Ch 28 - Child, Older Adult, and Intimate Partner Violence

A patient tells the nurse, "My husband lost his job. He's abusive only when he drinks too much. His family was like that when he was growing up. He always apologizes and regrets hurting me." What risk factor was most predictive for the husband to become abusive? a. History of family violence b. Abuse of alcohol c. Loss of employment d. Poverty

A An abuse-prone individual is an individual who has experienced family violence and was often abused as a child. This phenomenon is part of the cycle of violence. The other options may be present but are not as predictive.

After treatment for a detached retina, a survivor of intimate partner abuse says, "My partner only abuses me when I make mistakes. I've considered leaving, but I was brought up to believe you stay together, no matter what happens." Which diagnosis should be the focus of the nurse's initial actions? a. Risk for injury related to physical abuse from partner b. Social isolation related to lack of a community support system c. Ineffective coping related to uneven distribution of power within a relationship d. Deficient knowledge related to resources for escape from an abusive relationship

A Risk for injury is the priority diagnosis because the partner has already inflicted physical injury during violent episodes. The other diagnoses are applicable, but the nurse must first address the patient's safety.

The parents of a 15-year-old seek to have this teen declared a delinquent because of excessive drinking, habitually running away, and prostitution. The nurse interviewing the patient should recognize these behaviors often occur in adolescents who: a. have been abused. b. have eating disorders. c. are attention seeking. d. are developmentally delayed.

A Self-mutilation, alcohol and drug abuse, bulimia, and unstable and unsatisfactory relationships are frequently seen in teens who are abused. These behaviors are not as closely aligned with any of the other options.

An 11-year-old says, "My parents don't like me. They call me stupid and say they wish I were never born. It doesn't matter what they think because I already know I'm dumb." Which nursing diagnosis applies to this child? a. Chronic low self-esteem related to negative feedback from parents b. Deficient knowledge related to interpersonal skills with parents c. Disturbed personal identity related to negative self-evaluation d. Complicated grieving related to poor academic performance

A The child has indicated a belief in being too dumb to learn. The child receives negative and demeaning feedback from the parents. The child has internalized these messages, resulting in a low self-esteem. Deficient knowledge refers to knowledge of health care measures. Disturbed personal identity refers to an alteration in the ability to distinguish between self and non-self. Grieving may apply, but a specific loss is not evident in the scenario. Low self-esteem is more relevant to the child's statements.

Which comment by the nurse would best support relationship building with a survivor of intimate partner abuse? a. "You are feeling violated because you thought you could trust your partner." b. "I'm here for you. I want you to tell me about the bad things that happened to you." c. "I was very worried about you. I knew you were living in a potentially violent situation." d. "Abusers often target people who are passive. I will refer you to an assertiveness class."

A The correct option uses the therapeutic technique of reflection. It shows empathy, an important nursing attribute for establishing rapport and building a relationship. None of the other options would help the patient feel accepted.

An older adult with Lewy body dementia lives with family. After observing multiple bruises, the home health nurse talked with the daughter, who became defensive and said, "My mother often wanders at night. Last night she fell down the stairs." Which nursing diagnosis has priority? a. Risk for injury related to poor judgment, cognitive impairments, and inadequate supervision b. Wandering related to confusion and disorientation as evidenced by sleepwalking and falls c. Chronic confusion related to degenerative changes in brain tissue as evidenced by nighttime wandering d. Insomnia related to sleep disruptions associated with cognitive impairment as evidenced by wandering at night

A The patient is at high risk for injury because of her confusion. The risk increases when caregivers are unable to give constant supervision. Insomnia, chronic confusion, and wandering apply to this patient; however, the risk for injury is a higher priority.

An adult has a history of physical violence against family when frustrated, followed by periods of remorse after each outburst. Which finding indicates a successful plan of care? The adult: a. expresses frustration verbally instead of physically. b. explains the rationale for behaviors to the victim. c. identifies three personal strengths. d. agrees to seek counseling.

A The patient will have developed a healthier way of coping with frustration if it is expressed verbally instead of physically. The incorrect options do not confirm achievement of outcomes.

