Chapter 9: Violence and Abuse

The nurse is caring for a pregnant client who states her spouse verbally abuses her. Which response by the nurse is a priority? "Try to avoid making your partner angry to prevent the abuse from escalating until you are able to move out." "If your spouse becomes physically abusive, you have to leave for your safety and the safety of your unborn child." "Intimate partner violence often gets worse during pregnancy and stress. Do you have a safety plan in place?" "Has your spouse ever hit you in the past or forced you to perform sexual acts you did not consent to doing?"

"Intimate partner violence often gets worse during pregnancy and stress. Do you have a safety plan in place?" The nurse would be focused on the safety of the client and her unborn child. Ensuring the client has a safety plan is a priority. The nurse would then continue to gather additional information, as long as the client is comfortable. The nurse cannot make the client leave the situation. The nurse can provide resources for the client, but it is ultimately the client's decision to stay or leave. The nurse would not indicate it is the client's fault in any way.

A client is receiving treatment for injuries sustained during a fight with a partner. The nurse observes the partner visit the client daily in the hospital and appears very solicitous and contrite. The client states, "My partner always apologizes and brings gifts after a fight." Which response by the nurse is appropriate? "You both need to see a counselor to figure this out. Your partner will go if your partner truly loves you." "Your partner seems to be genuinely contrite. I understand why you stay with your partner." "Sometimes abusive partners try to apologize but this does not mean the person wants to change." "Although your partner seems sorry, often an abuser will continue to repeat the behavior in the future."

"Although your partner seems sorry, often an abuser will continue to repeat the behavior in the future." The nurse should clearly explain to the client that whatever the cause of the incident, no one deserves to be a victim of intimate partner violence and abusive behaviors are often repeated. Even though the partner appears to be genuinely contrite, most people who attack their partners are serial abusers, and there is no certainty that they will not repeat their actions. The nurse would not indicate an understanding of the client remaining in an abusive relationship because this could lead to additional exposure to harm. The nurse would not state attending counseling shows love for the client; however, counseling may be encouraged as a resource for the client.

The nurse is caring for a client suspected of being a victim of human trafficking. Which question, when given priority by the nurse during the admission interview, demonstrates a need for additional training? "Can you get in touch with your family easily?" "Are you afraid of those you work for?" "Are you working toward achieving American citizenship?" "Can you leave your job if you find a better one?"

"Are you working toward achieving American citizenship?" Although human traffickers prey on undocumented or illegal aliens, the status of the immigration process is not a priority in determining a client's risk factors for such abuse. All the other questions assess for freedom, safety, and autonomy, all factors that are considered when assessing for such an abusive situation.

A nurse is screening a client for intimate partner violence using indirect questions. Which question would the nurse most likely ask? "Have you ever been abused?" "Clients with your injuries are often abused. Is anything like this happening now?" "I know it can be difficult to talk about, but does your partner hit you?" "It's okay to talk about this subject. Are you in an abusive relationship?"

"Clients with your injuries are often abused. Is anything like this happening now?" "Does your partner hit you?" or "Have you ever been or are you now in an abusive relationship?" are direct questions. They are focused and address the topic with the client directly. If that approach feels uncomfortable, indirect questions can be used, such as "We see many clients with injuries or reports like yours, and often they are being abused. Is that what is happening to you?" or "Many people in our community experience abuse from their partners. Is anything like that happening in your life?" With either approach, nurses need to maintain a nonjudgmental acceptance of whatever answers the woman offers.

During a prenatal assessment, the nurse observes that the client is quiet and withdrawn. The client keeps asking if her partner can come into the examination room, because the partner does not like to be kept waiting. Which question would be most important for the nurse to ask before the partner comes into the examination room? "What happens when you and your partner argue?" "Is something bothering you?" "Do you feel safe in your home?" "Why do you keep asking for your partner?"

"Do you feel safe in your home?" Client safety is the priority. Asking if the client feels safe, before the partner is present, is important. Also, the client may be reluctant to answer this question if the partner is present. Feeling safe is a higher priority than gathering specifics about the relationship, such as what occurs when they argue. The other questions can be asked with the partner present, with the client's permission.

As part of a local college awareness program, a nurse is interviewing several of the participants about their views on rape. Which statement by a participant will lead the nurse to determine that additional education about rape is needed? "Men and women who are raped may take several years to recover emotionally and physically." "Most victims of rape never report the episode to the local authorities or tell anyone about being raped." "What a person wears has no effect on whether that person will be assaulted by someone else." "Health care providers can prevent pregnancy and sexually transmitted infection transmission after a rape."

"Health care providers can prevent pregnancy and sexually transmitted infection transmission after a rape." Health care providers can provide emergency contraceptive medication to limit the possibility of a pregnancy resulting from the rape; however, the medication is not 100% effective. Sexually transmitted infection (STI) transmission cannot be prevented after the rape has occurred. A barrier device, such as a condom, must be used during intercourse to prevent STI transmission. The majority of people who are raped never tell anyone about it, and almost two-thirds of victims never report it to the authorities. No victim invites rape or sexual assault, and what a person wears is irrelevant. It can take several years for victims to recover from rape. Medications can help initially, but counseling is necessary.

