Chapter 28 (EGW) Child, Older Adult, and Intimate Partner Abuse

The risk of elder abuse in a home is best determined by assessing 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.

What findings are important for the nurse to document at the initial assessment of a case of domestic abuse? Select all that apply. 1 Physical evidence of sexual abuse, whenever possible 2 Body map to describe the injuries along with explanations 3 Verbatim statements of who caused the injury and when 4 Discussion with other interviewers and their comments 5 The reactions of the nurse on the severity of the event

1,2,3

Abuse comes in which forms? Select all that apply. 1 Economic 2 Emotional 3 Sexual 4 Physical 5 Intellectual

1,2,3,4

A 79-year-old patient in the emergency department is 5'6", weighs 93 pounds, and is wearing old, dirty clothes that have holes. The patient is diagnosed with pneumonia. Which comment by this patient suggests a significant risk for abuse? 1 "Our family is poor, so my daughter gets my monthly retirement and Social Security checks." 2 "Volunteers from our community food bank have been bringing my groceries for the last few months." 3 "I've lived alone all my life. I have my own ways of doing things and I don't like others to interfere." 4 "I've had a bad cold for months. My daughter made chicken noodle soup for me, but I kept getting worse."

1

A married couple that has had a violent marriage decides to participate in family or marital therapy. What are the expected outcomes of family psychotherapy for the perpetrator? 1 To recognize destructive patterns of behavior and learn alternative responses 2 To become temperamental and handle a crisis situation impulsively 3 To express anger and disappointment to the members of the family 4 To develop reclusive behavior and isolate one's self from others in the family

1

A community health nurse starts working with the family of a victim of domestic abuse. What strategies for primary prevention are helpful in this case? Select all that apply. 1 Reducing stress in the family 2 Increasing the amount of social support 3 Increasing the use of coping skills 4 Arranging a legal advocacy program 5 Decreasing family interactions

1,2,3

Which principle will guide the nursing interview that is focused on identifying possible family-centered violence? Select all that apply. 1 A person who feels judged or accused of wrongdoing is likely to become defensive. 2 Stop the telling of the abuse whenever clarification is needed. 3 Focus upon identifying problems and acceptable ways of solving them. 4 Establishing a trustful rapport is the initial nursing intervention. 5 Tension is best minimized by asking the sensitive questions first.

1,3,4

A victim of domestic abuse is being treated for low selfesteem. What are the expected treatment outcomes? Select all that apply. 1 Describes positive level of confidence 2 Has neglectful behaviors towards the abuser 3 Expects positive responses from others 4 Conveys a desire to kill the perpetrator 5 Maintains eye contact and erect posture

1,3,5

A nurse assesses a victim of intimate partner violence and observes bruises, lacerations, scars, burns, and wounds in various phases of healing. The patient says, "He's going to kill me next time if I don't do something." Which nursing diagnosis has the highest priority? 1 Pain 2 Powerlessness 3 Risk for infection 4 Impaired skin integrity

2

A nursing intervention directed at the psychological needs of an abused woman is to 1 Encourage the patient to immediately leave the abuser 2 Affirm that the patient did not deserve or cause the abuse 3 Provide a referral to social services for economic problems 4 Facilitate contact with law enforcement to take legal action

2

A one-year-old child has respiratory problems and is vomiting. Examinations show the child has bulging fontanels and a retinal hemorrhage. What should the nurse suspect? 1 Injuries due to a fall 2 Shaken baby syndrome 3 Posttraumatic stress disorder 4 Upper respiratory illness

2

A patient prepares for discharge from the emergency department after treatment for injuries associated with intimate partner violence. The patient plans to return home. Which action by the nurse has priority? 1 Refer the patient for pastoral counseling. 2 Provide the patient with contact information for the local shelter. 3 Encourage the patient to file criminal charges against the perpetrator. 4 Tell the patient, "I have documented your injuries and treatment thoroughly."

