Chapter 23: Mental Health Care for Survivors of Violence
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? a) "Have you ever tried to leave your partner after an episode of physical violence?" b) "Is there a possibility that you are pregnant and that is what caused the incident?" c) "When did the physical violence with your partner begin?" d) "Have you ever tried to leave your partner after an episode of physical violence?"
"Have you ever tried to leave your partner after an episode of physical violence?"
Which question does the nurse include when assessing a client for physical violence associated with intimate partner abuse (IPV)? a) "Does your partner ever strike or kick you?" b) "Does your partner criticize or insult you?" c) "Does your partner humiliate you in public settings?" d) "Does your partner destroy your property?"
a) "Does your partner ever strike or kick you?"
The nurse can assess potential victims of domestic violence by asking which question? a) "Has a past or current partner ever caused you to be afraid?" b) "What did you do right before your partner hit you?" c) "Do you need the number of a shelter?" d) "What is your history of physical injuries?"
a) "Has a past or current partner ever caused you to be afraid?"
The nurse provides care to a client who is experiencing intimate partner violence (IPV). The client lives in a rural area and asks the nurse how they can receive support. Which response by the nurse is appropriate? a) "I can provide you with a list of virtual support groups." b) "You should discuss this issue with your practitioner." c) "I think it is best if you just make a plan to leave and stick to it." d) "You should find a support group that that meets during your lunch hour."
a) "I can provide you with a list of virtual support groups."
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? a) "Tell me more about your situation so that I can help you." b) "Do you know why your partner abuses you?" c) "Is there anything that you could have done to avoid the abuse?" d) "I will need to report this to your practitioner."
a) "Tell me more about your situation so that I can help you."
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? a) "You have the right to be safe and respected." b) "I wonder if your perceptions of the relationship are accurate." c) "Relationship counseling can be very helpful." d) "I am here to help you through every step of this process."
a) "You have the right to be safe and respected."
The nursing student learning about child abuse correctly identifies which of the following individuals to be at the highest risk for abuse? a) 5-year-old girl b) 16-year-old girl c) 18-year-old boy d) 12-year-old boy
a) 5-year-old girl
A nursing student learning about intimate partner violence (IPV) correctly identifies the percentage of deaths attributed to IPV to be what? a) 70% women and 30% men b) 50% women and 50% men c) 90% women and 10% men d) 70% men and 30% women
a) 70% women and 30% men
A nurse is working in the emergency department. Which situation would lead the nurse to suspect possible abuse of a client? Select all that apply. a) A baby with contrecoup injuries to the brain b) A 3-year-old with a deep finger laceration c) A 6-year-old is being seen for the 5th time for a urinary tract infection d) A 3-month-old with a fractured femur e) A 15-month-old with shortness of breath after peanut ingestion
a) A baby with contrecoup injuries to the brain c) A 6-year-old is being seen for the 5th time for a urinary tract infection d) A 3-month-old with a fractured femur
Which assessment finding can help the nurse differentiate a child experiencing child neglect rather than child abuse? a) A young child is admitted to the hospital with hypothermia because the child is inadequately dressed. b) A child tells a social worker that the child does not like it when the child's mother's boyfriend touches the child "down there." c) A child is brought to a clinic by a parent who is unable to adequately explain how the child broke an arm. d) A child exhibits multiple scars on the back and buttocks upon examination.
a) A young child is admitted to the hospital with hypothermia because the child is inadequately dressed.
Which type of elder abuse involves leaving an older adult and no longer providing care for the individual? a) Abandonment b) Physical c) Neglect d) Emotional
a) Abandonment
Which characteristics are found in violent families? Select all that apply. a) Abuse of power and control b) Social isolation c) Adequate support systems d) Alcohol use disorder
a) Abuse of power and control b) Social isolation d) Alcohol use disorder
The nurse is caring for a 16-year-old boy with a history of being sexually abused. The nurse might expect this adolescent to ... a) Experience nightmares and flashbacks b) Have no ill effects due to his age c) Reject his mother for not protecting him d) Want to confront the perpetrator
a) Experience nightmares and flashbacks
The mental health nurse should discuss an emergency plan for leaving an abusive situation when the client is able to do which of the following? Select all that apply. a) Keep emergency money available b) Compile a list of important phone numbers c) Compose a note to explain departure d) Identify safe places to go e) Have access to a car key or other transportation
a) Keep emergency money available b) Compile a list of important phone numbers d) Identify safe places to go e) Have access to a car key or other transportation
A client comes to the emergency department after being attacked and sexually assaulted. What is the most accurate nursing diagnosis for this client? a) Rape-trauma syndrome b) Hopelessness c) Anxiety d) Fear
a) Rape-trauma syndrome
A client comes to the clinic for a prenatal visit. While the client is in the examining room, her estranged husband appears and insists on seeing the client. The client tells the nurse that they are in the process of getting a divorce and she does not want to be around him. "He's been following me to work and at my home everyday." What should the nurse suspect? a) Stalking b) Sexual assault c) Intimate partner violence d) Neglect
a) Stalking
Which are common reasons why abused women remain with the abusive partner? Select all that apply. a) The abused person believes that she is unable to function without her husband. b) The abused person is afraid that the abuser will kill her if she tries to leave. c) The abused person is personally and financially dependent on the abuser. d) The abused person has low self-esteem and defines her success as a person by the ability to make the relationship work. e) The abused person uses alcohol or illegal drugs in the home.
