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4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 1/32 Exit Performance Chapter 21 Due Apr 16, 2023 by 11:59 pm Passed 45 out of 45 questions answered correctly Completed on Apr 10, 2023 11:44 am Incorrect (0) Correct (45) Which physical finding would lead a school nurse to suspect that a child is the victim of physical abuse? Select all that apply. One, some, or all responses may be correct. Poor hygiene Underweight

4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 2/32 Rationale The nurse should suspect physical abuse when cigarette burns are noted on the skin because these are physical indicators. Poor hygiene and being underweight are physical signs of neglect. Perineal itching is a sign of sexual abuse. A speech disorder is a symptom of emotional abuse. Test-Taking Tip: Attempt to select the answer that is most complete and includes the other answers within it. For example, a stem might read, "A child's intelligence is inﬂuenced by:" and three options might be genetic inheritance , environmental factors , and past experiences . The fourth option might be multiple factors , which is a more inclusive choice and therefore the correct answer. p. 354 A person with a history of abusing an intimate partner says, "When my partner leaves home, I think it's because she's meeting someone she likes better than me." Which emotion is most evident by this statement? Rationale Extreme pathological jealousy is characteristic of an abuser. Many refuse to allow their partners to work outside the home; others demand that their partners work in the Perineal itching Cigarette burns Speech disorder Guilt Anxiety Jealousy Remorse

4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 3/32 same place as they do, so they can monitor activities and friendships. Many accompany their partners to and from all activities and forbid them to have friends or participate in recreational activities outside the home. Anxiety is possible, but jealousy is more specific to the patient’s statement. There is no evidence of guilt or remorse, which would signify regret of the abuse. p. 357 Which statement concerning abuse is accurate? Rationale The majority of victims of who report intimate partner abuse are women. Older adults commonly face abuse both in domestic and institutional settings. Neglect is the most common form of child abuse, followed by physical abuse. Girls are slightly more likely to be abused, but boys die at a slightly higher rate than girls. p. 356 Which response would the nurse expect from a patient who is a recent victim of domestic violence when asked why the patient has not left the relationship? Select all that apply. One, some, or all responses may be correct. Elder abuse is uncommon. Children face physical abuse more than any other abuse. Girls facing child abuse die at a slightly higher rate than boys. Women face intimate partner abuse more often than men. "I cannot afford to live on my own." "Nobody else would want to be with me." "My spouse truly loves me, and it will get better." "My family lives close by, and I need to stay here."

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4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 4/32 Rationale Unfortunately, there are many reasons the victim of domestic violence chooses to stay in the abusive relationship. These include financial reasons because victims may not be able to live on their own. Many victims have poor self-esteem and may feel that nobody else would want to have them as a partner. The patient may also feel that the honeymoon phase that happens after an abusive event occurs will last and things will get better. A victim may also stay in the relationship for the children. Victims of abuse would not use the logic that their family lives nearby as a reason to stay in the relationship. p. 357 As the nurse sits down to talk with the parents of a 10-year-old suspected victim of physical abuse, which finding would support the nurse’s suspicions? Select all that apply. One, some, or all responses may be correct. Rationale Parents who are abusive tend to have certain common characteristics. Parents who are going through a divorce, are unemployed, or are facing financial diﬃculties have extra stressors that may increase the risk for abuse. Other common characteristics of abusive parents include blaming the child for the parent’s problem, being aggressive toward "I have to stay because my children need a home." Reports going through a divorce Blames the child for parental problems Demonstrates aggressive behaviors Belittles the child in front of other people Has unrealistic expectations of the child

4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 5/32 others, belittling the child in front of others, and having unrealistic expectations of the child. p. 356 Which strategy would the nurse use to facilitate communication with a 6-year-old child who is the victim of parental physical abuse? Rationale Young children may be afraid of betraying the parents. A technique that can be effective is to have the child role play using dolls to demonstrate what physical abuse is occurring. The nurse should not reward or bribe the child with candy to have the child talk about the injuries. A 6-year-old child may not have the writing vocabulary to document what happened. The parents would not be present because this can intimidate the child. p. 355 Which term is a type of abuse? Select all that apply. One, some, or all responses may be correct. Use dolls and role playing. Reward the child with candy. Write out what happened. Allow parents to be present. Physical Sexual Emotional Economic Intellectual

