Chapter 28 Flashcards
Which comment by the nurse would best support relationship building with a survivor of intimate partner abuse?
a. “You are feeling violated because you thought you could trust your partner.”
b. “I’m here for you. I want you to tell me about the bad things that happened to you.”
c. “I was very worried about you. I knew you were living in a potentially violent situation.”
d. “Abusers often target people who are passive. I will refer you to an assertiveness class.”
A: The correct option uses the therapeutic technique of reflection. It shows empathy, an important nursing attribute for establishing rapport and building a relationship. None of the other options would help the patient feel accepted.
An 11-year-old reluctantly tells the nurse, “My parents don’t like me. They said they wish I was never born.” Which type of abuse is likely?
a. Sexual
b. Physical
c. Emotional
d. Economic
C: Examples of emotional abuse include having an adult demean a child’s worth, frequently criticize, or belittle the child. No data support physical battering or endangerment, sexual abuse, or economic abuse.
What feelings are most commonly experienced by nurses working with abusive families?
a. Outrage toward the victim and discouragement regarding the abuser
b. Helplessness regarding the victim and anger toward the abuser
c. Unconcern for the victim and dislike for the abuser
d. Vulnerability for self and empathy with the abuser
B: Intense protective feelings, helplessness, and sympathy for the victim are common emotions of a nurse working with an abusive family. Anger and outrage toward the abuser are common emotions of a nurse working with an abusive family.
Which rationale best explains why a nurse should be aware of personal feelings while working with a family experiencing family violence?
a. Self-awareness enhances the nurse’s advocacy role.
b. Strong negative feelings interfere with assessment and judgment.
c. Strong positive feelings lead to healthy transference with the victim.
d. Positive feelings promote the development of sympathy for patients.
B: Strong negative feelings cloud the nurse’s judgment and interfere with assessment and intervention, no matter how well the nurse tries to cover or deny feelings. Strong positive feelings lead to over-involvement with victims rather than healthy transference.
The parents of a 15-year-old seek to have this teen declared a delinquent because of excessive drinking, habitually running away, and prostitution. The nurse interviewing the patient should recognize these behaviors often occur in adolescents who:
a. have been abused.
b. are attention seeking.
c. have eating disorders.
d. are developmentally delayed.
A: Self-mutilation, alcohol and drug abuse, bulimia, and unstable and unsatisfactory relationships are frequently seen in teens who are abused. These behaviors are not as closely aligned with any of the other options.
What is a nurse’s legal responsibility if child abuse or neglect is suspected?
a. Discuss the findings with the child’s parent and health care provider.
b. Document the observation and suspicion in the medical record.
c. Report the suspicion according to state regulations.
d. Continue the assessment.
C: Each state has specific regulations for reporting child abuse that must be observed. The nurse is a mandated reporter. The reporter does not need to be sure that abuse or neglect occurred, only that it is suspected. Speculation should not be documented, only the facts.
Several children are seen in the emergency department for treatment of various illnesses and injuries. Which assessment finding would create the most suspicion for child abuse? The child who has:
a. complaints of abdominal pain.
b. repeated middle ear infections.
c. bruises on extremities.
d. diarrhea.
C: Injuries such as immersion or cigarette burns, facial fractures, whiplash, bite marks, traumatic injuries, bruises, and fractures in various stages of healing suggest the possibility of abuse. In older children, vague complaints such as back pain may also be suspicious. Ear infections, diarrhea, and abdominal pain are problems that were unlikely to have resulted from violence.
An 11-year-old says, “My parents don’t like me. They call me stupid and say they wish I were never born. It doesn’t matter what they think because I already know I’m dumb.” Which nursing diagnosis applies to this child?
a. Chronic low self-esteem related to negative feedback from parents
b. Deficient knowledge related to interpersonal skills with parents
c. Disturbed personal identity related to negative self-evaluation
d. Complicated grieving related to poor academic performance
A: The child has indicated a belief in being too dumb to learn. The child receives negative and demeaning feedback from the parents. The child has internalized these messages, resulting in a low self-esteem. Deficient knowledge refers to knowledge of health care measures. Disturbed personal identity refers to an alteration in the ability to distinguish between self and non-self. Grieving may apply, but a specific loss is not evident in the scenario. Low self-esteem is more relevant to the child’s statements.
