Survivors of Abuse or Neglect

Multiple Choice

1. A kindergarten student is frequently violent toward other children. A school nurse notices bruises and burns on the child’s face and arms. What other symptom should indicate to the nurse that the child may 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
Rationale: The nurse should determine that a child who shrinks at the approach of adults in addition to having bruises and burns may be a victim of abuse. Maltreatment is considered, whether or not the adult intended to harm the child.

Cognitive Level: Application
Integrated Process: Assessment

2. A woman presents with a history of physical and emotional abuse in her intimate relationships. What should this information lead a nurse to suspect?
1. The woman may be exhibiting a controlled response pattern.
2. The woman may have a history of childhood neglect.
3. The woman may be exhibiting codependent characteristics.
4. The woman may be a victim of incest.

ANS: 4
Rationale: The nurse should suspect that this client may be a victim of incest. Many women who are battered have low self-esteem and have feelings of guilt, anger, fear, and shame. Women in abusive relationships often grew up in an abusive home.

Cognitive Level: Application
Integrated Process: Assessment

3. A nursing instructor is developing a lesson plan to teach about domestic violence. Which information should be included?
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
Rationale: The nursing instructor should include the concept that 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 very possessive and perceives the victim as a possession.

Cognitive Level: Application
Integrated Process: Planning

4. A client is brought to an emergency department after being violently raped. Which nursing action is appropriate?
1. Discourage the client from discussing the rape, because this may lead to further emotional trauma.
2. Remain nonjudgmental while actively listening to the client’s description of the violent rape event.
3. Meet the client’s self-care needs by assisting with showering and perineal care.
4. Probe for further, detailed description of the rape event.

ANS: 2
Rationale: The most appropriate nursing action is to remain nonjudgmental and actively listen to the client’s description of the event. It is important to also communicate to the victim that he/she is safe and that it is not his/her fault. Nonjudgmental listening provides an avenue for catharsis, which contributes to the healing process.

Cognitive Level: Application
Integrated Process: Implementation

5. A raped client answers a nurse’s questions in a monotone voice with single words, appears calm, and exhibits a blunt affect. How should the nurse interpret 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
Rationale: This client is most likely demonstrating a controlled response pattern. In the controlled response pattern, the client’s feelings are masked or hidden, and a calm, composed, or subdued affect is seen. In the expressed response pattern, feelings of fear, anger, and anxiety are expressed through crying sobbing, smiling, restlessness, and tension.

Cognitive Level: Application
Integrated Process: Assessment

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 is the nursing supervisor’s most appropriate response?
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 cognitive 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
Rationale: The nursing supervisor is accurate when stating that clients who are in abuse relationships are paralyzed into inaction by a combination of physical threats and a sense of powerlessness. Women often choose to stay with an abusive partner: for the children, for financial reasons, for fear of retaliation, for lack of a support network, for religious reasons, or because of hopefulness.

Cognitive Level: Application
Integrated Process: Evaluation

7. A woman comes to an emergency department with a broken nose and multiple bruises after being beaten by her husband. She states, “The beatings have been getting worse, and I’m afraid, next time, he will kill me.” Which is the appropriate nursing response?
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
Rationale: The most appropriate response by the nurse is to talk with the client about options so that the client does not have to return to the abusive environment. It is essential that clients make decisions on their own without the nurse being the “rescuer.” Imposing judgments and giving advice is nontherapeutic.

Cognitive Level: Application
Integrated Process: Implementation

8. A college student was sexually assaulted when out on a date. After several weeks of crisis intervention therapy, which client statement should indicate to a nurse that the student is handling this situation in a healthy manner?
1. “I know that it was not my fault.”
2. “My boyfriend 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
Rationale: The client who realizes that sexual assault was not her fault is handling the situation in a healthy manner. The nurse should provide nonjudgmental listening and communicate statements that instill trust and validate self-worth.

Cognitive Level: Application
Integrated Process: Evaluation

9. A client asks, “Why does a rapist use a weapon during the act of rape?” Which is the most appropriate nursing response?
1. “To decrease the victimizer’s insecurity.”
2. “To inflict physical harm with the weapon.”
3. “To terrorize and subdue the victim.”
4. “To mirror learned family behavior patterns related to weapons.”

ANS: 3
Rationale: The nurse should explain that a rapist uses weapons to terrorize and subdue the victim. Rape is the expression of power and dominance by means of sexual violence. Rape can occur over a broad spectrum of experience, from violent attack to insistence on sexual intercourse by an acquaintance or spouse.

Cognitive Level: Application
Integrated Process: Implementation

10. When questioned about bruises, a woman states, “It was an accident. My husband 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.” 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
Rationale: The client is in the honeymoon phase of the cycle of battering. In this phase, the batterer becomes extremely loving, kind, and contrite. Promises are often made that the abuse will not happen again.

Cognitive Level: Application
Integrated Process: Evaluation

11. Which information should 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 that can aid in divorce proceedings.
3. File charges of assault and battery.
4. Have ready access to the number of a safe house for battered women.

ANS: 4
Rationale: The nurse should provide information about the accessibility of safe houses for battered women when working with a client who has symptoms of domestic physical abuse. Many women feel powerless within the abusive relationship and may be staying in the abusive relationship out of fear.