The nurse is caring for a client who has been a victim of intimate partner violence (IPV) for a few years. The client states, "My partner has been so sweet to me the last few days by telling me how special I am and bringing me flowers. I believe my partner is sorry and will not do this again." How will the nurse respond? "Your partner is showing caring and loving actions toward you. This could indicate progress from your partner." "Your partner may love you, but staying in this relationship is not worth the risk of being abused over and over." "It may seem better now, but over time, IPV typically becomes accelerated and more dangerous." "It sounds like the honeymoon stage of IPV, which means your partner does not love you and will hurt you again."

"It may seem better now, but over time, IPV typically becomes accelerated and more dangerous." The cycle of IPV can cover a long period of time. IPV typically becomes accelerated over time and thus more dangerous. The client needs to know that this is normal behavior for an abuser and does not indicate love or a change. The nurse would respond with facts and not personal beliefs, such as the worth of the client's relationship. The nurse would not state the client is not loved because this could result in decreased trust and respect from the client toward the nurse.

A nurse is a guest speaker for a local college campus group discussing violence and rape. After discussing rape with the group, the nurse determines that additional discussion is needed when the group states which information? "A rape victim often feels vulnerable and betrayed afterwards." "It may take victims several years to recover from the rape." "Rape is not an act of impulsive, uncontrolled passion." "Most rape victims tell someone about the rape."

"Most rape victims tell someone about the rape." In reality, the most victims never tell anyone about being raped and almost two-thirds of victims never report the rape to the police. It can take several years to recover from rape, and the rape victim often feels vulnerable, betrayed, and insecure afterward. Rape is a premeditated act of violence; it is not an act of impulsive, uncontrolled passion.

The nurse suspects a client is a victim of intimate partner violence (IPV). Which statement by the client supports the nurse's suspicion? "My spouse refuses to let me go out to find a job." "My spouse hits and kicks our dog and it really makes me upset." "My spouse has terrible road rage and yells a lot when driving." "My spouse constantly complains about how stressful his job is."

"My spouse refuses to let me go out to find a job." Financial abuse (preventing one's spouse from going out to find a job) is a form of IPV. Constant complaints about a job, being abusive to animals, and road rage are not indicative of intimate partner violence.

A nurse is working with a victim of intimate partner violence. The client has decided that she is going to leave the relationship. Which instructions by the nurse would be most appropriate? Select all that apply. "Don't worry. I will make all the decisions for you about leaving." "Remember, it might take you several tries before you succeed." "Listen to me because I know when it would be best for you to leave the situation." "Let's work on a safety plan so that it is ready for when you leave." "I can offer you choices, but you are the one who has to choose."

"Remember, it might take you several tries before you succeed." "Let's work on a safety plan so that it is ready for when you leave." "I can offer you choices, but you are the one who has to choose." The choice to leave must rest with the victim. Nurses cannot choose a life for the victim; they can only offer choices. Leaving is a process, not an event. Victims may try to leave their abusers as many as seven or eight times before succeeding. Frequently, the final attempt to leave may result in the death of the victim. Individuals planning to leave an abusive relationship should have a safety plan, if possible. Nurses need to remember that their role is that of a guide, not a savior. The client will make the best decision for him or her at that moment in time.

A nurse involved in presenting a community education program that focuses on rape prevention is asked, "Who is likely to commit rape?" What response made by the nurse best demonstrates an understanding of who is likely to commit rape? "People with anger management issues are at high risk for such behavior." "Research has yet to provide a reliable profile of those who engage in rape." "The inability to effectively handle stress of daily life is a common factor among rapists." "Under the right set of circumstances almost any male is capable of committing rape

"Research has yet to provide a reliable profile of those who engage in rape." Assailants, like their victims, come from all walks of life and all ethnic backgrounds; there is no typical profile. What is known is that many assailants have trouble dealing with the stresses of daily life, and are frequently "hot headed." But it is not true that all rapists present with these characteristics. There is no research to support that any male is capable of committing rape.

The triage nurse receives a phone call from a client stating, "I was just raped and I need help. What should I do?" Which response by the nurse is a priority? "You need to call the local authorities and they will help you file a report." "Go to the nearest rape crisis center for a medical examination." "Tell me if you are in a safe location away from the assailant now." "Come to the emergency department and do not shower or change clothes."

"Tell me if you are in a safe location away from the assailant now." It is a priority for the nurse to determine the client's safety. After ensuring the client is safe, the nurse would tell the client to come to the emergency department, not a crisis center, prior to bathing or changing clothes. The authorities will be contacted from the emergency department. It is best to obtain evidence and specimens as soon as possible after the attack.

The nurse suspects a pregnant client is a victim of intimate partner violence (IPV). When the nurse asks the client if her partner abuses her, the client responds, "Oh no, my partner does not hit me." Which response by the nurse is most appropriate? "I am glad to be wrong. I will continue with your assessment." "I will give you information on shelters and resources for victims of IPV just in case." "It is important for you to think about the safety of your unborn child." "There are many types of intimate partner violence beyond physical abuse."

"There are many types of intimate partner violence beyond physical abuse." The nurse would explain the different types of IPV to the client, such as emotional, sexual, and financial abuse. The client may not understand her current situation is considered IPV even though it is not physical abuse. Telling the client to think of the safety of the unborn child does not reflect an understanding of the types of abuse. Continuing with the assessment ignores the potential IPV. Information would be provided after further investigation.

The nurse suspects a pregnant client is a victim of intimate partner violence (IPV). When the nurse asks the client if her partner abuses her, the client responds, "Oh no, my partner does not hit me." Which response by the nurse is most appropriate? "I am glad to be wrong. I will continue with your assessment." "There are many types of intimate partner violence beyond physical abuse." "It is important for you to think about the safety of your unborn child." "I will give you information on shelters and resources for victims of IPV just in case."