a) The abused person believes that she is unable to function without her husband. b) The abused person is afraid that the abuser will kill her if she tries to leave. c) The abused person is personally and financially dependent on the abuser. d) The abused person has low self-esteem and defines her success as a person by the ability to make the relationship work.
A coherent older client has been financially and emotionally abused by their adult children for the past several years but has not reported the abuse to anyone. Which is the most likely reason that the client has not reported the abuse? a) The client is emotionally close to the children and does not want to bring them harm. b) The client has no financial resources to hire legal representation against the client's children. c) Laws do not provide protection against abuse when the suspect(s) is/are family members. d) The client cannot claim abuse if there is no evidence of physical harm.
a) The client is emotionally close to the children and does not want to bring them harm.
The nurse is collecting assessment data on a client who is suspected to be a victim of violence. Which assessment data would support the suspicion that the client is a victim of abuse? Select all that apply. a) The client reports that the client's father was abusive during childhood. b) The client has few friends. c) The client is in charge of the family finances. d) The client holds a dominant role in the family. e) There is a large amount of alcohol use in the home.
a) The client reports that the client's father was abusive during childhood. b) The client has few friends. e) There is a large amount of alcohol use in the home.
The nurse is interviewing the parents of an injured child in the emergency department. Which sign would alert the nurse as the strongest indicator that child abuse may be a problem? a) The injury is not consistent with the history or the child's age. b) The parents are argumentative and demanding with emergency department personnel. c) The mother and father tell similar stories regarding what happened. d) The family is poor.
a) The injury is not consistent with the history or the child's age.
The nurse is aware that fewer than half of rapes and sexual assaults are reported. Which are some of the reasons people do not report being sexually assaulted? Select all that apply. a) They have a fear of being blamed for the incident. b) The perpetrator may use coercion or threats to control the victim. c) The person is concerned about the financial issues associated with the hospitalization. d) The victim is responsible for the attack. e) The client is embarrassed of the assault.
a) They have a fear of being blamed for the incident. b) The perpetrator may use coercion or threats to control the victim. e) The client is embarrassed of the assault.
What are some types of behavior that the nurse would recognize as qualifying as psychological abuse? Select all that apply. a) Threatening a victim's dog b) Ridiculing c) Using assertive language d) Asking for time alone when frustrated e) Criticizing
a) Threatening a victim's dog b) Ridiculing e) Criticizing
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? a) Unemployed young woman who dropped out of high school b) Middle-aged woman with a college degree c) Middle-aged, wealthy businessman d) Young college graduate who recently gave birth to her first child
a) Unemployed young woman who dropped out of high school
The nurse provides care to individuals who have been sexually assaulted during their childhood. Which characteristic is most commonly noted by the nurse during an assessment of such clients? a) Unusually aggressive b) Overly self-confident c) Overly social d) Too trustful
a) Unusually aggressive
The cycle of violence or abuse is a reason often cited for why women have difficulty leaving abusive relationships. Which of the following is an inaccurate picture of the cycle of abuse that occurs over time? a) Violent episodes are less frequent b) Violent episodes are more frequent c) Severity of the injuries worsen d) The period of remorse disappears
a) Violent episodes are less frequent
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: a) carefully assess the children for signs of trauma. b) reassure the client that this will never happen again. c) determine what initially caused the violence to begin. d) teach the client life skills for moving on from the relationship.
a) carefully assess the children for signs of trauma.