4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 6/32 Rationale Specific types of abuse have been identified as physical abuse, sexual abuse, emotional abuse, and economic abuse. Economic abuse is a form of neglect. Intellectual abuse is not considered a specific form of abuse or neglect. p. 353 Which family characteristic is considered a high risk factor for childhood sexual abuse? Rationale Having parents who were abused as children is a high risk factor for childhood abuse. Sexual abuse occurs in all types of families. Education, income, and multiple siblings are not high risk factors. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question. p. 356 Which action would the nurse implement initially when suspecting that a child has been abused? Undereducated parents Low-income families Multiple siblings Parents were abused Calling the local police to report it Following agency policy for reporting Confronting the parent or parents

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4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 7/32 Rationale Nurses are mandated reporters of child abuse . They must follow the rules set forth by the state regarding the steps to take to report child abuse. Calling the police, confronting the parents, and interrogating the child would not be the nurse’s initial steps. p. 362 An older adult female patient who has been abused by her caregiver daughter tells the nurse, "You don't have to worry about me. My daughter cried and apologized. She promised me she will never hit me again." Which stage of the cycle of violence would this statement represent? Rationale During the honeymoon stage , the perpetrator apologizes, promises never to abuse again, and tries to make up for the violence. This stage is usually brief. Tension- building, serious battering, and escalation are not accurate descriptions of this situation. p. 358 Interrogating the child to obtain proof Tension-building phase Serious battering phase Honeymoon phase Escalation phase

4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 8/32 A 4-year-old child tells the nurse, "I'm a bad boy. Daddy always says I'm not worth a second look." Which situation would this statement exemplify? Rationale Emotional abuse occurs when the child's self-esteem is attacked. It is as devastating to the child as physical abuse. Neglect is the inconsistent provision of basic needs. This example is not physical in nature. This situation falls under the category of abuse and is not an acceptable parenting style. p. 353 Which assessment information would the nurse record in the case report of a patient who has been sexually abused? Select all that apply. One, some, or all responses may be correct. Rationale Neglect Physical maltreatment Emotional abuse Harsh parenting Reports excessive masturbation No record of adequate immunization History of several untreated diseases Expresses an extreme fear of the dark Experiences feelings of anxiety frequently

4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 9/32 Sexually abused patients often indulge in excessive masturbation. Masturbation is a sexualized behavior commonly seen in sexually abused children in response to the traumatic event. The sexually abused patient may exhibit phobias, such as fear of the dark, and feelings of anxiety. Inadequate immunization and untreated diseases are seen in neglected patients as a result of inadequate medical care. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation. p. 354 A mother brings her 4-year-old daughter to the emergency department and states that the child has been "acting funny." The mother states, "She touches her vagina and rubs herself down there all the time, and she never did that before." Which conclusion can most likely be drawn from this behavior? Rationale Sexualized behavior is one of the most common symptoms of sexual abuse in children. Younger children may draw sexually explicit images, demonstrate sexual aggression, or act out sexual interactions in play, for example, with dolls. Masturbation may be excessive in sexually abused children. This is not normal developmental behavior for a 4-year-old child. The mother may need education in parenting skills, or the child may have been exposed to graphic sexual images, but sexual abuse is more likely and must be investigated. This is normal developmental behavior in a 4-year-old child. The child has been sexually abused. The mother needs education regarding age-appropriate parenting skills. The child has been exposed to graphic sexual images on television.