"There are many types of intimate partner violence beyond physical abuse." The nurse would explain the different types of IPV to the client, such as emotional, sexual, and financial abuse. The client may not understand her current situation is considered IPV even though it is not physical abuse. Telling the client to think of the safety of the unborn child does not reflect an understanding of the types of abuse. Continuing with the assessment ignores the potential IPV. Information would be provided after further investigation.

While talking to the nurse, a client states that every time she has a serious fight with her spouse, the client is forced to have intercourse. The client appears very disturbed when revealing this to the nurse. Which is an appropriate response by the nurse? "Are the fights a result of something you have done wrong?" "This behavior is called intimate partner violence." "Sexual abuse does still happen among married couples." "Such behavior is not okay and I am calling the authorities."

"This behavior is called intimate partner violence." The nurse should tell the client that this behavior indicates intimate partner violence because the spouse forces intercourse against the client's will. The nurse should also explain that the client is in no way responsible for such incidents and has a right to refuse sexual intimacy. There is no justification for intimate partner violence, and the client should not regard it as expected behavior of a married couple. Some states require health care professionals to report intimate partner violence, but not all. The nurse would discuss the situation with the client first and act based on local laws.

The nursing student is studying violence and mistreatment against the older woman. While researching it, the student learns that laws require health care professionals to report elder or vulnerable person mistreatment. How many states currently have these laws? 46 50 32 40

50 All fifty states have laws requiring health care professionals to report elder or vulnerable person mistreatment.

A nurse is assessing a victim of rape. Further assessment reveals that the client received rohypnol. The nurse understands that this drug can lead to memory loss for up to how many hours? 2 4 6 8

8 Rohypnol (also known as "roofies," "forget pills," "mind erasers" and the "drop drug") comes in the form of a liquid or pill that quickly dissolves in liquid with no odor, taste, or color. This drug is 10 times as strong as diazepam. The effects can be felt within 30 minutes, and the drug produces memory loss for up to 8 hours.

The nurse is educating college students on ways to protect themselves from date and acquaintance rape. What will the nurse include in the teaching? Select all that apply. Accept drinks in closed containers or from bartenders only. Pour out drinks left unattended for any length of time. Do not join fraternities or sororities at the university. Do not attend parties where alcohol will be served. If you believe you have been drugged, go home.

Accept drinks in closed containers or from bartenders only. Do not attend parties where alcohol will be served. Pour out drinks left unattended for any length of time. Ways to protect oneself from acquaintance and date rape include: not attending parties where alcohol will be served, pouring out drinks left unattended, only accepting drinks in closed containers or from bartenders, and not drinking anything with an odd taste or smell or from a bowl or keg. If someone is drugged, he or she should call 911 immediately. Joining social groups is appropriate as long as precautions are considered.

The nurse is caring for a client who was raped 3 hours ago. Which intervention is a priority for the nurse to perform? Refer the client to a counseling service. Schedule the client for sexually transmitted infection (STI) testing in 1 month. Assess the client for signs of posttraumatic stress disorder (PTSD). Administer prescribed emergency contraceptive pills.

Administer prescribed emergency contraceptive pills. To minimize the risk of pregnancy, it is a priority for the nurse to administer emergency contraceptive pills within 72 to 120 hours of unprotected intercourse. The nurse would test the client now for STIs, not in a month. Follow-up testing may be indicated but would not be a priority to schedule over administering medication. The nurse would refer the client to counseling and assess for signs of PTSD; however, these can be done after administering the medication.

To properly assist a victim of intimate partner violence, which action would be most appropriate for the nurse to do? Discuss the details with the victim. Confront the abuser about the details. Document the details. Summarize the details of the incident.

Document the details. Accurate documentation is critical because this evidence may support the client's case in court. Documentation must include details about the frequency and severity of violence; location, extent, and outcome of injuries; and any treatments or interventions. Documentation should always use direct quotes, and be very specific.

A client at 36 weeks' gestation presents in the emergency department with a broken arm. The client states, "I fell while cooking dinner." During the assessment, the nurse notes no prenatal care for this pregnancy, as well as bruises in multiple stages of healing on the client's abdomen, arms, and chest. What action will the nurse perform next? Provide brochures on shelters for victims of intimate partner violence Notify the health care provider of the findings Ask the client how she acquired the bruises Document the findings in the client's chart

Ask the client how she acquired the bruises First, the nurse will ask how the client acquired the multiple bruises. This will provide information on possible violence. The nurse would also notify the health care provider and document the findings. Information would be provided based on the finding of intimate partner violence.

The nurse is assessing a client whose partner is present. The nurse notes the partner swears and yells, makes lavish promises, and threatens to hit the client. Which nursing intervention is a priority? Ask the partner to leave the room. Notify the facility authorities. Document the findings. Ask the partner to remain calm.

Ask the partner to leave the room. Promising, swearing, or threatening to hit a partner are indications of emotional abuse. The nurse would first have the partner leave the room, then assess the client for emotional abuse. If the partner refuses to leave the room or becomes aggressive/hostile, the nurse would involve the facility authorities to ensure safety of the client and nurse. The nurse would document the findings; however, assessing for abuse is a priority. The nurse should not intervene by asking the partner to remain calm. This will likely cause the situation to escalate.

