Chapter 10: Assessing for Violence PrepU

The nursing instructor is educating her students on the important of assessing for victims of abuse and violence. What statement by the students indicate an understanding of when to assess for abuse and violence?

"I will assess a client for abuse and violence with every client encounter." Explanation: Routine assessment for violence and safety is important during every encounter with clients because of the high prevalence of human violence and its short- and long-term effects on health, relationships, and well-being.

What open-ended question might be helpful when assessing abuse with a client demonstrating discomfort discussing the issue?

"What would you like me to know?" Explanation: Open-ended questions, such as "What would you like to know?" "How can I help you understand?" or "What would you like me to know?" are especially helpful if a client appears uncomfortable. It would be inappropriate for the nurse to ask what she can tell the client about abuse or to tell the client that the nurse knows the client has been abused. While discussing the prevalence of abuse might help increase the client's knowledge, it might not make her feel any more comfortable about the situation or ready to share information.

A nurse is assessing an elderly client who may be a victim of elder mistreatment. Which of following are examples of elder mistreatment? Select all that apply.

-Failure to provide adequate nutrition to an elder -Shoving an elder into a wheelchair -Forcing an elder to perform a sexual act -Having an elder sign financial documents without an understanding of what is being signed Explanation: Elder mistreatment, also known as elder abuse, includes neglect (e.g., failure to provide adequate nutrition); physical abuse (e.g., shoving an elder into a wheelchair); sexual abuse (e.g., forcing an elder to perform a sexual act); financial abuse (e.g., having an elder sign financial documents without an understanding of what is being signed); psychological abuse (including humiliation, intimidation and threats; exploitation; and abandonment or prejudicial attitudes that decrease one's quality of life, and are demeaning to those over the age of 65 years. Administering the wrong medication to an elder inadvertently is a medical error but is not elder mistreatment, as it is an accident.

Which of the following are forms of psychological (emotional) abuse? Select all that apply

-Insulting -Humiliating -Threatening to destroy property Explanation: Psychological abuse includes behaviors such as criticizing, insulting, humiliating, or ridiculing someone in private or in public. It can also involve actions such as destroying another's property, threatening or harming pets, controlling or monitoring spending and activities, or isolating a person from family and friends. Rape and incest are forms of sexual assault.

A nurse is assessing a boy who appears to be undernourished. She can find no signs of physical abuse. She considers whether this may be a case of child abuse. Which of the following are included in the definition of child abuse? Select all that apply.

-Neglect -Physical abuse -Sexual abuse -Emotional abuse Explanation: There are four broad categories of child abuse: neglect, emotional abuse, sexual abuse, and physical abuse. Intimate partner violence involves victims who are adult women and men. Elder abuse involves victims who are over the age of 65 years.

What are some basic rules for nurses to follow when assessing for violence? Select all that apply.

-Perform assessment and screening only when the client is alone in a safe, private environment -Be very patient when the client talks -Demonstrate compassion, not judgment Explanation: Nurses assessing for violence should perform assessment and screening only when the client is alone in a safe, private environment. The nurse needs to establish rapport and connection by showing interest in the client and by listening. The nurse also needs to demonstrate compassion, not judgment. The nurse needs to start with general, open-ended questions and move to specific questions later. Having a family member present is the opposite of performing assessment with the client alone.

Which of the following is true of psychological abuse?

An abuser may use psychological behaviors such as belittling, exploiting, denigrating, or remaining emotionally unresponsive. Explanation: Psychological abuse involves the use of constant insults or criticism, blaming the victim for things that are not the victim's fault, threats to hurt children or pets, isolation from supporters (family, friends or coworkers), deprivation, humiliation, stalking and intimidation, and manipulation of various kinds, such as threats of suicide. Psychological abuse, also known as emotional abuse, has been defined as "any act including confinement, isolation, verbal assault, humiliation, intimidation, infantilization, or any other treatment which may diminish the sense of identity, dignity, and self-worth."

A nurse suspects that a 9-year-old girl who is in the office today regarding a sprained wrist has been physically abused. The nurse would like to screen the girl for signs of abuse. The girl's father is in the examination room. What should the nurse do in this situation?

Ask the father to leave the room so that the nurse can talk with the child in private Explanation: Creating a safe and confidential environment is essential to obtain concise and valid subjective data from any client who has experienced family violence. For any client over the age of 3 years, ask screening questions in a secure, private setting with no one else present in the room. Do not screen if there are any safety concerns for you or the client. To postpone the screening could jeopardize the child's safety, so the nurse should ask the father to leave the room.

Which approach would be most appropriate when counseling a woman who is a suspected victim of violence?

Ask, "Have you ever been physically hurt by your partner?" Explanation: If violence is suspected, the nurse must used direct or indirect questions to screen for abuse. Asking the woman if she has ever been physically hurt by her partner is most appropriate. Offering her a pamphlet, calling her at home, or waiting until she returns are inappropriate and do not validate the suspicion.

A nurse is working with a 25-year-old woman who has struggled with anger, depression, and anxiety since her mother stole her identity and opened up seven different credit cards in her name. The nurse recognizes this as which type of abuse?

Economic abuse Explanation: Economic abuse, also known as financial abuse, is the improper exploitation of another person's personal assets, properties, or funds. Examples of this type of abuse include the cashing of another person's checks without authorization or permission, forging signatures, and misusing or stealing money or possessions. Humiliating, depriving, and intimidating the victim is an example of psychological abuse. Elder mistreatment—also known as elder abuse—includes neglect and various types of abuse committed against those over the age of 65 years. Child abuse is neglect or abuse of a child under the age of 18.