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4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 10/32 p. 354 Which social learning perspective identifies why the nurse would be troubled when witnessing the parents of 6-year-old twins ignoring the boys being physically aggressive toward each other? Rationale Violence is a behavior learned through childhood experience. The child learns both the means and the approval of violence. Children learn specific aggressive behaviors but also come to believe that violence is a legitimate way to solve problems. When frustrated or angry as an adult, the person relies on this learned behavior and responds with violence. The acceptance of aggressive behavior would not reﬂect a lack of social skills. The parents may have a healthy attachment to their children but accept violence as a legitimate coping mechanism. Although it is true that the risk for physical injury increases, this risk is not related to the social learning perspective. p. 353 Which family characteristic is a possible trigger for abusive behaviors? The family seems to have very weak social skills. The parents have a severe lack of attachment to the children. The behavior greatly increases the risk for the children being physically injured. The allowed aggression can lead to the children developing violence as a coping mechanism. The father is a stay-at-home parent. The parents were teenagers when the children were born. The family socializes only with other immigrant families. The parents are of different ethnic and religious backgrounds.

4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 11/32 Rationale The classic frustration-aggression hypothesis proposes that when frustration is high in response to negative societal situations, frustration may lead to aggression. Early parenthood is considered such a stressor. A father who stays at home, families who socialize only with other immigrant families, and parents of different backgrounds are not considered triggers for abusive behaviors. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. p. 353 Which result commonly occurs from domestic abuse in childhood? Select all that apply. One, some, or all responses may be correct. Rationale Domestic abuse during childhood may manifest in depression later in life. The patient may have low self-esteem and feelings of worthlessness. PTSD develops from a trauma that the patient experienced. Later in life, those who lived through domestic abuse in childhood may develop nightmares, somatic complaints, or feelings of guilt. A victim of childhood trauma is in constant fear and may later develop phobias. Those who face abuse in childhood have slower physical and mental development because the energy needed for developmental tasks tends to be spent on coping with abuse. Abuse in Onset of clinical depression Faster physical and social development Confrontation with family members Posttraumatic stress disorder (PTSD) Social and specific phobias

4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 12/32 childhood does not lead to confrontation with the family; rather, the abused person is more likely to become withdrawn and avoid confrontation. p. 353 Which statement describes the basis of nursing action when considering the possible abuse of a patient? Select all that apply. One, some, or all responses may be correct. Rationale Nurses are legally mandated to report suspected or actual cases of child and vulnerable adult abuse. Nurses must attempt to maintain both an appropriate level of suspicion and a neutral, objective attitude. Each state has specific guidelines for reporting, including whether the report can be oral, written, or both, and within what period the suspected abuse or neglect must be reported (immediately, within 24 hours, or within 48 hours). No collaboration by another health care provider is required. p. 354 A female patient in a relationship characterized by a long history of battering and abuse tells the nurse, "We’ve had a rough time lately. I admit it; he beat me last night but then said he was sorry." Which event would the nurse most expect to occur next in this relationship? Reporting is a legal obligation. Abuse need only be suspected. Most states require a report within 24 hours. The nurse is required to display a neutral attitude. The report needs support by another health care provider. Another beating by the abusive partner Love, gifts, and praise from the abusive partner

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4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 13/32 Rationale In the cycle of abuse, the serious battering phase is followed by a honeymoon phase in which the abuser shows loving behavior to the victim. The woman’s statement is indicative of the transition between the two phases. Minor explosions or incidences of violence may follow the honeymoon phase, but they do not generally come after the serious battering phase. Periods in which the partners ignore each other or in which the abusive partner leaves are not typical of the general cycle of abuse. p. 358 A university football coach invites the campus nurse to talk to the team about healthy relationships in the community. Which topic is a priority for the nurse to include? Rationale Teen abuse takes many forms, including inappropriate behaviors such as jealousy, manipulation, stalking, and others. The nurse’s priority would be to emphasize appropriate behavior with intimate partners because this is a widespread problem among teenagers who are newly beginning to cultivate romantic relationships and understand their sexuality. University resources are important, but the priority would be on covering appropriate behaviors because this puts responsibility for the relationships appropriately in the teens’ hands. The importance of role modeling would be an appropriate topic for parents or professors, not for the teens themselves, A brief period in which the partners ignore each other An absence of the abusive partner from the relationship for a short time Appropriate behavior with intimate partners University resources for counseling and support The importance of role modeling for children and teens Public recognition of children with life-threatening illnesses

