Violence and Human Abuse

1. Which of the following statements is the best explanation as to why some countries are more violent than others?

a.
Civilized societies are less violent than primitive societies.
b.
Geographical differences are the primary factor.
c.
Population differences are the main determinant—for example, having more males than females.
d.
Violence is a learned behavior controlled or allowed by social norms.

ANS: D

Some societies are basically nonviolent, and for them violence is not a significant health problem. Violence is a learned behavior, and social norms can keep violence at low levels or even eliminate it.

DIF: Cognitive Level: Understand (Comprehension) REF: pp. 455-456, 461

2. Which of the following statements best explains the primary reason why violence is so high among young African-American men?

a.
Men tend to be more violent than women.
b.
They are young and thus lack maturity.
c.
Unemployment is higher in this population.
d.
Violent tendencies are transferred genetically along racial lines.

ANS: C

Most analyses conclude that the differential rates of violence between African Americans and whites in the United States have more to do with economic realities, such as poverty, unemployment, and overcrowding, than with race. Although violence among men may be higher than among women, this question specifically addresses “young

African-American men.”

DIF: Cognitive Level: Understand (Comprehension) REF: pp. 454-455

3. Which of the following is the top risk factor for intimate partner homicide?

a.
There is a gun in the house.
b.
The husband has made threats against wife before.
c.
The wife has previously called 911 because of husband’s beating her.
d.
The woman’s young daughter also lives with them.

ANS: C

The top risk factor for intimate partner homicide (IPH) is previous domestic violence. Other risk factors are access to guns, estrangement, threats to kill or threats with a weapon, nonfatal strangulation, and a stepchild in the home if the victim is a female.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 457

4. Which of the following persons is most likely to be assaulted?

a.
A young man
b.
A young woman
c.
An older man
d.
An older woman

ANS: A

Men are far more likely to be assaulted or killed than are women. The greatest risk factor for an individual’s victimization by violence is age; youths are at significantly higher risk.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 457

5. Which of the following is the most likely reason for a man to rape a woman?

a.
Because the woman was asking for it
b.
For power and control
c.
Provoked by the woman’s dress and behavior
d.
Sexual pleasure and release

ANS: B

The underlying issues of rape are hostility, power, and control rather than sexual desire.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 459

6. A nurse is counseling a woman following a rape. Which of the following feelings is the woman most likely to state she felt while being raped?

a.
Confusion
b.
Satisfaction
c.
Sexual release
d.
Helplessness

ANS: D

During the act of rape, survivors are often hit, kicked, stabbed, and severely beaten. It is this violence, as well as the violation of the sense of self, that most traumatizes the person because of the fear for her life and her feelings of helplessness, lack of control, and vulnerability.

DIF: Cognitive Level: Apply (Application) REF: p. 459

7. A nurse is concerned about the possibility of suicide in a teenage boy. Which of the following characteristics has the boy most likely displayed?

a.
He has threatened harm to his school peers.
b.
He is between the ages of 15 and 19.
c.
He is depressed and has a history of being sexually abused.
d.
He has been accused of abusing an animal.

ANS: C

Leading risk factors for suicide are depression and other mental disorders or substance-abuse disorders. Other risk factors include prior suicide attempt, family history of suicide, mental disorder, substance abuse or violence, firearms in the home, incarceration, and exposure to the suicidal behavior of others (family, peers, or figures in the media). Children who threaten to harm others or who abuse an animal are more likely to hurt others than themselves.

DIF: Cognitive Level: Apply (Application) REF: p. 460

8. Which of the following is a common factor typically found in those who abuse others?

a.
Fear and belief that others are “out to get them”
b.
Poor self-esteem and unawareness of alternatives
c.
Previous observations of violent behaviors to manage conflict
d.
Difficulty keeping commitments

ANS: C

People who become involved in violence typically had previous exposure to some form of violence. Abusers were often beaten when they were children, or they witnessed siblings or one of their parents being beaten. They learned that violence is a way to manage conflict.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 461

9. A public health nurse is hosting an informational meeting for young parents about how to balance their multiple responsibilities. Which of the following parents in attendance would be most at risk for abusing his or her own child?

a.
A new mother who has joined a parents’ support group
b.
A father who is overwhelmed and exhausted by overtime work
c.
A depressed father who was laid off from work and is missing his work colleagues
d.
A mother who is missing her career challenges and friends but enjoying being home with her baby

ANS: C

Parents with a lack of social support, a tendency toward depression, multiple stress factors, and a history of abuse are at risk for abusing their own children. Abusive parents often have unrealistic expectations of a child’s developmental abilities.