The nurse is caring for a woman in the prenatal clinic who comments that she just cannot seem to get things "right" anymore at home and that her husband says she knows so little about life. Which type of abusive or controlling behavior is the woman describing?

Emotional abuse Explanation: Emotional abuse refers to the victim being put down or made to feel bad about them. The perpetrator makes light of abuse and says abuse did not occur through minimizing and blaming. Intimidation makes the victim afraid through the use of looks, action, or gestures.

Which technique should a nurse implement when interviewing with a child who has suffered physical abuse by the father?

Establish a reassuring environment Explanation: The nurse should provide a reassuring environment during the interview. The nurse should not offer rewards for answering questions. The nurse should ask open ended questions and avoid questions that can be answered as "yes" or "no." The nurse should not provide a lot of information when asking questions so that the child will provide more information when answering.

A nurse is working with a client who confides in the nurse that her boyfriend will not let her get a job and insists on controlling all of their money. He gives her only a small allowance each month to buy food and a few necessities. When the nurse offers information on how to seek help for economic abuse, the client just shakes her head and says, "It's no use. Nothing can be done." Which of the following nursing diagnoses would be most appropriate in this situation?

Hopelessness related to remaining in a prolonged abusive relationship and inability to seek counseling and healthy supportive relationships Explanation: This client seems to be expressing a hopelessness regarding her situation. There is no evidence that the client is experiencing anxiety nor is their evidence that violence is occurring in the home, or that she is at risk for abusing her children as a result of her abusive relationship

The nurse is caring for a woman who presents to the Emergency Department with complaints of abdominal pain, as well as cuts and bruises on the arms. While observing the interaction between the husband and wife, the nurse observes the husband shaking his fist at the wife. Which type of abusive or controlling behavior did the nurse observe?

Intimidation Explanation: Intimidation makes the victim afraid through the use of looks, action, or gestures. Emotional abuse refers to the victim being put down or made to feel bad about them. A perpetrator makes or carries out threats to do something to hurt victims through coercion. Isolation refers to controlling what victims do or read, whom they see or talk to, or where they go.

A client arrives at the clinic accompanied by her husband. When the client is in the examination room she says to the nurse, "He loves me so much. He only lets me go out when he is with me because he says other men look at me." What type of behavior is this husband exhibiting?

Isolation Explanation: Isolation is when someone is controlling what victims do or read, whom they see or talk to, or where they go, limiting their involvement outside of the home; it is a way of using jealousy to justify actions.

The nurse is caring for a family in which the elderly mother has been a victim of abuse and neglect by her 48-year-old son. Which of the following would be most important for the nurse to keep in mind before interviewing the family?

The nurse must allow the elderly mother to decide if she wants to leave the situation or not. Explanation: Removing children and older adults from their families or caregivers often is necessary to ensure immediate safety. If the home of an abused or neglected child or older adult cannot be made safe, the nurse must facilitate other professionals involved in placing the child or older adult in a foster or nursing home. Still, intervening in cases of elder abuse is not a clear-cut issue. When an older adult's decision making is not impaired (competence is the legal term), he or she must be allowed an appropriate degree of autonomy in deciding how to manage the problem even if he or she chooses to remain in the abusive situation. Forcing someone to do something against his or her wishes is itself a form of victimization and denies autonomous decision making.

Which of the following is not a true statement about intimate partner violence?

a) One in every three women worldwide is a victim of intimate partner violence at some point in her life. b) Intimate partner violence is caused by the "victim" refusing her husband's desire for sex. c) The annual cost in the United States for intimate partner violence exceeds $4 billion for medical and health services and over $1 billion for lost productivity. d) Intimate partner violence is based on the abuser's need to maintain power and control over the victim. b) Intimate partner violence is caused by the "victim" refusing her husband's desire for sex. Explanation: Intimate partner violence, as defined by the Family Violence Prevention Fund, "is a pattern of assaultive behavior and coercive behavior that may include physical injury, psychologic abuse, sexual assault, progressive isolation, stalking, deprivation, intimidation, and reproductive coercion," and IPV "affects millions of women regardless of age, economic status, race, religion, ethnicity, sexual orientation, or educational background."

Elder abuse can include

economic exploitation. Explanation: Economic abuse may be evidenced by preventing the victim from getting or keeping a job, controlling money and limiting access to funds, spending the victim's money, and controlling knowledge of family finances. Economic abuse, also known as financial abuse, is the improper exploitation of another person's personal assets, properties, or funds. A consequences of elder mistreatment includes the inability to pay for food or medication because of financial abuse.

The nurse is interviewing Mr. Jenkins and, due particularly to his nervous affect and his reaction when his son is mentioned, suspects potential elder abuse. In assessing Mr. Jenkins, the nurse should

make sure that the assessment includes questions to ensure that Mr. Jenkins has access to food and needed medication. Explanation: A consequence of elder mistreatment is the inability to get food or medication because of neglect

When interviewing a pediatric client and attempting to determine the presence of abuse, the nurse should

remain calm and accepting in response to any information the client discloses. Explanation: Remember when asking questions to allow the client to answer completely. Do not interrupt the client. Convey a concerned and nonjudgmental attitude. Show appropriate empathy.