Deck 35: Survivors of Abuse or Neglect

Question 1

Sarah is being treated in the emergency department for wounds inflicted by her husband. Sandy says to the nurse, "He's really not a bad person. He's just under so much stress right now. His company is laying people off, and he thinks he will be next. He drinks a lot when he comes home from work. I just need to make things easier for him at home. I shouldn't have asked him to mow the lawn."
How would the nurse respond appropriately to this statement by Sarah?

Answer 1

Situation: S is being treated in the emergency department for wounds inflicted by her husband. S says to the nurse: "He's really not a bad person. He's just so stressed right now. His company is laying people off, and he thinks he will be next. He drinks a lot when he comes home from work. I just need to make things more relaxed for him at home. I shouldn't have asked him to mow the lawn."
Required: An appropriate response to S by the nurse.
Answer: "You are not to be blamed. You do not deserve to be abused this way. He is responsible for his own behavior."
Justification:
Many battered female victims often stereotypically accept the blame for the abuser's actions. Common feelings include: shame, fear, anger and guilt. It is important to instill self-esteem, trust and self-worth.

Question 2

What neurotransmitters have been implicated in the etiology of aggression and violence?

Answer 2

Neurotransmitters associated in aggression and violence:
A decrease in serotonin , or the happy hormone, is often linked to aggressive behavior and impulses. Accompanied by an increase in "norepinephrine", or the hormone that initiates the "fight or flight" response, this tandem plays a big role on a person's ferocious acts.

Question 3

Describe epidemiological statistics associated with intimate partner violence, child abuse, and sexual assault.

Answer 3

Epidemiological statistics:
Intimate partner violence:
Citing the report of C in 2012, nearly 3 out of 10 women and 1 out of 10 men reported having been a victim of intimate partner violence in the United States. The number of injuries associated with intimate partner violence is more than the combined number of rape, muggings, and automobile accidents.
Child abuse:
There are approximately 3.7 million child abuse cases reported in 2011 and one-fifth of these cases were verified. In 2011, the number of children that died associated with child abuse or neglect is 1,545.
Sexual assault:
Many rape or sexual assaults are left unrecognized or unreported that is why these attacks are often considered "silent-violence epidemic". Citing the report of C in 2012, 1 out of 5 women and 1 out of 71 men reported having been raped at some time in their lives.

Question 4

Sharon, a woman with multiple cuts and abrasions, arrives at the emergency department (ED) with her three small children. She tells the nurse her husband inflicted these wounds on her. She says, "I didn't want to come. I'm really okay. He only does this when he has too much to drink. I just shouldn't have yelled at him." The best response by the nurse is:

A) "How often does he drink too much?"
B) "It is not your fault. You did the right thing by coming here."
C) "How many times has he done this to you?"
D) "He is not a good husband. You have to leave him before he kills you."

Question 5

Sandy is a psychiatric RN who works at the Safe House for battered women. Lisa has just been admitted with her two small children after she was treated in the emergency department. She had been beaten severely by her husband while he was intoxicated last night. She escaped with her children after he passed out in their bedroom.
In her initial assessment, Sandy learns from Lisa that she has been battered by her husband for 5 years, beginning shortly after their marriage. She explained that she "knew he drank quite a lot before we were married, but thought he would stop after we had kids." Instead, the drinking has increased. Sometimes he doesn't even get home from work until 11 o'clock or midnight, after stopping to drink at the bar with his buddies.
Lately, he has begun to express jealousy and a lack of trust in Lisa, accusing her of numerous infidelities and indiscretions, none of which is true. Lisa says, "If only he wasn't under so much stress on his job, then maybe he wouldn't drink so much. Maybe if I tried harder to make everything perfect for him at home-I don't know. What do you think I should do to keep him from acting this way?"
Answer the following question related to Lisa:
What is an appropriate response to Lisa's question?

