abuse went on, and if the victim did not remember the abuse are important questions after the safety of other children is determined)

After a client reveals a history of childhood sexual abuse, what question should the nurse ask first? 1. what other forms of abuse did you experience 2. how long did the abuse go no? 3. Was there a time when you did not remember the abuse? 4. Does your abuser still have contact with young children?

a,c,d (Rationale The nurse would want to make these facts​ clear: Violence is preventable. Domestic violence rates are decreasing. Elder abuse happens to people over 65 years old. These facts are​ correct: Eighty percent of domestic violence victims are women. Violence does challenge coping efforts.)

After a lecture by a health department​ nurse, some members of the audience came up to congratulate the nurse on an effective presentation. Which statements by the audience members would the nurse want to​ correct? Select all that apply. a "Elder abuse happens to people over 55 years old. " b "Eighty percent of domestic violence victims are women. " c "Violence is not preventable. " d "Domestic violence rates are increasing. " d "Violence challenges coping efforts. "

2 (The nurse needs more info about the clients decision before deciding what intervention is most appropriate. Judgemental responses could make it difficult for the client to return for treatment should she want to do so. Telling the client that this is a bad dicision that she will regret is inappropriate because the nurse is making an assumption. Warning the client that abuse commonly stops when one partner is involved in treatment may be true for some clients, however, until the nurse determines the basis for the clients decision, this type of response is an assumption and therefore inappropriate. Reminding the client about her duty to protect the children would be appropriate if the client had talked about episodes of current abuse by her partner and the fear that her children may be hurt by him, but the scenario offers no evidence that the husband has threatened the children)

After months of counseling, a client abused by her husband tells the nurse that she has decided to stop treatment. There has been no abuse during this time, and she feels better able to cope with the needs of her husband and children. In discussing this decision with the client, the nurse should: 1. tell the client that this is a bad decision that she will regret in the future 2. find out more about the clients rationale for her decision to stop treatment. 3. warn the client that abuse commonly stops when one partner is in treatment, only to begin again later 4. remind the client of her duty to protect her children by continuing treatment

d (Rationale Reporting elder neglect to the appropriate​ agency, according to the requirements of state​ law, is a nonpharmacologic treatment of elder neglect and takes priority in this case. Developing trust is​ also, but it does not take priority in this case. The nurse should not confront the daughter or​ son-in-law but should report the suspected neglect to the proper authorities and allow them to investigate the situation.)

An alert and oriented older adult client is receiving home care services following a cerebrovascular accident that has left her with​ right-sided hemiparesis. She lives with her daughter and​ son-in-law. The nurse suspects that the client is being neglected when she observes that the client​'s hair and clothes are dirty and the client smells of urine. Which nonpharmacologic treatment would be a priority for this​ client? a Wait until enough trust has been developed to enable the client to approach the nurse first b Interview the​ son-in-law to gain his perspective on the situation c Confront the daughter with the suspicions d Report the neglect to the appropriate agency

c (Rationale The client may be at risk for future attacks because she is being abused by someone with whom she lives. The nurse needs to make a thorough assessment of the client​'s safety and assist the client in developing a safety plan in the event the son abuses her again. Having the client move may not be an​ option, as the client may have nowhere else to live. Even though the client is in the​ hospital, she is still in danger. Supporting the client​'s wishes to not press charges due to fear is not a therapeutic intervention.)

An older woman who has been physically and financially abused by her son tells the​ nurse, "I am not pressing charges against my son because I am afraid that he will put me out on the street and I will have no place to​ go." Which response should the nurse include in her interventions for this​ client? a Support the client​'s wishes to not press charges due to fear. b Encourage the client to move out of her son​'s home to avoid future encounters with him. c Assess the client​'s safety and help her develop a safety plan. d Instruct the client not to worry about her son because she is in the​ hospital, so he will not do it again.

a (Rationale The assessment findings in children who are physically abused include bruises and​ welts, in various stages of​ healing, in areas where one does not normally see bruising from being a​ child; whip marks on​ 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.)

A​ 2-year-old 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 is a physical sign that usually indicates child​ abuse? a Welts or bruises in various stages of healing on the child​'s back b Scraped and scabbed knees c A few bruises on shins d Diaper rash

3 (guilt and self blame are common feelings that need to be addressed directly and frequently. The client needs to be reminded periodically that she did not deserve and did not cause the rape. Continually encouraging the client to report the rape pressures the client and is not helpful. In most cases, resuming sexual relations is a difficult process that is not likely to occur quickly. It is not necessarily true that the rapist will be caught, tried and jailed. Most rapists are not caught or convicted.)

In working with a rape victim, which intervention is most important? 1. continuing to encourage the client to report the rape to the legal authorities 2. recommending that the client resume sexual relations with her partner as soon as possible 3. periodically reminding the client that she did not deserve and did not cause the rape 4. telling the client that the rapist will eventually be caught, put on trial and jailed.

a,c,e (Anger, shock, and disbelief are felt initially. Posttraumatic stress disorder and suicidal ideation may appear later in rape trauma syndrome.)

Many rape victims suffer from a multitude of emotions in the aftermath of the attack. Which emotions are felt​ initially? Select all that apply. a Shock b Posttraumatic stress disorder c Disbelief d Suicidal ideation e Anger

b (Rationale Social learning theory suggests that violence related to abuse and neglect is a learned behavior. Violent individuals are conditioned to respond aggressively and violently. Neurobiologic theory suggests that the tendency to​ abuse, neglect, and become violent toward others is a result of genetic considerations and distortion in neurotransmitters. Interpersonal theory suggests that the cause of violence lies in the personality of the individual who commits​ abuse; the perpetrator uses violence to control his anger.​ Gender-bias theory proposes that some​ families, cultures, and communities value the subordination of women through power and privilege.)