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? a) contact the police b) assess the client for injuries c) call for an ambulance for transport to the hospital d) call a family member to pick up the children
a) contact the police
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. a) missing teeth b) wearing clothing inappropriate for the weather c) low blood pressure d) variety of wounds in different stages of healing e) inability to fully extend the right leg
a) missing teeth b) wearing clothing inappropriate for the weather d) variety of wounds in different stages of healing e) inability to fully extend the right leg
When the school nurse is assessing an adolescent who reports trouble sleeping, which characteristics of the client indicate there may be violence in the home? (Select all that apply.) a) must go straight home after school each day b) feeling left out of peer group c) the client's father monitors contact with friends d) has a family history of alcohol abuse e) feeling social pressure to use alcohol
a) must go straight home after school each day c) the client's father monitors contact with friends d) has a family history of alcohol abuse
The nurse is approached by a teacher who suspects a student is being neglected after observing changes in the student's behavior. The teacher asks the nurse what other behaviors to watch for. Which symptoms of neglect should the nurse include in the discussion? Select all that apply. a) refusing to answer when called on in class b) smoking a cigarette after school c) fighting with other students d) deteriorating grades in school e) not having money for extracurricular activity fees
a) refusing to answer when called on in class b) smoking a cigarette after school c) fighting with other students d) deteriorating grades in school
A client who has been victimized repeatedly by a spouse is angry and verbally lashing out on the nurse. Based on the client's behavior, which technique would the nurse use with this client? a) use "I feel" statements b) provide stories about survivors of abuse c) instruct in relaxation techniques d) suggest reenacting the abuse
a) use "I feel" statements
Which statement made by a client raises the greatest concern that the client may be experiencing relationship violence? a) "His father physically abused his mother for years." b) "I don't know what else I can do to keep him from getting angry at me." c) "He doesn't like it when I go out with my girlfriends." d) "He was so much nicer when we started dating."
b) "I don't know what else I can do to keep him from getting angry at me."
Approximately what percentage of women rape victims are raped by someone they know? a) 55% b) 65% c) 45% d) 35%
b) 65%
The nurse is assessing an older adult in the emergency department. The client has many bruises on the body in varying stages of healing. After documenting the bruising in the assessment, what should the nurse do next? a) Call the nursing supervisor immediately b) Ask the client when and how the bruises occurred c) Notify the physician that abuse is suspected d) Follow the facility's policy and procedures for reporting abuse
b) Ask the client when and how the bruises occurred
Which of the following are biologic indicators of posttraumatic stress disorder (PTSD)? a) A feeling of unreality about oneself b) Flashbacks c) Memory difficulties d) Auditory hallucinations
b) Flashbacks
A young client telephones the emergency department and loudly tells the nurse, "I've been raped! Please help me!" Which is the priority for the nurse to determine? a) If the client had bathed, douched, or changed clothes b) If the client was in a safe place, the client's condition, and if transportation is available c) If the client knew the assailant, knew the client's location, and had notified the police d) If the client has insurance, if the client could get to the hospital by herself, and if pregnancy is a possibility
b) If the client was in a safe place, the client's condition, and if transportation is available
A nurse manager is working with the nursing staff of a busy community-based walk-in clinic that provides care to a large number of survivors of domestic violence. When helping the staff provide care, which information would be most important for the nurse manager to convey to the staff? a) Identification of consequences from changes made by survivors as minimal b) Importance of measuring the clients' progress in small steps c) Expectation that survivors will accept change right away d) Encouragement for staff discussion about specific clients to gain support
b) Importance of measuring the clients' progress in small steps
The nurse is involved in a community education program for new parents and plans to include information on child abuse. The nurse will teach the parents that the most common form of child abuse is what? a) Physical abuse b) Neglect c) Emotional abuse d) Sexual abuse
b) Neglect
In a toddler, which injury is most likely the result of child abuse? a) A hematoma on the occipital region of the head b) Several small, circular burns on the child's back c) A 1-inch forehead laceration d) A small, isolated bruise on the right lower extremity
b) Several small, circular burns on the child's back
Which is a pattern of repeated unwanted contact, attention, and harassment that often increases in frequency? a) Physical abuse b) Stalking c) Incest d) Rape
b) Stalking
After a series of admissions to the emergency department over the past several months, an 80-year-old client's malnutrition, vague history, and pattern of physical injuries lead the nurse to suspect elder abuse. Which aspect of the client's situation may contribute to elder abuse? Select all that apply. a) The client self-describes and describes the client's child as "not well-off, but not terribly poor either." b) The client is physically dependent on the client's son since losing mobility. c) The client has no income or savings of the client's own. d) The client and client's child are recent immigrants to the United States. e) The client's son describes the client as "needy, helpless, and pathetic."
b) The client is physically dependent on the client's son since losing mobility. c) The client has no income or savings of the client's own. e) The client's son describes the client as "needy, helpless, and pathetic."