Question 6

"I don't know what to do. I'm afraid he will hurt the kids."
How would the nurse respond appropriately to this statement by Sarah?

Question 7

What is the most common reason that women give for staying in an abusive relationship?

Question 8

Discuss characteristics of victims and victimizers.

Question 9

Sharon, a woman with multiple cuts and abrasions, arrives at the ED with her three small children. She tells the nurse her husband inflicted these wounds on her. In the interview, Sharon tells the nurse, "He's been getting more and more violent lately. He's been under a lot of stress at work the last few weeks, so he drinks a lot when he gets home. He always gets mean when he drinks. I was getting scared. So I just finally told him I was going to take the kids and leave. He got furious when I said that and began beating me with his fists." With knowledge about the cycle of battering, what does this situation represent?

A) Phase I; Sharon was desperately trying to stay out of his way and keep everything calm.
B) Phase I; a minor battering incident for which Sharon assumes all the blame.
C) Phase II; the acute battering incident that Sharon provoked with her threat to leave.
D) Phase III; the honeymoon phase where the husband believes that he has "taught her a lesson and she won't act up again."

Question 10

Sandy is a psychiatric RN who works at the Safe House for battered women. Lisa has just been admitted with her two small children after she was treated in the emergency department. She had been beaten severely by her husband while he was intoxicated last night. She escaped with her children after he passed out in their bedroom.
In her initial assessment, Sandy learns from Lisa that she has been battered by her husband for 5 years, beginning shortly after their marriage. She explained that she "knew he drank quite a lot before we were married, but thought he would stop after we had kids." Instead, the drinking has increased. Sometimes he doesn't even get home from work until 11 o'clock or midnight, after stopping to drink at the bar with his buddies.
Lately, he has begun to express jealousy and a lack of trust in Lisa, accusing her of numerous infidelities and indiscretions, none of which is true. Lisa says, "If only he wasn't under so much stress on his job, then maybe he wouldn't drink so much. Maybe if I tried harder to make everything perfect for him at home-I don't know. What do you think I should do to keep him from acting this way?"
Answer the following question related to Lisa:
Identify the priority psychosocial nursing diagnosis for Lisa.

Question 11

"I don't want to press charges. I just want to go home!"
How would the nurse respond appropriately to this statement by Sarah?

Question 12

Describe a compounded rape reaction.

Question 13

Identify predisposing factors to abusive behaviors.

Question 14

A battered woman presents to the ED with multiple cuts and abrasions. Her right eye is swollen shut. She says that her husband did this to her. The priority nursing intervention is:

A) Tending to the immediate care of her wounds
B) Providing her with information about a safe place to stay
C) Administering the prn tranquilizer ordered by the physician
D) Explaining how she may go about bringing charges against her husband

Question 15

Sandy is a psychiatric RN who works at the Safe House for battered women. Lisa has just been admitted with her two small children after she was treated in the emergency department. She had been beaten severely by her husband while he was intoxicated last night. She escaped with her children after he passed out in their bedroom.
In her initial assessment, Sandy learns from Lisa that she has been battered by her husband for 5 years, beginning shortly after their marriage. She explained that she "knew he drank quite a lot before we were married, but thought he would stop after we had kids." Instead, the drinking has increased. Sometimes he doesn't even get home from work until 11 o'clock or midnight, after stopping to drink at the bar with his buddies.
Lately, he has begun to express jealousy and a lack of trust in Lisa, accusing her of numerous infidelities and indiscretions, none of which is true. Lisa says, "If only he wasn't under so much stress on his job, then maybe he wouldn't drink so much. Maybe if I tried harder to make everything perfect for him at home-I don't know. What do you think I should do to keep him from acting this way?"
Answer the following question related to Lisa:
What must the nurse ensure that Lisa learns from this experience?

Question 16

What are some adult manifestations of childhood sexual abuse?

Question 17

Describe physical and psychological effects on the survivors of intimate partner violence, child abuse, and sexual assault.