4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 14/32 because they would not be doing the modeling. Recognition of children with life- threatening illnesses is not a relevant topic for a presentation about healthy relationships. p. 361 Which intervention would the nurse implement to help ensure the safety of a patient who has been physically abused by their life partner? Rationale The nurse should obtain a clear and detailed history from the patient. The nurse should assess the safety of the patient and help them explore alternatives to reduce danger on being discharged. The nurse should not just counsel and send the patient home if there is a risk for danger once the patient is discharged. The nurse should not tell the patient that they are "in trouble." The nurse should remain calm and objective. The nurse should not display anger or shock. The nurse should not be judgmental. p. 360 Which patient statement demonstrates a risk for abusive parenting? Select all that apply. One, some, or all responses may be correct. Providing a counseling session for the patient before discharge Advising the patient that they are "in trouble" and need to find a shelter Helping the patient explore alternatives to reduce dangers Clearly accusing the patient’s partner of abuse "I can't remember ever being told I was loved." "Drinking a beer or two helps me calm down." "It's been really hard since the divorce became final." "We've gone to counseling, but nothing seems to help." "If the children would only listen to me, things would be all right."

4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 15/32 Rationale Characteristics of abusive parents include a history of abuse, neglect, or emotional deprivation as a child; a history of drug or alcohol abuse; involvement in a crisis situation such as divorce; projection of blame onto the child; and the inability to seek help from others. Test-Taking Tip: Multiple choice questions can be challenging because students think they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each choice will seem like the correct response. p. 356 Which behavior is characteristic of the tension-building stage of the violence cycle? Select all that apply. One, some, or all responses may be correct. Rationale During the tension-building stage , the abuser feels on edge, and verbal and minor physical abuse occurs. The victim feels tense and afraid and accepts blame for the abuse. During the acute battering stage, the abuser releases the built-up tension by brutal beatings, which can result in serious injuries. The honeymoon stage is characterized by kindness and loving behaviors. The abuser, at least initially, feels Minor physical abuse may occur. Tension is released thorough physical violence. Calmness returns for a short period. The victim accepts blame for the incidents. Remorse is felt and expressed.

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4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 16/32 remorseful and apologetic. Over time, the periods of calmness and safety become briefer, and the periods of anger and fear are more intense. p. 358 Which pattern drives a man to act as a perpetrator in an abusive relationship? Select all that apply. One, some, or all responses may be correct. Rationale Male perpetrators believe in male supremacy and male dominance . They feel that they are in charge in a relationship, and using force makes them feel more powerful and proves their supremacy. Because of extreme jealousy, they do not want their partners to have personal friends or to take part in any recreational activities outside the home. They sometimes do not want their partner to go outside and work because of extreme jealousy. They use physical aggression to be in a powerful position in a relationship. Forcing the partner to work and an extreme sense of hatred for the abused partner is not typical of a perpetrator’s patterns. p. 353 Which nursing assessment question has the most significance when planning discharge for a victim of severe domestic abuse? Has a need to be in charge and dominant in the relationship Forces his partner to work while he is idle Has a feeling of power when using force and abuse Has an extreme sense of hatred for his partner Exhibits extreme pathological jealousy "Are you feeling anxious or depressed?" "Are you feeling any desire to kill your abuser?"