A pregnant client discloses to the nurse that she has been abused by her spouse for the past 4 years. Which action will the nurse take next? Perform an ultrasound to assess the fetus for any injuries. Assess the client for signs of intimate partner violence. Determine why the client has remained in an abusive relationship for 4 years. Encourage the client to seek refuge at a gender-specific victims' shelter.

Assess the client for signs of intimate partner violence. Pregnancy and birth are trigger points for intimate partner violence because the abuser may experience a sense of loss of control. During pregnancy, the mother and fetus take priority, and the abuser attempts to maintain or regain control by abusing the woman. The nurse would assess the client and document all indications of intimate partner violence. The nurse would notify the health care provider of findings and discuss a safety plan and provide information on resources to the client. The nurse would assess the fetus for injury after assessing the client, paying close attention to the client's abdominal and perineal areas.

A client has been admitted to the inpatient psychiatric facility with a diagnosis of posttraumatic stress disorder after a history of violence by a partner. During the admission process, which action is a priority for the nurse to complete? Administer medications as prescribed. Obtain the client's vital signs. Assess the client for suicide risk. Document findings of abuse.

Assess the client for suicide risk. Although all actions are important for the nurse to complete, for clients with posttraumatic stress disorder, depression is a common symptom. Thus, a thorough assessment of suicide intent is critical for the client's safety. This makes assessing the client for suicide risk a priority over the other actions. The nurse will obtain vital signs, administer medications and complete all other orders from the health care provider, and document findings indicating abuse in the client's medical record. However, client safety is a priority.

A client has been seen and treated in the emergency room several times for injuries that are deemed suspicious. The client is reluctant to participate in a screening process. How best can the nurse provide reassurance to this client? Giving assurances of help Being nonjudgmental Having the client be honest about the injuries Establishing a plan to protect the client

Being nonjudgmental During the screening process the victim is most likely to be uncomfortable and not want to participate. Victims are concerned about being judged by the interviewer, provoking more violence, and being disappointed by the provider's response to the disclosure. The nurse can best help the victim participate in screening by ensuring confidentiality and being nonjudgmental. There is no guarantee the nurse can assure the woman of help. At best, the nurse can provide information of agencies and services. Having the client be honest about the injuries can cause much distress for the client who may feel it will only lead to more injuries after the partner realizes details have been disclosed. Helping the client find community resources to develop a plan of protection is best done with the social worker and community agencies rather than the emergency room nurse. The nurse should make a referral to the social worker to help with this situation.

When initiating care for a client suspected of being a victim of human trafficking, what is the nurse's primary responsibility? Remaining nonjudgmental Supporting autonomy Building trust Protecting privacy

Building trust Building trust is the top priority. Although the other actions are appropriate, they are less achievable without first establishing a trusting relationship with the client.

Which statement is false regarding emergency contraception (EC)? EC works by preventing fertilization, ovulation, or implantation. EC will disrupt an established pregnancy if taken within 72 hours. EC simply contains the same hormones that are found in birth control pills. EC is most effective if it is taken within 12 hours of rape.

EC will disrupt an established pregnancy if taken within 72 hours. Emergency contraception will not disrupt an established pregnancy.

A nurse is working in a community hospital situated in an area with a history of grievous assaults on women, including rape. The nurse discovers that most rape victims come to the hospital but leave without seeking medical treatment. Which intervention should the nurse perform to ensure that rape victims get legal and medical aid? Let them wait in waiting rooms to collect their thoughts before approaching them. Ensure that the appropriate law enforcement agencies are apprised of the incident. Focus on treating them rather than on collecting evidence. Treat them as any other client to make them feel more comfortable.

Ensure that the appropriate law enforcement agencies are apprised of the incident. For every rape victim who turns up, the nurse should ensure that the appropriate law enforcement agencies are apprised of the incident. Victims should not be made to wait long hours in the waiting room, as they may leave if no one attends to them. Victims of rape should be treated with more sensitivity than other clients. Although the primary job of a nurse is to medically care for the rape victim, a nurse should also pay due attention to collecting evidence to substantiate the victim's claim in a court of law.

A client with multiple bruises comes to the clinic for treatment. The client appears withdrawn and quiet when communicating with the nurse. The spouse accompanies the client to the exam room and begins to answer all the questions the nurse asks the client. Which action will the nurse take next? Notify the primary health care provider. Document the findings in the client's medical record. Provide the client information on intimate partner violence (IPV). Escort the client to a private area to complete the assessment.

Escort the client to a private area to complete the assessment. One major indicator of intimate partner violence is the hovering behavior of the abusive partner during a visit. The client also has multiple bruises and is very quiet. The nurse needs to speak with the client privately to ask about IPV. After completing the assessment, the nurse would notify the primary health care provider and document the findings. The nurse may also need to report the findings to the proper authorities. Providing the client with information in the presence of the partner is not appropriate. This could subject the client to additional abuse upon leaving the medical facility.

A nurse is working with a client who is anticipating the possibility of leaving a relationship with intimate partner violence. In helping the client make the decision to leave or to stay in the abusive situation, which action would be most important for the nurse to take? Assist the client in finding a new apartment and a new job. Suggest that the client legally change his or her name and move out of state. Ensure the client understands the behaviors inherent in the cycle of intimate partner violence. Explain to the client how to develop a safety plan for leaving the relationship.

