28 - Child, Older Adult, & Intimate Partner Violence

Question 1

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.

Answer 1

c.) Violence occurs in families of all backgrounds.

Option C is a true statement. The others are false.

Question 2

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.

Answer 2

c.) the victim moves toward independence from the abuser.

When the abuser thinks he is losing control over the victim, the violence escalates.

Question 3

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.

Answer 3

c.) honeymoon.

During the honeymoon stage, the perpetrator apologizes, promises never to abuse again, and tries to make up for the violence.

This stage is usually brief.

Question 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.”

Answer 4

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.”

Job loss, financial problems, and a child who is “different” and has special needs should alert the nurse to the risk for family violence, because all these factors contribute to a crisis situation.

Question 5

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.

Answer 5

d.) financial maltreatment.

Financial maltreatment occurs when the perpetrator takes financial advantage of the elderly person, often through the use of subtle threats of what unpleasant or frightening outcome will occur if the elder does not supply funds.

Question 6

The nurse performing the assessment of a wheelchair-bound 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.

Answer 6

b.) have the wife wait in the waiting room so her husband can be interviewed in private.

Suspected victims of abuse should always be interviewed in private.

If the perpetrator is in the room, the victim cannot speak freely.

Question 7

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.

Answer 7

c.) direct and professional.

Expressing strong emotion does not help the victim.

A direct, honest, and professional manner of asking questions produces the best results.

Question 8

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. ) stop-gap therapy.

Answer 8

b.) secondary prevention.

Secondary prevention is synonymous with treatment.

Question 9

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.

Answer 9

c.) A 2-year-old who has leukemia and two working parents.

Although the child in option C has a serious physical disorder, she is at lower risk than the child in option A, whose inconsolable crying can be frustrating; the child in option B, who will not be as independent as other children his age and who has parents who may not understand his needs; or the child in option D, whose hyperactivity can be annoying, especially to a parent who himself has been abused.

Question 10

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.

Answer 10

d.) Neglect is a failure to provide; abuse is a failure to control aggression.

Neglect is failure to provide necessary care, and abuse is physical maltreatment.

Question 11

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.

Answer 11

a.) the vulnerability of the elder and the stress of the caregiver.

Abuse occurs across all segments of society and is reinforced by the society and the culture.

The actual occurrence of violence requires:

1. a perpetrator,
2. someone who by age or situation is vulnerable (e.g., children, women, men, the elderly, mentally ill persons, and physically challenged persons), and
3. a crisis situation.

Question 12

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.

Answer 12

b.) fear.

The client is expressing fear based on a known threat.

Question 13

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.

Answer 13

b.) begin attending anger management training sessions within 2 weeks.

Perpetrators of violence need help learning how to manage anger.

A structured group is an excellent way to provide this teaching.

Question 14

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.

Answer 14

b.) affirm that the client did not deserve or cause the abuse.

Abused clients often believe that they are deserving of the abuse and, in some way, prompt the abuser to attack.

They need specific reassurance that they did not deserve to be abused and they did not cause the attack.

Question 15

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

Answer 15

a.) How the victim will explain her decision to leave

Any abused person has been threatened.

This is a given and does not enter into the details of the escape planning.

Question 16

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.

Answer 16

a.) refuses to provide any information.

The nurse must respect the client’s right to confidentiality.

Whether the questioner asks pleadingly or in a demanding way, the answer must be the same.

Question 17

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

Answer 17

c.) Considering ways to commit suicide

A person experiencing violence may feel so trapped in a detrimental relationship, yet so desperate to get out, that suicide may seem the only answer.

A suicide attempt may be the presenting symptom in the emergency department.

At least 10% of abused women attempt suicide.

The other reports are not realistic for a woman who is being abused.

Question 18

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.

Answer 18

b.) assist her to develop a plan to go to a shelter in case of a crisis.

Every victim of abuse should have an escape plan, but one is particularly important when the nurse believes the client is in severe danger.

Question 19

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.

Answer 19

c.) emotional violence.

Emotional violence occurs when the child’s self-esteem is attacked.

It is as devastating to the child as physical abuse.

Question 20

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.

Answer 20

b.) follow agency policy for reporting.

Nurses are mandated reporters of child abuse.

They must follow the rules set forth by the state regarding the steps to take to report child abuse.

Question 21

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

Answer 21

d.) Rose, a 77-year-old woman living with her daughter and son-in-law

Older women dependent on family members for care are at higher risk for abuse.

The other options do not describe specific characteristics that put them at higher risk for abuse.

Question 22

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.

Answer 22

a.) with vague physical complaints such as insomnia or pain.

Patients may present with symptoms that may be vague and can include chronic pain, insomnia, hyperventilation, or gynecological problems.

Attention to the interview process and setting is important to facilitate accurate assessment of physical and behavioral indicators of family violence.

Presenting with extreme anger is possible but not as common as presenting with vague physical complaints.

Having many family members there is unlikely as many victims keep their history of being battered a secret.

It is not known that psychosis or mania is a result of physical violence, and this would not be a usual presenting complaint.

Question 23

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.

Answer 23

b.) Mikayla has been sexually abused.

Sexualized behavior is one of the most common symptoms of sexual abuse in children. Younger children may draw sexually explicit images, demonstrate sexual aggression, or act out sexual interactions in play, for example, with dolls.

Masturbation may be excessive in sexually abused children.

It is not normal developmental behavior for a 4-year-old child. The other options may be true, but sexual abuse is more likely and must be investigated.

Question 24

After arranging for a sexual assault nurse examiner (SANE) to see Lauren and Mikayla for further assessment for abuse and proper reporting and follow-up, 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.”

Answer 24

c.) “Darrin yells a lot and calls me names, but that’s because I am so stupid and make so many mistakes.”

Emotional abuse may be less obvious and more difficult to assess than physical violence, but it can be identified through indicators such as low self-esteem, reported feelings of inadequacy, and anxiety.

Controlling the finances and having the electricity turned off describes the possibility of economic abuse. Not wanting to add to the boyfriend’s stress does not describe an abusive situation.

The spouse being Latin American with a temper would more likely hint at physical abuse rather than emotional.

Question 25

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.

Answer 25

d.) The sexual abuse will cease.

The highest priority in this case is that the abuse stops so that the patient can be safe and undergo recovery. The question is asked about the priority outcome for the victim, not the mother.

Verbalizing exactly what happened is not a priority.

The victim will most likely stop the sexualized behavior when the abuse has stopped and recovery is supported by age appropriate interventions.