NCLEX Violence: Anger, Abuse, and Aggression Flashcards
A young child is being evaluated in the Emergency Department for injuries her mother reports resulted from a fall down the stairs. Which of these findings indicates that physical abuse may be a chronic problem for the child?
a. The mother’s description of the child as being ‘clumsy’
b. Several fractures revealed on x-ray in varying degrees of healing
c. Clinging to her mother as she attempted to leave the examining room
d. Struggling with the staff when attempts to obtain a blood specimen were made
ANS: B
Unhealed fractures indicate both numerous injuries and that medical intervention was not sought at the time of injury. Although unkind, the mother’s description of the child is not reason to believe chronic abuse has occurred. The remaining options reflect normal behavior, especially if pain or separation is suspected.
A child was admitted to the children’s unit, having been sexually abused by an acquaintance of her family. The child refuses to talk and participate in unit activities, choosing to stay in her room with her stuffed animals. Which therapeutic intervention will best help the child release pent-up feelings about the abuse?
a. Family therapy
b. Play therapy
c. Individual communication with the nurse
d. Role-play with other children on the unit
ANS: B
Play helps communicate and release feelings about the child’s problems. A child may have difficulty expressing feelings verbally. Family therapy may be useful, but it is not designed for releasing feelings. Role-playing is more effective with older children or adults.
The nurse is leading a support group for women who have experienced interpersonal violence. When a patient asks about the characteristics of the perpetrators of interpersonal violence, the nurse accurately responds that they are:
a. Usually under the influence of alcohol
b. Most often someone the victim knows
c. A stranger to the victim in most cases
d. Often in a psychotic state during the act
ANS: B
Statistics show that interpersonal violence is usually committed by someone the victim knows. Drugs and alcohol are not necessarily involved. The victim usually knows the perpetrator. The perpetrators are aware of what they are doing.
Which nursing intervention will assist a patient being treated in the Emergency Department for extensive soft tissue injuries to disclose an experience of domestic violence?
a. Allowing the patient to initiate the topic of violence
b. Speaking with the patient in the absence of her husband
c. Providing a safe, nonintimidating, and supportive environment
d. Interviewing her in the presence of another healthcare professional
ANS: C
Providing a safe environment is the first step in assisting a patient who is a victim of domestic violence. Including others in the conversation may increase anxiety and reluctance to disclose. Isolating the husband is assumed in providing a safe, nonintimidating environment. The patient may not disclose without prompting by the nurse.
A patient admits to having been battered by her live-in boyfriend several times over the past 2 years. She states to the nurse, “We plan to get married next June, and I think things will be better then. He is always so sorry afterward, that I think I can trust him to change.” Which intervention should be included in the patient’s teaching plan?
a. Discourage her hope that the battering will end after they are married.
b. Assist her in enrolling in a class to learn techniques of self-defense.
c. Assist her in developing an emergency plan, because the pattern of violence is likely to continue.
d. Emphasize that the battering pattern usually remains the same in frequency and severity over time.
ANS: C
Developing an emergency plan is critical for any battered woman. The battering is not likely to cease unless the batterer seeks help but stating that fact is not therapeutic by itself. This will not stop the violence, although it might afford her some protection. Violence usually increases over time
The nurse in the Emergency Department is taking a history from a family accompanying a child with suspicious traumatic injuries. The nurse should:
a. Be open, concerned, and honest.
b. Obtain information as covertly as possible.
c. Avoid responding to hints that abuse has occurred.
d. Separate the family from the child during the interview.
ANS: A
The nurse serves as a role model for the parents and the child. Being open and honest and showing appropriate concern for the child is the most appropriate approach. Direct questioning is necessary to obtain the history. Concerns about the possibility of abuse must be addressed in a sensitive manner. The family will be able to remain with the child during history taking. It is helpful for the nurse to observe family interactions.
When an elderly patient is brought into the Emergency Department by family members who reported a fall the nurse became suspicious that the patient had suffered physical abuse. The patient denied that she had been abused. Her denial is most likely based on her:
a. Feeling that she deserved the physical abuse
b. Strong belief that nothing could be done to help her
c. Lack of trust that the situation could ever be changed
d. Fear of the possibility of being removed from her family
ANS: D
Fear of being separated from family and institutionalized is a powerful motive that keeps elders from revealing abuse. The other options may be factors in some cases but they are not primary motivators of silence.