4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 17/32 Rationale Safety always comes first. Therefore, the nurse would assess the patient’s homicide potential. If a victim has any desire to kill the perpetrator, an intervention would be needed so that any such possibility can be prevented. For anxiety or depression, counseling can be done, and the patient can be referred to a proper care facility. If the patient wants further treatment, based on the patient’s condition, a psychiatric inpatient care facility or an outpatient facility can be referred. After knowing about the abuse, the nurse mandatorily reports it to the police. The patient can take legal action, and the health care record of abuse will be helpful in legal proceedings. p. 361 Which data obtained during a family assessment would be considered an early indicator for family-focused abuse? Rationale Early indicators of families at risk include violence in the family of origin of either partner. Although having a legally blind child, the children often playing violent video games, and the father traveling for work and home only on weekends are potential sources of family stress or aggressiveness, there is an option with more potential for family-focused abuse. p. 352 "Are you willing to engage in further treatment?" "Are you willing to have your abuser arrested?" The oldest child is legally blind. The children often play violent video games. The mother's brother is in jail for assault and battery. The father travels for work and is home only on weekends.

4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 18/32 Which person has the highest risk for experiencing physical abuse? Rationale Older women who are dependent on family members for care are at higher risk for abuse. The baby with colic, the man with cardiovascular disease, and the woman whose husband has an anxiety disorder do not have specific characteristics that put them at higher risk for abuse. p. 353 The school nurse assesses multiple bruises and welts in odd shapes on a child's back. Lately, the child has been frequently tardy and has had episodes of aggressive behavior in school. Which action would the nurse implement first? Rationale The nurse is a mandated reporter of suspected abuse . It is not necessary for the nurse to determine whether abuse actually occurred. Asking the child the identity of the person who caused the injury is premature. Discussing the findings with the child's A 7-month-old baby who has colic and does not sleep through the night A 53-year-old man with cardiovascular disease living with his son A 28-year-old woman whose husband has a diagnosis of an anxiety disorder A 77-year-old woman living with her daughter and son-in-law Ask the child, "Who did this to you?" Discuss the findings with the child's teacher. Notify the appropriate child protective agency of the findings. Report the findings at the multidisciplinary educational meetings.

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4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 19/32 teacher and reporting the findings at educational meetings may apply later. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. p. 355 Which outcome would the nurse identify as being the initial priority for a child who is suspected of being physically abused? Rationale Establishment of trust and rapport is the priority outcome. This outcome precedes focusing on details of the injuries because trust is crucial if the child is to feel comfortable enough to self-disclose. Attending school on time, acknowledging abuse by caregivers, and refraining from aggressive behavior may apply later in the nurse– patient relationship. p. 353 An older adult has experienced both physical and emotional abuse while living with a family member. The family member has been compliant with the required therapy, and, at the patient’s request, the two will be living together again. Which intervention would best ensure that both the patient and the family member’s needs are being met? The child will attend school on time. The child will acknowledge abuse by caregivers. The child will form a trusting relationship with the nurse. The child will refrain from aggressive behavior with others. Initially, 24-hour home aides are provided 7 days a week.

4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 20/32 Rationale Follow-up is crucial in ensuring ongoing safety of the older adult patient and support of the caregiving system. Temporary home aides, law enforcement interventions, and reliance on the abused elder to report incidences do not provide long-term support and supervision. p. 363 After the admission interview and assessment, the emergency department nurse has reason to believe a child is being physically abused. Which intervention would the nurse implement to best determine if the child has been abused? Rationale In the case of suspected child abuse, after the initial interview with the parents, the child would be seen alone; this gives the child a chance to disclose mistreatment. The nurse should not prompt the child about possible abuse or delay the examination The patient agrees to report any incidences of abuse by the family member immediately. The family member is informed that criminal charges will be filed if any abuse occurs. The home will have regular but unscheduled visits by adult protective services agents. Providing the child with suggestions of other possible examples of abuse Insisting that the child be further assessed without the parents being present Delaying the assessment until the appropriate child protection authorities are present Allowing the child to pick one parent to be present during the remaining examination

