Maternity and Pediatric Nursing Ch 33

Which statement made by a new nurse demonstrates an understanding of the prevalence of sexual assault and related violence among the population?

"I've come to realize that I need to include questions related to sexual assault and related violence into the assessment of all my clients."

An obviously pregnant woman appears for her first prenatal visit. She reports a headache and generalized abdominal pain which has persisted over the past couple months. Which question should the nurse prioritize after determining the client is approximately 24 weeks' gestation, appears nervous, and is reluctant to have a full physical assessment?

"do you feel safe at home?"

A nurse suspects that a 6-year-old girl is being sexually maltreated by her father, based on some comments made by the girl. Which of the following methods would be most effective in confirming the nurse's suspicion?

Ask the girl to draw a picture of what happened

When living in a household with substance use, which parental characteristic provides the leading negative effect?

Inability to provide consistent parenting

The nurse is caring for a client in an abusive situation. In developing a plan of care, which factors does the nurse consider? Select all that apply.

It often takes several attempts before a woman leaves an abusive situation. Women in abusive relationships usually feel isolated and unsupported. Substance use is a common factor in abusive relationships.

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?

Provide the client with contact information for a 24-hour shelter and social worker on discharge.

A nurse working in the emergency department who suspects child abuse should do which of the following?

Report it to the authorities

The responsibility of the nurse caring for a victim of child abuse in the emergency room would include which of the following?

Suggesting to the attending physician that the child be admitted for observation

A teenage client has been undergoing individual psychotherapy following a sexual assault a few days ago. The nurse would determine that the early stage of therapy is successful when the client meets which outcome?

The client is able to describe what happened and express feelings.

A school nurse is developing a plan of care for a child with suspected violence between the child's parents. The nurse monitors for which behaviors in the child?

aggressive behavior in school

When initiating care for a client suspected of being a victim of human trafficking, what is the nurse's primary responsibility?

building trust

The nurse visits the foster home of a newborn with failure to thrive syndrome. Which observation indicates a successful outcome for this child's care?

child eagerly takes a bottle and is gaining weight

A child with acute bronchitis has just been hospitalized. The nurse overhears the child's mother say to the child that if he is not good, she will leave and not come back until he is ready to return home. What should the nurse suspect in this situation?

emotional abuse

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?

inform the client about risk factors and determine the immediate level of danger

A 5-year-old child has frequent visits to the school nurse's office. Which assessment data should alert the nurse that this child may be a victim of physical neglect?

malnourished with frequent absences from school

The nurse is caring for a pediatric client with the injury pictured. When asking the caregivers about the way in which the client received these injuries, which communication manner is essential?

nonjudgmental manner

which statement by a parent of a 4-year-old child is most likely to suggest child abuse?

"He doesn't ever help me clean house."

In which age range are women most vulnerable for intimate partner violence?

16-24 years

A nursing instructor is discussing child maltreatment. What response by the student shows an understanding of what is included in the description of child maltreatment? Select all that apply.

Intentional physical maltreatment Intentional psychological maltreatment Sexual maltreatment Negligence by someone responsible for the care of a child

Which patient's physical assessment finding of a school-age child should the nurse question as a potential indication of abuse?

Linear abrasions on his ankles and wrists

The parents bring their 4-week-old infant to the emergency room unresponsive. The parents indicate that the infant was shaken. Which diagnostic test is anticipated?

MRI

The caregiver of a 2-year-old child reports to the nurse that the child vomits at least five or six times a day, sometimes continuously. The child is admitted for observation and the mother continues to report the child is vomiting, but the nurses never see the child vomit or any evidence the child has vomited. The child will likely be found to have

Munchausen syndrome by proxy.

A 6-year-old child is playing. Which play scenarios witnessed by the nurse are indicative that the child is sexually abused? Select all that apply.

Playing with a boy and girl doll in a sexually graphic manner Using inappropriate adult language Arranging dolls in unnatural positions for play

The nurse is visiting the home of a family with a previous history of physical neglect. Which observation indicates that interventions have not been successful?

The father allows the children to stay home from school whenever they desire

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?

being nonjudgmental

A nurse is caring for a 6-year-old in the hospital with gastroenteritis and dehydration. The parent has been visiting intermittently. Today, the nurse overhears the parent say to the child, "If you are going to cry while I am here, I am not coming back and will leave you here for someone else to take care of!" What type of situation is this?

insufficient or poor nurturing

The nurse is caring for a child who has unusual bruises and marks that do not match the child's developmental age. When completing an admission assessment, which other information does the nurse identify as a potential factor in child abuse?

long-term unemployment without supplemental income

The nurse advises a family that all health care personnel are to report suspected child abuse. Who orders this directive?

The state in which the nurse works

A 1-year-old is a victim of child abuse. Which of the following factors obtained on history is most apt to be associated with the risk of Munchausen syndrome by proxy physical abuse in children?

The mother was abused as a child.

The nurse is completing the physical assessment of a 12-year-old child who has a series of bruises in various stages of healing. When asked about the bruises the child appears frightened and offers inconsistent accounts about how the child got the bruises. The nurse suspects abuse. Which initial action of the nurse is most appropriate?

Document the bruises and any statements made by the child relating to them

The nurse is concerned that a child is the victim of factitious disorder (Munchausen syndrome by proxy). Which assessment finding supports this concern? Select all that apply

The child's ymptoms are vague and only reported by the parent. The mother stays with the child continuously and provides care. The family makes repeated visits to the health care facility the when child is well. The mother is a student nurse and is under a great deal of stress.