A community health nurse visits a family with four children. The father behaves angrily, finds fault with the oldest child, and asks twice, "Why are you such a stupid kid?" The wife says, "I have difficulty disciplining the children. It's so frustrating." Which comments by the nurse will facilitate an interview with these parents? Select all that apply. a. "Tell me how you discipline your children." b. "How do you stop your baby from crying?" c. "Caring for four small children must be difficult." d. "Do you or your husband ever spank your children?" e. "Calling children 'stupid' injures their self-esteem."

A, B, C An interview with possible abusing individuals should be built on concern and carried out in a nonthreatening, nonjudgmental way. Empathetic remarks are helpful in creating rapport. Questions requiring a descriptive response are less threatening and elicit more relevant information than questions that can be answered by yes or no.

A 10-year-old cares for siblings while the parents work because the family cannot afford a babysitter. This child says, "My father doesn't like me. He calls me stupid all the time." The mother says the father is easily frustrated and has trouble disciplining the children. The community health nurse should consider which resources as priorities to stabilize the home situation? Select all that apply. a. Parental sessions to teach childrearing practices b. Anger management counseling for the father c. Continuing home visits to give support d. A safety plan for the wife and children e. Placing the children in foster care

A, B, C Anger management counseling for the father is appropriate. Support for this family will be an important component of treatment. By the wife's admission, the family has deficient knowledge of parenting practices. Whenever possible, the goal of intervention should be to keep the family together; thus, removing the children from the home should be considered a last resort. Physical abuse is not suspected, so a safety plan would not be a priority at this time.

A nurse assists a victim of intimate partner abuse to create a plan for escape if it becomes necessary. Which components should the plan include? Select all that apply. a. Keep a cell phone fully charged. b. Hide money with which to buy new clothes. c. Have the phone number for the nearest shelter. d. Take enough toys to amuse the children for 2 days. e. Secure a supply of current medications for self and children. f. Assemble birth certificates, Social Security cards, and licenses. g. Determine a code word to signal children when it is time to leave.

A, C, E, F, G The victim must prepare for a quick exit and so should assemble necessary items. Keeping a cell phone fully charged will help with access to support persons or agencies. Taking a large supply of toys would be cumbersome and might compromise the plan. People are advised to take one favorite small toy or security object for each child, but most shelters have toys to further engage the children. Accumulating enough money to purchase clothing may be difficult.

Which statement made by a parent of a child diagnosed with Tourette's syndrome would be assessed as a risk factor for family violence? A. "My husband lost his job, and it seems all our savings are going to pay for our son's expensive medication and all the other things he needs." B. "Our son is really a good little boy, but he needs to be disciplined both at home and in school." C. "We shouldn't be, but we are ashamed of our son's disorder and his inability to control the tics in public." D. "We have become active in the support group but still find the suggestions extremely difficult to put into practice."

A. "My husband lost his job, and it seems all our savings are going to pay for our son's expensive medication and all the other things he needs." Job loss, financial problems, and a child who is "different" and has special needs should alert the nurse to the risk for family violence, because all these factors contribute to a crisis situation. None of the other options present with numerous risk factors

What is a nurse's legal responsibility if child abuse or neglect is suspected? a. Discuss the findings with the child's parent and health care provider. b. Document the observation and suspicion in the medical record. c. Report the suspicion according to state regulations. d. Continue the assessment.

C Each state has specific regulations for reporting child abuse that must be observed. The nurse is a mandated reporter. The reporter does not need to be sure that abuse or neglect occurred, only that it is suspected. Speculation should not be documented, only the facts.

The risk of elder abuse in a home is best determined by conducting which assessment? A. the vulnerability of the elder and the stress of the caregiver. B. the amount of disruption the elder causes in the home. C. how much actual physical assistance the elder needs on a daily basis. D. the financial contribution of the elder and the caregiver's early life experience with abuse.

A. the vulnerability of the elder and the stress of the caregiver. Abuse occurs across all segments of society and is reinforced by the society and the culture. The actual occurrence of violence requires (1) a perpetrator, (2) someone who by age or situation is vulnerable (e.g., children, women, men, the elderly, mentally ill persons, and physically challenged persons), and (3) a crisis situation

Nurses working in emergency departments and walk-in clinics should be aware that some victims of violence may present with which assessment characteristic? A. with vague physical complaints such as insomnia or pain. B. with extreme anger and unpredictable behavior. C. with many family members there to support them. D. with psychosis and/or mania as a result of long-term abuse.