A nurse planning a group to help batterers learn more effective ways to cope would teach participants that the key component in wife battering is:
a. Their need for the batterer to control
b. The role of alcohol in the pattern of abuse
c. History of psychotic or paranoid behavior
d. Failure of the woman involved to assert herself
ANS: A
The batterer uses violence as a means of controlling his partner to meet his own needs. Alcohol use is not the root cause of spousal abuse. There are no data to support mental illness as a factor in abusive relationships. Assertive behavior may result in increased abuse.
The nurse caring for a school-age child who has been sexually abused by a close family member demonstrates an understanding of communication barriers in this situation by:
a. Realizing that repeated questioning by others will occur
b. Assuring the child that the story they are telling is believed
c. Reinforcing that the child will not be in trouble with the police
d. Promising to tell only those who need to know about the incident
ANS: B
Fear of being blamed or of being disbelieved is a powerful motivator of silence. When the child fears that there will be no support, there is no reason to disclose the abuse. The other options are much more remote.
The nurse is considering making a child abuse or neglect report to protective services. To make the report, the nurse needs to:
a. Have strong evidence that the abuse/neglect has occurred.
b. Obtain the supervisor’s permission to make the report.
c. Notify the parents of the intent to file the report.
d. Have suspicions that the abuse has occurred.
ANS: D
Suspicions are all that are required by state mandatory child abuse and neglect reporting laws. The agency bears the burden of collecting evidence. As a mandated reporter, the nurse does not need anyone’s permission to make the report. Only a suspicion is required. Parent notification is unnecessary.
A community health nurse is working with a family in which an elderly woman was neglected by her son and his wife but insists on remaining with the young couple despite the threat of future neglect. Which intervention should be given highest priority?
a. Identifying community resources to decrease the caregivers’ stress
b. Establishing patient rights and consequences of abuse and monitoring
c. Providing stress management techniques for both of the caregivers
d. Educating the caregivers on the aging process and how to cope with it
ANS: B
Securing the patient’s safety is the priority for care. This option sets forth expectations for the family and establishes the fact that the patient’s state will be monitored. The other options are appropriate interventions but are not the highest priority.
To provide nursing care to abused children and their families, the nurse must first:
a. Recommend removal of the children from the family.
b. Complete a comprehensive physical and mental assessment.
c. Refer each case to the appropriate social worker for follow-up.
d. Examine personal feelings regarding the trauma of child abuse and neglect.
ANS: D
Self-examination is required in order for the nurse to be objective and therapeutic in providing care. Although important, an assessment is not the initial step in this situation. Removal is not always recommended. A social service referral may not be required, depending on the situation.
According to statistical research data, which of these children currently being followed by the pediatric nurse practitioner is at the greatest risk for fatal abuse?
a. A child who is 2 years old and has cerebral palsy
b. A child who is 5 years old and has chicken pox
c. A child who is 8 years old and has appendicitis
d. A child who is 11 years old and has a fractured humerus
ANS: A
At highest risk for fatal abuse are children under 3 years of age and those with disabilities. The remaining options do not present children meeting the criteria.
A patient has been physically abused by her boyfriend frequently since moving in together. During her last discussion with the nurse, the patient stated, “I probably should not keep going back to him, because he continues to abuse me.” The nurse is aware that the final decision to leave a batterer is:
a. Usually a gradual process that occurs over time
b. Likely to occur after the victim suffers a serious injury
c. More likely if the patient has approval from her family
d. Made when the batterer gives her permission to do so
ANS: A
The victim usually moves slowly when making the decision to leave the batterer because of many self-imposed constraints and many environmental factors that must be considered. It is unlikely that a batterer will give permission for the victim to leave. The remaining options are not supported by current research.
A patient has been chronically battered by her husband since they were married. Until now she had avoided dealing with her situation, but she now expresses a desire to deal with the problem since the attacks are occurring more frequently. Which outcome is realistic for the patient?
a. Setting a goal date for divorcing her husband
b. Verbalizing an awareness of her increasingly dangerous situation
c. Citing possible ways she may have contributed to the abusive episodes
d. Employing methods of retaliating in order to gain experience being assertive
ANS: B
Because the abuse has been long-term and is increasing in intensity, the patient needs to state her awareness of being in danger. When the patient accepts this fact, she may be increasingly ready to make further plans to extricate herself. The victim is not at fault for abuse. Setting a divorce date is not practical because she has not begun to pursue litigation. Retaliation is not an effective means of resolving the problem.
