Chapter 12: Abuse and Violence
A mental health nurse presenting an educational program on rape for high school students responds to the statement, "Women cry rape often times just to get even with the guy," by offering which answer?
"Actually, fewer than 2% of all reported rapes are found to be false." Explanation: Rape is an underreported crime due to feelings of guilt on the part of the victim. Only approximately 2% of all reported rape cases are false.
Which assessment question should the nurse ask of a client suspected of being ostracized by a school bully?
"Do you feel like a part of a group in school?" Explanation: Ostracism, ignoring and excluding a target individual, has recently emerged as one of the more common and damaging forms of bullying. The victim experiences threats to belonging, self-esteem, meaningful existence, and sense of control. Ostracism may pose an even greater threat to children's adjustment than bullying. Those who bully are more likely to have poor grades and to use alcohol and tobacco. None of the remaining options are directly associated with the issue of ostracizing.
A client states to the nurse, "My husband hits me. I want to leave him, but I have to be sure that I can leave and won't have to go back." Which question does the nurse ask during the psychosocial interview to assess the client's social network?
"Do you have any friends who can provide emotional support?" Explanation: An evaluation of social networks provides additional clues of psychological abuse and controlling behavior. Having supportive family or friends is crucial in short-term planning for developing a safety plan and is also important to long-term recovery. A survivor cannot leave an abusive situation with nowhere to go. Supportive family and friends may be willing to provide shelter and safety, as well as emotional support. Asking if the spouse criticizes and belittles the client assesses self-esteem, and inquiring about blame assesses for guilt and shame. Asking the client if they experienced any form of abuse as a child assesses for revictimization.
Which question does the nurse include when assessing a client for physical violence associated with intimate partner abuse (IPV)?
"Does your partner ever strike or kick you?" Explanation: Physical abuse involves any act of aggression with or without use of an object or weapon that results in injury, pain, or impairment to another. Examples include striking, kicking, shoving, choking, burning. Based on this information, the question the nurse asks when assessing for physical violence associated with IPV is "Does your partner ever strike or kick you?" Criticism, insults, destroying personal property, and humiliation in public settings are examples of psychologic, not physical, violence associated with IPV.
The nurse provides care for a client who presents to the emergency department (ED) with injuries sustained due to intimate partner violence (IPV). Which question does the nurse include to determine the client's risk for danger when conducting the interview portion of the assessment process?
"Have you ever tried to leave your partner after an episode of physical violence?" Explanation: When using the Danger Assessment screening tool, the nurse wants to determine the client's risk for homicide due to the physical violence that is associated with IPV. The question the nurse includes in the interview portion of the assessment process to assist in determining this risk is "Has the frequency or severity of the physical violence increased in the last year?" When physical violence escalates in frequency and/or severity, the client is at an increased risk for death. Although determining when the physical violence started is important and if the client has ever attempted to leave the abuser is appropriate information to collect, this information does not determine the client's specific risk for becoming a victim of homicide. Asking the client if the physical violence occurred during a current or previous pregnancy is not appropriate to determine the client's risk for homicide, is not therapeutic, and may even cause the client to think they are responsible for the physical violence that occurred.
A nurse is interviewing a client who is a survivor of abuse. The client is telling the nurse about how the violence occurred. Which statement would the nurse interpret as reflecting the honeymoon phase of the cycle of violence?
"He told me that he was sorry and that he would never hit me again." Explanation: The cycle of violence typically involves three phases. There is a buildup of tension. The perpetrator commits an act of violence. The perpetrator becomes kind, contrite, and loving, begging for forgiveness and promising never to inflict abuse again. This phase is sometimes referred to as the "honeymoon phase." When the violence begins, the victim is not expecting it and thus is often not aware of the buildup of tension; then the assault comes as a surprise.
An emergency department nurse is assessing a client with traumatic injuries. To assess whether or not the client's injuries have resulted from abuse, which question would be most appropriate for the nurse to ask the client?
"It looks like someone has hurt you. Tell me about it." Explanation: The nurse should say to the client, "It looks like someone has hurt you. Tell me about it." This is an open-ended statement and allows the client to verbalize thoughts and feelings. Asking whether the partner is being mean or asking why the client thinks the spouse has done this beating assumes that the client has been abused. Asking about the person who did this would be ineffective because survivors of violence are unlikely to disclose sensitive information unless they perceive the nurse to be trustworthy and nonjudgmental. Additionally, this question is a closed question that does not allow the client to verbalize her thoughts and feelings openly.