2

A person comes to the health care facility with a bleeding head injury and some bruises to both hands. What signs would indicate this person is a victim of domestic abuse? Select all that apply. 1 The patient exaggerates the seriousness of the injury. 2 The patient has weak and nervous behavior. 3 The patient's explanation is inconsistent. 4 The patient gives hesitant explanations. 5 The patient makes direct eye contact.

2,3,4

The nurse is caring for a victim of elder abuse. What are the issues addressed in abuse protection support for older adults? Select all that apply. 1 Education on preventing family interaction to reduce abuse 2 Prevention of infliction of physical, sexual, or emotional harm 3 Identification of high-risk, dependent elder relationships 4 Education on maintaining older adult's power in relationships 5 Prevention of neglect of the older adult's basic necessities of life

2,3,5

When planning care for a woman who has been in an abusive relationship for five years, the nurse facilitates the woman's sense of empowerment when: 1 Offering the woman several different suggestions regarding how to stop the abuse. 2 Asking the woman to identify behaviors that trigger her partner's violence. 3 Suggesting that the woman needs to leave the abuser immediately. 4 Assisting the woman in developing a plan to assure her safety.

4

A nurse visits an old age home to assess the presence of abuse. Which response of a patient would indicate that he or she has been neglected? 1 "I spend my time by interacting with my neighbors; we pour our hearts out." 2 "I am grateful for this wheelchair; without it I would be dependent on my children to move." 3 "I am unable to administer the medications; the medication bottles are not clearly marked." 4 "I sit near this window in the morning; the warm sunrays and cool breeze lift my mood."

3

A patient who was physically abused is diagnosed with hopelessness related to social isolation, fear related to perceived physical threat, and risk of infection related to injuries. What outcomes indicate effective treatment? 1 Has minor pain in the joints 2 Needs assistance to set goals 3 Has effective wound healing 4 Has nightmares quite often

3

A person with a history of abusing an intimate partner says, "When my partner leaves home, I think it's because she's meeting someone she likes better than me." Which emotion is most evident by this comment? 1 Guilt 2 Anxiety 3 Jealousy 4 Remorse

3

A school nurse assesses multiple bruises and welts in odd shapes on a child's back. Lately, this child has been frequently tardy and has had episodes of aggressive behavior in school. Identify the best initial outcome. The child will: 1 Attend school on time 2 Acknowledge abuse by caregivers 3 Form a trusting relationship with the nurse 4 Refrain from aggressive behavior with others

3

An emergency department nurse whispers to a colleague, "That woman is back again. She does the same thing repeatedly. He beats her up, she comes to the emergency department, we stitch her up, they make up, and then he beats her again. Why does she let it keep happening?" What is the colleague's best action? 1 Determine whether the nurse is a victim of abuse. 2 Suggest the nurse consider transfer to a different hospital unit. 3 Encourage the nurse to discuss this reaction with the supervisor. 4 Recommend that the nurse share these sentiments with the patient.

3

The nurse is developing a plan of care for a person who is hostile, demonstrates poor social skills, and is addicted to substances. What would be an appropriate nursing diagnosis for this person? 1 Anxiety and hopelessness 2 Dysfunctional family process 3 Ineffective individual coping 4 Ineffective role performance

3

A woman reports being in an abusive relationship with her husband. What drives a man to act as a perpetrator in an abusive relationship? Select all that apply. 1 He uses physical aggression because he hates his partner. 2 He forces his partner to work because he feels idle. 3 He feels more powerful when he uses force and abuse. 4 He feels he is in charge and dominant in the relationship. 5 He imposes restrictions due to extreme pathological jealousy.

3,4,5

In the context of abuse assessment, on which areas should a nurse concentrate? Select all that apply. 1 Assessment by a group of interviewers 2 Approaching the abuser 3 Levels of anxiety and coping responses 4 Observations of the family's patterns of coping 5 Indications or patterns of violence

3,4,5

The nurse is physically assessing a 7-year-old who is suspected of being physically abused. Which observation supports this diagnosis? 1 The child stutters when answering questions. 2 The father refuses to leave his child alone with the nurse. 3 The mother informs the nurse that the child is very clumsy. 4 The child has bruises in various stages of healing on his or her arms.