Explain to the client how to develop a safety plan for leaving the relationship. In situations of intimate partner violence, leaving an abuser may result in harm or death to the victim. Therefore, teaching the client how to develop a safety plan for leaving the relationship is of the most importance. Although survivors also need information about the cycle of intimate partner violence, this is not the priority when discussing the decision to leave. The nurse should provide information on available resources to assist the client in finding shelter and employment, as well as legal services, government benefits, and support networks. The nurse should not perform these actions for the client.

The nurse is caring for a client believed to be a victim of human trafficking. What action is most important for the nurse to perform? Assess for bruising. Gain the client's trust. Notify the authorities. Test for pregnancy.

Gain the client's trust. It is most important for the nurse to gain the trust of the victim. This will allow the nurse to obtain the most information to appropriately help the client. The nurse may notify the authorities and test for pregnancy if the client is a victim. The client will be assessed, but it isn't the priority.

A newly pregnant 19-year-old woman grew up in an abusive home, and moved in with a 22-year-old man who is displeased with her cooking and housekeeping skills. He often becomes angry and physically abusive. The pregnant client has no diploma or job, no money for birth control, and her boyfriend demands sex at his leisure without use of condoms. What is the strongest risk factor for intimate partner violence during this pregnancy? Low socioeconomic status Lack of access to health care Prior abuse Unintended pregnancy

Prior abuse The strongest predictor of abuse during pregnancy is prior abuse. For women who have been abused before, beating and violence during pregnancy are "business as usual." Unintended pregnancy, low socioeconomic status and lack of access to care are stressors, but are not the highest risk factor for intimate partner violence.

A client at 34 weeks' gestation comes to the clinic with her partner and reports neck and back pain. During the assessment, the nurse notes multiple contusions in various stages of healing on the client's torso and weight gain of 3 lb (1.36 kg) during the course of the pregnancy. Which action will the nurse take next? Have the client's partner leave the room during the examination. Report the findings to the client's health care provider. Assess the client for indications of an eating disorder. Determine the client's weight gain during prior pregnancies.

Have the client's partner leave the room during the examination. The nurse would suspect intimate partner violence (IPV) due to the client's presentation of poor weight gain (should gain 25 to 35 lb/11.5 to 6 kg) during a normal pregnancy, current injuries, and multiple contusions in various stages of healing. When IPV is detected, the nurse should immediately isolate the client to provide privacy during questioning to prevent potential retaliation from the abuser. The client does not present with signs of an eating disorder. However, if IPV is ruled out, this may be further explored. The nurse would notify the health care provider after completing the assessment and admission process. Knowing the client's prior weight gain is not a priority at this time. This can be reviewed last.

The nurse is caring for a woman with injuries as a result of intimate partner violence. What is the nurse's responsibility in providing appropriate care to this client? Encourage the client to leave the unsafe situation and to not return to the abusive relationship. Remain nonjudgmental by not asking questions or giving advice about what the client needs to do. Tell the client to inform the police and assess the need for protection from the abuser. Inform the client about risk factors and determine the immediate level of danger.

Inform the client about risk factors and determine the immediate level of danger. The nurse's role is to inform, educate, identify resources, and to empower the client to take action. The nurse cannot take action on the part of the client or tell the client what she needs to do.

A nurse is preparing a presentation for a local community group about intimate partner violence. Which statement would be most appropriate for the nurse to include in the presentation? Intimate partner violence primarily affects young, unmarried women. Until the 1990s, society tended to legitimize a man's control over a woman. Intimate partner violence in lesbian, gay, bisexual, transgender, queer (LGBTQ) relationships may go unreported for fear of harassment. Children who witness intimate partner violence against a parent are less likely to become abusers.

Intimate partner violence in lesbian, gay, bisexual, transgender, queer (LGBTQ) relationships may go unreported for fear of harassment. Intimate partner violence occurs in both heterosexual and LGBTQ relationships, but violence within LBGTQ relationships may go unreported for fear of harassment or ridicule. Little is known about the national prevalence of IPV, sexual violence, and stalking among the LGBTQ community in the United States. However, research indicates that rates of IPV among LGBTQ individuals are equal to or greater than rates among heterosexual individuals. Risk factors are also similar to those of heterosexual individuals, as are needs related to help with leaving and the recovery process. Moreover, there is as much IPV in the LGBTQ population as in heterosexual relationships with the added psychological abuse of "outing," when one partner threatens to disclose the other's sexual preference in an effort to maintain power and control. Intimate partner violence affects people at nearly every stage of their lives and may occur in old or young, beautiful or unattractive, married or single individuals. Until the 1970s, society tended to legitimize a man's power and control over a woman. Children who witness one parent abusing another are more likely to become delinquents or abusers themselves.

A nurse is caring for a pregnant client and discovers signs of bruises near her neck. On questioning, the nurse learns that the bruises were caused by her spouse. The client tells the nurse that the spouse had stopped hitting her some time ago, and that this was the first time during the pregnancy that she was assaulted. The client blames herself because she admits to not paying enough attention to her spouse. Which facts about intimate partner violence during pregnancy should the nurse tell the client to convince her that the violence was not her fault? Select all that apply. Intimate partner violence is a result of concern for the unborn child when the mother doesn't fulfill her responsibilities toward the newborn. Intimate partner violence is a result of the perception of the partner that the baby will be a competitor after he or she is born. Intimate partner violence is a result of resentment toward the interference of the growing fetus and change in the woman's shape. Intimate partner violence is a result of insecurity and jealousy of the pregnancy and the responsibilities it brings. Most spouses exhibit violent reactions during pregnancy as a way of coping with the stress.