A nurse is presenting to a church group a program about domestic violence. During the presentation, a member of the audience asks the nurse to explain what "intergenerational transmission of violence" means because the person has seen that phrase used in the media. Which response by the nurse would be most appropriate?
"People who grow up in violent home situations tend to be involved in domestic violence situations as an adult." Explanation: Violent families create an atmosphere of tension, fear, intimidation, and tremendous confusion about intimate relationships. Children in violent homes often learn violent behavior as an approved and legitimate way to solve problems, especially within intimate relationships. The social learning or intergenerational transmission of violence theory posits that children who witness violence in their homes often perpetuate violent behavior in their own families as adults. Moreover, children who grow up in violent homes learn to accept violence and expect it in their own adult relationships. Neurochemical imbalances, genetics, or skipping generations are unrelated to this theory.
The nurse provides care to a client at a scheduled health maintenance visit who states, "My partner abuses me. I don't know what to do to ensure my safety." Which is the best response by the nurse based on the client's statement?
"Tell me more about your situation so that I can help you." Explanation: Establishing a trusting nurse-client relationship is one of the most important steps in caring for any person experiencing violence. When interviewing, to establish rapport and put the survivor at ease, start with the least sensitive areas and progress to more sensitive topics. Survivors are unlikely to disclose sensitive information unless they perceive the nurse to be trustworthy and nonjudgmental. Important considerations in establishing open communication are ensuring confidentiality and providing a quiet, private place in which to interact. A supportive, empathetic approach is most effective. Based on this information, the best response by the nurse is to say, "Tell me more about your situation so that I can help you." Asking why the partner abuses the client is judgmental and, therefore, not therapeutic. Although mandatory reporting may be required, this is not the best response by the nurse based on the initial client statement. Asking the client what can be done to avoid the abuse indicates judgment and is, therefore, not therapeutic.
A nurse is assessing a client in a community clinic who reports feeling anxious lately because she is considering leaving her marriage. The client describes a long history of partner abuse associated with this relationship. How should the nurse respond to this client?
"You have the right to be safe and respected." Explanation: When working with someone who is a victim of partner abuse, it is important that the nurse assertively support the client's decision. The affirmation of the client's decision can help to improve the client's self-confidence as she begin the process of leaving her partner. It is important the nurse refrain from recommending couple's counseling or imply doubt about the client's situation. The nurse will likely not be involved in every step of the client's process of leaving the relationship, as the client will use a variety of resources outside the nurse-client relationship, nor should the nurse take charge and do everything for the client or imply that this will happen.
A nurse is caring for a child who had experienced sexual abuse. Which are expected behaviors of a child who has experienced sexual abuse? Select all that apply. -Avoidance of sexually related content -Secretiveness of behaviors -Open and honest discussion about history -High self-esteem -Distorted view of sex
-Avoidance of sexually related content -Secretiveness of behaviors -Distorted view of sex Explanation: A victim of prolonged sexual abuse will develop low self-esteem, a feeling of worthlessness, and a distorted view of sex. The child may become withdrawn, distrustful, or suicidal. Other characteristics of children who have been sexually abused include an unusual interest or avoidance of sexually related content, seductiveness, refusal to go to school, delinquency, secretiveness, and unusual aggressiveness.
A nurse is gathering information about a health history of a person who has experienced violence. Which are important caring behaviors a nurse should implement during the interview? Select all that apply. -Establish trustworthiness. -Maintain a nonjudgmental attitude. -Ask questions regarding religious background and preference. -Secure open communication. -Discuss the nurse's personal feelings on victims of violence.
-Establish trustworthiness. -Maintain a nonjudgmental attitude. -Secure open communication. Explanation: Establishing a trusting nurse-client relationship is one of the most important steps in caring for any person experiencing violence. Survivors are unlikely to disclose sensitive information unless they perceive the nurse to be trustworthy and nonjudgmental. Important considerations in establishing open communication are ensuring confidentiality and providing a quiet, private place to which to interact. The nurse must continually monitor personal feelings toward the perpetrator and survivor, especially in cases of child abuse or in situations where the person decides to remain in an abusive relationship. Seeking value clarification by the nurse may prevent negative feelings from influencing the nurse-client relationship that could lead to a nontherapeutic interaction and perhaps re-traumatize the survivor. The nurse should not ask about religious background or disclose personal feelings about the victim.