The nurse manager is educating staff about the mandate of health care workers to report suspected child abuse. A staff member asks, "What if you are not certain that it is an abuse situation. What should the nurse do?" The nurse manager is most correct when providing which answer?

"Feel comfortable about reporting your suspicion as the law protects you."

A nurse is discussing concerns about possible child abuse with the nursing supervisor. Which statement by the nurse requires correction by the supervisor?

"HIPAA prevents nurses from disclosing confidential information from parents."

While performing an assessment on a female client, the nurse notes signs of sexual assault. When questioned, the client states, "I am married, so I have not been raped or abused." What statement by the nurse is most appropriate?

"If you do not consent, it is still assault when you are married."

Which parental statements identify emotional abuse on a 5-year-old child? Select all that apply.

"If you don't stay home and help me, don't come back. I don't want you." "Why are you so stupid? I told you to feed your sister, but not oatmeal." "Once I got pregnant with you my life was over. I could not go to school."

A 14-year-old girl is brought to the emergency department saying she was sexually assaulted. She tells the nurse that she feels guilty for having gone to a party where alcohol was being served. What is the nurse's best response?

"No one deserves to be raped, even going to a party with alcohol."

A 4-year-old has been sexually abused. As you watch her play with anatomically correct dolls, she inserts the male doll's penis into the female doll's mouth. What is your best response to this action?

"what are the dolls doing?"

If the following data was collected on a group of children, which of the following would most likely be evaluated as possibly related to child abuse? Select all that apply.

A child whose X-ray shows bone fractures in various stages of healing. A child who has a spiral fracture in the femur. A child whose CT scan shows an unexplained cerebral hemorrhage.

The elementary school nurse is caring for four clients with physical injuries. Which child would require follow-up?

An 8-year-old with bruising noted on the inner aspect of the arms

When beginning care for a victim of rape, the nurse asks the patient to "talk about what happened" to her. For which nursing diagnosis is the nurse using this approach?

Anxiety related to recent rape

During a routine well-child visit, the mother of a preadolescent patient asks the nurse to explain signs of sexual abuse. The mother is concerned because an older male neighbor has been making comments and overtly admiring the child when playing outdoors. What signs of sexual abuse should the nurse tell the mother to look out for? Select all that apply.

Child reports abdominal pain. Child has a change in school performance. Child demonstrates anxiety or trouble sleeping. Child does not want to be left alone with a certain adult.

Which clinical symptoms are documented as being indications of sexual abuse? Select all that apply.

Gastrointestinal upset Changes in bowel and bladder habits Behaviors of aggression and hostility

Which symptoms does the nurse identify as potential clinical manifestations resulting from physical abuse in the home? Select all that apply.

Poor attendance in school Feelings of guilt Behavioral issues Bedwetting

A nurse is working with the burn clinic at a local hospital. Which types of burns would the nurse address with the health care provider and social worker? Select all that apply.

Small, round burns Hand burns with a pattern Linear pattern burns

A nurse is working with a child she suspects may be a victim of maltreatment in her home. Which combination of characteristics related to the parent, the child, and the circumstances would most strongly indicate the risk for maltreatment of this child?

The mother was maltreated as a child; the child was born prematurely; the father recently lost his job

When does the nurse identify that corporal punishment becomes child abuse? Select all that apply.

When the punishment leaves marks on the child's body When physical harm is threatened, leaving the child in fear When emotional harm has occurred due to the results of the punishment When an injury has occurred as a result of the punishment

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?

ask he client how she acquired the bruises

A family nurse practitioner is speaking to a community group about family abuse and informs the group that such abuse can take various forms, including which of the following? Select all that apply.

child abuse spouse abuse other family member abuse substance abuse

A 16-year-old girl is seen in an emergency department following a rape. The management of a rape victim should be directed primarily toward:

decreasing guilt and increasing self-esteem

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?

do you feel safe at home?

A nurse is performing a routine physical for a 7-year-old girl who is thin, unwashed, and dressed in rags. Although it is winter time, she has no coat with her. Her teenage brother in the waiting room, however, is dressed in trendy clothes and looks healthy and well-fed. Which of the following should the nurse most strongly suspect regarding this girl?

physical neglect

In addition to physical examination, what is another important way that nurses know physical abuse is confirmed?

radiography

A 10-year-old accompanies a parent to the emergency department. The child reports that the parent has taken pills and "a lot" of alcohol. The child assists the parent onto a stretcher. The parent states, "I wouldn't be drinking if it wasn't for you!" In what type of situation are the parent and child existing?

role reversal

Which type of fracture is most indicative of child abuse?

spiral fracture

During a prenatal examination the nurse observes bruises on a woman's arms and a black eye. When asked about the bruises, the client states, "It was an accident. My husband just had a bad day at work, and I was late getting his dinner. But he is being so kind now; he brought me flowers yesterday. He is looking for a new job, so it won't happen again." This client is in which phase of the cycle of violence?

the honeymoon phase

The nurse is teaching a group of nursing students about intimate partner violence. Which statement by the nurse is accurate?

"Power and control are central to the dynamic of intimate partner violence."

A nurse is assigned to care for a hospitalized 14-year-old with gastroenteritis. The teen tells the nurse that a brother ran away about 2 months ago and hasn't been heard from since, a sister has a substance abuse problem, and both parents are fighting. What type of situation is this family displaying?

Dysfunctional dynamics

What behaviors would the school nurse observe when suspecting that a child is living with a family in which there is an addiction problem? Select all that apply.

The child is a loner and avoids interaction with classmates. The child frequently comes into the nurse's office with vague complaints of a stomach ache. The child has missed a significant amount of school for "illness."