The etiologies of interpersonal​ violence, abuse, and neglect relate to several different theories. Which explanation best describes the social learning​ theory? a Some​ families, cultures, and communities value the subordination of women through power and privilege. b Violence related to abuse and neglect is a learned behavior. c The cause of violence lies in the personality of the individual who commits abuse. d The tendency to​ abuse, neglect, and become violent toward others is a result of genetic considerations and distortion in neurotransmitters.

a,c (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).

The home care nurse is talking to an entire family when 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 individuals are in age groups less likely to report or admit to being the victims of​ violence? Select all that apply. ​a 88-year-old ​b 18-year-old ​c 8-year-old ​d 48-year-old ​e 28-year-old

b (Over​ 40% of the women reporting rape are under 18 years of age.)

The number of women who report being raped is estimated at 1 in 5. Of this​ number, how many report being raped before reaching 18 years of​ age? a Over​ 15% b Over​ 40% c Less than​ 22% d Less than​ 37%

a (Rationale Never walk down the street by oneself at​ night, even just to cross it. It is important to be aware of the surroundings and who may be nearby. Always travel with a couple of people when at​ clubs, raves, or​ concerts, and when walking to your car.)

The nurse has just completed a seminar presenting strategies to prevent rape. Which participant statement indicates that more instruction on rape prevention is​ needed? ​a "I am only running to the laundromat across the street. I will be okay​ tonight." ​b "I never go to the clubs by myself and I never leave by​ myself." ​c "I make sure that I look around the parking lot to make certain no one is near before I head to my​ car." ​d "I will leave the classroom and walk to my car with a couple of​ friends.

d (Rationale The nurse should suspect intimate partner violence based on the client assessment and the husband​'s controlling behaviors. Elder​ abuse, rape, and financial abuse are not in evidence at this time.)

The nurse in the emergency department is caring for a woman of Asian descent who was brought in by a neighbor. The right side of the client​'s face is​ swollen, bruised, and bleeding. She has multiple bruises on her arms. The client​'s husband arrives and does not let her​ speak; he answers questions for her. The nurse should suspect which type of​ abuse? a Rape b Elder abuse c Financial abuse d Intimate partner violence

b (Rationale Refusing to report the rape or accept help indicates the client is still in the shock phase and needs a revised plan of care. Allowing the nurse to assess and gather evidence and asking for an advocate indicate the client is participating and meeting the goals of the plan of care.)

The nurse is assessing the plan of care initiated for a client who is the victim of rape. Which finding indicates that the plan of care should be​ revised? a The client has agreed to the physical assessment. b The client has refused to report the rape or accept help. c The client has allowed physical evidence to be collected. d The client has asked for a rape counselor.

b (Rationale: Providing resource information on adult day cares is most appropriate in this situation. The client's caregiver is expressing concern about leaving them home alone and an adult day care may give the caregiver a safe option for the times the caregiver is at work. Play therapy most commonly helps children play out traumatic themes, fears, and distorted beliefs. It is a nonthreatening way to process thoughts and feelings associated with the abuse, both symbolically and directly. Art therapy provides an opportunity to express feelings for which there are no words. While elder abuse is a reportable event, the lack of the caregiver's knowledge of resources has attributed to the safety issue. )

The nurse is caring for an elderly client who has been admitted with a recent fall. The admission assessment revealed several bruised areas on the back and legs. During the interview with the caregiver, the caregiver states, "I don't know what to do with her when I go to work during the day so I leave her home alone." What is the most appropriate action for the nurse to take? a Suggest art therapy. b Provide resource information on adult day cares. c Encourage play therapy. d Threaten to contact the authorities.

d (Rationale Chain of custody ensures the laws are observed so that the evidence can be used in court. Double​ verification, sworn​ affidavits, and a doctor​'s gathering the evidence do not guarantee that the evidence collected can be used.)

The nurse is performing diagnostic tests for a client who is the victim of rape. Which of the following ensures that evidence from the diagnostic tests can be used to convict the​ attacker? a Evidence gathered by a doctor b Double verification c Sworn affidavit d Chain of custody

c (Rationale Calling the police is not done unless the victim requests to report the rape. Once the client​'s safety is​ assured, assessing for wounds and offering counseling are part of the assessment.)

The nurse is providing care in the emergency department to a victim of rape. Which action is not part of the physical assessment of this​ client? a Providing safety for the client. b Assessing for wounds. c Calling the police. d Offering counseling services

c,d,e (Rationale Nursing actions that provide the client with emotional support during the assessment process include calling a friend or family​ member; offering counseling​ services; and providing access to a rape advocate. Stating that the client invited the rape because of drug​ use, or assuming that pregnancy prevention is wanted are not supportive behaviors for this client during the assessment process.)

The nurse is providing care to a client who is the victim of rape. Which action by the nurse offers the client emotional support during the assessment​ process? Select all that apply. a Assuming that pregnancy prevention medication is wanted. b Stating that the client invited the rape because of drug use. c Offering counseling services. d Calling a friend or family member. e Providing access to a rape advocate.

a,b,c,d (Rationale Appropriate nursing interventions for this client include placing the client is a private​ room; treating for sexually transmitted​ infections; administering emergency contraceptive​ medications; and making appropriate referrals to meet the client​'s psychosocial needs. Interviewing in the triage area does not provide the client with privacy and is inappropriate.)

