Deck 21: Child, Partner, and Elder Violence

Question 1

An adult tells the nurse, "My partner abuses me only when drinking. The drinking has increased lately, but I always get an apology afterward and a box of candy. I've considered leaving but haven't been able to bring myself to actually do it." Which phase in the cycle of violence prevents the patient from leaving?

A) Tension building
B) Acute battering
C) Honeymoon
D) Recovery

Answer 1

Honeymoon

Question 2

After treatment for a detached retina, a victim of intimate partner violence says, "My partner only abuses me when intoxicated. I've considered leaving, but I was brought up to believe you stay together, no matter what happens. I always get an apology, and I can tell my partner feels bad after hitting me." Which nursing diagnosis applies?

A) Social isolation, related to lack of community support system
B) Risk for injury, related to partner's physical abuse when intoxicated
C) Deficient knowledge, related to resources for escape from the abusive relationship
D) Disabled family coping, related to uneven distribution of power within a relationship

Answer 2

Risk for injury, related to partner's physical abuse when intoxicated

Question 3

An adult has recently been absent from work for 3-day periods on several occasions. Each time, the individual returns to work wearing dark glasses. Facial and body bruises are apparent. What is the occupational health nurse's priority assessment?

A) Interpersonal relationships
B) Work responsibilities
C) Socialization skills
D) Physical injuries

Answer 3

Physical injuries

Question 4

An employee has recently been absent from work on several occasions. Each time, this employee returns to work wearing dark glasses. Facial and body bruises are apparent. During the occupational health nurse's interview, the employee says, "My partner beat me, but it was because there are problems at work." What should the nurse's next action be?

A) Notify the police.
B) Refer the employee to a shelter.
C) Notify the adult protective agency.
D) Document injuries with a body map.

Question 5

Several children are seen in the emergency department for treatment of illnesses and injuries. Which finding would create a high index of suspicion for child abuse? The child who has:

A) repeated middle ear infections.
B) severe colic.
C) bite marks.
D) croup.

Question 6

A patient tells the nurse, "My husband is 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

Question 7

What feelings are most commonly experienced by nurses working with abusive families?

A) Outrage toward the victim and sympathy for the abuser
B) Sympathy for 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

Question 8

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

A) Dementia
B) Living in a rural area
C) Being part of a busy family
D) Being home only in the evening

Question 9

An adult has recently been absent from work for 3-day periods on several occasions. Each time, this person returns to work wearing dark glasses. Facial and body bruises are apparent. What is the occupational health nurse's priority question?

A) "Do you drink excessively?"
B) "Did your partner beat you?"
C) "How did this happen to you?"
D) "What did you do to deserve this?"

Question 10

An older adult diagnosed with dementia lives with family and attends an adult day care center. A nurse at the center notices the adult has a disheveled appearance, a 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

Question 11

What is a nurse's legal responsibility if child abuse or neglect is suspected?

A) Discuss the findings with the child's teacher, principal, and school psychologist.
B) Report the suspected abuse or neglect according to state regulations.
C) Document the observations and speculations in the medical record.
D) Continue the assessment.

Question 12

An older adult, diagnosed with Alzheimer disease, lives with family and has multiple bruises. The home health nurse talks with the older adult's daughter, who becomes defensive and says, "My mother often wanders at night. Last night she fell down the stairs." Which nursing diagnosis has priority?

A) Risk for injury, related to cognitive impairment and lack of caregiver supervision
B) Noncompliance, related to confusion and disorientation as evidenced by lack of cooperation
C) Impaired verbal communication, related to brain impairment as evidenced by the confusion
D) Insomnia, related to cognitive impairment as evidenced by wandering at night

Question 13

A victim of physical abuse by an intimate partner is treated for a broken wrist. The patient has considered leaving but says, "You stay together, no matter what happens." Which outcome should be met before the patient leaves the emergency department? The patient will:

A) limit contact with the abuser by obtaining a restraining (protective) order.
B) name two community resources that can be contacted.
C) demonstrate insight into the abusive relationship.
D) facilitate counseling for the abuser.