4

What is the most appropriate statement about the victims of abuse? 1 Elder abuse is uncommon. 2 Children face physical abuse more than any other abuse. 3 Girls facing child abuse die at a slightly higher rate than boys. 4 Females face intimate partner abuse more often than males.

4

What nursing intervention can be incorporated to assist parents in stopping the use of corporal punishment to discipline their child? 1 The child is separated from its parent and sent to boarding school to stop the abuse. 2 The parents are threatened that a legal action will take place in case of further abuse. 3 The child is given a help line number to call in case of any further abuse by the parents. 4 Parents are referred to parenting resources to learn alternative approaches to discipline.

4

A nurse delivered a lecture at a community health center on interventions to reduce family abuse. The nurse asks the participants about what they learned from the session. Which statement given by the participants indicates effective learning? 1 "The violent behavior of the victim provokes the abuser to abuse." 2 "One should not interfere with others' family abuse cases." 3 "Violence occurs only between heterosexual partners." 4 "Victims are not believed when they disclose their situation."

4

A nurse is caring for a pediatric patient who has severe injuries on his or her face and neck. The nurse says to the nurse manager, "I empathize with the patient; I wish I could make this patient happy by resolving all the problems." What response does the nurse have to the patient? 1 Embarrassment 2 Confusion 3 Discouragement 4 Helplessness

4

A person was admitted at a health care facility following a suicide attempt resulting from family violence. After the crisis is resolved, what should be the next intervention? 1 Give the patient an outpatient referral. 2 Refer the patient to an inpatient psychiatric unit. 3 Identify the perpetrator and have him or her arrested. 4 Ask the patient if he or she has a plan to repeat this.

4

During a health screen in a boarding school, the nurse finds that the older children have been physically abused. Which signs and symptoms does the nurse find in the children? 1 The children give appropriate reasons for their injuries. 2 The children have nonspecific bruising on their hands. 3 The children tend to maintain stable eye contact with the nurse. 4 The children hesitate to interact with the nurse.

4

From a psychosocial perspective, the nurse is most troubled when witnessing the parents of 6-year-old twins ignoring the boys being physically aggressive toward each other because this behavior: 1 Suggests that the family has very weak social skills. 2 Indicates a severe lack of parental attachment to the children. 3 Greatly increases the risk of the children being physically injured. 4 Can lead to the children developing violence as a coping mechanism.

4

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.

A battered woman has been referred to a women's shelter. When the woman's abuser demands to be told where she is, the nurse A. refuses to provide any information. B. gives him the telephone number, but not the address, of the shelter. C. informs him that no information can be given for a minimum of 24 hours. D. calls law enforcement to arrest the husband for the assault and battery of his wife.

A.

Nurses working in emergency departments and walk-in clinics should be aware that some victims of violence may present: 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.

A nursing intervention directed at the psychological needs of an abused woman is to 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.

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.

Lauren brings her 4-year-old daughter, Mikayla, to the emergency department and states that Mikayla has been "acting funny." Lauren states, "She touches her vagina and rubs herself down there all the time and she never did that before. She drew me a picture showing two people with one on top of the other and said they were 'doing sex' and I saw her acting that out with her dolls too. I didn't know where else to go." Based on Lauren's description, you suspect that: A. this is normal developmental behavior in a 4-year-old child. B. Mikayla has been sexually abused. C. Lauren needs education in parenting skills. D. Mikayla has been exposed to graphic sexual images on television.

B.

The nurse performing the assessment of a wheelchairbound 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.

To best assure the safety of a 3-year-old child whose parent admits to finding it difficult to control their anger, the most appropriate short-term goal would be for the parent to 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.

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.

When there is reason to suspect that a child is being abused, the nurse must initially 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.

