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PMHN, 10e
Chapter 34 - ETB
Chapter 34. Survivors of Abuse or Neglect
MULTIPLE CHOICE
1. A kindergarten student is frequently violent toward other children. The school nurse
notices bruises and burns on the child’s face and arms. Which other symptom would
indicate to the nurse that the child might have been physically abused?
1. The child shrinks at the approach of adults.
2. The child begs or steals food or money.
3. The child is frequently absent from school.
4. The child is delayed in physical and emotional development.
ANS: 1
Chapter: Chapter 34, Survivors of Abuse or Neglect
Objective: Describe physical and psychological effects on the survivors of intimate
partner violence, child abuse, and sexual assault.
Page: 770
Heading: Child Abuse > Signs of Physical Abuse
Integrated Processes: Nursing Process
Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive Level: Comprehension [Understanding]
Concept: Violence
Difficulty: Easy
1.
2.
3.
4.
Feedback
This is correct. A child who shrinks at the approach of adults and has bruises and
burns might be a victim of abuse. Maltreatment is considered whether the caretaker
intended to cause harm, or even if the injury resulted from overdiscipline or physical
punishment.
This is incorrect. Begging or stealing food or money are indicators of neglect.
This is incorrect. Frequent absences from school are indicators of neglect.
This is incorrect. These are indicators of neglect and sexual abuse.
CON: Violence
2. A woman describes a history of physical and emotional abuse in intimate
relationships. Which additional factor would the nurse suspect?
1. The woman may be exhibiting a controlled response pattern.
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Chapter 34 - ETB
2. The woman may have a history of childhood neglect.
3. The woman may be exhibiting codependent characteristics.
4. The woman might be a victim of incest.
ANS: 4
Chapter: Chapter 34, Survivors of Abuse or Neglect
Objective: Discuss characteristics of victims and victimizers.
Page: 773
Heading: The Adult Survivor of Incest
Integrated Processes: Nursing Process
Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive Level: Knowledge [Remembering]
Concept: Violence
Difficulty: Easy
1.
2.
3.
4.
Feedback
This is incorrect. In a controlled response pattern, the feelings are masked or hidden.
This is incorrect. There is nothing to indicate the individual has a history of
childhood neglect.
This is incorrect. An individual in an abusive relationship is not exhibiting
codependent characteristics.
This is correct. Adult survivors of incest often have a pattern of unstable
relationships and may experience depression, anxiety, substance use, eating
disorders, and/or suicidal behaviors.
CON: Violence
3. Which statement by an emergency department nurse indicates accurate knowledge of
domestic violence?
1. “Power and control are central to the dynamic of domestic violence.”
2. “Poor communication and social isolation are central to the dynamic of domestic
violence.”
3. “Erratic relationships and vulnerability are central to the dynamic of domestic
violence.”
4. “Emotional injury and learned helplessness are central to the dynamic of domestic
violence.”
ANS: 1
Chapter: Chapter 34, Survivors of Abuse or Neglect
Objective: Discuss characteristics of victims and victimizers.
Page: 773
Heading: Intimate Partner Violence > Battering; Profile of the Victimizer
Integrated Processes: Nursing Process
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Chapter 34 - ETB
Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive Level: Comprehension [Understanding]
Concept: Violence
Difficulty: Moderate
1.
2.
3.
4.
Feedback
This is correct. Power and control are central to the dynamic of domestic violence.
Battering is defined as a pattern of coercive control founded on physical and/or
sexual violence or threat of violence. The typical abuser is possessive and perceives
the victim as a possession.
This is incorrect. Poor communication is not typically a factor in domestic violence.
This is incorrect. Erratic relationships and vulnerability are not central to domestic
violence.
This is incorrect. Emotional injury and learned helplessness are not key factors in
domestic violence.
CON: Violence
4. A client is brought to an emergency department after being violently raped. Which
nursing action is most appropriate?
1. Discourage the client from discussing the event, as this may lead to further emotional
trauma.
2. Remain nonjudgmental and actively listen to the client’s description of the event.
3. Meet the client’s self-care needs by assisting with showering and perineal care.
4. Provide cues, based on police information, to encourage further description of the
event.
ANS: 2
Chapter: Chapter 34, Survivors of Abuse or Neglect
Objective: Identify nursing diagnoses, goals of care, and appropriate nursing
interventions for care of survivors of intimate partner violence, child abuse, and sexual
assault.
Page: 777
Heading: Sexual Violence > Planning/Implementation; Table 34–1
Integrated Processes: Nursing Process
Nursing Process: Implementation
Client Need: Psychosocial Integrity
Cognitive Level: Analysis [Analyzing]
Concept: Violence
Difficulty: Moderate
1.
Feedback
This is incorrect. Active listening develops trust and builds rapport. The nurse would
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Chapter 34 - ETB
2.
3.
4.
encourage the client to talk about the event is they choose to.
This is correct. The nurse should actively listen to the client’s description of the
event and should communicate to the victim that they are safe and that the rape is
not their fault. Nonjudgmental listening provides an avenue for client catharsis
needed to begin the process of healing.
This is incorrect. A shower and perineal care would not be appropriate until evidence
is collected.
This is incorrect. Providing cues is not an appropriate nursing action.