The nurse is providing care to a client who is the victim of rape. Which intervention is appropriate for this​ client? Select all that apply. a Administering emergency contraceptive medications. b Submitting referrals to a social​ worker, counselor, and support groups. c Placing the client in a private room for assessment and collection of evidence. d Treating the client for sexually transmitted infections. e Taking the history of the incident in the triage area before the physical assessment.

b,d,e (Rationale Eating​ disorders, anger and sexual dysfunction are all​ long-term effects. Confusion is an immediate response to rape.)

The nurse is providing care to a victim of rape. The rape occurred over a year ago. Which assessment findings are expected for this​ client? Select all that apply. a Anxiety b Eating disorders c Confusion d Anger e Sexual dysfunction

d (The priority when caring for a child who is the victim of violence is always safety. Because Andy 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 Andy. It is not appropriate to ask​ Andy's mother to leave the​ room, as her leaving may increase​ Andy's anxiety. The nurse should not make negative comments about the abuser and must follow established protocols for mandatory reporting.)

The nurse is providing care to​ Andy, a​ school-age child brought to the pediatric practice for an examination.​ Andy's mother,​ Noel, tells the nurse that she suspects that Andy has been subjected to sexual abuse by his babysitter. Which approach is most appropriate for the nurse to take when providing care for​ Andy? a Call the police to report the crime committed against Andy b Tell Andy that the babysitter will be made to pay for what he or she did c Ask​ Andy's mother to leave the room to conduct a thorough examination d Develop a trusting relationship with Andy by doing exactly what is promised

a (Rationale Clients who have experienced​ trauma, such as interpersonal or intimate partner​ violence, may experience flashbacks. The flowers may trigger flashbacks for this client. The nurse needs to assess if the client is having a flashback and stay with her to help her cope through the flashback. Leaving the client alone while she is having a flashback of previous events is not​ therapeutic, as the client may feel that she is in danger. Telling the client that the abuse was in the past does not acknowledge the client​'s past experience with abuse. It also does not allow the client to express her feelings about the past events that have occurred.)

The nurse is talking with a client who just had a beautiful potted flower delivered. Suddenly the client starts to cry and stares out the window. The client has a history of abuse by her husband. Which response should the nurse include in the plan of care for this​ client? a Assess if the client is having a flashback of previous abuse. b Tell the client to enjoy the flowers and that she will feel better in a little while. c Tell the client that the abuse was in the past. d Give the client some time and return later.

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 being 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 goal.)

The nurse who is caring for 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 should the nurse identify as the victim​'s main goal in reconstructing her​ 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

4 (Parental use of nonviolent discipline, the childs talk about what the family is doing , and the easing of the parents negativity toward the school nurse are all signs of progress. Avoidance and wearing clothes inappropriate for the weather implies that the child has something to hide, likely signs of physical abuse)

The parent of a school aged child tells the nurse that "For most of the past year, my husband was unemployed and I worked a second job. Twice during the year I spanked my son repeatedly when he refused to obey. It has not happened again. Our family is back to normal."After assessing the family, the nurse decides that the child is still at risk for abuse. Which observation best supports this conclusion? 1. The parents say they are taking away privileges when the son refuses to obey 2. The child has talked about family activities with the nurse 3. The parents are less negative to the nurse 4. The child wears long sleeve shirts and long pants even in warm weather

a (Rationale One third of high school students reported involvement in a physical​ fight, so it is an​ expected, not​ unexpected, event in that age group. Its prevalence was determined by a research study. It is due to causes other than hunger.)

The parents of a teenager are talking with the nurse in the urgent care clinic about the injuries their son sustained in a physical fight during his high school lunch hour. What can the nurse tell them about fighting in​ adolescence? a One third of high school students get into physical fights. b It is an unexpected event in that age group. c It is due to the effect of hunger on teenagers. d Its prevalence is not known.

a (Rationale Behavioral symptoms of children who have been sexually abused include regression​ (thumb-sucking would be regressive behavior in a​ third-grade child, who is 8dash-9 years of​ age), clinging​ behaviors, lack of peer​ friendship, and crying out or showing fear when approached by strangers.​ Impulsivity, hyperactivity,​ stuttering, and leadership traits are not manifestations of abuse.)

The school nurse is assessing a​ third-grade child for symptoms of sexual abuse. Which behavioral manifestations support the possibility of sexual​ abuse? ​a Thumb-sucking, isolating self from peers on​ playground, and excessive fear of strangers ​b Hyperactivity, stuttering, and isolating self from peers on the playground c ​Stuttering, impulsivity, and being the team leader when playing games with peers ​d Enuresis, impulsivity, and decline in school performance

b (Rationale: Caregiver stress and frustration may lead to abuse or even homicide of children with special needs. Children who are physically abused by their parents are more likely to abuse siblings; sibling abuse is the most unrecognized form of abuse. Physically abused children may appear overly submissive and eager to please their teacher; abused children are frequently overly compliant in response to all adults. Inadequate physical care or lack of care for a child may be a sign of child abuse.)

The school nurse teaches elementary school teachers about occurrences of violence towards children. The nurse knows that further teaching is necessary if a teacher makes which statement? a "Poor hygiene and inappropriate clothing are possible signs of child abuse." b "Children with special needs are less vulnerable to physical abuse than other children." c "Physically abused children may appear overly submissive and eager to please their teacher." d "Children who are physically abused by their parents are more likely to abuse siblings."

a (Rationale The first priority is assuring safety from the partner​'s abuse. The other approaches come​ next: the lack of​ blame, the need for​ resources, and giving information.)