The pediatric nurse is caring for a 15-month-old child recently admitted to the hospital for a fractured femur. Which data obtained during the assessment would raise the nurse's suspicion that the child has suffered physical abuse? a) There are bruises over the child's bony prominences b) The injury occurred several days before the parents sought treatment c) Both parents report the exact same details pertaining to the injurious event d) The parents appear overprotective of the child
b) The injury occurred several days before the parents sought treatment
Which would not increase the likelihood that an older adult will incur physical abuse? a) An older adult reports frequent multiple bruises that are related to falls. b) The older adult is independent with activities of daily living. c) The older adult lives with a son who receives financial aid. d) The older adult has difficulty with mobility and can become confused.
b) The older adult is independent with activities of daily living.
The nurse in the emergency room is assessing a client who was brought in by the police for evaluation after receiving a call from a neighbor. The client reports to the nurse that the person who has been cooking and helping around the house has not been home for days. Which type of abuse does the nurse suspect based on the client's statement? a) physical b) abandonment c) emotional d) neglect
b) abandonment
The school health nurse is asked to see a child who has been coming to school with no lunch for the past week. The child tells the nurse, "I don't get a lunch this week, I have been wetting the bed." The nurse identifies that this child is experiencing which type of abuse? a) physical b) neglect c) sexual d) psychological
b) neglect
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? a) "Does your husband criticize and belittle you?" b) "Does your husband blame you for his abusive behavior?" c) "Do you have any friends who can provide emotional support?" d) "Did you experience any form of abuse when you were a child?"
c) "Do you have any friends who can provide emotional support?"
The nurse is discussing expectations of raising a child with a pregnant teenager expecting her first baby. The father will not be a participant in the parenting. Which statement made by the expectant mother would be of greatest concern to the nurse? a) "I am not sure how I am going to pay for all the things my child will need." b) "I was raised with very strict discipline." c) "My child will love me, unlike my parents ever did." d) "I am going to rely on my sisters for a lot of help raising my baby."
c) "My child will love me, unlike my parents ever did."
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) A client who is currently exploring long-term care options for her elderly father b) A client who expressed interest in joining a grief support group following the death of her husband c) A client who is in the third trimester of pregnancy and who is having biweekly prenatal appointments at a clinic d) A client who has brought her young son to the emergency department because he fell at the playground and may have an arm fracture
c) A client who is in the third trimester of pregnancy and who is having biweekly prenatal appointments at a clinic
A client has just presented at the emergency department after being raped. What initial action by the nurse would be most appropriate? a) Perform a nursing history and physical as quickly as possible b) Encourage the client to file charges immediately c) Provide emotional support d) Refer the client to a rape crisis hotline
c) Provide emotional support
The community health nurse meets with the family members of an older adult client. The nurse includes which in the plan of care as a preventive measure to guard against elder abuse? a) Assist in the transfer of legal authority for care to the primary caregiver b) Reassure the primary caregiver that he or she is in the best position to provide care to the client c) Provide the primary caregiver with additional resources to meet the client's needs d) Teach the primary caregiver skills to meet all of the client's needs
c) Provide the primary caregiver with additional resources to meet the client's needs
A nurse is screening a new client for intimate partner violence (IPV). What aspect of this woman's current circumstances is the most significant risk factor? a) The client immigrated less than 5 years ago. b) The client has no extended family in the area. c) The client's family lives on less than $1,000 per month. d) The client has four children.
c) The client's family lives on less than $1,000 per month.