Intimate partner violence is a result of resentment toward the interference of the growing fetus and change in the woman's shape. Intimate partner violence is a result of the perception of the partner that the baby will be a competitor after he or she is born. Intimate partner violence is a result of insecurity and jealousy of the pregnancy and the responsibilities it brings. Some of the factors that may lead to intimate partner violence during pregnancy are resentment toward the interference of the growing fetus and change in the woman's shape, perception of the baby as a competitor once he or she is born, and insecurity and jealousy of the pregnancy and the responsibilities it brings. Concern for the child will never result in physical abuse, as the unborn child is also at risk through assault during pregnancy. Serial abusers may exhibit violent tendencies during pregnancy, and such behavior is unacceptable.

The nurse is working with a client who is in a relationship with a man who controls her activities, calls her names, and occasionally hits her. What are the goals in the treatment of this client? Select all that apply. Provide support to the client Maximize the client's safety Involve the police in the situation Empower the client to take control Hospitalize the client to protect her

Maximize the client's safety Empower the client to take control Provide support to the client The goal is to provide support, to empower the woman, and to maximize her safety. Hospitalization might keep her safe in the short-term, but is not a solution. It is not the nurse's place to involve the police in the client's situation. It is beyond the nurse's scope of practice as well as a HIPAA violation.

The nurse is caring for a client who was raped a few hours ago. The client is concerned about the possibility of having contracted a sexually transmitted infection and requests an emergency contraceptive pill to prevent pregnancy. Which action by the nurse is a priority? Notify the health care provider. Test the client for sexually transmitted infections (STIs). Notify the local authorities of the client's situation. Consult a psychologist to come speak with the client.

Notify the health care provider. The nurse would notify the health care provider to obtain a prescription for an emergency contraceptive pill for the client. This medication should be taken as soon as possible. Seeking counseling is advised, but not before taking an emergency contraceptive as the effectiveness decreases every 12 hours. The nurse can test the client for STIs at any point following the rape. Testing for some STIs, such as HIV, require testing weeks and even months later. The nurse may be required to report to authorities, depending on the area the rape occurred. The nurse would have to review local laws to determine if reporting is mandatory or the client's choice.

The nurse is caring for a client who was raped approximately 10 hours ago. The client states, "I do not want to have a baby by whoever did this to me." Which action will the nurse do next? Notify the health care provider. Obtain a urine specimen for a pregnancy test. Request the facility chaplain speak with the client. Continue to assess the client.

Notify the health care provider. The nurse should notify the health care provider to determine if the client can be prescribed an emergency contraceptive pill. The effectiveness of the medication decreases every 12 hours after the rape occurred; therefore, the client needs this medication as soon as possible. The nurse would then complete the assessment. The victim should seek counseling, but more information is needed to determine the client's religious preference before having a chaplain come to speak with the client. Performing a pregnancy test at this time is not indicated. The test would not be positive this soon after the event or, if the client were pregnant before the rape, the medication will not have an effect on that pregnancy.

The nurse notes injuries indicating intimate partner violence (IPV) when assessing a client. When questioned, the client confirms the nurse's suspicions. Which nursing action is a priority? Refer the client to a psychologist for counseling. Provide the client information on resources for IPV victims. Document the findings in the client's medical record. Encourage the client to move forward and not dwell on past abuse.

Provide the client information on resources for IPV victims. The nurse should offer referrals to the client, such as safety plans, support groups, and shelters, to ensure the client remains safe. The nurse would document the findings and client statements; however, the client's immediate safety is a priority. A referral may be needed. The nurse would further assess the client to determine if a referral is appropriate for this client at this time. The nurse should help the client cope with the incident rather than telling the client to forget about it.

A pregnant woman comes to the clinic with a head injury. She tells the nurse that her partner came home drunk and she made him angry by not having dinner ready. He lashed out, she got in the way, and her head hit the corner on the table. What action should the nurse take in this situation? Have the client call the police and obtain a restraining order against the partner. Provide the client with contact information for a 24-hour shelter and social worker on discharge. Call the police and have the social worker find a place for the client to stay until she gives birth. Do not discharge the client until she makes arrangements to stay at a friend's home.

Provide the client with contact information for a 24-hour shelter and social worker on discharge. The nurse should empower the client by making her aware of the resources and options available to her. The client cannot be forced to leave her situation, stay at a friend's home, or to report the abuse.

During the assessment, a client states, "I need something to calm my nerves and help me with sleeping. My spouse will not let me look for a job, and when I need money, I am told I cannot have any since I do not work." Which action by the nurse is most appropriate at this time? Assist the client in finding work the client can do from home. Determine if it is appropriate for the client to leave the spouse. Provide the client with education on intimate partner violence. Consult with the facility's case management team.

Provide the client with education on intimate partner violence. The nurse would suspect the client is suffering from financial abuse, which is a form of intimate partner violence (IPV). Financial abuse includes preventing a partner from getting a job, sabotaging a current job, controlling how all money is spent, or failing to contribute financially. The nurse would provide the client education and materials on IPV, specifically financial abuse, and answer any questions the client may have. The nurse would discuss the need for any referrals with the health care provider after completing the client's assessment and determining the level of IPV. If the client states a desire to leave the spouse, the nurse would provide information on resources to assist the client. It is not the nurse's place to determine if it is appropriate for the client to leave a spouse. The nurse would not assist the client in locating an at-home job because this action could intensify the spouse's anger and abuse.