CON: Violence
5. In the emergency department, a client who was raped appears calm and exhibits a
blunt affect. The client answers the nurse’s questions in a monotone using single words.
Which statement indicates the nurse interpretation of this client’s responses?
1. The client may be lying about the incident.
2. The client may be experiencing a silent rape reaction.
3. The client may be demonstrating a controlled response pattern.
4. The client may be having a compounded rape reaction.
ANS: 3
Chapter: Chapter 34, Survivors of Abuse or Neglect
Objective: Describe physical and psychological effects on the survivors of intimate
partner violence, child abuse, and sexual assault.
Page: 770
Heading: Sexual Violence > The Victim
Integrated Processes: Nursing Process
Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive Level: Analysis [Analyzing]
Concept: Violence
Difficulty: Moderate
1.
2.
3.
4.
Feedback
This is incorrect. The client’s response is not indicative of lying but of a controlled
response pattern.
This is incorrect. The silent rape reaction is evident when the survivor tells no one
about the assault. Anxiety is suppressed, and the emotional burden may become
overwhelming.
This is correct. This client’s responses reflect a controlled response pattern, in which
a rape victim’s affect is calm, controlled, or subdued, and feelings are masked or
hidden.
This is incorrect. In a compounded rape reaction, additional symptoms such as
depression and suicide, substance abuse, and psychotic behaviors may occur.
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Chapter 34 - ETB
CON: Violence
6. A client who is in a severely abusive relationship is admitted to a psychiatric inpatient
unit. The client fears for her life. A staff nurse asks, “Why doesn’t she just leave him?”
Which reply by the nursing supervisor is most appropriate?
1. “These clients don’t know life any other way, and change is not an option until they
have improved insight.”
2. “These clients have limited skills and few vocational abilities to be able to make it on
their own.”
3. “These clients often have a lack of financial independence to support themselves and
their children, and most have religious beliefs prohibiting divorce and separation.”
4. “These clients are paralyzed into inaction by a combination of physical threats and a
sense of powerlessness.”
ANS: 4
Chapter: Chapter 34, Survivors of Abuse or Neglect
Objective: Describe physical and psychological effects on the survivors of intimate
partner violence, child abuse, and sexual assault.
Page: 770
Heading: Intimate Partner Violence > Why Do They Stay?
Integrated Processes: Nursing Process
Nursing Process: Implementation
Client Need: Psychosocial Integrity
Cognitive Level: Analysis [Analyzing]
Concept: Violence
Difficulty: Difficult
1.
2.
3.
4.
Feedback
This is incorrect. This is not an appropriate reply. It makes the client seem like they
are comfortable staying with the abuser.
This is incorrect. This reply is not appropriate. There is nothing to indicate the
victim is staying with the abuser because they have limited skills and cannot make it
on their own.
This is incorrect. This reply is not appropriate. There is nothing in the question to
indicate the client is staying for religious or financial reasons.
This is correct. Clients in severely abusive relationships may be paralyzed into
inaction by a combination of physical threats and a sense of powerlessness. Victims
have been known to stay with an abusive partner for some of the following reasons:
fear of losing custody of children, financial dependence, fear of retaliation, lack of a
support network, cultural or religious reasons, and/or dissociation related to posttraumatic stress disorder (PTSD).
CON: Violence
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Chapter 34 - ETB
7. An individual comes to an emergency department with a broken nose and multiple
bruises after being beaten by her spouse. She states, “The beatings have been getting
worse, and I’m afraid that next time he might kill me.” Which reply by the nurse is
appropriate?
1. “Leopards don’t change their spots, and neither will he.”
2. “There are things you can do to prevent him from losing control.”
3. “Let’s talk about your options so that you don’t have to go home.”
4. “Why don’t we call the police so that they can confront your husband with his
behavior?”
ANS: 3
Chapter: Chapter 34, Survivors of Abuse or Neglect
Objective: Identify nursing diagnoses, goals of care, and appropriate nursing
interventions for care of survivors of intimate partner violence, child abuse, and sexual
assault.
Page: 777
Heading: Treatment Modalities > Crisis Intervention; Table 34–1
Integrated Processes: Nursing Process
Nursing Process: Implementation
Client Need: Psychosocial Integrity
Cognitive Level: Analysis [Analyzing]
Concept: Violence
Difficulty: Moderate
1.
2.
3.
4.
Feedback
This is incorrect. This statement reflects imposing judgment. The most appropriate
reply is to talk with the client about options so the client can remain safe. Following
a discussion of available options, the woman must make her own choice. The nurse
must respect the woman’s decision should she choose to return to the relationship. It
is essential that clients make decisions independently.
This is incorrect. This statement is an example of the nontherapeutic technique of
advice giving. The most appropriate reply is to talk with the client about options so
the client can remain safe. Following a discussion of available options, the woman
must make her own choice. The nurse must respect the woman’s decision should she
choose to return to the relationship. It is essential that clients make decisions
independently.
This is correct. The most appropriate reply is to talk with the client about options so
the client can remain safe. Following a discussion of available options, the woman
must make her own choice. The nurse must respect the woman’s decision should she
choose to return to the relationship. It is essential that clients make decisions
independently.
This is incorrect. This statement is an example of the nontherapeutic technique of
advice giving. The most appropriate reply is to talk with the client about options so
the client can remain safe. Following a discussion of available options, the woman
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Chapter 34 - ETB
must make her own choice. The nurse must respect the woman’s decision should she
choose to return to the relationship. It is essential that clients make decisions
independently.