The telephone advice nurse is fielding a complex question about possible intimate partner abuse. From the description that the caller is​ giving, it seems likely. What is the first priority of the advice​ nurse? a Assuring safety from the partner​'s abuse b Emphasizing that the caller is not to blame for the abuse c Giving information about helpful services d Exploring the need for resources

d (The purpose of focused assessment by sonography in trauma​ (FAST) test is to find blood in body cavities. It is not concerned with level of​ consciousness, pain, or antibodies.)

What is the purpose of the focused assessment by sonography in trauma​ (FAST) test? a Assessing level of consciousness b Measuring response to pain c Screening for antibodies d Finding blood in body cavities

4 (Ultimately a victim of crime needs to move from being a victim to being a survivor. A reasonable sense of safety and security is key to this transition. Getting thru the shock and confusion, carrying out home and work routines, and resolving grief over any losses represent steps along the way to becoming a survivor.)

When caring for a client who was a victim of a crime, the nurse is aware that recovery from any crime can be a long and difficult process depending on the meaning it has for the client. What should the nurse establish as a victims ultimate goal in reconstructing his or her life? 1. getting thru the shock and confusion 2. carrying out home and work routines 3. resolving grief over any losses 4. regaining a sense of security and safety

4 (Parents of an abused child have difficulty controlling their aggressive behaviors. They may blame the child or others for the injury, may not ask questions about treatment, and may not know developmental information)

When obtaining a nursing history from parents who are suspected of abusing their child, which characteristic about the parents should the nurse particularly assess? 1. attentiveness to the childs needs 2. self blame for the injury for the child 3. ability to relate the childs developmental achievements 4. difficulty with the controlling aggression

3 (Parents who are abusive often suffer from low self esteem, commonly because of the way they were parented, including not being able to develop trust in caretakers and not being encouraged or offered emotional support by parents. Therefore the nurse works to bolster the parents self esteem. This can be achieved by praising the parents for appropriate parenting. Employment and socioeconomic status are not indicators of abusive parents. Abusive parents usuallly are attached to their children and do not want to give them up to foster care. Parents who are abusive usually love their children and feel close to them emotionally)

When planning interventions for parents who are abusive, the nurse should incorporate knowledge of which factor as a common parental indicator? 1. lower socioeconomic group 2. unemployment 3. low self-esteem 4. loss of emotional family attachments

4 (The clients safety, including the need to stay alive is crucial. Therefore, helping the client develop a safety plan is most important to include in the plan of care. Being empathetic, teaching about abuse and explaining the persons rights are also important after safety is ensured)

When planning the care for a client who is being abused, which measure is most important to include? 1. being compassionate and empathetic 2. teaching the client about abuse and the cycle of violence 3. explaining to the client about abuse and the cycle of violence 4. helping the client develop a safety plan

2,3,4,5 (Using a foam bat while symbolically confronting the abuser, keeping a journal of memories and feelings, and writing letters about the abuse but not sending them are appropriate strategies because they allow anger to be expressed safely. Directly confronting the abuser is likely to result in further harm because the abusers commonly deny the abuse, rationalize about it or blame the victim)

When working with a group of adult survivors of childhood sexual abuse, dealing with anger and rage is a major focus. Which strategies should the nurse expect to be successful? select all that apply 1. directly confronting the abuser 2. using a foam bat while symbolically confronting the abuser 3. keeping a journal of memories and feelings 4. writing letters to the abusers but not sending them 5 writing letters to the adults who did not protect them but not sending them

a,c,d,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.)

Which actions are appropriate nonpharmacologic treatments of a neglected or abused​ child? Select all that apply. a Family therapy for the parents b Pain medication for the child​'s injuries c Providing a safe environment for the child d Play therapy e Reporting the abuse or neglect to the appropriate agency

a,b,c,d (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 are appropriate nursing interventions for child abuse and​ neglect? Select all that apply. a Initiating a complete physical assessment b Developing rapport c Reporting the abuse d Promoting a trusting relationship e Encouraging the child to confront the abuser

a,b,e

Which are appropriate nursing interventions for intimate partner​ violence? Select all that apply. a Initiating a thorough physical and emotional assessment b Offering resources and assistance c Giving the client your opinion of his or her intimate partner d Mediating discussion between the victim and the abuser e Documenting the description and location of any injuries

b,c,d,e (Influencing factors define trends and identify warning signs. They are not causative or predictive. They do not follow laws.)

Which are characteristics of the influencing factors of​ violence? Select all that apply. a They follow laws. b They are not predictive. c They are not causative. d They define trends. e They identify warning signs.

a,d,e (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 neurobiologic​ 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.)

Which are etiologic factors in the social learning theory of interpersonal​ violence, abuse, and​ neglect? Select all that apply. a Children learn about violence from observation. b Some communities value the subordination of women. c Early life stress leads to mood and anxiety disorders in the individuals who are abused. d The potentially abusive individual makes a conscious choice to abuse. e The media expose children to many models of violence.

a,b,d,e (Nonpharmacologic treatment of elder abuse may include adult day​ care, a safe living​ environment, elder abuse reported to the appropriate​ agency, and respite care for the caregiver. It does not include referral to a homeless​ shelter, which is an appropriate referral to a client who is homeless.)

Which are forms of nonpharmacologic treatment of elder abuse and​ neglect? Select all that apply. a Respite care for caregiver b Elder abuse reported to appropriate agency c Referral to a homeless shelter d Safe living environment e Adult day care

c (Rationale: It is common for children to model the behaviors of parents, siblings, other adults, or actions they see on television. Therefore, children have a high likelihood of adopting abusive tendencies perpetrated by their parents or siblings. Acting obediently when being scolded indicates appropriate discipline by the parent. There may be many reasons why the child does not want to participate in a physical sport. An abused child may be withdrawn and isolated from peers. Nonphysical interventions such as time-outs are more effective than spanking at modifying unwanted behavior.)