4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 21/32 because these actions can affect the outcome of the assessment. The child would be interviewed without either parent present. p. 355 Which question best demonstrates the nurse’s understanding of the need to assess a patient who has been physically abused for additional forms of trauma? Rationale The physical damage caused by physical abuse is usually accompanied by emotional abuse. Emotional abuse includes threats and intimidation. Asking about the injuries, when the physical abuse began, and what triggers the physical abuse would focus on the physical abuse rather than assessing for other forms of abuse. p. 353 Which statement by a female patient about her spouse would support the suspicion that she is being emotionally abused? "What types of injuries have you received as a result of the physical abuse?" "Did your abuser ever intimidate or threaten you?" "Can you tell me when the physical abuse began?" "Do you know what triggers the physical abuse?" "He has a good job and keeps control of all the finances, but our electricity was turned off last week." "I didn't tell him I was coming because he is under so much stress at work I didn't want to add to it." "He yells a lot and calls me names, but I can be pretty stupid and make a lot of mistakes." "He has a fiery temper. It’s best to stay out of his way when he gets angry."

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4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 22/32 Rationale Emotional abuse may be less obvious and more diﬃcult to assess than physical violence, but it can be identified through indicators such as low self-esteem, reported feelings of inadequacy, and anxiety. Controlling the finances and having the electricity turned off describe the possibility of economic abuse. Not wanting to add to the spouse’s stress does not describe an abusive situation. The spouse with a temper would more likely hint at physical, rather than emotional, abuse. p. 353 A patient comes to the health care facility with a bleeding head injury and bruises on both hands. Which characteristic suggests to the nurse that the patient may be experiencing domestic abuse? Select all that apply. One, some, or all responses may be correct. Rationale If the patient comes in with a bleeding injury, especially to the head or face, the nurse should suspect abuse. If the explanation does not match with the injury, the nurse should ask the patient direct questions in a nonthreatening way to determine if the injury is caused by a person in the family. The nurse should document the patient’s nonverbal responses. Examples include the patient hesitating, giving inconsistent explanations, not making eye contact, or displaying anxious behavior. Direct eye contact and exaggerating the seriousness of the injury would not reveal underlying abuse. Makes direct eye contact Gives hesitant explanations Gives inconsistent explanations Demonstrates anxious behavior Exaggerates the seriousness of the injury

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4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 23/32 p. 359 Which action would the nurse take to support and protect a patient who has been physically abused with the patient’s consent? Select all that apply. One, some, or all responses may be correct. Rationale The nurse should identify patients at risk for abuse and those who are being abused. The nurse should suggest to the patient that they be admitted to the hospital for further investigation. The nurse should listen effectively to the victim to know the cause of the abuse. This would help the nurse give suitable advice to the patient. The nurse should document the evidence by taking photographs with the patient’s consent and by using assessment tools. It is the duty of the nurse to legally report the abuse of children and vulnerable adults. The nurse should interact with the patient in complete privacy. The patient would likely feel uncomfortable interacting in the presence of a group. Patients should not be forced to undergo a whole-body examination. p. 360 An emergency department nurse assesses a child with a fractured ulna. The nurse also observes yellow and purple bruises across the child’s back and shoulders. Which statement by the parents would prompt the nurse to consider making a report to child protective services? Suggest to the patient that a complete physical examination is needed Asking the panel of health care professionals to interact with the patient Listening attentively and reﬂectively to the patient while conducting the interview Taking photographs of the patient’s wounds for evidence as needed Insisting that the patient undergo a whole-body examination "We do not believe in immunization of our children."

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4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 24/32 Rationale One characteristic of an abusive parent is projection of blame onto the child for the parent’s problem. This characteristic is exhibited in the statement that the child is always creating problems. Choosing not to immunize one’s child would not constitute abuse. A child may choose to play alone for many reasons; this behavior is not abnormal on its own. Homeschooling a child to include religious education is not an example of abuse. p. 356 A battered female patient has been referred to a women's shelter. Which action would the nurse implement when the patient's abuser demands to be told where she is? Rationale The nurse must respect the patient’s right to confidentiality. Whether the questioner asks pleadingly or in a demanding way, the nurse would refuse to provide any information. Exceptions would not be made to release the shelter’s phone number or after 24 hours. Calling law enforcement would not be appropriate at this time. "This child is always creating problems for the family." "Our child would rather play alone than with other children." "We homeschool our children to include religious education." Refusing to provide any details Giving the abuser the phone number, but not the address, of the shelter Informing the abuser that no information can be given for a minimum of 24 hours Calling law enforcement to arrest the abuser for the assault and battery of the victim