CON: Violence
8. A college student was sexually assaulted when out on a date. After several weeks of
crisis intervention therapy, which client statement would indicate to the nurse that the
student is handling this situation in a healthy manner?
1. “I know that it was not my fault.”
2. “My partner has trouble controlling his sexual urges.”
3. “If I don’t put myself in a dating situation, I won’t be at risk.”
4. “Next time I will think twice about wearing a sexy dress.”
ANS: 1
Chapter: Chapter 34, Survivors of Abuse or Neglect
Objective: Evaluate nursing care of survivors of intimate partner violence, child abuse,
and sexual assault.
Page: 777
Heading: Sexual Violence > Evaluation; Table 34–1
Integrated Processes: Nursing Process
Nursing Process: Evaluation
Client Need: Psychosocial Integrity
Cognitive Level: Evaluation [Evaluating]
Concept: Violence
Difficulty: Moderate
1.
2.
3.
4.
Feedback
This is correct. The client has begun the process of a healthy grief resolution.
Nonjudgmental listening provides an avenue for catharsis, as the client needs to
begin healing.
This is incorrect. The statement “My partner has trouble controlling his sexual
urges” does not indicate healthy grief resolution.
This is incorrect. This statement “If I don’t put myself in a dating situation, I won’t
be at risk” does not indicate healthy grief resolution.
This is incorrect. This statement indicates the client is blaming themself for the
assault.
CON: Violence
9. Which action by the parent leads the nurse to suspect they may be emotionally
abusing their child?
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Chapter 34 - ETB
1. The child has bite marks on their arms.
2. The child shows up for school without a lunch.
3. The parent blames the child whenever something goes wrong.
4. The child has no coat, and it is very cold outside.
ANS: 3
Chapter: Chapter 34, Survivors of Abuse or Neglect
Objective: Describe physical and psychological effects on the survivors of intimate
partner violence, child abuse, and sexual assault.
Page: 770
Heading: Emotional Abuse
Integrated Processes: Nursing Process
Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive Level: Comprehension [Understanding]
Concept: Violence
Difficulty: Moderate
1.
2.
3.
4.
Feedback
This is incorrect. The child having bite marks on the arm is an example of physical
abuse.
This is incorrect. The child having no lunch at school is an example of neglect.
This is correct. This situation describes an example of emotional abuse. The parent is
constantly blaming their child when things go wrong.
This is incorrect. The child having no coat when it is cold outside is an example of
neglect.
CON: Violence
10. When questioned about bruises, an individual states, “It was an accident. My spouse
just had a bad day at work. He’s being so gentle now and even brought me flowers. He’s
going to get a new job, so it won’t happen again.” The nurse recognizes this client is in
which phase of the cycle of battering?
1. Phase I: The tension-building phase
2. Phase II: The acute battering incident phase
3. Phase III: The honeymoon phase
4. Phase IV: The resolution and reorganization phase
ANS: 3
Chapter: Chapter 34, Survivors of Abuse or Neglect
Objective: Discuss characteristics of victims and victimizers.
Page: 778
Heading: Intimate Partner Violence > The Cycle of Battering; Figure 34–2
Integrated Processes: Nursing Process
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PMHN, 10e
Chapter 34 - ETB
Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive Level: Comprehension [Understanding]
Concept: Violence
Difficulty: Easy
1.
2.
3.
4.
Feedback
This is incorrect. In the tension-building phase, the abuser becomes angry with little
provocation and minor battering incidents may occur. As minor battering incidents
continue, the tension mounts as the woman waits for the abuser’s impending
explosion.
This is incorrect. This phase is the most violent and shortest phase.
This is correct. In the honeymoon phase, the batterer becomes extremely loving,
kind, and contrite and often promises the abuse will not happen again.
This is incorrect. There is no resolution and reorganization phase.
CON: Violence
11. Which teaching would the nurse in an employee assistance program provide to an
employee who exhibits symptoms of domestic physical abuse?
1. Have ready access to a gun and learn how to use it.
2. Research lawyers who can aid in divorce proceedings.
3. File charges of assault and battery.
4. Have ready access to the number of a shelter for battered women.
ANS: 4
Chapter: Chapter 34, Survivors of Abuse or Neglect
Objective: Evaluate nursing care of survivors of intimate partner violence, child abuse,
and sexual assault.
Page: 777
Heading: The Safe House or Shelter; Table 34–1
Integrated Processes: Nursing Process
Nursing Process: Implementation
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Application [Applying]
Concept: Violence
Difficulty: Moderate
1.
2.
3.
Feedback
This is incorrect. Teaching the client how to use a gun is not an appropriate nursing
action.
This is incorrect. The nurse would not research lawyers to assist with divorce
proceedings.
This is incorrect. The nurse would not file charges of assault and battery on the
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Chapter 34 - ETB
4.
employee’s behalf.
This is correct. The nurse should stress to the individual the importance of safety and
provide information about available resources, including shelters and crisis hotlines.
Safe houses or shelters are where women can be assured of protection for themselves
and their children. Most shelters provide individual and group counseling; child care
and children’s programming; aid for the woman in making future plans, such as
employment counseling and linkages with housing authorities; and help with
bureaucratic institutions, such as the police, legal representation, and social services.