An adult has recently been absent from work for 3-day periods on several occasions. Each time, the individual returned wearing dark glasses. Facial and body bruises were apparent. What is occupational health nurse’s priority assessment?
a. Interpersonal relationships
b. Work responsibilities
c. Socialization skills
d. Physical injuries
D: The individual should be assessed for possible battering. Physical injuries are abuse indicators and are the primary focus for assessment. No data support the other options.
A young adult has recently had multiple absences from work. After each absence, this adult returned to work wearing dark glasses and long-sleeved shirts. During an interview with the occupational health nurse, this adult says, “My partner beat me, but it was because I did not do the laundry.” What is the nurse’s next action?
a. Call the police.
b. Arrange for hospitalization.
c. Call the adult protective agency.
d. Document injuries with a body map.
D: Documentation of injuries provides a basis for possible legal intervention. In most states, the abused adult would need to make the decision to involve the police. Because the worker is not an older adult and is competent, the adult protective agency is unable to assist. Admission to the hospital is not necessary.
A patient tells the nurse, “My husband lost his job. He’s abusive only when he drinks too much. His family was like that when he was growing up. He always apologizes and regrets hurting me.” What risk factor was most predictive for the husband to become abusive?
a. History of family violence
b. Loss of employment
c. Abuse of alcohol
d. Poverty
A: An abuse-prone individual is an individual who has experienced family violence and was often abused as a child. This phenomenon is part of the cycle of violence. The other options may be present but are not as predictive.
An adult tells the nurse, “My partner abuses me when I make mistakes, but I always get an apology and a gift afterward. I’ve considered leaving but haven’t been able to bring myself to actually do it.” Which phase in the cycle of violence prevents this adult from leaving?
a. Tension-building
b. Acute battering
c. Honeymoon
d. Stabilization
C: The honeymoon stage is characterized by kind, loving behaviors toward the abused spouse when the perpetrator feels remorseful. The victim believes the promises and drops plans to leave or seek legal help. The tension-building stage is characterized by minor violence in the form of abusive verbalization or pushing. The acute battering stage involves the abuser beating the victim. The violence cycle does not include a stabilization stage.
After treatment for a detached retina, a survivor of intimate partner abuse says, “My partner only abuses me when I make mistakes. I’ve considered leaving, but I was brought up to believe you stay together, no matter what happens.” Which diagnosis should be the focus of the nurse’s initial actions?
a. Risk for injury related to physical abuse from partner
b. Social isolation related to lack of a community support system
c. Ineffective coping related to uneven distribution of power within a relationship
d. Deficient knowledge related to resources for escape from an abusive relationship
A: Risk for injury is the priority diagnosis because the partner has already inflicted physical injury during violent episodes. The other diagnoses are applicable, but the nurse must first address the patient’s safety.
A survivor of physical spousal abuse was treated in the emergency department for a broken wrist. This patient said, “I’ve considered leaving, but I made a vow and I must keep it no matter what happens.” Which outcome should be met before discharge? The patient will:
a. facilitate counseling for the abuser.
b. name two community resources for help.
c. demonstrate insight into the abusive relationship.
d. reexamine cultural beliefs about marital commitment.
B: The only outcome indicator clearly attainable within this time is for staff to provide the victim with information about community resources that can be contacted. Development of insight into the abusive relationship and reexamining cultural beliefs will require time. Securing a restraining order can be accomplished quickly but not while the patient is in the emergency department. Facilitating the abuser’s counseling may require weeks or months.
An older adult with Lewy body dementia lives with family and attends a day care center. A nurse at the day care center noticed the adult had a disheveled appearance, strong odor of urine, and bruises on the limbs and back. What type of abuse might be occurring?
a. Psychological
b. Financial
c. Physical
d. Sexual
C: Lewy body dementia results in cognitive impairment. The assessment of physical abuse would be supported by the nurse’s observation of bruises. Physical abuse includes evidence of improper care as well as physical endangerment behaviors, such as reckless behavior toward a vulnerable person that could lead to serious injury. No data substantiate the other options.
