Question 1

The nurse is talking to a female client who is a survivor of intimate partner violence. The woman relates that her husband has the characteristics of an antisocial personality disorder and an extensive criminal record. The nurse interprets this information and suspects that the woman's husband would most likely demonstrate which behavior?

Accepted Answer

Evidence suggests that when people with borderline personality disorder are distressed, they are predisposed to interpret social situations as threatening and to respond with emotional dysregulation, verbal attacks, and physical violence. People who meet the diagnostic criteria of antisocial personality disorder have an extensive history of criminal behavior, and who are generally violent are also more likely to be both aggressive and assaultive. These perpetrators have a heightened sensitivity to emotional displays that predispose them to interpret social situations as threatening and to respond with emotional dysregulation, verbal attacks, and physical violence.

Question 2

A nurse is caring for a young adult in the mental health clinic. The client tells the nurse that the client was physically neglected as a child. The nurse should assess the client for symptoms of what?

Accepted Answer

An important outcome of nursing intervention with survivors is appropriate treatment of any disorder resulting from abuse, such as acute stress disorder, posttraumatic stress disorder, anxiety disorders, dissociative identity disorder, major depression, or substance abuse.

Question 3

An emergency department nurse is assessing a client with traumatic injuries. To assess whether or not the client's injuries have resulted from abuse, which question would be most appropriate for the nurse to ask the client?

Accepted Answer

The nurse should say to the client, "It looks like someone has hurt you. Tell me about it." This is an open-ended statement and allows the client to verbalize thoughts and feelings. Asking whether the partner is being mean or asking why the client thinks the spouse has done this beating assumes that the client has been abused. Asking about the person who did this would be ineffective because survivors of violence are unlikely to disclose sensitive information unless they perceive the nurse to be trustworthy and nonjudgmental. Additionally, this question is a closed question that does not allow the client to verbalize her thoughts and feelings openly.

Question 4

A client has been admitted to an inpatient psychiatric facility with a diagnosis of posttraumatic stress disorder (PDSD) after a history of violence by a partner. During the initial assessment interview, which assessment would be the priority?

Accepted Answer

The first, and most important, assessment conducted is a lethality assessment that determines whether the survivor's life is in danger, either from homicide or suicide, and, if children are in the home, whether they are in danger. Then the physiologic areas such as nutrition, hydration, and sleep can be assessed.

Question 5

A nurse is caring for a family in which the elderly parent has been a victim of abuse and neglect by an adult child. Which of the following would be most important for the nurse to keep in mind before interviewing the family?

Accepted Answer

Removing children and older adults from their families or caregivers often is necessary to ensure immediate safety. If the home of an abused or neglected child or older adult cannot be made safe, the nurse must facilitate the involvement of other professionals in placing the child or older adult in a foster home or nursing home. Still, intervening in cases of elder abuse is not a clear-cut issue. When an older adult's decision-making is not impaired (competence is the legal term), he or she must be allowed an appropriate degree of autonomy in deciding how to manage the problem, even if the choice is to remain in the abusive situation. Forcing someone to do something against his or her wishes is in itself a form of victimization and denies autonomous decision-making.

Question 6

A nurse is working with a client who is anticipating the possibility of leaving an abusive relationship. In helping the client arrive at the decision to leave or to stay in the abusive situation, which would be most important for the nurse to do?

Accepted Answer

Survivors must understand the cycle of violence and the danger of homicide that increases as violence escalates or when the survivor attempts to leave the relationship. Although survivors also need information about resources (e.g., shelters for battered women), legal services, government benefits, and support networks, the nurse first needs to discuss the possibility of the perpetrator's reaction and the possibility of extreme violence leading to death.

Question 7

A school nurse is aware that a student has requested aspirin three times during the past week because of a backache. The nurse has noticed that the student often wears long-sleeved sweaters and sweatshirts even in warm weather. The nurse suspects that the student may be the victim of physical abuse. Which response would the nurse anticipate being reported by the child if abuse was taking place?

Accepted Answer

Most survivors do not report violence to health-care providers without specifically being asked about it. Survivors may be reluctant to report abuse because of shame and fear of retaliation, especially if the victim depends on the abuser as a caregiver. In addition, children may fear they will not be believed.

Question 8

A nurse is presenting to a church group a program about domestic violence. During the presentation, a member of the audience asks the nurse to explain what "intergenerational transmission of violence" means because the person has seen that phrase used in the media. Which response by the nurse would be most appropriate?

Accepted Answer

Violent families create an atmosphere of tension, fear, intimidation, and tremendous confusion about intimate relationships. Children in violent homes often learn violent behavior as an approved and legitimate way to solve problems, especially within intimate relationships. The social learning or intergenerational transmission of violence theory posits that children who witness violence in their homes often perpetuate violent behavior in their own families as adults. Moreover, children who grow up in violent homes learn to accept violence and expect it in their own adult relationships. Neurochemical imbalances, genetics, or skipping generations are unrelated to this theory.

Question 9

A group of nursing students is reviewing information about intimate partner violence (IPV). The group demonstrates understanding of this topic when they identify which of the following?

Accepted Answer

Within a patriarchal society, men often hold traditional gender role beliefs. For example, whereas men are heads of households and provide for their families, women are homemakers and mothers. Nearly one in four women and one in nine men are victims of IPV at some point in their lives. Women are much more likely than men to be seriously injured as a result of IPV and to require medical treatment. IPV in same-sex couples occurs with at least the same frequency as in heterosexual relationships, but individuals with same-sex partners may not be afforded the same support. The reaction to IPV may differ by gender.