DIF: Cognitive Level: Apply (Application) REF: p. 463

10. A teacher asks the school health nurse to assess a child for neglect. Which of the following assessment findings could indicate neglect?

a.
Bruises in various stages of healing
b.
Failure of parent to attend parent-teacher conferences or return teacher phone calls
c.
Lack of weight gain and wearing dirty clothes
d.
Lice in the hair

ANS: C

Physical neglect refers to failure to provide adequate food, clothing, shelter, hygiene, or necessary medical care; emotional neglect refers to the omission of basic nurturing, acceptance, and caring essential for health development. Lice are a common problem among school children, and the presence of lice does not indicate neglect. Failure to attend parent-teacher conferences should not be construed as neglect, because various reasons, such as employment requirements, may prevent parents who care from attending. Bruising is a sign of physical abuse rather than neglect.

DIF: Cognitive Level: Apply (Application) REF: p. 464

11. Which of the following statements by a parent indicates a need for increased learning regarding appropriate (nonabusive) discipline of a child?

a.
“I have stopped using a switch on my child, and I am learning to count to 10 before reacting.”
b.
“I never spank or hit; I yell at them to stop being stupid, and if they don’t, I tell them no one is ever going to love them if they act like that.”
c.
“I use time-outs when my child acts out or is naughty. Sometimes my child doesn’t cope well with this, but I am persistent.”
d.
“When my child misbehaves, I distract him and focus his attention on other things. If he throws a tantrum, I have been known to just pick him up and leave from wherever we are.”

ANS: B

Emotional abuse involves extreme debasement of feelings and may result in the child feeling inadequate, inept, uncared for, and worthless. Yelling at a child and threatening loss of love are devastating.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 464

12. A mother cannot understand why her daughter ran away from home. When the police locate the daughter, she complains of a severe headache, so the police take both of them to the emergency department for assessment. Which of the following potential problems should be assessed by the nurse?

a.
The daughter’s inability to do well in school
b.
Intimacy problems with the daughter’s boyfriend
c.
The mother’s abuse of the daughter over a long period of time
d.
Sexual abuse by the father

ANS: D

Nurses must be aware of the incidence, signs and symptoms, and psychological and physical trauma of incest. Symptoms include headaches, as well as other physiological problems. Children often try to avoid or escape the abusive behavior.

DIF: Cognitive Level: Apply (Application) REF: p. 465

13. The wife of an abusive husband reports to the nurse that her husband has been increasingly more abusive over the past year. Which of the following should be the first action that is taken by the nurse?

a.
Arrange for the couple to attend marital counseling.
b.
Develop a plan for the wife’s escape if the violence starts again.
c.
Teach the client how to avoid initiating her husband’s anger.
d.
Work with the client on development of self-esteem.

ANS: B

Although marital counseling may be useful at an early stage of abuse, it is generally contraindicated at all other stages because of the risk to the woman’s safety. Unfortunately, abuse tends to escalate in frequency and severity over time, and the man’s remorse tends to lessen. A nurse encountering severe abuse needs to consider the safety of the woman and her children as the priority. The woman will need an order of protection and help in getting to a safe place. At the very least, the woman must design a carefully thought-out plan for escape and arrange for someone to call the police if another violent episode occurs.

DIF: Cognitive Level: Apply (Application) REF: p. 466

14. During a group counseling session for perpetrators of intimate partner violence, which of the following statements made by a client indicates a lack of insight into his violent behavior?

a.
“I have been taking out my frustrations with work on my girlfriend.”
b.
“I love my girlfriend and didn’t want to hurt her; it was an accident.”
c.
“It might be a good idea for me to temporarily leave the house when I feel myself becoming angry.”
d.
“When I drink alcohol, I become more abusive toward my girlfriend.”

ANS: B

An alternative to ending the relationship is the male partner’s attendance at programs for batterers. These programs are most effective if they are court-mandated and if the man’s underlying values about women are addressed, as well as his violence. Violence is defined as those nonaccidental acts that result in physical or psychological injury. Although this client may now be feeling remorse, at the time the violent act was committed against the girlfriend, the intent was to inflict harm and maintain control. It was not an accident. The other three statements indicate an admission of a problem—at least on the surface.

