Deck 26: Child, Older Adult, and Intimate Partner Abuse

Question 1

A child,aged 11 years,stays home from school to care for his siblings while his mother works,because the family cannot afford a babysitter.The home is cluttered and dirty.When asked about his parents,the child reluctantly reveals that he thinks his father does not like him very much because he calls him "stupid" and says he can never do anything right.This should be assessed as:

A) physical abuse.
B) sexual abuse.
C) emotional abuse.
D) economic abuse.

Answer 1

emotional abuse.

Question 2

A community mental health nurse is assigned to investigate the frequent school absences of an 11-year-old child.The nurse finds the child home alone,caring for his 1- and 3-year-old siblings.The house is cluttered and dirty,and both parents are at work.The child tells the nurse that whenever his mother is called to work at her part-time job,he must watch the kids because the family cannot afford a babysitter.Based on the information obtained thus far,what preliminary assessment can be made?

A) The child is coping well with a difficult situation.
B) The child and his siblings are experiencing neglect.
C) The children are at high risk for sexual abuse.
D) The children are experiencing physical abuse.

Answer 2

The child and his siblings are experiencing neglect.

Question 3

A victim of partner abuse,parent of one child,describes the partner as someone who is easily frustrated and more likely to be abusive after a experiencing an event in which self-esteem is challenged.The most recent episodes of violence were related to feeling "upset" over a job loss.What type of therapy would provide the greatest help to the victim?

A) Individual therapy
B) Group therapy
C) Couples therapy
D) Family therapy

Answer 3

Group therapy

Question 4

A woman has been severely beaten by her husband,has no relatives or friends in the community,is afraid to return home,has no financial resources of her own,and has no job skills.Which would be the most important referral for the nurse to make?

A) Community food cupboard
B) Vocational counseling
C) Law enforcement
D) Safe house or shelter

Question 5

A child,aged 11 years,has to stay home from school to care for his siblings while his mother works,because the family cannot afford a babysitter.The father appears to be emotionally abusive.Which intervention could be used for the primary prevention of problems such as these?

A) Involve the parents in a parenting support group,and help them find affordable childcare.
B) Meet with elected officials to lobby for subsidized childcare and increasing the minimum wage.
C) Screen for signs of abuse and neglect in all children so that it can be discovered and treated early.
D) Provide supportive counseling services for those who have survived neglect or abuse.

Question 6

A patient,aged 82 years,has Alzheimer's disease.She lives with her daughter's family and goes to a day care facility on weekdays.The nurse at the day care center noticed the patient was unkempt and had multiple bruises.When the daughter arrived to pick her up,the nurse discussed her observations.The daughter became defensive and said that her mother was very difficult to manage.She stated,"My mother is not my mother anymore.She is confused,and she wanders all night.We have to watch her constantly.Last night I fell asleep,and she fell down the stairs.Sometimes I just cannot bear to care for her." Which nursing diagnosis would be most important to address for this patient?

A) Risk for injury related to impaired cognition,judgment,and coordination and lack of caregiver supervision
B) Nonadherence related to confusion and disorientation,as evidenced by lack of cooperation
C) Anxiety related to increasing disorientation,as evidenced by the patient wandering at night
D) Impaired verbal communication related to brain impairment,as evidenced by the patient's confusion

Question 7

A child,aged 11 years,stays home from school to care for his siblings while his mother works,because the family cannot afford a babysitter.The home is cluttered and dirty when the community mental health nurse visits to investigate the child's school absences.When the parents arrive home from work,the child's father behaves angrily.He orders his wife and son about.He finds fault with the son,asking him twice,"Why are you such a stupid kid?" The wife tells the nurse she has difficulty disciplining the children and gets frustrated easily.The nurse desires to build some trust and continue to gather assessment data.The remark or question that would interfere with the nurse's goals is:

A) "Tell me what happens when the children misbehave."
B) "When your baby cries,how do you get him to stop?"
C) "Caring for three young children must be difficult."
D) "Do you or your husband ever beat the children?"

Question 8

A patient,aged 82 years,has Alzheimer's disease.She lives with her daughter's family and goes to a day care facility on weekdays.The family cares for her during the evening and at night.Noting the patient had several bruises,the nurse discussed her observations with the daughter,who became defensive and said that her mother was very difficult to manage because she is confused and wanders all night.She says the bruises resulted from a fall down stairs.The daughter states,"I have lost my mother,and I cannot bear it anymore.It is wrecking my family." The nursing intervention that should take priority is:

A) teaching the daughter more about the effects of Alzheimer's disease.
B) identifying two options for caregiver respite and care assistance at night.
C) supporting the daughter to grieve the loss of her mother's ability to function.
D) teaching the family how to give physical care more effectively and efficiently.