The nurse suspects that a client is a victim of intimate partner violence. What should the nurse consider when caring for this client? Select all that apply. -cost-effective care -availability of support -legal counsel is obtained -family counseling is provided -support can be accessed safely
-availability of support -support can be accessed safely Explanation: The challenge for health care providers is twofold—ensuring that support is both available and safely accessible. Many victims of intimate partner violence are afraid or reluctant to identify their abusers, fearing retaliation against themselves and/or their children. They may continue to hold strong feelings for their partners despite the abuse. When medical care is required, women may attribute their injuries to other causes; health care providers may be reluctant to inquire about abuse. Provision of assistance to clients who are involved in violent intimate relationships can pose unique problems in that seeking support can be dangerous to the women if their activities are discovered by the abusive partner. Cost of care, legal counsel, and family counseling are not areas for consideration for a client suspected of being a victim of intimate violence.
The nurse is assessing a client and suspects that the client is a victim of intimate partner violence. The client is experiencing palpatations. What additional findings should the nurse assess the client for related to intimate partner violence? Select all that apply. -missing teeth -low blood pressure -inability to fully extend the right leg -wearing clothing inappropriate for the weather -variety of wounds in different stages of healing
-missing teeth -inability to fully extend the right leg -wearing clothing inappropriate for the weather -variety of wounds in different stages of healing Explanation: Physical findings that can suggest abuse include missing teeth and limited range of motion in an extremity. Wearing clothes that are inappropriate for the weather could be an action to hide bruises or wounds. Various wounds in different stages of healing could indicate repeated episodes of abuse. An elevated blood pressure is associated with intimate partner violence and not a low blood pressure.
The nurse assists in the care of a client who presents to the emergency department (ED) after a sexual assault. Evidence is collected and the nurse needs to treat extragenital trauma. The nurse understands that which of the following are considered extragenital? Select all that apply. -vaginal tears -wrist abrasions -oral ulcerations -anal lacerations -breast ecchymosis
-wrist abrasions -oral ulcerations -breast ecchymosis Explanation: Generalist nurses may be involved in treating the injuries that result from the assault, including genital (e.g., anal, vaginal) trauma and extragenital trauma (e.g., injury to the arms, breasts, mouth, thighs, throat). Based on this information, the nurse focuses on implementing the prescribed care to the client's wrist abrasions, oral ulcerations, and breast ecchymosis.
A nurse is aware of the high incidence of intimate partner violence (IPV) and actively seeks opportunities to screen women for IPV. Which female client represents the best opportunity for assessing for IPV?
A client who is in the third trimester of pregnancy and who is having biweekly prenatal appointments at a clinic Explanation: Women who are pregnant have frequent contact with the health care system, creating a useful opportunity for IPV screening. None of the other listed situations precludes screening, but none are as ideal as frequent appointments at a consistent setting.
Which assessment finding can help the nurse differentiate a child experiencing child neglect rather than child abuse?
A young child is admitted to the hospital with hypothermia because the child is inadequately dressed. Explanation: Child neglect is the failure to provide for a child's basic physical, medical, or educational needs. Examples of child neglect include withholding adequate clothing. Injuries and sexual touching are examples of child abuse.
A client is brought to the Emergency Department by a family member that reports being sexually assaulted while leaving work. What action by the nurse would best promote placing control back to the client?
Allow the client to make decisions regarding care whenever possible Explanation: The nurse can best offer support by allowing decisions to be made about care, who to call, and allow the care to be delivered at a pace that is comfortable for the client. It is the clients decision about whether or not to file charges and testify against the perpetrator. Educating the client about attending a support group may be done after the assessment and would be important but does not directly offer the support that is needed at this time. The assessment can be very traumatic for the client and should not be hurried or rushed through.
The nurse is legally obligated to report suspected child abuse to local authorities. Which information is essential?
Child's name, location, age, and suspected perpetrator Explanation: Registered nurses are legally mandated to report child abuse. When reporting, the nurse must provide the child's name, location, age, and the suspected perpetrator. The nurse is not required to prove that abuse has occurred.
A 27-year-old has been brought to the emergency department by emergency medical services following a violent sexual assault that took place in the parking garage of the client's building. Which task would fall most clearly within the scope of practice of a forensic nurse?
Collecting specimens from the client for use as evidence Explanation: While a forensic nurse would certainly attempt to reassure a client such as this one, a priority forensic nursing task would be collecting specimens for use as evidence. This would supersede assisting with diagnostics, which falls within the scope of any registered nurse. The police, not a nurse, would be responsible for taking the client's statement.
When attempting to preserve evidence from a possible rape with no report of oral sex, the female victim should be instructed that which self-care activities are permitted?