Which behavior does the school nurse recognize as an indicator that a school-age child has been physically abused? a The child acts obediently when a parent scolds the child to be quiet. b The child sits quietly with a friend in the schoolyard instead of playing kickball. c The child bullies other children and threatens them to "keep quiet about it." d The child tells other children that they will get a "time-out" if they continue to misbehave.

a,d (Both predisposing factors and vulnerability factors increase an individual​'s risk of becoming a victim of violence. Risk factors increase the possibility of someone​'s becoming a​ perpetrator, not a​ victim, of violence. Precipitating factors cause a violent event. Protective factors decrease an individual​'s chances of violence.)

Which factors increase an individual​'s chances of becoming a victim of​ violence? Select all that apply. a Vulnerability factors b Risk factors c Protective factors d Predisposing factors e Precipitating factors

a,b,c,d (Older​ adults, very young​ children, and those with intellectual disabilities are at greater risk for interpersonal violence or abuse. The presence of a firearm in the home increases the risk for violence.​ Poverty, not high socioeconomic​ status, is a risk factor for interpersonal violence and abuse.)

Which factors increase the risk for interpersonal violence or​ abuse? Select all that apply. a Being an older adult b Being a young child c Intellectual disability d Presence of firearms in the home e High socioeconomic status

b,d,e (In cases of child​ abuse, behavioral therapy is recommended for the family member or individual who is harming the child. Behavioral therapy may include parenting skills​ classes; substance abuse therapy if​ needed; and conflict or anger management training as needed. Assertiveness training would not be​ indicated, as the individual who abuses does not need assistance in gaining power. Play therapy is a​ non-pharmacologic treatment for younger children who have been abused.)

Which is a behavioral therapy for individuals who abuse​ children? Select all that apply. a Play therapy b Anger management training c Assertiveness training d Parenting skills classes e Substance abuse therapy

c (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.)

Which is an example of a collaborative intervention by a nurse working with a client who has experienced elder​ abuse? a Exploring options for help b Completing mandatory reports to authorities c Referring the client to a social worker case manager d Sharing information about services

b (Rationale The nurse has the responsibility to report elder abuse to the appropriate agency and to support the victim. Protecting the client​'s privacy by not documenting the abuse would be a violation of the nurse​'s duties. Counseling must be done by a trained professional.)

Which nonpharmacologic treatment is appropriate in an abuse situation involving an older​ adult? a Protect the client​'s privacy by not documenting the abuse. b Report the situation to the proper​ agency, and provide support for the victim. c Provide counseling for the victim. d Provide counseling to the person committing the abuse.

a (Rationale: The safety of the client is the priority diagnosis. The greatest predictor of continued violence is the previous history of violence by the partner. Although powerlessness related to feelings of dependence on the significant other is an appropriate diagnosis, a concern for safety is the number-one priority. Chronic low self-esteem related to guilt and shame for being a victim of abuse may be appropriate for this client, but safety is the first concern. Social isolation related to control by the significant other and feelings of inadequacy may be an appropriate diagnosis for this client, but a threat to safety would supersede this diagnosis.)

Which nursing diagnosis would be priority for a homosexual client who has been repeatedly physically assaulted by the partner? a Risk for injury related to history of abuse by significant other b Chronic low self-esteem related to guilt and shame for being a victim of abuse c Powerlessness related to feelings of dependence on significant other d Social isolation related to control by the significant other and feelings of inadequacy

3 (An almost universal finding in descriptions of abused children is underdevelopment for age. This may be reflected in small physical size or in poor psychosocial development. The child should be evaluated further until a plausible diagnosis can be established. A child who appears happy when personnel work with him is exhibiting normal behavior. Children who are abused often are suspicious of others, especially adults. A child who plays alongside others is exhibiting normal behavior, that of parallel play. A child who sucks his thumb contentedly is also exhibiting normal behavior)

Which observation by the nurse should suggest that a 15 month old toddler has been abused? 1. The child appears happy when personnel play with him 2. The child plays alongside others contentedly 3. The child is underdeveloped for his age 4. The child sucks his thumb

b (Emotional abuse occurs when one partner​ threatens, controls, or humiliates the other partner. Battering is the chronic and continuing violence of one partner against the other. Sexual violence is forcible sexual contact. Financial abuse occurs when someone appropriates the financial resources​ of, or denies financial support​ to, a vulnerable person.)

Which term is used to describe the type of intimate partner violence that exists when there is no physical​ abuse, but one partner is humiliating and controlling the partner by lowering or restricting his movement or​ self-esteem? a Financial abuse b Emotional abuse c Battering d Sexual abuse

3 (A 3 year old child has limited verbal skills and should not be asked to describe and explain a picture, or respond verbally or nonverbally to questions. More appropriately, the child can act out the event using dolls. The child is likely to be too fearful to name the perpetrator or will not be able to do so)

While interviewing a 3 year old girl who has been sexually abused about the event, which approach would be most effective? 1. describe what happened during the abusive act 2. draw a picture and explain what it means 3. play out the event using anatomically correct dolls 4. name the perpetrator

b (Marcus's repetitive habit of biting his nails may be a clinical manifestation of interpersonal abuse and neglect. Other repetitive habits in children that may be clinical manifestations of interpersonal abuse and neglect include thumb​ sucking, hair​ twisting, or rocking back and forth.​ Marcus's friendliness with strangers would not be considered a manifestation of​ abuse; rather, a child who is being abused might cry when approached by strangers.​ Marcus's aversion to going to the doctor would also not be considered an indication that he is being abused or neglected. The bandage over a scrape on​ Marcus's knee indicates that Marcus is being cared for when he has an​ injury, and​ thus, it would not be considered a manifestation of abuse or neglect.)