A client who is a rape survivor has appeared to cope very well. However, at a routine visit several months later, the client describes a new onset of nightmares and flashbacks. Which action by the nurse is most appropriate for this client? Encourage the client to begin writing a journal reflecting on the rape. Recommend the client receive a selective serotonin reuptake inhibitor (SSRI). Determine the client's actions and routine prior to bed each night. Refer the client to a psychologist for psychotherapy treatment.

Refer the client to a psychologist for psychotherapy treatment. The client is experiencing signs and symptoms of posttraumatic stress disorder (PTSD), which are experienced by a significant proportion of rape victims. Symptoms can include nightmares, flashbacks, increased emotional arousal, and irritability. The nurse would refer the client for counseling. An SSRI is a type of antidepressant that works by increasing levels of serotonin within the brain. SSRI medications may be used to treat PTSD; however, counseling is recommended before, or at least in conjunction with, beginning medication therapy. A bedtime routine may help with other sleep disturbances; however, this is not the client's complication. The prior event is causing the client's nightmares and flashbacks. A journal may be appropriate for the client but should also be done under the supervision of a counselor/psychologist.

The nurse notices the caregiver of a 6-year-old child yell at, belittle, and call the child "stupid" and "ignorant" on multiple occasions. Which action will the nurse take first? Document the findings in the client's medical record. Report the abuse to the client's health care provider. Inform the caregiver that child protective services will be notified. Determine if the client wants the caregiver removed from the hospital room.

Report the abuse to the client's health care provider. Psychological maltreatment includes acts such as verbal abuse and belittlement, acts designed to terrorize a child, and lack of nurturance or emotional availability. The nurse would report such findings to the health care provider to determine the plan of care for the client. The nurse would then document the findings. The nurse would not inform the caregiver if child protective services are notified. This could result in the caregiver leaving with the client, placing the client in additional harm. The caregiver may need to be removed from the room; however, this would not be the decision for a client, who is a minor.

A nurse is using the SAVE model to assess a client for possible violence. When validating the client, which action would the nurse most likely perform? Inform the client of community resources. Tell the client that the nurse believes the story. Have the client describe the present relationship. Make continuous eye contact with the client.

Tell the client that the nurse believes the story. When using the SAVE model, the nurse would validate the client by telling the client that the nurse believes the story. Having the client describe the present relationship is part of the screening of all clients for violence; making continuous eye contact is part of asking direct questions in a nonjudgmental way; and informing the client about community resources is part of evaluating, educating, and referring the client.

A female client shares that her partner often comes home in the evening after a couple of beers, and is jealous, tense and verbally abusive. He sometimes destroys things, such as breaking a vase of flowers. The client says this makes her feel embarrassed, but she tries to be submissive to her partner to calm him down. The nurse recognizes this interaction as which phase of a relationship with intimate partner violence? Tension-building phase Honeymoon phase Violent episode phase Remorseful phase

Tension-building phase These behaviors are characteristic of the tension-building phase of the cycle of violence. During the honeymoon or remorseful phase the partner is loving and often brings gifts. In the violent phase there are direct attacks on the abused partner.

A nurse is conducting an awareness session on sexual abuse, and she is explaining the psychological profile of an average abuser. Which trait is often displayed by abusers? They belong to the low-income group. They are usually physically imposing. They have parents who are divorced. They exhibit antisocial behaviors.

They exhibit antisocial behaviors. Abusers are most likely to exhibit antisocial behavior or childlike aggression. They use aggression to control their victims. Abusers come from all walks of life; they are not just restricted to low-income groups, nor are they necessarily products of divorced parents. The physical characteristics of the abusers vary, and they are not necessarily physically imposing.

When establishing a rapport with the client who is a victim of intimate partner violence, it is important that a nurse remain nonjudgmental, be alert for subtle clues of abuse, and avoid classifying the client as: accident-prone. a chronic complainer. attention-seeking. a hypochondriac.

a chronic complainer. Routine screening for intimate partner violence is the first way to detect abuse. The nurse should build rapport by showing an interest in the concerns of the client, listening, and creating an atmosphere of openness. The nurse should communicate support through a nonjudgmental attitude, or by telling the client that no one deserves to be abused. Rather than overlooking abused clients as "chronic complainers" astute nurses need to be vigilant for subtle clues of intimate partner violence.

The nurse is caring for four clients. Which client will the nurse suspect is a victim of intimate partner violence? a client whose partner refuses to attend recommended counseling for alcohol use disorder a client whose clothing is dirty and who has not seen a health care provider in the past 3 years a client who states, "I am not sure" and "I cannot remember" to several of the nurses' history and physical questions a client whose partner does not leave the client's side or hospital room at any point of the day or night

a client whose partner does not leave the client's side or hospital room at any point of the day or night Indicators of intimate partner violence (IPV) include timid client, overly protective partner, a partner who speaks for the client, and unexplained injuries. A lack of cleanliness and health care, a partner who refuses treatment, and a forgetful client are not signs of IPV. These are not specific signs and could indicate a wide range of complications such as low socioeconomic status, lack of support, and low educational status.

The nurse is caring for a client who is a victim of sexual violence. How can the nurse best support the necessary grieving process? actively listening to the client as he or she talks about the experience educating the client about the symptoms of posttraumatic stress disorder reinforcing the fact that violence is never deserved teaching the client stress management strategies

actively listening to the client as he or she talks about the experience Providing support and allowing the client to grieve for the loss is achieved by listening to and clarifying the reactions to the traumatic event. Although the other actions are appropriate, they are not focused on successful grieving but rather coping with stress and preparing the client to effectively deal with the common complications of this form of trauma.