CON: Violence
12. A client who has been raped is crying, pacing, and cursing her attacker in an
emergency department. Which behavioral defense would the nurse recognize?
1. Controlled response pattern
2. Compounded rape reaction
3. Expressed response pattern
4. Silent rape reaction
ANS: 3
Chapter: Chapter 34, Survivors of Abuse or Neglect
Objective: Describe physical and psychological effects on the survivors of intimate
partner violence, child abuse, and sexual assault.
Page: 770
Heading: Sexual Violence > The Victim
Integrated Processes: Nursing Process
Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive Level: Comprehension [Understanding]
Concept: Violence
Difficulty: Moderate
1.
2.
3.
4.
Feedback
This is incorrect. In the controlled response pattern, the client’s feelings are masked
or hidden, and a calm, composed, or subdued affect is seen.
This is incorrect. In addition to feeing defiled and unable to wash themselves clean,
some rape survivors develop a compounded rape reaction in which additional
symptoms such as depression, suicide, substance abuse, and psychotic behaviors
may be present.
This is correct. The client is exhibiting an expressed response pattern. In the
expressed response pattern, feelings of fear, anger, and anxiety are expressed
through crying, sobbing, smiling, restlessness, and tension. In the controlled
response pattern, the client’s feelings are masked or hidden, and a calm, composed,
or subdued affect is seen.
This is incorrect. The silent rape reaction is evident when the survivor tells no one
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Chapter 34 - ETB
about the assault. Anxiety is suppressed, and the emotional burden may become
overwhelming.
CON: Violence
13. Which assessment data should the school nurse recognize as signs of physical
neglect?
1. The child is often absent from school and seems apathetic and tired.
2. The child is very insecure and has poor self-esteem.
3. The child has multiple bruises on various body parts.
4. The child has sophisticated knowledge of sexual behaviors.
ANS: 1
Chapter: Chapter 34, Survivors of Abuse or Neglect
Objective: Discuss characteristics of victims and victimizers.
Page: 771
Heading: Child Abuse > Indicators of Neglect
Integrated Processes: Nursing Process
Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive Level: Knowledge [Remembering]
Concept: Violence
Difficulty: Difficult
1.
2.
3.
4.
Feedback
This is correct. Signs of physical neglect of a child include frequent absences from
school, apathy, and a tired appearance. Other indicators of neglect include stealing
food or money, lacking medical or dental care, being consistently dirty, lacking
sufficient clothing, or stating that there is no one home to provide care.
This is incorrect. These are signs of emotional abuse.
This is incorrect. This is a sign of physical abuse.
This is incorrect. This is a sign of sexual abuse.
CON: Violence
14. An anorexic client states to the nurse, “My parent has recently moved back to town.”
Since that time, the client has experienced insomnia, nightmares, and panic attacks that
occur nightly. She has never married or dated and lives alone. Which should the nurse
suspect?
1. Possible major depressive disorder
2. Possible history of childhood incest
3. Possible histrionic personality disorder
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Chapter 34 - ETB
4. Possible history of childhood bulimia
ANS: 2
Chapter: Chapter 34, Survivors of Abuse or Neglect
Chapter learning objective: Objective: Discuss characteristics of victims and victimizers.
Page: 771
Heading: Indicators of Sexual Abuse
Integrated Processes: Nursing Process
Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive Level: Analysis [Analyzing]
Concept: Violence
Difficulty: Easy
1.
2.
3.
4.
Feedback
This is incorrect. These are not symptoms of major depressive disorder.
This is correct. The client may have a history of childhood incest. Adult survivors of
incest are at risk for developing PTSD, sexual dysfunction, somatization disorders,
compulsive sexual behavior disorders, depression, anxiety, eating disorders, and
substance abuse disorders.
This is incorrect. These are not symptoms indicative of personality disorder.
This is incorrect. These are not symptoms of childhood bulimia.
CON: Violence
15. Which statement describes the main goal of crisis intervention for sexual assault?
1. Help survivors return to their previous lifestyle as quickly as possible.
2. Determine the appropriate long-term assistance needed.
3. Treat any physical symptoms that have resulted from the assault.
4. Focus on the rape incident alone.
ANS: 1
Chapter: Chapter 34, Survivors of Abuse or Neglect
Objective: Discuss modalities relevant to treatment of survivors of abuse.
Page: 780
Heading: Treatment Modalities > Crisis Intervention
Integrated Processes: Caring
Nursing Process: Planning
Client Need: Psychosocial Integrity
Cognitive Level: Comprehension [Understanding]
Concept: Safety
Difficulty: Moderate
Feedback
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Chapter 34 - ETB
1.
2.
3.
4.
This is correct. The goal of crisis intervention is to help survivors return to their
previous lifestyle as quickly as possible. The client should be involved in the
intervention from the beginning. This promotes a sense of competency, control, and
decision-making.
This is incorrect. Crisis intervention is time limited, usually 6 to 8 weeks. If
problems resurface beyond this time, the individual is referred.
This is incorrect. Any physical symptoms present because of the trauma are assessed
and evaluated before crisis intervention begins.
