Sem 3 - Unit 5 - IPV - NCO
When intimate partner violence (IPV) is suspected, the nurse plays an important role as an advocate for the victim. The advocate role includes what important components? Select all that apply. 1 Planning for future safety 2 Normalizing victimization 3 Validating the experiences 4 Promoting access to community services 5 Providing housing for the victim
1 Planning for future safety 3 Validating the experiences 4 Promoting access to community services 5 Providing housing for the victim Planning for the client's future safety needs, validating the client's experiences by letting the victim know that he or she is not alone, and promoting access to community services are all important roles of the nurse advocate. An advocate would not normalize the victimization by seeing the abuse as normal in the victim's relationship and failing to respond to the disclosure of the abuse. The advocate role would include information and resources for housing if needed, but not necessarily provide it.
A mother and her three young children arrive at the mental health clinic. The woman says that she is seeking help in leaving her husband. She reports that he has been beating her for years but just started hitting the children. What is the best initial action by the nurse? 1 Arranging for a staff member to watch the children so the mother and nurse can talk 2 Calling a facility where the mother and her children will be safe until the crisis is resolved 3 Determining whether the mother is ambivalent about this decision before making permanent plans 4 Suggesting that the mother and her husband return for couples counseling so the marriage can be saved
1 Arranging for a staff member to watch the children so the mother and nurse can talk This emotionally charged topic should be discussed with the client in a confidential session; after the nurse has assessed the situation, the woman and the nurse can plan the family's future. Although a safe facility may be called, a determination of the client's ambivalence may be made, and couples counseling may be recommended eventually, all three actions are premature if a thorough assessment of the situation has not been made.
A nurse is assessing a toddler and the dynamics of the child's family, in which abuse is suspected. What behaviors are expected? Select all that apply. 1 The child cringes when approached. 2 The child has unexplained healed injuries. 3 The parents are overly affectionate toward the child. 4 The child lies still while surveying the environment. 5 The parents give detailed accounts of the child's injuries.
1 The child cringes when approached. 2 The child has unexplained healed injuries. 4 The child lies still while surveying the environment. The child cringes when approached because past experiences with adults have resulted in pain rather than comfort. Evidence of past injuries may exist, but the parents do not discuss it, because this would be an admission of child abuse. Abused children are always on the alert for potential abuse. Lying motionless is an attempt to avoid attention; also, in the past the abused child's attempts to resist abuse have often precipitated more abuse. Abusive parents are unable to provide any emotional support and will not exhibit overly affectionate behavior. Because abusive parents try to hide the fact of abuse, explanations about injuries are usually fabricated, inconsistent, and vague.
A nurse is teaching a class about child abuse. What defense mechanism most often used by the physically abusive individual should the nurse include? 1 Repression 2 Manipulation 3 Transference 4 Displacement
4 Displacement Displacement is a defense mechanism in which one's pent-up feelings toward a threatening person are discharged on those who are less threatening. Repression is the unintentional putting out of the mind unacceptable or troubling thoughts, desires, or experiences. Transference is a mechanism by which affects or emotional tones are shifted from one individual to another; it is unrelated to child abuse. Manipulation is a mechanism by which individuals attempt to manage, control, or use others to suit their own purpose or to gain an advantage; it is unrelated to child abuse.
The nurse is caring for a client in preterm labor who reports that she fell down the stairs. Bruises are apparent on the left part of the client's lower abdomen, the back of each shoulder, and on both wrists. After instituting electronic fetal monitoring, starting tocolytic therapy, and examining the monitor strips, what action should the nurse take next? 1 Ambulating the client to promote circulation 2 Inserting two small-bore intravenous catheters 3 Determining whether the client feels safe at home 4 Ensuring that the client has her glasses to ambulate
3 Determining whether the client feels safe at home Bruising on the backs of both shoulders and both wrists indicates potential abuse; asking the client whether she feels safe at home will open a dialogue to discuss the possible physical abuse. Whether or not the client admits abuse, the nurse is required to report the finding. A client in preterm labor should have a large-bore intravenous catheter. Ambulation is not appropriate for a client in preterm labor, and bed rest should be maintained. Reporting should not be delayed.