A. with vague physical complaints such as insomnia or pain. Patients may present with symptoms that may be vague and can include chronic pain, insomnia, hyperventilation, or gynecological problems. Attention to the interview process and setting is important to facilitate accurate assessment of physical and behavioral indicators of family violence. Presenting with extreme anger is possible but not as common as presenting with vague physical complaints. Having many family members there is unlikely as many victims keep their history of being battered a secret. It is not known that psychosis or mania is a result of physical violence, and this would not be a usual presenting complaint.

Which referral will be most helpful for a woman who was severely beaten by intimate partner, has no relatives or friends in the community, is afraid to return home, and has limited financial resources? a. A support group b. A women's shelter c. A mental health center d. Vocational counseling

B Because the woman has no safe place to go, referral to a shelter is necessary. The shelter will provide other referrals as necessary.

11-year-old reluctantly tells the nurse, "My parents don't like me. They said they wish I was never born." Which type of abuse is likely? a. Sexual b. Emotional c. Physical d. Economic

B Examples of emotional abuse include having an adult demean a child's worth, frequently criticize, or belittle the child. No data support physical battering or endangerment, sexual abuse, or economic abuse.

Several children are seen in the emergency department for treatment of various illnesses and injuries. Which assessment finding would create the most suspicion for child abuse? The child who has: a. complaints of abdominal pain. b. bruises on extremities. c. repeated middle ear infections. d. diarrhea.

B Injuries such as immersion or cigarette burns, facial fractures, whiplash, bite marks, traumatic injuries, bruises, and fractures in various stages of healing suggest the possibility of abuse. In older children, vague complaints such as back pain may also be suspicious. Ear infections, diarrhea, and abdominal pain are problems that were unlikely to have resulted from violence

What feelings are most commonly experienced by nurses working with abusive families? a. Outrage toward the victim and discouragement regarding the abuser b. Helplessness regarding the victim and anger toward the abuser c. Unconcern for the victim and dislike for the abuser d. Vulnerability for self and empathy with the abuser

B Intense protective feelings, helplessness, and sympathy for the victim are common emotions of a nurse working with an abusive family. Anger and outrage toward the abuser are common emotions of a nurse working with an abusive family.

An older adult with Lewy body dementia lives with family and attends a day care center. A nurse at the day care center noticed the adult had a disheveled appearance, strong odor of urine, and bruises on the limbs and back. What type of abuse might be occurring? a. Psychological b. Physical c. Financial d. Sexual

B Lewy body dementia results in cognitive impairment. The assessment of physical abuse would be supported by the nurse's observation of bruises. Physical abuse includes evidence of improper care as well as physical endangerment behaviors, such as reckless behavior toward a vulnerable person that could lead to serious injury. No data substantiate the other options.

Which rationale best explains why a nurse should be aware of personal feelings while working with a family experiencing family violence? a. Self-awareness enhances the nurse's advocacy role. b. Strong negative feelings interfere with assessment and judgment. c. Strong positive feelings lead to healthy transference with the victim. d. Positive feelings promote the development of sympathy for patients.

B Strong negative feelings cloud the nurse's judgment and interfere with assessment and intervention, no matter how well the nurse tries to cover or deny feelings. Strong positive feelings lead to over-involvement with victims rather than healthy transference.

An adult tells the nurse, "My partner abuses me when I make mistakes, but I always get an apology and a gift afterward. I've considered leaving but haven't been able to bring myself to actually do it." Which phase in the cycle of violence prevents this adult from leaving? a. Tension-building b. Honeymoon c. Acute battering d. Stabilization

B The honeymoon stage is characterized by kind, loving behaviors toward the abused spouse when the perpetrator feels remorseful. The victim believes the promises and drops plans to leave or seek legal help. The tension-building stage is characterized by minor violence in the form of abusive verbalization or pushing. The acute battering stage involves the abuser beating the victim. The violence cycle does not include a stabilization stage.

A survivor of physical spousal abuse was treated in the emergency department for a broken wrist. This patient said, "I've considered leaving, but I made a vow and I must keep it no matter what happens." Which outcome should be met before discharge? The patient will: a. facilitate counseling for the abuser. b. name two community resources for help. c. demonstrate insight into the abusive relationship. d. reexamine cultural beliefs about marital commitment.