Question 9

A 45-year-old married woman who works full time in a factory has recently been absent for 3-day periods on several occasions.Each time,she returned to work wearing dark glasses.Facial and body bruises were apparent.Her supervisor became suspicious that she was a victim of battering and referred her to the occupational health nurse.Which initial inquiry would be most important for the nurse to make?

A) "Tell me what has happened to you."
B) "Did your husband beat you?"
C) "Why do you let this happen?"
D) "What can you do to prevent this?"

Question 10

An 82-year-old widow with Alzheimer's disease lives with her daughter's family,which owns a catering business.During the week,the patient attends a day care center for patients with dementia.During the evenings,members of the family care for the patient.One day,the nurse at the day care center notices the patient's appearance is disheveled and that she startles easily.She has a strong odor of urine,and her hair is uncombed.When the nurse escorts the patient to the bathroom,she notices bruises on her wrists and back.What most likely explains the nurse's observations?

A) The patient is being neglected and abused within the family.
B) The dementia is progressing,reducing self-care and increasing falls.
C) The patient is being inadequately cared for,resulting in accidents.
D) The patient has developed delirium,resulting in poor hygiene and injuries.

Question 11

A nurse is working with a perpetrator of family violence who has a long history of violent rages when frustrated,with periods of remorse after each outburst.The nurse is most likely to establish the nursing diagnosis of:

A) Risk for injury related to victim reprisal.
B) Risk for other-directed violence related to stress.
C) Ineffective coping related to poor anger management.
D) Caregiver role strain related to feelings of being overwhelmed.

Question 12

A victim of physical abuse by her domestic partner is being treated for a broken humerus.Which indicator for the outcome of Abuse protection is most important to achieve before the patient leaves the emergency department?

A) The patient has completed and reviewed a workable safety plan.
B) She agrees to seek a restraining order limiting contact by the perpetrator.
C) The patient demonstrates insight into the abusive nature of the relationship.
D) She has been referred to counseling and battered-person support groups.

Question 13

A 45-year-old married woman who works full time in a factory has recently been absent for 3-day periods on several occasions.Each time,she returned to work wearing dark glasses.Facial and body bruises were apparent.Her supervisor became suspicious that she was a victim of battering and referred her to the occupational health nurse.What should the nurse first focus on as she meets the patient?

A) Notifying the police of the abuse
B) Documenting the woman's injuries
C) Establishing trust and building rapport
D) Collecting evidence to prosecute the abuser

Question 14

A child,aged 11 years,stays home from school to care for his siblings while his mother works,because the family cannot afford a babysitter.The home is cluttered and dirty when the community mental health nurse visits to investigate the child's school absences.The nurse's legal responsibility if child abuse or neglect is suspected is to:

A) consult with the child's teacher,principal,and school psychologist.
B) document the observations and impressions in the family health record.
C) report her suspicions of abuse or neglect according to state regulations.
D) wait until she has proof of abuse or neglect,then report it to authorities.

Question 15

A woman tells the nurse that her husband abuses her most often when he is intoxicated,just as his father had beaten him and his mother.The woman is aware of the location of a safe house and has considered leaving home with her two children,but she cites being brought up to believe "you keep quiet and stay together,no matter what happens." She states the husband is always apologetic and remorseful after an incident.What evidence exists that the husband is at risk of becoming a perpetrator of physical abuse? He:

A) is unable to make lasting behavioral changes.
B) was an abused child.
C) is without a job.
D) experiences remorse.

Question 16

An 11-year-old child stays home from school to care for his siblings while his mother works,is demeaned by his father,and has negative self-perceptions.Which indicator would suggest that nursing interventions are succeeding?

A) The child attends school regularly.
B) The child is observed playing calmly.
C) The father rarely speaks during nurse visits.
D) The mother corrects negative comments by the child.

Question 17

An 11-year-old boy stays home from school to care for his siblings while his mother works,because the family cannot afford a babysitter.During the community mental health nurse's visit,he reveals that he thinks his father does not like him because he calls him "stupid" all the time.He states he is too dumb to learn much and has no friends at school because he does not deserve them.Which nursing diagnosis should be the priority for the child?

A) Helplessness
B) Knowledge deficit
C) Ineffective coping
D) Chronic low self-esteem

Question 18

A victim of partner abuse,parent of one child,describes the partner as someone who is easily frustrated and more likely to be abusive after a experiencing an event in which self-esteem is challenged.The most recent episodes of violence were related to feeling "upset" over a job loss.What type of therapy would provide the greatest help to the abuser?