A female college student comes to the counseling center and tells the nurse she is afraid of her boyfriend. She states, "He is so jealous and overprotective; he wants to know where I am and who I'm with every minute." The nurse recognizes this as which of the following? a) A situation requiring a restraining order b) An overreaction on the part of the student c) The tension-building phase of the violence cycle d) The boyfriend is insecure and needs reassurance
c) The tension-building phase of the violence cycle
Which referral would a nurse make for a client who was badly beaten by a spouse, has no place to go, and no financial means? a) law enforcement b) community food bank c) a women's shelter d) vocational counseling
c) a women's shelter
The nurse provides care to a 4-month-old infant who presents to the emergency department (ED) with the parents at the advice of the pediatrician due to poor feeding and potential dehydration. Which finding noted by the nurse during the physical examination indicates the need to assess for child abuse? a) dry mucous membranes b) mild diaper rash c) ecchymosis to the arms d) sunken fontanelle
c) ecchymosis to the arms
The nurse provides care for a client who reports intimate partner violence (IPV). Which intervention does the nurse include in the client's plan of care to address safety planning? a) providing the client with supplies to treat physical injuries b) teaching about sleep hygiene techniques c) educating about perpetrator about behaviors indicative of losing control d) initiating the paperwork required for a guardianship
c) educating about perpetrator about behaviors indicative of losing control
Which statement, made by a nurse who experienced sexual abuse as as a child, demonstrates being best prepared to work with sexual abuse and trauma survivors? a) "Working with survivors of sexual trauma is very fulfilling work." b) "Survivors of sexual assault deserve the best care I can give them." c) "I've put the incident behind me and seldom think of it." d) "I've been supported by health care professionals and now I want to support other survivors."
d) "I've been supported by health care professionals and now I want to support other survivors."
A nurse is working with a client who is a survivor of rape. The client asks the nurse, "It's been 6 months since it happened. Why can't I get back into doing the things I did before?" What is the nurse's best response? a) "Let's talk about what happened to you again. It can help." b) "Life is different for you now, you will gradually accept that." c) "You are a victim. You need to give yourself some time." d) "It can take at least a year or more to get back to where you were before."
d) "It can take at least a year or more to get back to where you were before."
The nurse provides care to a client who presents for an initial prenatal appointment. When reviewing the client's medical record, intimate partner violence (IPV) is documented. Which client statement made during the health history interview indicates phase 1 of the cycle of violence? a) "My husband has not hit me since he promised to stop drinking several months ago." b) "My husband is happy about this pregnancy and even bought me flowers." c) "My husband begged me not to leave him after the last incident." d) "My husband monitors my cell phone calls every month when the bill arrives."
d) "My husband monitors my cell phone calls every month when the bill arrives."
A female client states that she has been receiving numerous text and phone messages from a co-worker. Which type of harrassment should be documented in the nurse's notes? a) Harassment b) Jealousy c) Isolation d) Cyberstalking
d) Cyberstalking
A 19-year-old college student has been date raped. She is in the emergency department undergoing a forensic examination and being assessed by the psychiatric emergency response team. The nurse notices that the client describes the series of events leading up to the rape with a blank facial expression, saying, "I feel like it didn't happen at all." Which of the following statements most accurately describes the client's response? a) Reaction formation to manage the anger she feels toward her attacker b) Denial as a defense mechanism to cope with the pain of the attack c) Shock phase of a crisis, with repressed feelings associated with the attack d) Dissociation as a defense mechanism to cope with the attack
d) Dissociation as a defense mechanism to cope with the attack
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? a) Douching b) Showering c) Changing clothes d) Drinking a glass of water
d) Drinking a glass of water
Which statement requires additional education regarding the truth about rape? a) Rape can occur between married individuals. b) No person deserves to be raped. c) No person wants to be raped. d) Rape is a crime of passion.
d) Rape is a crime of passion.
The nursing student learning about intimate partner violence correctly identifies its prevalence in same-sex couples as what? a) Half as frequent as in heterosexual couples b) Twice as often as in heterosexual couples c) Three times more frequent as in heterosexual couples d) Same frequency as in heterosexual couples
d) Same frequency as in heterosexual couples
Which assessment finding should cause the nurse the greatest concern regarding the possible abuse of an older adult client? a) Has lost weight since breaking an ankle b) Often cries, mourning the recent death of a beloved pet c) Has developed a urinary tract infection d) Sends money every month to each adult child
d) Sends money every month to each adult child
The nurse is working in the emergency department with a client who was raped 1 hour ago. Which is most important for the nurse to remember when planning care? a) The nurse will need to make decisions for this client. b) Evidence collection according to procedures is not as important as treating the client's injuries. c) The client should set aside any angry feelings until physical care is completed. d) The client may feel threatened by some of the procedures.
d) The client may feel threatened by some of the procedures.
A client has not been to work in three days. When she returns to work, she is wearing dark glasses. Facial and body bruises are visible. Her supervisor takes her to the occupational nurse. Which assessment is the priority for the nurse? a) emotional distress b) coping mechanisms c) psychological trauma d) physical injuries
d) physical injuries