This is incorrect. The focus of the initial interview and follow-up with the client who
has been sexually assaulted is on the rape incident alone. Problems not associated
with the rape are not dealt with during this time.
CON: Safety
16. The client has been newly diagnosed with comorbid psychosis. With an
understanding of the neurobiology of violence, which of the following classifications of
medication will the physician likely prescribe to help control aggression and violence?
1. Selective serotonin reuptake inhibitors (SSRIs)
2. Mood stabilizers (Tegretol, Dilantin, Depakote, lithium)
3. Anti-adrenergic agents (propranolol)
4. Antipsychotics (typical and atypical)
ANS: 4
Chapter: Chapter 34, Survivors of Abuse or Neglect
Objective: Describe epidemiological statistics associated with intimate partner violence,
child abuse, and sexual assault.
Page: 770
Heading: Figure 34–1, Neurobiology of Violence
Integrated Processes: Nursing Process
Nursing Process: Assessment
Client Need: Physiological Integrity > Pharmacological and Parenteral Therapies
Cognitive Level: Application [Applying]
Concept: Violence
Difficulty: Difficult
1.
2.
3.
Feedback
This is incorrect. SSRIs may reduce irritability and aggression consistent with the
hypothesis of reduced serotonergic activity in aggression.
This is incorrect. Mood stabilizers may be important in reducing the susceptibility to
react to provocation or threatening stimuli by overactivation of limbic system
structures, such as the amygdala.
This is incorrect. Anti-adrenergic agents, such as beta-blockers, have been shown to
reduce aggression in some individuals, presumably by dampening excessive
noradrenergic activity.
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Chapter 34 - ETB
4.
This is correct. In their ability to modulate excessive dopaminergic activity,
antipsychotics—both typical and atypical—have been helpful in the control of
aggression and violence, particularly in individuals with comorbid psychosis.
CON: Violence
17. As a domestic violence nurse specialist, you are asked to testify in a court case
involving intimate partner abuse. The defense attorney asks, “When Mr. and Mrs. Smith
came to the emergency room, several people were around, yet Mrs. Smith still did not
say that Mr. Smith hit her.” Which statement describes the rationale for Mrs. Smith not
accusing her husband?
1. Abuse victims are not likely to accuse spouses without photographic evidence.
2. Abuse victims who are accompanied by the person who battered them are not likely to
be truthful about the cause of the injuries.
3. Abuse victims are not always aware of the resources available to them.
4. Abuse victims often lie about their injuries because they are afraid they will be killed
or their children will be harmed.
ANS: 2
Chapter: Chapter 34, Survivors of Abuse or Neglect
Objective: Discuss characteristics of victims and victimizers.
Page: 778
Heading: Table 34–1, Powerlessness
Integrated Processes: Communication and Documentation
Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive Level: Analysis [Analyzing]
Concept: Violence
Difficulty: Moderate
1.
2.
3.
4.
Feedback
This is incorrect. Photographs may be called in as evidence if charges are filed. The
nurse, in collaboration with physician, should ensure that all physical wounds,
fractures, and other evidence of injury are photographed with permission of the
client. This, however, does not explain why Mrs. Smith did not accuse her spouse.
This is correct. Abuse victims are not likely to be truthful about the incidence as
long as the victimizer is nearby.
This is incorrect. Knowledge of available resources can help decrease the victim’s
feeling of powerlessness; however, it does not explain why Mrs. Smith did not
accuse her spouse.
This is incorrect. Some people will attempt to keep secret how their injuries occurred
in an effort to protect their partner or because they are fearful that the partner will
kill them if they tell. This could be the reason Mrs. Smith does not accuse her
spouse; however, given the scenario, this is not the most likely reason.
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Chapter 34 - ETB
CON: Violence
18. Which medications could be used to reduce aggression by dampening excessive
nonadrenergic activity?
1. Tegretol
2. Dilantin
3. Lithium
4. Propranolol
ANS: 4
Chapter: Chapter 34, Survivors of Abuse or Neglect
Objective: Identify predisposing factors to abusive behaviors
Page: 777
Heading: Figure 34–1, Neurobiology of Violence
Integrated Processes: Nursing Process
Nursing Process: Assessment
Client Need: Physiological Integrity > Pharmacological and Parenteral Therapies
Cognitive Level: Application [Applying]
Concept: Mood
Difficulty: Difficult
1.
2.
3.
4.
Feedback
This is incorrect. Tegretol is a mood stabilizer that dampens limbic irritability in
structures such as the amygdala.
This is incorrect. Dilantin is a mood stabilizer that dampens limbic irritability.
This is incorrect. Lithium is a mood stabilizer.
This is correct. Propranolol could be used to reduce aggression.
CON: Mood
19. A child is brought in to the emergency room with physical injuries being reported as
an accident. The nurse should consider if the explanation is reasonable, if the injury is
consistent with the explanation, and which of the following?
1. If it is consistent with the child’s developmental capabilities
2. If previous hospital admissions have occurred for the same injuries
3. The time of the day or night when admission occurs
4. The level of concern exhibited by the parent or caregiver
ANS: 1
Chapter: Chapter 34, Survivors of Abuse or Neglect
Objective: Evaluate nursing care of survivors of intimate and partner violence, child
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Chapter 34 - ETB
abuse, and sexual assault.