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4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 25/32 p. 360 Which area would the nurse concentrate on in the context of abuse assessment? Select all that apply. One, some, or all responses may be correct. Rationale In an abuse assessment, the nurse should include violence indicators, family coping patterns, and levels of anxiety and coping responses to plan the interventions. The nurse should not express horror, anger, shock, or disapproval of the perpetrator, or make any judgmental statement to the perpetrator. The interview would not be conducted by a group of interviewers. Rather, the patient would be made to feel comfortable and build a rapport with the interviewing nurse. Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly because there usually is no pattern to the answers. p. 360 Which nursing intervention is most appropriate when counseling a family in which corporal punishment is regularly used to discipline their child? Indications or patterns of violence Observations of the family's patterns of coping Levels of anxiety and coping responses Approaching the abuser Assessment by a group of interviewers The child is separated from the parents and sent to live with relatives to stop the abuse. The parents are threatened with legal action if further abuse is observed.

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4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 26/32 Rationale Parents should be referred to parenting resources to learn alternative approaches to corporal punishment for disciplining their children. Hitting, slapping, or other expressions of violence should not be used when disciplining a child. The child should not be separated from the parents except in cases of severe abuse. While being counseled, parents should not be threatened. Counseling should be done in a calm and relaxed way, and questions should be rephrased so that parents do not feel threatened. There should be repetitive counseling to ensure that corporal punishment has stopped. A help line number is not necessary in this case. p. 363 Which principle would guide the nursing interview that is focused on identifying possible family-centered violence? Select all that apply. One, some, or all responses may be correct. Rationale Important and relevant information about the family situation can be gathered by routine assessment conducted with tact, understanding, and a calm, relaxed attitude. A The child is given a help line number to call in case of any further abuse by the parents. The parents are referred to parenting resources to learn alternative approaches to discipline. A person who feels judged or accused of wrongdoing is likely to become defensive. Focus should be on identifying problems and acceptable ways of solving them. Tension is best minimized by asking the sensitive questions first. The telling of the abuse should be stopped whenever clarification is needed. Establishing a trustful rapport is the initial nursing intervention.

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4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 27/32 person who feels judged or accused of wrongdoing is likely to become defensive and may not be receptive to changing behavior. It is better to ask about ways of solving disagreements or methods of disciplining children. When interviewing, the nurse would spend time establishing trust and rapport before focusing on the details of the violent experience. Establishing trust is crucial if the patient is to feel comfortable enough to self-disclose. The person who experienced the violence should be allowed to tell the story without interruption. p. 353 Based on the following patient statements, which intervention would the nurse add to the plan of care? Referring the patient for cognitive behavioral therapy-I (CBT-I)

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4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 28/32 Rationale CBT focuses on changing patterns of thinking, especially negative thinking (Sadock et al., 2015), to reduce stress and promote rest. CBT-I is a newer form of CBT for insomnia that focuses on sleep hygiene and changing thoughts, feelings, and behaviors that contribute to poor sleep. Pharmacological treatment for sleep disorders is with sedative-hypnotic drugs like zolpidem, not with methylphenidate. When a stimulant is given, it is with modafinil for narcolepsy. Mechanical devices such as ventilation assistance devices (e.g., CPAP machines) may be necessary for obstructive sleep apnea, but there is nothing in the question stem to indicate that the patient has sleep apnea. Appropriate doses for melatonin are 0.3 to 1 mg several hours before sleep. Though melatonin appears safe for short-term use, long-term safety has not been confirmed. p. 435 The parents of a 3-year-old patient admit to finding it diﬃcult to control their anger when the child acts out. Which short-term goal would the nurse include in the family’s plan of care to ensure the child’s safety? Rationale Administering methylphenidate as prescribed Having the patient use a continuous positive airway pressure (CPAP) machine Educating the patient about taking melatonin 3 to 5 mg at bedtime Understand the impact of violence on the child within 2 days Begin attending anger management training sessions within 1 week State a willingness to attend a support group for physical abusers within 1 week Show remorse for their anger management issues within 2 days