A 6-year-old child with a leg fracture of suspicious origin is brought into the emergency department by the mother and the mother's boyfriend. It is the child's first visit to this hospital. After assessing the child, a nurse anticipates that the healthcare provider will order a skeletal survey. Why is a skeletal survey the preferred diagnostic tool? 1 The exact location and extent of the fracture will be pinpointed. 2 Three separate x-ray films of the leg and hip should be ordered, making it more cost-effective. 3 The skeletal history of the current fracture and any previous healing or healed fractures are identified. 4 It is the first step toward a complete assessment before computed tomography and magnetic resonance imaging are done.
3 The skeletal history of the current fracture and any previous healing or healed fractures are identified. Abusive parents may "shop" for hospitals that do not have a previous record of their child; the skeletal survey will provide a revealing injury history if abuse has occurred. Pinpointing the exact location of a fracture is necessary to plan appropriate treatment and can be done with a single x-ray film of the area; a skeletal survey is more extensive and helpful when abuse is suspected. Cost-effectiveness is not the primary concern if abuse is suspected. Computed tomography and magnetic resonance imaging are not required unless internal injuries are suspected.
What is the best room assignment for a 5-year-old child admitted with injuries that may be related to abuse? 1 In an isolation room 2 With a friendly older child 3 With a child of the same age 4 In a room near the nurses' desk
4 In a room near the nurses' desk A child who exhibits signs of abuse needs close supervision, especially when members of the family visit. The child requires close monitoring and should not be left alone. There is no indication that this child needs to be placed in an isolation room for the sake of infection control. An older child who exhibits signs of friendliness may be threatening to this child. Placement with a child of the same age may be desirable from a developmental level, but it does not meet the child's safety needs.
A woman who is frequently physically abused tells the nurse in the emergency department that it is her fault that her husband beats her. What is the most therapeutic response by the nurse? 1 "Maybe it was your husband's fault, too." 2 "I can't agree with that—no one should be beaten." 3 "Tell me why you believe that you deserve to be beaten." 4 "You say that it was your fault—help me understand that."
4 "You say that it was your fault—help me understand that." Paraphrasing and clarifying are interviewing techniques that promote communication between the nurse and client and help the client hear and explore her words and gain insight into her behavior. "Maybe it was your husband's fault, too" is a declarative statement that is closed, will limit dialog, and is not therapeutic. When the nurse voices her opinion saying, "I can't agree with that—no one should be beaten", the nurse is shutting off communication with the client. Nurses are to be nonjudgmental and not offer an opinion, and should ask open-ended questions to facilitate communication with the client. Asking a "why" question is generally not therapeutic because most clients cannot respond to these questions with logical explanations.
A nurse providing care in a hospital witnesses a client's spouse shaking the client vigorously because the client has had an episode of incontinence. Because of the suspicion of physical abuse, legally the nurse should discuss the concerns with which party? 1 The client 2 The client's spouse 3 The client's primary healthcare provider 4 Adult Protective Services
4 Adult Protective Services The nurse has a legal responsibility to report suspicions of abuse to the appropriate agency, which in this instance is Adult Protective Services. The client will not be able to understand the discussion. It is not the nurse's responsibility to directly challenge the spouse's behavior in this situation; the nurse may act as a client advocate by interrupting the spouse's behavior and providing immediate physical and emotional care. The nurse should then report suspicions of abuse to Adult Protective Services. Although the nurse may report suspicions about the spouse's behavior to the healthcare provider, the law requires that Adult Protective Services be notified.
A teacher's aide in a kindergarten class informs the school nurse that a male student said that his mother beat him and that he has bruises on the back and shoulders. What is the priority nursing action? 1 Notifying Child Protective Services 2 Reporting this information to the principal 3 Calling the parents to arrange a conference 4 Assessing the child for the presence of bruises
4 Assessing the child for the presence of bruises The nurse must validate the presence of physical injury and potential abuse before initiating other interventions. Child Protective Services, the school principal, and the parents should not be notified until signs of possible abuse are verified.