You are assessing​ Marcus, a child whose teacher suspects he is the victim of abuse or neglect. Your physical assessment of Marcus reveals no unexplained or untreated​ injuries, and Marcus does not appear to be malnourished or dehydrated. Which clinical manifestation would indicate to you that Marcus might be the victim of abuse or​ neglect? a He tells you he​ doesn't like going to the doctor. b He repeatedly bites his nails. c He is friendly with strangers. d He has a bandage over a scrape on his knee.

b (You would respond to Mr.​ Davis's concerns by telling him that you will not share anything he tells you with his caregiver. Assuring the client of confidentiality will help promote a trusting​ relationship, which is an essential nursing intervention. You would not tell him that it would be better for him if you share what he tells you with his​ caregiver, because this may make him feel unsafe. You would not tell Mr. Davis that​ it's necessary for you to share what he tells you with his caregiver because this is untrue. You would not tell Mr. Davis that he​ shouldn't be afraid of his caregiver because this statement is judgmental and would not promote a trusting relationship between you and Mr. Davis.)

You are caring for Mr.​ Davis, an​ 84-year-old man who has been hospitalized for malnutrition. You suspect that elder abuse may be responsible for Mr.​ Davis's condition, but when you ask him about the care he receives from his​ caregiver, he tells you he is afraid of what will happen if his caregiver finds out that he is complaining. Which is your best response to Mr.​ Davis? ​a "You shouldn't be so afraid of what your caregiver will​ do." ​b "I will not share anything you tell me with your​ caregiver." ​c "It would be better for you if I share what you tell me with your​ caregiver." d ​"It's necessary that I share what you tell me with your​ caregiver."

b,c,d (Rationale Possible perpetrators include​ caregivers, spouses, and children. Possible perpetrators are not the prescriber of anticoagulants or​ meals-on-wheels volunteers.)

A nurse at a geriatric clinic notices bruises on the arms and legs of a frail older client. If the bruises are caused by​ abuse, who might be possible​ perpetrators? Select all that apply. a ​Meals-on-wheels volunteers b Children visiting a parent c Caregiver living in home d Client​'s spouse e Prescriber of anticoagulants

b (Rationale An influencing factor defines trends. None of the other factors point to trends.)

A nurse is reading a newspaper report about a​ 60% decrease in domestic violence over the past few years. What kind of factor does this statistic​ represent? a Predisposing factor b Influencing factor c Protective factor d Precipitating factor

1 (It is not normal for a preschooler to be totally passive during a painful procedure. Typically a preschooler reacts to a painful procedure crying or pulling away because of the fear of pain. However an abused child may become "immune" to pain and may find that crying can bring on more pain. The child needs to learn that appropriate emotional expression is acceptable.Telling the child that it did not really not hurt is inappropriate because it is untrue. Telling the child that nurses are mean does not build a trusting relationship. Praising the child will reinforce the childs response not to cry even though it is acceptable to do so. )

A 3 year old with a history of being abused has blood drawn. The child lies very still and makes no sound during the procedure. Which comment by the nurse would be most appropriate? 1. It is ok to cry when something hurts 2. That really did not hurt, did it? 3. We must seem very mean to hurt you that way 4. You were very good not to cry with the needle

b (Rationale: Asking about support at home will assess the support system and ability of the spouse to care for the client in a safe manner. This question also indicates that the nurse is aware of possible stress on the caregiver without accusing the spouse of abuse. Asking about placing the client in a nursing home subtly implies the spouse is abusing the client and is unable to care for the client properly. The nurse first assesses the client before planning interventions. Asking about turning the client in bed does not assess the possibility of caregiver strain nor does it offer support to the caregiver. Asking about the length of time the client is alone assumes that the client's injuries are signs of neglect or abuse.)

A 63-year-old client with Alzheimer disease is brought to the emergency department (ED) with pressure sores and severe dehydration. Upon further assessment, the nurse notices bruises on the client's neck, arms, and legs. Which question could the nurse ask the client's spouse? a "How often do you turn your spouse while your spouse is in bed?" b "What kind of support do you have at home to care for your spouse?" c "Have you considered placing your spouse in a nursing home?" d "How long do you leave your spouse at home alone?"

2 (safety of the client and children most immediate concern. If there is immed danger action must be taken to protect them. The other options can be discussed after the clients safety is assured)

A married female client has been referred to the mental health center because she is depressed. The nurse notices bruises on her upper arms and asks about them. After denying any problems, the client starts to cry and says. "He did not really mean to hurt me, but I hate for the kids to see this. I am so worried about them" What is the most crucial information for the nurse to determine? 1. The type and extent of the abuse occurring in the family 2. The potential of immediate danger to the client and her children 3. The resources available to the client 4. Whether the client wants to be separated from her husband

c (The​ boyfriend's previous behavior makes a​ high-risk situation for violence. Neither the​ client's pregnancy or​ age, or the​ boyfriend's marital​ status, increases the risk.)

An​ OB-GYN nurse at a prenatal clinic listens as Tonya​ Jacobs, a​ 17-year-old pregnant​ woman, talks about her boyfriend. Tonya​ says, "He beat up his​ ex-wife a lot of​ times, but so​ far, he​ hasn't done more than yell at​ me." What feature of the situation is evidence that the young woman is at high risk of​ violence? ​a Boyfriend's divorce b ​Client's pregnancy ​c Boyfriend's previous behavior ​d Client's age

a (Testing for HIV infection is done on arrival to the emergency department or crisis center and again at​ 3, 6, and 12 months after the attack. A pregnancy test is not accurate until the woman misses her first menstrual period after the attack. Swabs for such sexually transmitted infections as chlamydia are performed in the emergency department or crisis center initially. Ultrasound is not performed for sexual attacks.)