Question 14

A clinic nurse interviews an adult patient who reports fatigue, back pain, headaches, tension, and sleep disturbances. The patient then becomes reluctant to provide more information and wants to leave. How can the nurse best serve the patient?

A) Explore the possibility of patient social isolation.
B) Have the patient complete an abuse assessment screen.
C) Ask whether the patient has ever had psychiatric counseling.
D) Ask the patient to disrobe; then assess for signs of physical abuse.

Question 15

A nurse visits the home of an 11-year-old child and finds the child caring for three younger siblings. Both parents are at work. The child says, "I want to go to school but we can't afford a babysitter. It doesn't matter; I'm too dumb to learn." What preliminary assessment is evident?

A) Insufficient data are present to make an assessment.
B) Child and siblings are experiencing neglect.
C) Children are at high risk for sexual abuse.
D) Children are experiencing physical abuse.

Question 16

A patient at the emergency department is diagnosed with a concussion. The patient is accompanied by a spouse who insists on staying in the room and answering all questions. The patient avoids eye contact and has a sad affect and slumped shoulders. Assessment of which additional problem has priority?

A) Risk of intimate partner violence
B) Phobia of crowded places
C) Migraine headaches
D) Depressive symptoms

Question 17

An 11-year-old child says, "My parents don't like me. They call me stupid and say I never do anything right, but it doesn't matter. I'm too dumb to learn." 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

Question 18

An 11-year-old child is absent from school to care for siblings while the parents work. The family cannot afford a babysitter. When asked about the parents, the child reluctantly says, "My parents don't like me. They call me stupid and say I never do anything right." Which type of abuse is likely?

A) Sexual
B) Physical
C) Emotional
D) Economic

Question 19

Which rationale best explains why a nurse should be aware of personal feelings while working with a family experiencing family violence?

A) Self-awareness protects one's own mental health.
B) Strong negative feelings interfere with assessment and judgment.
C) Strong positive feelings lead to underinvolvement with the victim.
D) Positive feelings promote the development of sympathy for patients.

Question 20

An older adult diagnosed with dementia lives with family and attends day care. After observing poor hygiene, the nurse at the center talks with the patient's adult child. This caregiver becomes defensive and says, "It takes all my time and 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 more about the effects of dementia.
B) Secure additional resources for the mother's evening and night care.
C) Support the caregiver to grieve the loss of the mother's ability to function.
D) Teach the family how to give physical care more effectively and efficiently.

Question 21

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

A) Keep a cell phone fully charged.
B) Hide money with which to buy new clothes.
C) Have the telephone 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.

Question 22

A 10-year-old child 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 to stabilize the home situation? (Select all that apply.)

A) Parental sessions to teach child-rearing practices
B) Anger management counseling for the father
C) Continuing home visits to provide support
D) Safety plan for the wife and children
E) Foster placement of the children in foster care
F) Determine a code word to signal children that it is time to leave.
G) Assemble birth certificates, Social Security cards, and licenses.

Question 23

A patient has a history of physical violence against family members when frustrated and then experiences periods of remorse after each outburst. The patient attends anger management classes. Which finding indicates success in this plan of care? The patient:

A) expresses frustration verbally instead of physically.
B) explains the rationale for behaviors to the victim.
C) identifies three personal strengths.
D) agrees to seek counseling.

Question 24

Which referral is most appropriate for a woman who is severely beaten by her husband, has no relatives or friends in the community, is afraid to return home, and has limited financial resources?

A) Support group
B) Law enforcement
C) Women's shelter
D) Vocational counseling

Question 25

Which family scenario presents the greatest risk for family violence?

A) An unemployed husband with low self-esteem, a wife who loses her job, and a developmentally delayed 3-year-old child
B) A husband who finds employment 2 weeks after losing his previous job, a wife with stable employment, and a child diagnosed with attention deficit disorder
C) A single mother with an executive position, a gifted and talented child, and a widowed grandmother living in the home to provide child care
D) A single homosexual male parent and an adolescent son who has just begun dating girls

Question 26

A community health nurse visits a family with four children. The father behaves angrily, finds fault with a 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 the interview with these parents? (Select all that apply.)

A) "Tell me how you punish 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 beat the children?"
E) "Calling children 'stupid' injures their self-esteem."