Question 18

A woman who has a long history of being battered by her husband is staying at the woman's shelter. She has received emotional support from staff and peers and has been made aware of the alternatives open to her. Nevertheless, she decides to return to her home and marriage. The best response by the nurse to the woman's decision is:

A) "I just can't believe you have decided to go back to that horrible man."
B) "I'm just afraid he will kill you or the children when you go back."
C) "What makes you think things have changed with him?"
D) "I hope you have made the right decision. Call this number if you need help."

Question 19

Identify nursing diagnoses, goals of care, and appropriate nursing interventions for care of survivors of intimate partner violence, child abuse, and sexual assault.

Question 20

Jana, age 5, is sent to the school nurse's office with an upset stomach. She has vomited and soiled her blouse. When the nurse removes her blouse, she notices that Jana has numerous bruises on her arms and torso, in various stages of healing. She also notices some small scars. Jana's abdomen protrudes on her small, thin frame. From the objective physical assessment, the nurse suspects that:

A) Jana is experiencing physical and sexual abuse.
B) Jana is experiencing physical abuse and neglect.
C) Jana is experiencing emotional neglect.
D) Jana is experiencing sexual and emotional abuse.

Question 21

Evaluate nursing care of survivors of intimate partner violence, child abuse, and sexual assault.

Question 22

A school nurse notices bruises and scars on a child's body, but the child refuses to say how she received them. Another way in which the nurse can get information from the child is to:

A) Have her evaluated by the school psychologist.
B) Tell her she may select a "treat" from the treat box (e.g., sucker, balloon, junk jewelry) if she answers the nurse's questions.
C) Explain to her that if she answers the questions, she may stay in the nurse's office and not have to go back to class.
D) Use a "family" of dolls to role-play the child's family with her.

Question 23

Discuss various modalities relevant to treatment of survivors of abuse.

Question 24

A school nurse notices bruises and scars on a child's body. The nurse suspects that the child is being physically abused. How should the nurse proceed with this information?

A) As a health-care worker, report the suspicion to the Department of Health and Human Services.
B) Check Jana again in a week and see if there are any new bruises.
C) Meet with Jana's parents and ask them how Jana got the bruises.
D) Initiate paperwork to have Jana placed in foster care.

Question 25

Kate is an 18-year-old freshman at the state university. She was extremely flattered when Don, a senior star football player, invited her to a party. On the way home, he parked the car in a secluded area by the lake. He became angry when she refused his sexual advances. He began to beat her and finally raped her. She tried to fight him, but his physical strength overpowered her. He dumped her in the dorm parking lot and left. The dorm supervisor rushed Kate to the emergency department. Kate says to the nurse, "It's all my fault. I shouldn't have allowed him to stop at the lake." The nurse's best response is:

A) "Yes, you're right. You put yourself in a very vulnerable position when you allowed him to stop at the lake."
B) "You are not to blame for his behavior. You obviously made some right decisions, because you survived the attack."
C) "There's no sense looking back now. Just look forward, and make sure you don't put yourself in the same situation again."
D) "You'll just have to see that he is arrested so he won't do this to anyone else."

Question 26

A young woman who has just undergone a sexual assault is brought into the ED by a friend. The priority nursing intervention would be:

A) Help her to bathe and clean herself up.
B) Provide physical and emotional support during evidence collection.
C) Provide her with a written list of community resources for survivors of rape.
D) Discuss the importance of a follow-up visit to evaluate for sexually transmitted diseases.

Question 27

A woman who was sexually assaulted 6 months ago by a man with whom she was acquainted has since been attending a support group for survivors of rape. From this group, she has learned that the most likely reason the man raped her was:

A) Because he had been drinking, he was not in control of his actions.
B) He had not had sexual relations with a girl in many months.
C) He was predisposed to become a rapist by virtue of the poverty conditions under which he was reared.
D) He was expressing power and dominance by means of sexual aggression and violence.