Drinking a glass of water Explanation: To preserve possible evidence, the physical examination should occur before the women has showered, brushed her teeth, douched, changed her clothes, or had anything to drink. If there is no report of oral sex, then rinsing the mouth or drinking fluids can be permitted immediately.
Which characteristic would a nurse least likely see in an abused individual?
High self-esteem Explanation: Abused individuals often demonstrate a pattern of learned helplessness, manifest characteristics of low self-esteem and shame, and often experience feelings of increased dependence, isolation, guilt, and entrapment.
The nurse should consider which as a possible indicator of child neglect?
Malnourishment unrelated to illness Explanation: Malnourishment is a possible indicator of neglect. Helplessness, hesitance to talk openly, and anger could be psychological or emotional indicators of abuse.
An 8-month-old infant has been brought to the emergency department by the infant's teenage parent. The infant is unresponsive, and after initial assessment, the care team suspects shaken baby syndrome. When providing care for this infant, the nurse should prioritize which assessment?
Neurological assessment Explanation: The care team has performed sufficient assessment to suspect shaken baby syndrome rather than some other problem. While there may be musculoskeletal damage as a result of shaken baby syndrome, the most serious damage is neurological. It is neurological damage that would result in respiratory dysfunction. Cardiac and genitourinary assessments are not priorities with shaken baby syndrome.
A nurse who provides care in a large, urban emergency department has worked with numerous victims of various forms of abuse as well as those who are abusers. The nurse recognizes that persons who commit abuse are most likely what?
Past victims of abuse themselves Explanation: While persons who commit abuse are by no means a homogeneous group, they do tend to be victims of abuse themselves. They are not necessarily poor, acutely ill, or older in age.
In clients who do not completely recover from the trauma of rape, which mental illness is most likely to develop?
Post-traumatic stress syndrome Explanation: Post-traumatic stress syndrome can result at least 1 month after an identifiable traumatic event. Symptoms include generalized anxiety, intrusive thoughts or images of the trauma, flashbacks, nightmares, and other sleep disturbances.
Which statement requires additional education regarding the truth about rape?
Rape is a crime of passion. Explanation: Rape is a crime of violence and humiliation of the victim expressed through sexual means. The remaining options present accurate information about the act of rape so no further education or correction is needed.
Which provides the most appropriate example of neglect according to the definition of the term?
Rejecting a 3-year-old who cries and seek affection after falling Explanation: Neglect is an act of omission that involves a failure by a parent or other adult to meet a dependent's basic needs, such as by providing appropriate emotional care. Rejecting a crying 3-year-old who seeks comfort after falling is an example of neglect. Harsh or humiliating discipline is an act of commission in which the adult actively inflicts physical or psychological harm. Attempting to improve a child's emotional or physical well-being in a misguided and harmful manner does not fit the definition of neglect.
When health care professionals detect signs of elder abuse in clients, the law requires them to take which action?
Report the abuse to the state authorities. Explanation: Once nurses have detected elder abuse, they are responsible for reporting the mistreatment. Each state has its own guidelines to follow. Usually, after nurses have reported the abuse, a state protective services worker meets with the victim.
In a toddler, which injury is most likely the result of child abuse?
Several small, circular burns on the child's back Explanation: Small circular burns on a child's back are no accident and may be from cigarettes. Toddlers are injury prone because of their developmental stage, and falls are frequent because of their unsteady gait; head injuries are not uncommon. A small area of ecchymosis is not suspicious in this age group.
An older adult client has been attending a local day program for the elderly. The nurse who facilitates the program notices the client has multiple bruises on the arms, has scrapes to the hands and face, and is socially withdrawn. A referral to the client's family physician confirms the client has genital herpes. Which type of elder abuse should the nurse suspect?
Sexual abuse Explanation: The physical bruising and presence of genital herpes indicate abuse that is sexual in nature. Older adults are increasingly the victims of abuse (e.g., physical, sexual, psychological, or neglect).
Which is a pattern of repeated unwanted contact, attention, and harassment that often increases in frequency?
Stalking Explanation: Stalking is a pattern of repeated unwanted contact, attention, and harassment that often increases in frequency. Stalking is a crime of intimidation. Rape is the penetration of any bodily orifice by the penis, fingers, or an object. Incest involves sexual contact between family members. Physical abuse involves bodily harm.
Which feature would most likely predispose an adult to engage in family violence?
The adult was physically abused as a child Explanation: The tendency for adults to raise their children in the same way that they were raised perpetuates the cycle of family violence. Adults who were victims of abuse as children frequently abuse their own children.
The psychiatric nurse recognizes that a male rape victim is less likely to report the crime due to which reason?