Page: 777
Heading: Table 34–1, Care Plan for the Survivors of Abuse; Nursing Diagnosis: Risk for
Delayed Development
Integrated Processes: Nursing Process
Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive Level: Evaluation [Evaluating]
Concept: Violence
Difficulty: Moderate
1.
2.
3.
4.
Feedback
This is correct. The nurse should be cautious when assessing the child’s physical
injuries to rule out any form of abuse.
This is incorrect. If the child plays a sport or engages in high-risk behaviors, it is
possible that the injury resulted from those activities as opposed to abuse.
This is incorrect. By itself, the time of admission would not indicate abuse had
occurred.
This is incorrect. Parents who bring a child for treatment are likely to exhibit signs
of concern regardless of whether abuse had occurred.
CON: Violence
20. When Beverly told her sister Liz about the repeated episodes of abuse she’d
experienced, her sister replied, “If you leave him, how will you be able to pay your
bills?” Liz’s reply supports which notion?
1. Battered women may be encouraged by their social network to remain in the abusive
relationship.
2. Women who are battered often take blame for their situations.
3. The sisters were victims of child abuse.
4. Family members rarely believe that intimate partner violence is occurring.
ANS: 1
Chapter: Chapter 34, Survivors of Abuse or Neglect
Objective: Discuss characteristics of victims and victimizers.
Page: 782
Heading: Summary and Key Points
Integrated Processes: Nursing Process
Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive Level: Comprehension [Understanding]
Concept: Family Dynamics
Difficulty: Moderate
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PMHN, 10e
Chapter 34 - ETB
1.
2.
3.
4.
Feedback
This is correct. It can often be difficult for battered women to escape their abusive
relationships.
This is incorrect. There is no indication in the scenario that Beverly is blaming
herself.
This is incorrect. While it is possible that the sister may have experienced child
abuse, that does not directly support Liz’s statement.
This is incorrect. Family members may not have knowledge of abuse but typically
believe their family member.
CON: Family Dynamics
21. After being found in an alley, Theresa was taken to a nearby emergency room. Upon
her arrival, police notified the nurse that Theresa was a suspected rape victim, which
Theresa confirmed. The doctor orders a rape kit to retrieve any DNA that may still be
present on or in the victim. Which intervention by the nurse is appropriate?
1. Try to have as few people as possible collecting immediate evidence.
2. Offer to call the victim’s pastor or spiritual advisor.
3. Provide a variety of support resources for survivors of sexual assault.
4. Clean the victim’s wounds and administer sedative medications as ordered.
ANS: 1
Chapter: Chapter 34, Survivors of Abuse or Neglect
Objective: Evaluate nursing care of survivors of intimate partner violence, child abuse,
and sexual assault.
Page: 777
Heading: Table 34–1, Care Plan for Survivors of Abuse; Nursing Diagnosis: RapeTrauma Syndrome
Integrated Processes: Nursing Process
Nursing Process: Implementation
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Violence
Difficulty: Moderate
1.
2.
3.
4.
Feedback
This is correct. The nurse should ensure that the client has adequate privacy for all
immediate postcrisis interventions.
This is incorrect. Theresa may want to have a pastor or spiritual advisor for support,
but the collection of evidence as early as possible is critical.
This is incorrect. At this time, the victim is likely experiencing significant physical
and emotional trauma and could not process support service materials appropriately.
This is incorrect. If no life-threatening injuries are noted, collection of evidence
would need to occur before cleaning any wounds or administering medications.
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PMHN, 10e
Chapter 34 - ETB
CON: Violence
22. A student at a local college attended a party with a classmate. After a few alcoholic
beverages, she reported he raped her, and she does not remember anything. Which type
of rape does this describe?
1. Date
2. Marital
3. Sexual Abuse
4. Statutory
ANS: 1
Chapter: Chapter 34, Survivors of Abuse or Neglect
Objective: Describe physical and psychological effects on the survivors of intimate
partner violence, child abuse, and sexual assault.
Page: 773
Heading: Rape
Integrated Processes: Nursing Process
Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive Level: Comprehension [Understanding]
Concept: Violence
Difficulty: Moderate
1.
2.
3.
4.
Feedback
This is correct. Date rape is a term used if the encounter occurs during a social
engagement agreed to by the victim or applied to situations in which the rapist is
acquainted with the victim.
This is incorrect. Marital rape is a term used when the rapist is married to the
victim.
This is incorrect. Sexual abuse is when an individual is being used for the sexual
pleasure of another any other person.
This is incorrect. Statutory rape is intercourse between an individual who is over the
age of consent and someone under the legal age of consent.
CON: Violence
MULTIPLE RESPONSE
Townsend
PMHN, 10e
Chapter 34 - ETB
23. When planning care for women in abusive relationships, which information is
important for the nurse to understand? Select all that apply.
1. It often takes several attempts before a woman leaves an abusive situation.
2. Substance abuse is a common factor in abusive relationships.
3. Until children reach school age, they are usually not affected by parental discord.
4. Women in abusive relationships usually feel isolated and unsupported.
5. Economic factors rarely play a role in the decision to stay in abusive relationships.
ANS: 1, 2, 4
Chapter: Chapter 34, Survivors of Abuse or Neglect
Objective: Discuss characteristics of victims and victimizers.