B The only outcome indicator clearly attainable within this time is for staff to provide the victim with information about community resources that can be contacted. Development of insight into the abusive relationship and reexamining cultural beliefs will require time. Securing a restraining order can be accomplished quickly but not while the patient is in the emergency department. Facilitating the abuser's counseling may require weeks or months.

older woman diagnosed with Alzheimer's disease lives with family and attends day care. After observing poor hygiene, the nurse talked with the caregiver. This caregiver became defensive and said, "It takes all my energy to care for my mother. She's awake all night. I never get any sleep." Which nursing intervention has priority? a. Teach the caregiver about the effects of sundowner's syndrome. b. Secure additional resources for the mother's evening and night care. c. Support the caregiver to grieve the loss of the mother's cognitive abilities. d. Teach the family how to give physical care more effectively and efficiently.

B The patient's caregivers were coping with care until the patient began to stay awake at night. The family needs assistance with evening and night care to resume their pre-crisis state of functioning. Secondary prevention calls for the nurse to mobilize community resources to relieve overwhelming stress. The other interventions may then be accomplished.

The mother of a 4-year-old daughter states that the child has recently begun, "Touching her vagina and rubs herself down there all the time." The child drew a picture showing two people with one on top of the other and said they were "doing sex." Based on the assessment description, what conclusion should the nurse explore further? A. Educate the mother to normal developmental behavior in a 4-year-old child. B. There is a possibility that the child has been sexually abused. C. The mother should be enrolled in parenting classes to improve her parenting skills. D. The child's exposure to graphic sexual images on television should be monitored closely.

B. There is a possibility that the child has been sexually abused. Sexualized behavior is one of the most common symptoms of sexual abuse in children. Younger children may draw sexually explicit images, demonstrate sexual aggression, or act out sexual interactions in play, for example, with dolls. Masturbation may be excessive in sexually abused children. It is not normal developmental behavior for a 4-year-old child. The other options may be true, but sexual abuse is more likely and must be investigated.

Which nursing intervention is best directed at the psychological needs of a physically abused client? A. encourage the client to immediately leave the abuser. B. affirm that the client did not deserve or cause the abuse. C. provide a referral to social services for economic problems. D. facilitate contact with law enforcement to take legal action.

B. affirm that the client did not deserve or cause the abuse. Abused clients often believe that they are deserving of the abuse and, in some way, prompt the abuser to attack. They need specific reassurance that they did not deserve to be abused and they did not cause the attack. The remaining options are directed to either safety or physical needs

When the nurse believes the cycle of abuse is escalating and that a woman may be in severe physical danger, the priority nursing intervention is to A. advise her to enter counseling at the mental health center. B. assist her to develop a plan to go to a shelter in case of a crisis. C. suggest she leave the abuser and go to a trusted friend's home. D. teach her to counter verbal abuse with assertive replies.

B. assist her to develop a plan to go to a shelter in case of a crisis. Every victim of abuse should have an escape plan, but one is particularly important when the nurse believes the client is in severe danger. None of the remaining options are as directly involved in client safety.

To best assure the safety of a 3-year-old child whose parent admits to finding it difficult to control his/her anger, what is the most appropriate short-term goal for the parent? A. understand the impact of violence on the child within 2 days. B. begin attending anger management training sessions within 2 weeks. C. state a willingness to attend a support group for physical abusers within 1 week. D. show remorse for their anger management issues within 2 days.

B. begin attending anger management training sessions within 2 weeks. Perpetrators of violence need help learning how to manage anger. A structured group is an excellent way to provide this teaching. This option most directly addresses the issue of preventing the anger from escalating to physical abuse

An abuse victim tearfully tells the nurse in the emergency department, "Don't tell my husband that you know he beats me because if he thinks anyone knows, he will beat me again." Based on this information, the most appropriate nursing diagnosis is A. chronic pain. B. fear. C. post-trauma syndrome. D. risk for self-directed violence.

B. fear. The client is expressing fear based on a known threat. None of the other options are supported by information provided in the scenario.

When there is reason to suspect that a child is being abused, the nurse must initially implement which intervention? A. call the local police to report it. B. follow agency policy for reporting. C. confront the parent or parents. D. interrogate the child to obtain proof.

B. follow agency policy for reporting. Nurses are mandated reporters of child abuse. They must follow the rules set forth by the state regarding the steps to take to report child abuse.