The belief that his masculinity will be in question Explanation: It is a common misconception that males cannot be sexually abused, that only "sissies and weaklings allow abuse," leading to the possibility that his masculinity is at stake if he is identified as a victim.
The nurse can assess potential victims of domestic violence by asking which question?
The nurse can assess potential victims of domestic violence by asking which question?
Which statement is true regarding children being raised in a home where they have witnessed intimate partner violence?
They are at increased risk for being abused. Explanation: Children being raised in a home where they have witnessed intimate partner violence demonstrate higher levels of depression and lower levels of self-esteem; these effects are pronounced in boys especially. Children of battered women are at an increased risk for abuse. Exposure to intimate partner violence adversely affects a range of child functioning.
A nurse is giving a talk about child abuse to a local community group. When discussing risk factors for child abusers, which would the nurse identify as the most likely profile of the perpetrator of fatal child abuse?
Unemployed young woman who dropped out of high school Explanation: Perpetrators of fatal child abuse are most likely to be caregivers who are young, poorly educated, and living at or below poverty level.
Which three elements are necessary to legally define rape of a male, female, or mixed gendered person?
Use of force; vaginal, oral, or anal penetration; nonconsent of victim Explanation: Three essential elements are necessary to legally define rape of a man or woman:• Use of force, threat, intimidation, or duress• Vaginal, oral, or anal penetration• Nonconsent by the victim
Which is an inaccurate picture of the cycle of abuse that occurs over time?
Violent episodes are less frequent Explanation: Over time, the violent episodes are more frequent, the period of remorse disappears altogether, and the level of violence and severity of injuries worsen.
A nurse is preparing a presentation for an adolescent and young adult community group about stalking. Which group would the nurse identify as having the highest risk of being stalked?
Women, ages 18 to 24 years Explanation: Women ages 18 to 24 years are at the highest risk of being stalked.
A middle-aged client with young children has been the victim of intimate partner violence (IPV). When providing initial care to this family, the nurse should:
carefully assess the children for signs of trauma. Explanation: Children are inevitable victims in an IPV situation and must be assessed and cared for accordingly. The nurse must avoid false reassurance. It is unnecessary, and often impossible, to identify specific causes for IPV. Relationship skills can be addressed in follow-up care.
A client runs to the urgent care center because the spouse is at home drinking and waving a gun around while yelling at the children. Which action should the nurse take first?
contact the police Explanation: The client was in a lethal situation and escaped for help. Since children are in the home with an adult who is impaired with a firearm, the police should be immediately notified. There is no evidence to suggest the client is injured. The client should not return to a potentially lethal situation however the children need to be removed. The police should remove the children and not another family member since this could place them all in harm's way.
A school health nurse is seeing an 11-year-old child who is refusing to attend school for the past 3 weeks. On assessment, the child describes a recent school experience where the child has been deliberately isolated from social groups. The child tells the nurse this began after an argument with their "best friend." The child is describing:
ostracism Explanation: In this case, the child is experiencing ostracism. Ostracism refers to ignoring or excluding a target individual and is a damaging form of bullying. The child's adjustment is clearly being threatened as the child is no longer able to attend school. Terrorism refers to community violence that takes place on a larger scale. Neglect refers to the malicious or ignorant withholding meeting a child's needs for their well-being. This is the abuse of a child by a parent or primary caregiver. Child abuse refers to the various forms of abuse rendered on a child by an adult in the role of caregiver.
The nurse is assessing a victim who is brought into the hospital after being found badly beaten and raped by an unknown person. Which healthcare professional should the nurse contact to collect evidence of the assault?
sexual assault nurse examiner Explanation: Examination for sexual abuse may require referral to a trained registered nurse in sexual assault, known as a SANE (sexual assault nurse examiner). This person is specially trained in protecting evidence. The healthcare provider on call and the client's primary care provider are not the appropriate professionals to contact to collect evidence from a rape. The charge nurse would not be appropriate either.
While assessing for intimate partner violence, the nurse learns that a client has not seen immediate family members for several years because the visits would upset the client's spouse. On which potential issue should the nurse focus with this client?
social isolation Explanation: Many perpetrators of intimate partner violence isolate their family from all social contacts, including other relatives. Revictimization refers to exposure to abuse or intimate partner violence later in life after experiencing the abuse or violence as a child. Women who have young children and depend on the perpetrator financially may believe that they cannot leave the abusive relationship. Those who are emotionally dependent on the perpetrator may experience an intense grief reaction that further complicates their leaving.
