Chapter 28 - Child, Older Adult, and Intimate Partner Violence

Question 1

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.”

Answer 1

a. “You are feeling violated because you thought you could trust your partner.”

Question 2

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

Answer 2

c. Emotional

Question 3

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

Answer 3

b. Helplessness regarding the victim and anger toward the abuser

Question 4

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 clients.

Answer 4

b. Strong negative feelings interfere with assessment and judgment.

Question 5

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 client should recognize these behaviors often occur in adolescents who are having or had what experience?

a. Been abused.
b. Attention seeking.
c. An eating disorders.
d. Are developmentally delayed.

Answer 5

a. Been abused.

Question 6

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.

Answer 6

c. Report the suspicion according to state regulations.

Question 7

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?

a. complaints of abdominal pain.
b. repeated middle ear infections.
c. bruises on extremities.
d. diarrhea.

Answer 7

c. bruises on extremities.

Question 8

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

Answer 8

a. Chronic low self-esteem related to negative feedback from parents

Question 9

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

Answer 9

d. Physical injuries

Question 10

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

Answer 10

d. Document injuries with a body map

Question 11

A client 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

Answer 11

a. History of family violence

Question 12

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

Answer 12

c. Honeymoon

Question 13

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

Answer 13

a. Risk for injury related to physical abuse from partner

Question 14

A survivor of physical spousal abuse was treated in the emergency department for a broken wrist. This client 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?
a. The client will facilitate counseling for the abuser.
b. The client will name two community resources for help.
c. The client will demonstrate insight into the abusive relationship.
d. The client will reexamine cultural beliefs about marital commitment.

Answer 14

b. The client will name two community resources for help.

Question 15

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

Answer 15

c. Physical

Question 16

An older adult diagnosed with Alzheimer’s disease lives with family in a rural area. During the week, this adult attends a day care center while the family is at work. In the evenings, members of the family provide care. Which factor makes this adult most vulnerable to abuse?

a. Multiple caregivers
b. Alzheimer’s disease
c. Living in a rural area
d. Being part of a busy family

Answer 16

b. Alzheimer’s disease

Question 17

An older adult with Lewy body dementia lives with family. After observing multiple bruises, the home health nurse talked with the daughter, who became defensive and said, “My mother often wanders at night. Last night she fell down the stairs.” Which nursing diagnosis has priority?

a. Risk for injury related to poor judgment, cognitive impairments, and inadequate supervision
b. Wandering related to confusion and disorientation as evidenced by sleepwalking and falls
c. Chronic confusion related to degenerative changes in brain tissue as evidenced by nighttime wandering
d. Insomnia related to sleep disruptions associated with cognitive impairment as evidenced by wandering at night

Answer 17

a. Risk for injury related to poor judgment, cognitive impairments, and inadequate supervision

Question 18

An older woman diagnosed with Alzheimer’s disease lives with family and attends day care. After observing poor hygiene, the nurse talked with the caregiver. This caregiver became defensive and said, “It takes all my energy to care for my mother. She’s awake all night. I never get any sleep.” Which nursing intervention has priority?

a. Teach the caregiver about the effects of sundowner’s syndrome.
b. Secure additional resources for the mother’s evening and night care.
c. Support the caregiver to grieve the loss of the mother’s cognitive abilities.
d. Teach the family how to give physical care more effectively and efficiently.

Answer 18

b. Secure additional resources for the mother’s evening and night care.

Question 19

An adult has a history of physical violence against family when frustrated, followed by periods of remorse after each outburst. Which finding indicates a successful plan of care?

a. The adult expresses frustration verbally instead of physically.
b. The adult explains the rationale for behaviors to the victim.
c. The adult identifies three personal strengths.
d. The adult agrees to seek counseling.

Answer 19

a. The adult expresses frustration verbally instead of physically.

Question 20

Which referral will be most helpful for a woman who was severely beaten by intimate partner, has no relatives or friends in the community, is afraid to return home, and has limited financial resources?

a. A support group
b. A mental health center
c. A women’s shelter
d. Vocational counseling

Answer 20

c. A women’s shelter

Question 21

A 10-year-old cares for siblings while the parents work because the family cannot afford a babysitter. This child says, “My father doesn’t like me. He calls me stupid all the time.” The mother says the father is easily frustrated and has trouble disciplining the children. The community health nurse should consider which resources as priorities to stabilize the home situation? (Select all that apply.)

a. Parental sessions to teach childrearing practices
b. Anger management counseling for the father
c. Continuing home visits to give support
d. A safety plan for the wife and children
e. Placing the children in foster care

Answer 21

a. Parental sessions to teach childrearing practices
b. Anger management counseling for the father
c. Continuing home visits to give support

Question 22

A nurse assists a victim of intimate partner abuse to create a plan for escape if it becomes necessary. Which components should the plan include? (Select all that apply.)

a. Keep a cell phone fully charged.
b. Hide money with which to buy new clothes.
c. Have the phone number for the nearest shelter.
d. Take enough toys to amuse the children for 2 days.
e. Secure a supply of current medications for self and children.
f. Assemble birth certificates, Social Security cards, and licenses.
g. Determine a code word to signal children when it is time to leave.

Answer 22

a. Keep a cell phone fully charged.
c. Have the phone number for the nearest shelter.
e. Secure a supply of current medications for self and children.
f. Assemble birth certificates, Social Security cards, and licenses.
g. Determine a code word to signal children when it is time to leave.

Question 23

A community health nurse visits a family with four children. The father behaves angrily, finds fault with the oldest child, and asks twice, “Why are you such a stupid kid?” The wife says, “I have difficulty disciplining the children. It’s so frustrating.” Which comments by the nurse will facilitate an interview with these parents? (Select all that apply.)

a. “Tell me how you discipline your children.”
b. “How do you stop your baby from crying?”
c. “Caring for four small children must be difficult.”
d. “Do you or your husband ever spank your children?”
e. “Calling children ‘stupid’ injures their self-esteem.”

Answer 23

a. “Tell me how you discipline your children.”
b. “How do you stop your baby from crying?”
c. “Caring for four small children must be difficult.”