Diagnostic tests are performed when a victim of rape comes to the emergency department or crisis center. Which test is performed initially and then again at​ 3, 6, and 12 months after the​ attack? a HIV infection b Ultrasound c Pregnancy d Chlamydia

b,c,d (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.)

During the nursing assessment​ interview, which complaints might be associated with physical​ abuse? Select all that apply. a Chronic pelvic pain b Headache c Irritable bowel syndrome d Depression e Urinary tract infection

3 (Coercion is the most common strategy used because the child commonly trusts the abuser. Tying the child down is usually not necessary. Typically the abusive person can control the child by his or her size and weight alone. Bribery usually is not necessary because the child wants love and affection from the abusive person, not money. Young children are not capable of giving consent for sex before they develop an adult concept of what sex is)

One of the myths about sexual abuse of young children is that is usually involves physically violent acts. Which behavior is more likely to be used by the abuser? 1. tying the child down 2. bribery with money 3. coercion as a result of the trusting relationship 4. asking for the childs consent to sex

a,e (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.)

How is emotional abuse different from physical​ abuse? Select all that apply. a It is seldom measured. b It is inflicted accidentally. c It occurs because the caregiver failed to protect the victim. d It occurs without the victim​'s consent. e It cannot be seen.

4 (Use of alcohol reflects unhealthy coping mechanisms. The client report of needing alcohol to calm down needs to be addressed. Survival is the most important goal during a rape. The clients acknowledging this indicates that she is aware that she made the right choice. Although suicidal thoughts are common, the statement that suicide is an easy escape but the client would be unable to do it indicates low risk. Fantasies of revenge, such as giving the death penalty to all rapists, are natural reactions and are a problem only if the client intends to carry them out directly.)

In the process of dealing with the intense feelings about being raped, victims commonly verbalize that they were afraid they would be killed during the rape and wish that they had been. The nurse should decide if further counseling is needed if the client makes which statement? 1. I did not fight him, but I guess I did the right thing because I am alive 2. Suicide would be an easy escape from all this pain, but I could not do it to myself 3. I wish they gave the death penalty to all rapists and other sexual predators 4. I get so angry at times that I have to have a couple of drinks before I sleep

c,d,e (Rationale During the initial physical examination for a client who is the victim of a​ rape, the nurse assists in collecting skin scrapings from the​ fingernails; examining and swabbing the​ vagina, anus, and​ throat; and collecting the clothes the client was wearing when the attack occurred. A complete blood cell count and electrolyte panel are not diagnostic tools used to collect evidence during the initial physical examination of a client who has been raped.)

The nurse is assisting in the initial physical examination for a victim of rape. The nurse performs which action to assist with collection of evidence during this​ examination? Select all that apply. a Drawing blood for a complete blood count b Drawing blood for an electrolyte panel c Examining the client​'s ​vagina, anus, and throat d Collecting the client​'s clothing e Collecting skin scrapings from fingernails

b (Rationale Appropriate nonpharmacologic interventions for abused or neglected children include​ play, cognitive,​ behavioral, and group therapy depending on the age of the child. Acetaminophen and burn ointment are pharmacologic treatments. Assessing the child​'s back and abdomen is part of the nursing assessment that is done each shift.)

The nurse on the pediatric unit is caring for a​ 3-year-old child who has​ dime-size burns on her legs and bruises in various stages of healing on her abdomen and back. Which is an appropriate nonpharmacologic treatment for this​ child? a Treat the burns with silvadene ointment. b Refer the child for play therapy. c Give acetaminophen as ordered by the physician. d Assess the child​'s back and abdomen for any changes.

a,e (Environmental factors that influence the risk of violence include socioeconomic conditions and traumatic brain damage. Becoming easily​ frustrated, losing one​'s temper​ frequently, and intense anger are warning​ signs, not environmental factors.)

What are some of the environmental factors that influence the risk of violence in young​ people? Select all that apply. a Traumatic brain damage b Becoming easily frustrated c Frequent loss of temper d Intense anger e Socioeconomic conditions

d (Physical neglect occurs when a person intentionally ignores the physical and healthcare needs of another. Physical abuse is the intentional infliction of physical harm on another person. Emotional abuse is the intentional infliction of psychological harm on another. When a person ignores his own physical and healthcare​ needs, that is​ self-neglect.)

What is the definition of physical​ neglect? a Ignoring​ one's own physical and healthcare needs b Intentionally causing physical harm to another c Intentionally causing psychological harm to another d Intentionally ignoring the physical needs of another

d (he first priority for a nurse dealing with a child victim of violence is to ensure the safety of the child. The second priority is to develop a trusting relationship with the​ child, to make it easier for the child reveal abuse.​ Throughout, the nurse avoids making negative comments about the​ perpetrator, but that is not the first priority.)

What is the first priority for a nurse dealing with a child victim of​ violence? a Avoid making negative comments about the perpetrator. b Let the child reveal the abuse. c Develop a trusting relationship with the child. d Ensure the safety of the child.

a,c,d,e (Rationale The nurse must​ remember: The client​'s decisions should not be judged by the nurse. The client​'s choice should be supported by the nurse. The client has the case manager​'s contact information. The client feels unable to leave an unsafe situation. The nurse cannot be sure of the​ future, so it is not true that the client will never make other living arrangements.)