DIF: Cognitive Level: Apply (Application) REF: p. 466

15. Which of the following statements, made by a caregiver of an older client, should alert the nurse to assess for evidence of elder abuse?

a.
“Mom is always into something and can’t seem to stay still, so I’ve been giving her half a Valium to get her to relax so I can get some rest.”
b.
“Mom wanted to stay at her home, but we were scared for her safety, so we moved some of her personal things into our home and brought her to live with us.”
c.
“She has not been having incontinence problems since we have been taking her to the toilet every 2 to 3 hours when she is awake.”
d.
“We have to feed Mom baby food now because she has trouble chewing and swallowing regular food.”

ANS: A

Giving medication to induce confusion or drowsiness so that the elders will be less troublesome or will need less care is considered a form of elder abuse. Such medication may also make it easier for adult children to control the elder’s assets. All other options are examples of proper care.

DIF: Cognitive Level: Apply (Application) REF: p. 467

16. A nurse is implementing a primary prevention strategy to address abuse in the community. Which of the following actions is the nurse most likely taking?

a.
Encouraging others to interfere when they see children hit or hurt in a public place
b.
Referring caregivers to community respite centers if abuse is beginning to occur
c.
Lobbying for passage of legislation to outlaw physical punishment in schools
d.
Screening each pregnant woman privately for intimate partner abuse

ANS: C

Primary prevention involves action before damage has occurred. The other options are all screening for abuse or reactions to abuse that has already taken place.

DIF: Cognitive Level: Apply (Application) REF: p. 470

17. A nurse is working with a family to reduce the incidence of home violence. Which of the following actions by the nurse would most likely have a positive effect?

a.
Being assertive and taking control of decisions because family members cannot be expected to have this ability
b.
Focusing attention on family weaknesses that need to be fixed before healing can begin
c.
Pointing out things that victims should do differently to avoid antagonizing the abuser
d.
Soliciting ideas from the family regarding what they feel will improve their situation

ANS: D

To empower the family, the nurse needs to recognize and capitalize on the violent family’s strengths and to guide the family in recognizing and dealing with its problems. The nurse must use a nurse-family partnership rather than a paternalistic or authoritarian approach. Families often can generate many of their own solutions—in fact, the family’s own solutions tend to be more culturally suitable and individualized than those the nurse generates.

DIF: Cognitive Level: Analyze (Analysis) REF: pp. 470-471

18. Which of the following best describes a principle of care that the nurse should abide by when working with abusive families?

a.
Confront the abuser and shame him into penitence and a desire to change.
b.
Demonstrate respect for all family members, including the abuser.
c.
Exclude the abuser from family meetings because the abuser is the one creating problems.
d.
Notify the abuser’s clergyman, boss, and others who can exert pressure for change.

ANS: B

Principles of giving care to families who are experiencing violence include the following: intolerance for violence; respect and caring for all family members; safety as the first priority; absolute honesty; and empowerment.

DIF: Cognitive Level: Understand (Comprehension) REF: pp. 470-471

19. A mother confides to the nurse that her live-in boyfriend knocked down her 2-year-old child because he was crying too much. She begs the nurse not to tell anyone because her boyfriend has agreed to take anger management classes. Which of the following actions should be taken by the nurse?

a.
Abide by the mother’s wishes because this information was provided in confidence.
b.
Arrange for counseling for the boyfriend at the earliest possible availability.
c.
Encourage the mother to take the child and find alternate housing right away.
d.
Report the incident to child protective services or other appropriate legal authority.

ANS: D

Nurses are mandatory reporters of child abuse, even when only suspected, in all states. All of the other options put the child’s welfare at risk, including encouraging the mother to seek alternatives, since encouraging an action will not ensure that it will happen.

DIF: Cognitive Level: Apply (Application) REF: p. 471

MULTIPLE RESPONSE

1. Which of the following factors may lead to increased violence? (Select all that apply.)

a.
Adequate social support
b.
Feelings of powerlessness
c.
Violence shown in the media
d.
Living in a crowded environment

ANS: B, C, D

Factors that increase violence include seeing violence in daily life or in the media, living in poverty with few opportunities for employment, and feelings of powerlessness. Crowded environments can be a factor but can also lead to banding together for the common good.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 455|p. 456|p. 461