A) Voluntary individual or group therapy
B) Court-ordered individual or group therapy
C) Voluntary couples or family therapy
D) Court-ordered couples or family therapy

Question 19

A woman who is a victim of severe emotional violence tells the nurse that her husband abuses her most often when he is intoxicated,just as his father had beaten him and his mother.The woman is aware of the location of a safe house and has considered leaving home with her two children,but she cites being brought up to believe "you keep quiet and stay together,no matter what happens." She states the husband is always apologetic and remorseful after an incident.The nurse responds,"You cannot live like this;you have to defend yourself and your children." Which statement most accurately describes the nurse's response?

A) It is an honest and direct response that will help build trust and rapport.
B) It suggests that the nurse herself has been a victim of physical abuse.
C) It is unprofessional,but it will likely help by motivating the patient.
D) It is a human but unprofessional response and is not helpful.

Question 20

The plan of care for a patient who has demonstrated outbursts of physical violence against his family when frustrated,followed by periods of remorse after each outburst,would be considered successful when the patient:

A) expresses frustration verbally instead of physically.
B) agrees to seek group counseling at a future time.
C) explains the reason for his behavior toward the victim.
D) identifies three personal strengths and coping strategies.

Question 21

Several children a day are seen in the emergency department for treatment of illnesses and injuries.The situation that would create a high index of suspicion of child abuse is a child who:

A) has repeated middle ear infections.
B) complains of abdominal cramps and upset stomach.
C) has perineal bruises and urinary tract infections.
D) displays reduced functioning at school.

Question 22

A woman has concerns about a man she recently began to date.She confides to her friend,a nurse in the clinic,that she recently discovered that he had been charged with domestic violence in a previous relationship.She asks if this means he will also hurt her and what signs would indicate that he is likely to be abusive.What should the nurse tell her friend?

A) "If he hasn't been abusive or controlling so far.chances are he won't be abusive later."
B) "Abuse occurs within dysfunctional relationships,so it may not occur in your situation."
C) "Danger signs include pathological jealousy and controlling the partner's activities."
D) "Because you are not masochistic or provocative,it is unlikely you will be abused."

Question 23

The nurse is assisting a victim of spousal abuse to create a plan for escape if it becomes necessary.What components should the plan include? Select all that apply.

A) A code word to signal children that it is time to leave
B) Phone numbers for the nearest shelter and crisis hotline
C) Telling the spouse that she has a plan and will leave
D) Collecting birth certificates and other essential documents
E) Bringing a cell phone or change to make phone calls

Question 24

A patient,aged 77 years,has Alzheimer's disease and lives wither daughter.While checking her blood pressure at the clinic,the nurse noticed fresh bruises on the patient's palms and buttocks.The patient could not explain these bruises.The nurse discussed her observations with the daughter,who became defensive and said that her mother was very difficult to manage.She stated,"My mother is getting worse every week.She is not my mother anymore.She can't recognize me,and she wanders all night.We take turns because she has to be watched constantly.Last night I fell asleep,and she fell down the stairs while wandering." Which statement is most accurate?

A) Reporting the injuries in this case is not indicated by available data.
B) The nurse should report the injuries as suggestive of elder abuse.
C) The nurse is only required to report the injury if the patient is incompetent.
D) The nurse is legally required to report the injuries as possible abuse.

Question 25

The nurse at the clinic is interviewing a patient who offers a number of vague somatic complaints that might not ordinarily prompt a visit to a caregiver: fatigue,back pain,headaches,and sleep disturbance.The patient seems tense,and after having spoken of the symptoms,seems reluctant to provide more information and is in a hurry to leave.The nurse can best serve the patient by:

A) asking if the patient has ever had psychiatric counseling.
B) completing a structured abuse assessment protocol.
C) exploring the possibility of patient social isolation.
D) asking the patient to disrobe to check for signs of abuse.

Question 26

A patient,aged 77 years,has Alzheimer's disease.She goes to day care during the week and is otherwise cared for by her daughter and grandchildren.The nurse at the day care center noticed multiple bruises on the patient's palms,elbows,and buttocks.When the daughter arrived to pick her up,the nurse discussed her observations.The daughter became defensive and said that her mother was very difficult to manage.She stated,"My mother is not my mother anymore.She is confused,and she wanders all night.We have to watch her constantly.Last night I fell asleep,and she fell down the stairs.Sometimes she cannot recognize me and accuses me of trying to poison her.I can't concentrate at work,and it's wrecking the family.Sometimes I just cannot bear it." Which nursing diagnosis would be most important to address for this family?

A) Knowledge deficit pertaining to dementia
B) Grieving related to mother's deterioration
C) Risk for injury related to cognitive impairment
D) Caregiver role strain related to increased care needs