The nurse performing the assessment of a wheelchair bound client suspects that his wife's explanation of how he sustained facial contusions and a broken nose may not be entirely truthful. The nurse should A. confront the wife with the suspicion that her husband's injuries are the result of abuse. B. have the wife wait in the waiting room so her husband can be interviewed in private. C. report the husband's injuries to the police and ask for a confidential investigation. D. document the suspicion and follow a policy of "wait and see" whether he returns again.

B. have the wife wait in the waiting room so her husband can be interviewed in private. Suspected victims of abuse should always be interviewed in private. If the perpetrator is in the room, the victim cannot speak freely. Confronting the wife would likely cause her to be uncooperative and increase tensions. Neither of the other options address the assessment interview process

When treatment for injuries sustained during an incident of abuse is sought from the primary physician, the client is receiving which form of treatment? A. primary prevention. B. secondary prevention. C. tertiary prevention. D. stopgap therapy.

B. secondary prevention Secondary prevention involves early intervention in abusive situations to minimize their disabling or long-term effects. This scenario demonstrates actions only associated with secondary prevention

An older adult with Alzheimer's disease lives with family in a rural area. During the week, the person attends a day care center while the family is at work. In the evenings, members of the family provide care. Which factor makes this patient most vulnerable to abuse? a. Multiple caregivers b. Living in a rural area c. Alzheimer's disease d. Being part of a busy family

C Older adults are at high risk for violence, particularly those with cognitive impairments. The other characteristics are not identified as placing an individual at high risk.

Which statement, made by a female adult concerning her boyfriend, should cause the nurse to suspect that the client is at risk for being emotionally abused? A. "He has a good job and keeps control of all the finances but our electricity still got turned off last week." B. "I didn't tell him I was coming because he is under so much stress at work I didn't want to add to it." C. "He yells a lot and calls me names, but that's because I am so stupid and make so many mistakes." D. "He has always had a fiery temper."

C. "He yells a lot and calls me names, but that's because I am so stupid and make so many mistakes." Emotional abuse may be less obvious and more difficult to assess than physical violence, but it can be identified through indicators such as low self-esteem, reported feelings of inadequacy, and anxiety. Controlling the finances and having the electricity turned off describes the possibility of economic abuse. Not wanting to add to the boyfriend's stress does not describe an abusive situation. Describing the boyfriend as having a temper would more likely hint at physical abuse rather than emotional.

Which child is at lowest risk for abuse? A. A 3-month-old who has colic and teenaged parents. B. A 4-year-old who has cerebral palsy and retarded parents. C. A 2-year-old who has leukemia and two working parents. D. A 5-year-old who has ADHD and a father who was abused as a child.

C. A 2-year-old who has leukemia and two working parents. Although the child in option C has a serious physical disorder, she is at lower risk than the child in option A, whose inconsolable crying can be frustrating; the child in option B, who will not be as independent as other children his age and who has parents who may not understand his needs; or the child in option D, whose hyperactivity can be annoying, especially to a parent who himself has been abused.

Which behavior demonstrated by a woman attempting to escape a chronically abusive relationship presents the greatest personal risk? A. Relying on alcohol to escape the emotional pain of abuse B. Adapting an aggressive attitude toward her abuser to scare him C. Considering ways to commit suicide D. Threatening to call the police if she is abused again

C. Considering ways to commit suicide A person experiencing violence may feel so trapped in a detrimental relationship, yet so desperate to get out, that suicide may seem the only answer. A suicide attempt may be the presenting symptom in the emergency department. At least 10% of abused women attempt suicide. None of the other options present the degree of personal risk associated with suicidal ideations.

Which statement reflects a fact about family violence? A. Ninety-five percent of abuse victims are women. B. The victim's behavior is often the cause of the violence. C. Violence occurs in families of all backgrounds. D. Alcohol and stress are the major causes of abuse.

C. Violence occurs in families of all backgrounds. Family violence is a serious community health problem common among all backgrounds. None of the other statements provide accurate information about family violence.

When interviewing an adult victim of abuse, what is the nurse's best approach when asking relevant questions? A. confrontational and assertive. B. gentle and direct. C. direct and professional. D. sympathetic and outraged.

C. direct and professional. Expressing strong emotion does not help the victim. A direct, honest, and professional manner of asking questions produces the best results. None of the other options are recognized as being effective in this type of interview situation.