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

B.

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.

After arranging for a sexual assault nurse examiner (SANE) to see Lauren and Mikayla for further assessment for abuse and proper reporting and followup, Lauren tells you she lives with her boyfriend, Darrin, who is not Mikayla's father. What statement by Lauren would make you suspect she is being emotionally abused? A. "Darrin 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 Darrin I was coming because he is under so much stress at work I didn't want to add to it." C. "Darrin yells a lot and calls me names, but that's because I am so stupid and make so many mistakes." D. "Darrin is Latin American and has a fiery temper."

C.

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 can assess that this is the stage in the cycle of violence known as A. tension building. B. acute battering. C. honeymoon. D. escalation.

C.

The victim of abuse can expect the abuse to worsen when 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.

When interviewing an adult victim of abuse, the nurse's best approach is to be A. confrontational and assertive. B. gentle and direct. C. direct and professional. D. sympathetic and outraged.

C.

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.

Which of the following is a likely behavior for a woman attempting to escape a chronically abusive relationship? 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.

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.

If it is determined that Mikayla has been sexually abused, what is the priority outcome for Mikayla? A. Mikayla's mother will learn coping techniques to support Mikayla. B. Mikayla will be able to verbalize exactly what happened to her. C. Mikayla will no longer act out sexually. D. The sexual abuse will cease.

D.

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.

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.

The nurse is preparing a safety plan for a victim of family violence. How does a safety plan help the victim? 1 The victim can identify signs of occurrence of violence and leave. 2 The victim can call law enforcement to intervene in a crisis situation. 3 The victim can call the nurse if there is any suicidal ideation. 4 The victim can stay calm and relaxed during an episode of violence.

1

A nurse is assessing an infant and concludes that he or she has shaken baby syndrome. Which symptoms has the nurse found in the infant? Select all that apply 1 Retinal hemorrhages 2 Ear infection 3 Bulging fontanels 4 Respiratory problems 5 Malnourishment

1,3,4

A nurse is teaching patients in a primary health care center how to escape and avoid being a victim of abuse by their partners. Which action of a participant indicates effective teaching? Select all that apply. 1 Identifying the signs of escalation of violence 2 Staying with the abuser to make him or her calm and relaxed 3 Showing extreme trust of his or her partner 4 Packing a bag with money and birth certificates 5 Leaving the place immediately if there are signs of violence

1,4,5

What are the three levels of help that can be provided to the abusive family to build a healthy therapeutic environment? Select all that apply. 1 Providing family therapy 2 Helping to prosecute the perpetrator 3 Discouraging social interactions 4 Arranging visits by a nurse 5 Providing economic support

1,4,5

In the tertiary prevention method, what measures are taken to assist the survivors of abuse in the healing process? Select all that apply. 1 Support the survivors to remain in social isolation and avoid interaction. 2 Counsel the individuals and families for healing and rehabilitation. 3 Counsel the survivors to hate and stay away from the perpetrator. 4 Assist the survivors of violence to achieve safety, health, and well-being. 5 Assist in dealing with the legal proceedings against the perpetrator.

2,4,5

When a woman reports an injury after being abused by her husband, the nurse listens to her attentively and asks her necessary questions to understand the history. What should the nurse do next to help this woman? 1 Provide a counseling session for the woman and send her home. 2 Advise the woman that she is "in trouble" and needs to find a shelter. 3 Assess safety and help explore alternatives to reduce dangers. 4 Display anger and

3

Which data obtained during a family assessment could be considered an early indicator of the greatest potential for family-focused abuse? 1 The oldest child is legally blind. 2 The children often play violent video games. 3 The mother's brother is in jail for assault and battery. 4 The father travels for work and is home only on weekends.

3

Which factor is of least importance as a victim of spousal abuse constructs an escape plan? A. How the victim will explain her decision to leave B. Where the victim will go to be safe C. How the victim will arrange for transportation D. What the victim will need to take with her when she leaves

A.

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.