Page: 773
Heading: Intimate Partner Violence > Profile of the Victim
Integrated Processes: Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive Level: Comprehension [Understanding]
Concept: Violence
Difficulty: Moderate
1.
2.
3.
4.
5.
Feedback
This is correct. It often takes a woman several attempts to leave an abusive situation.
Women in abusive relationships are often isolated from their families, feel
unsupported, and have limited economic options. Substance abuse is a common
factor in many abusive relationships.
This is correct. Substance abuse is a common factor in many abusive relationships. It
often takes a woman several attempts to leave an abusive situation. Women in
abusive relationships are often isolated from their families, feel unsupported, and
have limited economic options.
This is incorrect. Children can be affected by domestic violence from infancy. It
often takes a woman several attempts to leave an abusive situation. Women in
abusive relationships are often isolated from their families, feel unsupported, and
have limited economic options. Substance abuse is a common factor in many
abusive relationships.
This is correct. It often takes a woman several attempts to leave an abusive situation.
Women in abusive relationships are often isolated from their families, feel
unsupported, and have limited economic options. Substance abuse is a common
factor in many abusive relationships.
This is incorrect. It often takes a woman several attempts to leave an abusive
situation. Women in abusive relationships are often isolated from their families, feel
unsupported, and have limited economic options. Substance abuse is a common
factor in many abusive relationships.
CON: Violence
Townsend
PMHN, 10e
Chapter 34 - ETB
24. Which individuals are at highest risk for exhibiting aggressive behavior? Select all
that apply.
1. A parent who has been struggling to find work
2. A person who suffers from epilepsy
3. A child who has been raised by their grandparents since birth
4. An adult whose father would abuse his mother
5. A teen who prefers to read instead of play video games or watch television
ANS: 1, 2, 4
Chapter: Chapter 34, Survivors of Abuse or Neglect
Objective: Discuss characteristics of victims and victimizers.
Page: 766
Heading: Psychological Theories
Integrated Processes: Nursing Process
Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive Level: Analysis [Analyzing]
Concept: Violence
Difficulty: Moderate
1.
2.
3.
4.
5.
Feedback
This is correct. Poverty and long-term unemployment can lead to aggressive
behavior.
This is correct. Disorders of the brain, including epilepsy, can lead to personality
changes, including aggressive behavior.
This is incorrect. A child raised by their grandparents is not at risk for aggressive
behavior.
This is correct. An individual who witnessed abuse is likely to exhibit aggressive
behavior or become an abuser.
This is incorrect. Individuals who play a lot of video games with violence or watch a
lot of television with violence are likely to exhibit aggressive behaviors.
CON: Violence
25. Which nursing diagnoses would be expected for an adult survivor of incest? Select
all that apply.
1. Low self-esteem
2. Powerlessness
3. Disturbed personal identity
4. Knowledge deficit
5. Noncompliance
ANS: 1, 2
Chapter: Chapter 34, Survivors of Abuse or Neglect
Townsend
PMHN, 10e
Chapter 34 - ETB
Objective: Identify nursing diagnoses, goals of care, and appropriate nursing
interventions for care of survivors of intimate partner violence, child abuse, and sexual
assault.
Page: 775
Heading: The Victim > Diagnosis/Outcome Identification
Integrated Processes: Nursing Process
Nursing Process: Nursing Diagnosis
Client Need: Psychosocial Integrity
Cognitive Level: Comprehension [Understanding]
Concept: Violence
Difficulty: Easy
1.
2.
3.
4.
5.
Feedback
This is correct. An adult survivor of incest is expected to have low self-esteem.
This is correct. An adult survivor of incest is expected to have a sense of
powerlessness.
This is incorrect. Disturbed personal identity refers to an inability to distinguish
between self and nonself and is seen in disorders such as autistic disorders,
borderline personality disorders, dissociative disorders, and gender identity
disorders.
This is incorrect. An adult survivor of incest may not have a diagnosis of knowledge
deficit.
This is incorrect. An adult survivor of incest may not have a diagnosis of
noncompliance.
CON: Violence
26. A client and his spouse arrived for the client’s follow-up appointment 10 minutes
late. The client appeared to be very frustrated and aggravated. The spouse repeatedly
asked the client to keep his voice down and apologized to the receptionist when
checking in. “I sure hope you figure out what is causing this change in his behavior.
He’s starting to scare me,” said the spouse. Which statements are true regarding possible
causes of the change in the client’s behavior? Select all that apply.
1. Decreased dopamine release
2. High plasma concentrations of 5-hydroxyindoleacetic acid (HIAA)
3. Adverse side effect of testosterone therapy
4. Amygdala dysfunction
ANS: 2, 3, 4
Chapter: Chapter 34, Survivors of Abuse or Neglect
Objective: Identify predisposing factors to abusive behavior.
Page: 764
Heading: Predisposing Factors > Biological Influences > Neurophysiological Influences
> Biochemical Influences
Townsend
PMHN, 10e
Chapter 34 - ETB
Integrated Processes: Nursing Process
Nursing Process: Assessment
Client Need: Physiological Integrity > Pharmacological and Parenteral Therapies
Cognitive Level: Analysis [Analyzing]
Concept: Violence
Difficulty: Difficult
1.
2.
3.
4.
Feedback
This is incorrect. Studies have associated increased dopamine release with
aggression.