Question 10

A nurse is assessing a survivor of intimate partner violence. During the interview, the nurse determines that the survivor's partner is using power and control over the client through coercion and threats. Which client statement would lead the nurse to suspect this?

Accepted Answer

The statement about telling child services that the client is a bad parent reflects coercion and threats. The statement about the abuse never happening reflects power and control through minimizing, denying, and blaming. The statement about whom the client can and cannot see reflects power and control through the use of isolation. The statement about the partner being the master of the castle reflects power and control through the use of privilege.

Question 11

A group of nursing students is reviewing information about the types of abuse. The students demonstrate understanding of the information when they identify stalking as a crime of which of the following?

Accepted Answer

Stalking is a crime of harassment in which stalkers terrorize their victims through behavior that causes fear or substantial emotional distress. Rape is a crime of violence.

Question 12

A nurse is assessing a client who is a survivor of abuse. Which method would be most appropriate to use when conducting a lethality assessment?

Accepted Answer

The Danger Assessment Screen is a useful tool for assessing the risk that either an adult survivor or perpetrator will commit homicide. It would be appropriate to use when conducting a lethality assessment. The Abuse Assessment Screen and Burgess-Partner Abuse Scale are appropriate tools to use to screen for violence and abuse. The Beck Depression Inventory is used to screen for depression.

Question 13

A nurse is interviewing a client who is a survivor of abuse. The client is telling the nurse about how the violence occurred. Which statement would the nurse interpret as reflecting phase 3 of the cycle of violence?

Accepted Answer

During phase 3 of the cycle, the perpetrator becomes kind, contrite, and loving, begging for forgiveness and promising never to inflict abuse again. The actual violence occurs in phase 2. Yelling at the client for not having dinner ready and saying the client is stupid and incompetent reflect phase 1, or tension building.

Question 14

A nurse is working on developing a safety plan with a client who is a survivor of violence. Which item would the nurse address first?

Accepted Answer

One of the most important teaching goals is to help survivors develop a safety plan. The first step in developing such a plan is helping the survivor recognize the signs of danger. Changes in tone of voice, use of alcohol and other drugs, and increased criticism may indicate that the perpetrator is losing control. Detecting early warning signs helps survivors to escape before battering begins. The next step is to devise an escape route. This involves mapping the house and identifying where the battering usually occurs and what exits are available. The survivor needs to have a bag packed and hidden, but readily accessible, containing what is needed to get away. If children are involved, the adult survivor should make arrangements to get them out safely. That might include arranging a signal to indicate when it is safe for them to leave the house and to meet at a prearranged place. A safety plan for a child or dependent older adult might include safe places to hide and important telephone numbers, including 911, police and fire departments, and other family members and friends.

Question 15

A nurse is caring for a child who had experienced sexual abuse. Which are expected behaviors of a child who has experienced sexual abuse? Select all that apply.

Accepted Answer

A victim of prolonged sexual abuse will develop low self-esteem, a feeling of worthlessness, and a distorted view of sex. The child may become withdrawn, distrustful, or suicidal. Other characteristics of children who have been sexually abused include an unusual interest or avoidance of sexually related content, seductiveness, refusal to go to school, delinquency, secretiveness, and unusual aggressiveness.

Question 16

A nurse is gathering information about a health history of a person who has experienced violence. Which are important caring behaviors a nurse should implement during the interview? Select all that apply.

Accepted Answer

Establishing a trusting nurse-client relationship is one of the most important steps in caring for any person experiencing violence. Survivors are unlikely to disclose sensitive information unless they perceive the nurse to be trustworthy and nonjudgmental. Important considerations in establishing open communication are ensuring confidentiality and providing a quiet, private place to which to interact. The nurse must continually monitor personal feelings toward the perpetrator and survivor, especially in cases of child abuse or in situations where the person decides to remain in an abusive relationship. Seeking value clarification by the nurse may prevent negative feelings from influencing the nurse-client relationship that could lead to a nontherapeutic interaction and perhaps re-traumatize the survivor. The nurse should not ask about religious background or disclose personal feelings about the victim.

Question 17

A nurse is preparing to gather a health history of a client. Which questions can elicit disclosure if a client has been abused? Select all that apply.

Accepted Answer

The US Preventive Service Task Force recommends routine screening to detect current or past abuse, and risk of abuse. Most survivors do not report violence to health-care workers without specifically being asked about it. Survivors may be reluctant to report abuse due to shame and fear of retaliation. Asking specific abuse screening questions has been shown to increase the detection of abuse substantially. Questions should be open-ended and clients need time to disclose the abuse. Clients need to know the nurse is listening, believes them, and is concerned for their safety and well-being. Asking the client to tell the truth means the nurse does not believe the client's response. By telling the client, "You appear distracted," the nurse is not allowing time for the victim to discuss at the client's own pace.

Question 18

A client comes to the clinic for an evaluation. Upon assessment, the nurse suspects that the client is a victim of abuse. Which finding would support the nurse's suspicion? Select all that apply.

Accepted Answer

Findings that would support a suspicion of abuse include: vagueness about any injuries and how they occurred, a delay in seeking treatment for the injuries, minimizing or denying about the severity of the injuries, history of frequent visits to the emergency department for injuries, and statements feelings of a loss of control or powerlessness.

Quiz 23: Mental Health Care for Survivors of Violence