Cognitive Level: Application
Integrated Process: Implementation

12. A survivor of rape presents in an emergency department crying, pacing, and cursing her attacker. A nurse should recognize these client actions as which behavioral defense?
1. Controlled response pattern
2. Compounded rape reaction
3. Expressed response pattern
4. Silent rape reaction

ANS: 3
Rationale: The nurse should recognize that this 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.

Cognitive Level: Application
Integrated Process: Evaluation

13. Which assessment data should a school nurse recognize as a sign 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
Rationale: The nurse should recognize that a child who is often absent from school and seems apathetic and tired may be a victim of neglect. Other indicators of neglect are 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.

Cognitive Level: Application
Integrated Process: Assessment

14. A client diagnosed with an eating disorder experiences insomnia, nightmares, and panic attacks that occur before bedtime. She has never married or dated, and she lives alone. She states to a nurse, “My father has recently moved back to town.” What should the nurse suspect?
1. Possible major depressive disorder
2. Possible history of childhood incest
3. Possible histrionic personality disorder
4. Possible history of childhood physical abuse

ANS: 2
Rationale: The nurse should suspect that this client may have a history of childhood incest. Adult survivors of incest are at risk for developing post-traumatic stress disorder, sexual dysfunction, somatization disorders, compulsive sexual behavior disorders, depression, anxiety, eating disorders, and substance abuse disorders.

Cognitive Level: Application
Integrated Process: Assessment

Multiple Response

15. In planning care for a woman who presents as a survivor of domestic abuse, a nurse should be aware of which of the following data? (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 abuse between their parents.
4. Women in abusive relationships usually feel isolated and unsupported.
5. Economic factors rarely play a role in the decision to stay.

ANS: 1, 2, 4
Rationale: When planning care for a woman who is a survivor of domestic abuse, the nurse should be aware that it often takes several attempts before a woman leaves an abusive situation, that substance abuse is a common factor in abusive relationships, and that women in abusive relationships usually feel isolated and unsupported. Children can be affected by domestic violence from infancy, and economic factors often play a role in the victim’s decision to stay.

Cognitive Level: Application
Integrated Process: Planning

16. Which of the following nursing diagnoses are typically appropriate for an adult survivor of incest? (Select all that apply.)
1. Low self-esteem
2. Powerlessness
3. Disturbed personal identity
4. Knowledge deficit
5. Non-adherence

ANS: 1, 2
Rationale: An adult survivor of incest would most likely have low self-esteem and a sense of powerlessness. Adult survivors of incest are at risk for developing post-traumatic stress disorder, sexual dysfunction, somatization disorders, compulsive sexual behavior disorders, depression, anxiety, eating disorders, and substance abuse disorders.

Cognitive Level: Application
Integrated Process: Assessment

17. A nursing instructor is teaching about intimate partner violence. Which of the following student statements indicate that learning has occurred? (Select all that apply.)
1. “Intimate partner violence is a pattern of abusive behavior that is used by an intimate partner.”
2. “Intimate partner violence is used to gain power and control over the other intimate partner.”
3. “Fifty-one percent of victims of intimate violence are women.”
4. “Women ages 25 to 34 experience the highest per capita rates of intimate violence.”
5. “Victims are typically young married women who are dependent housewives.”

ANS: 1, 2, 4
Rationale: Intimate partner violence is a pattern of abusive behavior that is used by an intimate partner. It is used to gain power and control over the other intimate partner. Women ages 25 to 34 experience the highest per capita rates of intimate violence. Eighty-five percent of victims of intimate violence are women. Battered women represent all age, racial, religious, cultural, educational, and socioeconomic groups. They may be married or single, housewives or business executives.

Cognitive Level: Application
Integrated Process: Assessment

Ordered Response

18. Order the description of the progressive phases of Walker’s model of the “cycle of battering?”
________ This phase is the most violent and the shortest, usually lasting up to 24 hours.
________ In this phase, the man’s tolerance for frustration is declining.
________ In this phase, the batterer becomes extremely loving, kind, and contrite.

ANS: The correct order is 2, 1, 3
Rationale: In her classic studies of battered women and their relationships, Walker identified a cycle of predictable behaviors that are repeated over time. The behaviors can be divided into three distinct phases that vary in time and intensity both within the same relationship and among different couples.
1. Tension building phase. In this phase, the man’s tolerance for frustration is declining.
2. Acute battering incident phase. This phase is the most violent and the shortest, usually lasting up to 24 hours.
3. Honeymoon phase. In this phase, the batterer becomes extremely loving, kind, and contrite.

Cognitive Level: Analysis
Integrated Process: Assessment

Fill-in-the-Blank

19. A pattern of coercive control founded on and supported by physical and/or sexual violence or threat of violence of an intimate partner is termed ______________________.

ANS: battering
Rationale: Battering is a pattern of behavior used to establish power and control over another person with whom an intimate relationship is or has been shared through fear and intimidation, often including the threat or use of violence. Battering happens when one person believes they are entitled to control another.

Cognitive Level: Application
Integrated Process: Assessment

20. Physical ________________ of a child includes refusal of or delay in seeking health care, abandonment, expulsion from the home or refusal to allow a runaway to return home, and inadequate supervision.

ANS: neglect
Rationale: Physical neglect of a child includes refusal of or delay in seeking health care, abandonment, expulsion from the home or refusal to allow a runaway to return home, and inadequate supervision. Children are vulnerable and relatively powerless, and the effects of maltreatment are infinitely deep and long lasting.

Cognitive Level: Application
Integrated Process: Assessment