A case management nurse is working with a familiar​ client, a proven victim of repeated and severe domestic abuse. The client has chosen to return for the third time to live with the abuser. What must the nurse remember in this frustrating​ situation? Select all that apply. a The client​'s choice should be supported by the nurse. b The client will never make other living arrangements. c The client​'s decisions should not be judged by the nurse. d The client feels unable to leave an unsafe situation. e The client has the case manager​'s contact information.

a (Asking if the client is being hurt is a critical step in a comprehensive assessment. Referring the client to a shelter without assessment may be a disservice; the nursing process requires assessment before intervention. After assessment and the determination of domestic violence, collaboration with social services is appropriate. Documenting the assessment does nothing to help the client resolve the issue.)

A client comes to the emergency department with multiple bruises on the face and head. The nurse suspects that domestic violence may be the cause of the injuries. What is the most appropriate initial action for the nurse to take? a Ask if the client is afraid of being hurt by someone at home. b Refer the client to a shelter for battered partners. c Document the concern, but do nothing else. d Call a social worker to evaluate the client for domestic violence.

2 (The experience of rape is a crisis. Crisis intervention services, especially with a rape crisis nurse are essential to help the client begin dealing with the aftermath of a rape. Legal assistance may be recommended if the client decides to report the rape and only after crisis intervention services have been provided. A rape support group can be helpful later in the recovery process. Medications for sleep disturbance, especially benzodiazepines, should be avoided if possible. Benzodiazepines are potentially addictive and can be used in suicide attempts, especially when consumed with alcohol)

A client tells the nurse that she has been raped but has not reported it to the police. After determining whether the client was injured, whether it is still possible to collect evidence, and whether the client wants to file a report, the nurses next priority is to offer which intervention to the client? 1. legal assistance 2. crisis intervention 3. a rape support group 4. medications for disturbed sleep

b (Rationale The toys and dolls in a play therapy room are useful props to help the child remember situations and​ re-experience the​ feelings; acting out the experiences with toys rather than putting them into words is sometimes easier for the child.​ Role-playing for a younger child is​ difficult, especially without the use of toys or dolls. Giving the drawing to the abuser can put the child in danger. It is the nurse​'s responsibility to report suspected child abuse to the proper​ agency, but the reporting does not help the child express her feelings.)

A​ 5-year-old girl who has been physically abused is having difficulty putting her feelings into words. Which nursing intervention best enables the child to express her​ feelings? a Reporting the abuse to a prosecutor b Engaging in play therapy c Giving the child​'s drawings to the abuser ​d Role-playing

b (Rationale Gang members might or might not report the true cause of their injuries. Gang culture does value violence as a rite of passage. Gang members do protect each other​'s identity. Nurses should not have negative preconceived ideas about gangs.)

In the emergency​ department, a nurse is handing a doctor sterile supplies to suture several young people who reportedly got into a​ gang-related altercation. Which statement by the nurse best shows the need for more education for the​ nurse? a ​"I should not have negative preconceived ideas about​ gangs." ​b "Gang members always lie about the cause of their​ injuries." ​c "Gang members protect each ​other's ​identity." ​d "Gang culture values violence as a rite of​ passage."

4 (From documented cases of child abuse a profile has emerged of a high risk parent as a person who is isolated, impulsive, impatient, and single with low self esteem, a history of substance abuse, a lack of knowledge about a childs normal growth and development, and multiple life stressors. Just because a parent comes from a large family there is no increase in the incidence of the parent abusing their own children unless they possess other risk factors)

Which parental characteristic is least likely to be a risk factor for child abuse? 1. low self esteem 2. history of substance abuse 3. inadequate knowledge of normal growth and development patterns 4. being a member of a large family

c (The nurse knows that this behavior is indicative of the husband continuing to control the victim to ensure she does not ask for help and to avoid punishment. It is not a gesture suggesting that he wants to seek help. It is not an indication of a better future for the couple. It is not​ confusing; this is a clear situation of abusive control.)

You are caring for Mrs.​ Xavier, a woman who is being treated for cuts and bruises to her arms and face. Mrs. Xavier reluctantly tells you that her husband caused the​ injuries, but she stresses that it was the only time he has ever hit her. While you are caring for Mrs.​ Xavier, her husband enters the room and asks her to forgive him. He promises never to hurt her again and gives her a large bouquet of flowers. The nurse recognizes this act as​ what? a A demonstration of the​ husband's willingness to seek help and refrain from hurting his wife again b Extremely​ confusing, considering he just abused her and is now being so kind c An attempt by the husband to continue controlling the client to prevent her from asking for help and to demonstrate he is​ repentant, to avoid punishment d A kind gesture to move toward a better future for the couple

b (The best response is to explain that the antibiotics will help treat possible sexually transmitted diseases​ (STDs). Telling Ms. Hernandez she does not need the medication would be misleading and would not provide her with information she needs to make an informed decision. The antibiotics will not help Ms. Hernandez forget the trauma that happened to her. Antibiotics do not prevent​ pregnancy; Ms. Hernandez may receive an order for emergency contraception to prevent pregnancy. )

You are caring for Ms.​ Hernandez, a young woman who was recently raped. Ms. Hernandez is in shock and disbelief. When you try to give her antibiotics per the healthcare​ provider's order, she refuses to take them. Which is the best response to Ms.​ Hernandez's refusal to take​ medication? ​a "It is not necessary for you to take​ medication." ​b "The medication will help treat possible​ STDs." c ​"The medication will help you forget the​ trauma." ​d "The medication will prevent​ pregnancy."