A 4-year-old child tells the nurse, "I'm a bad boy. Daddy always says I'm not worth a second look." This situation can be an example of A. neglect. B. physical maltreatment. C. emotional violence. D. harsh parenting.

C. emotional violence. Emotional violence occurs when the child's self-esteem is attacked. It is as devastating to the child as physical abuse. None of the other options are focused on damaging a child's self-esteem. Tough love is a form of parenting that includes consequence but does not involve emotional abuse.

An elderly woman who has been abused by her caregiver daughter tells the nurse, "You don't have to worry about me. My daughter cried and apologized. She promised me she will never hit me again." The nurse recognizes that the client is describing which stage of the cycle of violence? A. tension building. B. acute battering. C. honeymoon. D. escalation.

C. honeymoon. During the honeymoon stage, the perpetrator apologizes, promises never to abuse again, and tries to make up for the violence. This stage is usually brief. None of the other stages in this cycle are characterized by this behavior.

When should the nurse expect the abuse of a victim to worsen? A. the perpetrator feels he is in complete control. B. the perpetrator is feeling remorseful for being abusive. C. the victim moves toward independence from the abuser. D. the victim submits to the domination of the perpetrator.

C. the victim moves toward independence from the abuser When the abuser thinks they are losing control over the victim, the violence escalates. None of the other options are associated with the escalation of abuse by the perpetrator against the victim.

A young adult has recently had multiple absences from work. After each absence, this adult returned to work wearing dark glasses and long-sleeved shirts. During an interview with the occupational health nurse, this adult says, "My partner beat me, but it was because I did not do the laundry." What is the nurse's next action? a. Call the police. b. Call the adult protective agency. c. Arrange for hospitalization. d. Document injuries with a body map.

D Documentation of injuries provides a basis for possible legal intervention. In most states, the abused adult would need to make the decision to involve the police. Because the worker is not an older adult and is competent, the adult protective agency is unable to assist. Admission to the hospital is not necessary.

An adult has recently been absent from work for 3-day periods on several occasions. Each time, the individual returned wearing dark glasses. Facial and body bruises were apparent. What is occupational health nurse's priority assessment? a. Interpersonal relationships b. Socialization skills c. Work responsibilities d. Physical injuries

D The individual should be assessed for possible battering. Physical injuries are abuse indicators and are the primary focus for assessment. No data support the other options.

What distinction can be made between abuse and neglect? A. Neglect occurs in the psychological domain; abuse occurs in the physical domain. B. Neglect is always physical; abuse can be verbal, physical, sexual, or emotional. C. Neglect is perpetrated against children; abuse victims can be children or adults. D. Neglect is a failure to provide; abuse is a failure to control aggression.

D. Neglect is a failure to provide; abuse is a failure to control aggression. Neglect is failure to provide necessary care, and abuse is physical maltreatment.

Which of the following persons has the highest risk factors for physical abuse? A. Emma, a 7-month-old baby who has colic and doesn't sleep through the night B. Roland, a 53-year-old man with cardiovascular disease living with his son C. Penny, a 28-year-old wife whose husband has a diagnosis of an anxiety disorder D. Rose, a 77-year-old woman living with her daughter and son-in-law

D. Rose, a 77-year-old woman living with her daughter and son-in-law Older women dependent on family members for care are at higher risk for abuse. The other options do not describe specific characteristics that put them at higher risk for abuse.

What is the priority outcome for a toddler who has been sexually abused? A. The mother will learn coping techniques to support the child. B. The child will be able to verbalize exactly what happened to her. C. The child will no longer demonstrate inappropriate sexual behavior. D. The sexual abuse will cease immediately.

D. The sexual abuse will cease immediately. The highest priority in this case is that the abuse stops so that the patient can be safe and undergo recovery. The question is asked about the priority outcome for the victim, not the mother. Verbalizing exactly what happened is not a priority. The victim will most likely stop the sexualized behavior when the abuse has stopped and recovery is supported by age-appropriate interventions.

An elderly client pays the bills because she fears that her family will make her live elsewhere if she doesn't "help out." The nurse assesses it as A. neglect. B. physical violence. C. psychological abuse. D. financial maltreatment.

D. financial maltreatment. Financial maltreatment occurs when the perpetrator takes financial advantage of the elderly person, often through the use of subtle threats of what unpleasant or frightening outcome will occur if the elder does not supply funds. None of the remaining options is as directly associated with money as is the correct option.