A nurse is assigned to care for a client who was brought to the emergency department. The client was a victim of human trafficking. When providing care to this client, which intervention would have priority? promoting privacy completing documentation ensuring safety building trust

building trust Although privacy, safety, and documentation are important, the priority for this client would be to build trust.

The nurse is educating a group of student nurses on symptoms of sexually abused women. What symptoms will the nurse include in the teaching? Select all that apply. chronic pelvic pain increased anger substance use disorder headaches social withdrawal

chronic pelvic pain substance use disorder headaches social withdrawal Women can experience psychological, physical, and cognitive symptoms that include chronic pelvic pain, substance use disorder, headaches, backaches, withdrawal, anxiety, sexually transmitted infections, pregnancy, depression, guilt, nervousness, and sexual dysfunction. Increased anger is seen in abusers, not their victims.

A nurse is caring for a client who has been admitted with an ear infection. While discussing the partner with the nurse, the client says that the lover's behavior is "threatening" and "intimidating" at times, even though the partner has not physically harmed the client. The client wants to know what emotional abuse is. Which statement best describes an example of emotional abuse? destroying valued possessions or attacking pets being overly watchful of the client's every move forcing the client to have intercourse throwing objects at the client

destroying valued possessions or attacking pets Attacking pets and destroying valued possessions are examples of emotional abuse. Observing the client's movements closely may be a sign of suspicion. Throwing objects at the client is physical abuse. Forcing the client to have intercourse against her will is an act of sexual assault.

Which behaviors are forms of emotional abuse? Select all that apply. insulting rape incest destroying another's property humiliating

insulting humiliating destroying another's property Emotional 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 caring for a 28-year-old female client in the emergency department (ED) who is accompanied by their partner. The client reports accidentally falling down stairs. Assessment reveals bruising at multiple stages of healing on upper extremities, back, and abdomen. X-ray reveals a right wrist fracture. The client does not make eye contact with the nurse and allows their partner to answer most of the questions. Complete the following sentence(s) by choosing from the lists of options. The nurse suspects the client is experiencing Select... intimate partner violence depression vertigo as evidenced by Select... lack of eye contact frequent falling stages of bruising

intimate partner violence stages of bruising Signs and symptoms of intimate partner violence (IPV) include multiple bruises at different stages of healing on multiple areas of the body, and the partner controlling the conversation while the victim responds minimally and makes little to no eye contact. Multiple bruises at different stages of healing on multiple parts of the body are indicators of IPV. The client may be depressed due to the IPV, but this is not the best answer. The question is asking about the cause, not the effect. The assessment findings indicate IPV is the cause of the injuries, not vertigo. The client stating frequent falling is most likely due to IPV or the client is trying to cover up how they really obtained the injuries. The lack of eye contact may be an indication of IPV, but this may have multiple causes. The stages of the client's bruising is indicative of IPV.

The nurse is assessing a client who was a previous victim of rape. The nurse believes the client is in the integration and recovery phase following the rape. Which action will the nurse recommend to the client for continued recovery? changing positions with current employer pressing formal charges against the abuser joining a rape survivor group returning to a normal daily routine

joining a rape survivor group During the integration and recovery phase, the victim begins to feel safe and starts to trust others. The victim also may become an advocate for other rape survivors. During this time, it is appropriate for the client to join a support group for rape survivors. During the disorganization phase, the victim typically experiences shock, fear, disbelief, anger, shame, guilt, and feelings of uncleanliness. During denial, the victim appears outwardly composed and returns to work or school but refuses to discuss the assault and denies the need for counseling. At this time, the client would return to daily routines. During the reorganization phase, the victim attempts to make life adjustments by moving or changing jobs and uses emotional distancing to cope. At this time, the client may change positions or employers. The client must decide whether to file charges; this is not the nurse's choice.

When a pregnant client is victim of intimate partner violence during pregnancy, what complication is likely to occur after birth due to the abuse? postpartum depression edema low birth weight schizophrenia

postpartum depression Several studies have confirmed the relationship between intimate partner violence and poor mental health, especially depression. For the pregnant woman, this most often manifests itself as postpartum depression.

The nurse who has experience in caring for victims of intimate partner violence knows that goals for a victim may fall into which categories? Select all that apply. primary prevention secondary prevention tertiary prevention none of the above

primary prevention secondary prevention tertiary prevention Depending on when in the cycle of violence the nurse encounters a victim of intimate partner violence, goals may fall into three groups: primary, secondary and tertiary. Primary is aimed at breaking the cycle of violence, secondary focuses on dealing with the victims and abusers in early stages with goal of preventing progression, and tertiary is geared toward helping victims of severe intimate partner violence recover and become productive members of society.

Place the three phases of intimate partner violence in the order in which they occur. Use all options. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. tension-building phase acute violence phase honeymoon phase

tension-building phase acute violence phase honeymoon phase Tension building, the first phase, is seen as a building up of anger, arguments, and verbal fighting. The acute violence phase is the next phase, wherein physical harm comes to the victim. This can be a result of internal factors in the abuser or an external crisis. The honeymoon phase is the final phase in the cycle; during this phase, the relationship regains a feeling of calm and tranquility. This phase is filled with exchanges of love and passion.