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4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 29/32 Perpetrators of violence need help learning how to manage anger. A structured training is an excellent way to provide this teaching. Understanding the impact of violence, willingness to attend a support group, and showing remorse may also play a role but are not the most appropriate short-term goals. p. 355 Which behavior demonstrated by a woman attempting to escape a chronically abusive relationship is of most concern? Rationale A person experiencing violence may feel so trapped in a detrimental relationship, yet so desperate to get out, that suicide may seem like the only answer. A suicide attempt may be the presenting symptom in the emergency department. Risk for self-harm is more serious than using alcohol, adopting an aggressive attitude, or threatening to call the police. p. 356 The nurse is discussing the possible existence of abuse of a 4-year-old patient currently being treated in the emergency department. Which statement by the nurse would require immediate intervention? Relying on alcohol to escape the emotional pain of abuse Adopting an aggressive attitude toward her abuser to scare them Considering ways to commit suicide Threatening to call the police if she is abused again "A 4-year-old can be an unreliable source because they have such wonderful imaginations." "It’s up to the state’s child protection agency to determine if our fears are valid." "I’m absolutely sure every state requires that we report our concerns."

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4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 30/32 Rationale When child abuse is suspected, persons in authority, including nurses, teachers, spiritual leaders, coaches, counselors, and child care providers, are legally responsible for reporting to the appropriate child protective agency. Each state mandates that a report must be filed when suspected abuse or neglect is encountered. It is not necessary to have proof of the abuse. If there is a suspicion or the child says something is happening, that is enough grounds to report. It is then up to the child protective services agency to investigate and make a determination. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question. p. 355 A patient prepares to return home after receiving treatment for injuries associated with intimate partner violence. Which is the priority action by the nurse? Rationale Safety is the nurse's highest priority. Patients should be given the number of the nearest available shelter, even if they decide for the present to stay with their partners. Referral phone numbers may be kept for years before deciding to call. Pastoral "We don’t need physical proof of injury to report this situation." Referring the patient for pastoral counseling Providing the patient with contact information for the local shelter Encouraging the patient to file criminal charges against the perpetrator Telling the patient that you have documented the injuries and treatment thoroughly

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4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 31/32 1 topics covered counseling may be helpful but is not the priority. The nurse would not give advice, such as encouraging the patient to file criminal charges against the perpetrator. Documentation is part of the nurse's responsibility, but adamantly informing the patient of the documentation is likely to increase fear. p. 360 During a health screening, the nurse suspects that the older children have been physically abused. Which assessment data would serve to support this suspicion? Rationale Physically abused children may be mistrustful and wary of adults . They may hesitate to interact with the nurse. Physically abused patients give vague reasons and explanations for their injuries. The reason for the injury does not correlate with the severity of the injury. Nonspecific bruising in children older than 2 years of age can be considered common. Nonspecific bruising can occur in older children while playing. Physically abused patients do not maintain proper eye contact because they try to hide their feelings. They believe that others will not trust or understand their situation. p. 355 The children give seemingly appropriate reasons for their injuries. The children have nonspecific bruising on their hands. The children tend to keep eye contact with the nurse. The children hesitate to interact with the nurse.

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4/10/23, 11:45 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/37317691 32/32 Chapter 21, Child, Partner, and El… Fosbre: Varcarolis' Essentials of Psychiatric Mental Health Nursing,… Proficient You Quiz me on this topic Novice Intermed . Prof . Q's ans'd 45

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