This is correct. Evidence demonstrates that high plasma (and low cerebrospinal
fluid) concentrations of 5-HIAA are associated with aggression.
This is correct. In general, testosterone replacement therapy is safe; however, an
adverse side effect of this therapy includes increased aggression and mood swings.
This is correct. Research consistently demonstrates that lower amygdala volume
plays a role in aggression.
CON: Violence
27. Which are behavioral indicators of emotional maltreatment? Select all that apply.
1. Extreme aggression
2. Suicide attempts
3. Inappropriately adult behavior for a child
4. Begging or stealing for food or money
ANS: 1, 2, 3
Chapter: Chapter 34, Survivors of Abuse or Neglect
Objective: Describe physical and psychological effects in the survivors of intimate
partner violence, child abuse, and sexual assault.
Page: 770
Heading: Child Abuse > Emotional Abuse
Integrated Processes: Nursing Process
Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive Level: Analysis [Analyzing]
Concept: Abuse/Neglect
Difficulty: Moderate
1.
2.
3.
Feedback
This is correct. Extreme aggression can be a behavioral indicator of emotional
maltreatment.
This is correct. Suicidal thoughts, speech, or attempts can be a behavioral indicator
of emotional maltreatment.
This is correct. Inappropriately adult behavior for a child can be a behavioral
Townsend
PMHN, 10e
Chapter 34 - ETB
4.
indicator of emotional maltreatment.
This is incorrect. Begging or stealing for food or money is not identified as a
behavioral indicator of emotional maltreatment.
CON: Abuse/Neglect
FILL IN THE BLANK
28. ____________________ is defined by federal law as “a commercial sex act induced
by force, fraud, or coercion, or in which the person induced to perform such act has not
attained 18 years of age.”
1. Rape
2. Abuse
3. Human trafficking
4. Child prostitution
ANS: 3
Chapter: Chapter 34, Survivors of Abuse or Neglect
Objective: Describe epidemiological statistics associated with intimate partner violence,
child abuse, and sexual assault.
Page: 785
Heading: Homework Assignment
Integrated Processes: Nursing Process
Nursing Process: Assessment
Client Need: Physiological Integrity > Reduction of Risk Potential
Cognitive Level: Knowledge [Remembering]
Concept: Violence
Difficulty: Easy
1.
2.
3.
4.
Feedback
This is incorrect. Rape is defined as the penetration, no matter how slight, of the
vagina or anus with any body part or object, or oral penetration by a sex organ of
another person, without the consent of the victim.
This is incorrect. Abuse is defined as the maltreatment of one person by another.
This is correct. Human trafficking, which includes sex trafficking, is defined by
federal law as “a commercial sex act induced by force, fraud, or coercion, or in
which the person induced to perform such act has not attained 18 years of age” (U.S.
Department of Education, 2013). Prevalence statistics are difficult to compile, but
sex trafficking of children has been reported in all 50 states. Traffickers have been
known to prey on children as young as 9 years of age.
This is incorrect. Prostitution requires consent to sex for money by both parties.
Townsend
PMHN, 10e
Chapter 34 - ETB
CON: Violence
29. ____________________ refers to a chronic failure by the parent or caretaker to
provide the child with the hope, love, and support necessary for the development of a
sound, healthy personality.
1. Abandonment
2. Physical neglect
3. Emotional neglect
4. Indifference
ANS: 3
Chapter: Chapter 34, Survivors of Abuse or Neglect
Objective: Discuss characteristics of victims and victimizers.
Page: 770
Heading: Child Abuse > Physical and Emotional Neglect
Integrated Processes: Nursing Process
Nursing Process: Assessment
Client Need: Safe and Effective Care Management > Safety and Infection Control
Cognitive Level: Analysis [Analyzing]
Concept: Abuse/Neglect
Difficulty: Moderate
1.
2.
3.
4.
Feedback
This is incorrect. Abandonment is to leave.
This is incorrect. Physical neglect includes refusal to seek or delay in seeking health
care, abandonment, expulsion from the home or refusal to allow a runaway to return
home, and inadequate supervision.
This is correct. Emotional neglect can lead to abuse if it results in serious
impairment of the child’s social, emotional, or intellectual functioning.
This is incorrect. Indifference is lack of interest.
CON: Abuse/Neglect
30. ____________________ aggression is associated with impulsivity and is more
common among people who have a history of being abused.
1. Proactive
2. Sexual
3. Reactive
4. Extreme
ANS: 3
Chapter: Chapter 34, Survivors of Abuse or Neglect
Townsend
PMHN, 10e
Chapter 34 - ETB
Objective: Identify predisposing factors to abusive behaviors.
Page: 764
Heading: Predisposing Factors
Integrated Processes: Nursing Process
Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive Level: Knowledge [Remembering]
Concept: Stress
Difficulty: Moderate
1.
2.
3.
4.
Feedback
This is incorrect. Proactive aggression is initiated rather than provoked and is more
common in psychopathy.
This is incorrect. Sexual aggression is related to power, dominance, and violence,
usually resulting in a sexual assault.
This is correct. Reactive aggression is associated with impulsivity and is more
common among people who have a history of being abused. Proactive aggression,
which is initiated rather than provoked, is more common in psychopathy.
This is incorrect. Extreme aggression can be associated with other mental health
issues.
CON: Stress