Jarvis ch. 8 - interpersonal violence Flashcards
During admission assessment of a 72-year-old patient with dementia from a long-term care facility, the nurse notices multiple signs of old bruising to the patient’s wrists and arms. The nurse should assess for:
a. Functional capabilities
b. Fall risk
c. Normal aging
d. Elder abuse
ANS: D
With increasing numbers of older adults in Canada and the greater need for institutionalization of these older adults, recognition of abuse has become important and may include rough or violent handling during personal care, force feeding or withholding food, and neglect
The nurse is aware that screening for intimate partner violence (IPV) using the trauma- and violence-informed care (TVIC) approach should occur with which type of situation?
a. When IPV is suspected
b. When a woman has an unexplained injury
c. As a routine part of each health care encounter
d. When a history of abuse in the family is known
ANS: C
Many nursing professional organizations have called for routine, universal screening for IPV to assist women in getting help for the problem.
Using the TVIC approach during patient assessment, the nurse focuses on:
a. Assessing for violence in high-risk populations
b. Obtaining evidence of abuse by a family member
c. Gathering information of violence
d. Creating a safe, nonjudgmental environment
ANS: D
The TVIC approach builds on the idea of trauma-informed practice, to take into account ongoing and historical violence and how structural violence (e.g., systemic racism, poverty, discriminatory policies) is related to interpersonal violence. TVIC focuses on creating a safe environment, not on getting a “disclosure.”
The nurse is interviewing the parents of a 5-year-old patient who seriously physically hurt another child. The parents inform the nurse that they adopted the patient when he was removed from his parents’ custody at 8 months of age. What does the nurse ask?
a. “Is he the only child you have adopted?”
b. “Did he have issues with the child he hurt?”
c. “Can you tell me anything about his parents and the family situation?”
d. “Did he have siblings when you adopted him?”
ANS: C
For children of all ages, being exposed to abuse (e.g., hearing abuse, directly witnessing abuse), seeing the effect of abuse on their mothers, and living under conditions of chronic stress can lead them to experience a wide range of problems (e.g., physical, behavioural, emotional, and social problems). An infant living in such an environment can experience the stress and physical violence. It is important that the nurse determine if there was family violence of any sort in the patient’s history
A patient has come to the clinic with persistent abdominal pains. During the interview, the patient tells the nurse that her husband controls the finances, gives her a minimal allowance, and makes her account for what she spends to the penny. The patient constantly looks down and will not make eye contact with the nurse. What will the nurse assess for?
a. Situational violence
b. Chronic ulcerative colitis
c. Stomach flu
d. Intimate partner terrorism
ANS: D
“Intimate partner terrorism” is characterized by coercive control in which one partner tries to control the other; it results in the most severe health consequences and is most commonly perpetrated by men
During a home visit with an 80-year-old patient cared for by family, the nurse notices that the patient is in severe pain. The nurse knows that the patient was prescribed medication for the pain and family administered all medications. When asked, the patient states not receiving any medications for the past week. The nurse recognizes this situation as:
a. Caregiver burden
b. Criminal neglect
c. Malnourishment
d. Unintentional neglect
ANS: B
Some family members or caregivers working with older persons consciously and with malice withhold food, water, medication, and appropriate necessities, often concurrently stealing the financial assets of the older, dependent person. This type of neglect is by definition, criminal in nature
The 25-year-old female Indigenous patient in for her first prenatal checkup appears despondent and unhappy. The nurse finds numerous old bruises on the patient during the physical examination. With use of a relational approach and further questioning, the patient admits that her husband has been hitting her when he is frustrated with work. The best response by the nurse is:
a. “What do you do that makes him angry? Maybe avoiding saying things to frustrate him will stop the hitting.”
b. “You need to leave him. Don’t be weak.”
c. “I am really concerned for you and your baby, and I really want to help you. Can you tell me how I can best support you?”
d. “Are you sure you are not imagining this? Is it just your normal fighting?”
ANS: C
Specific clinical contexts have assessment approaches that integrate attention to violence. In the perinatal context, the possibility that being in an abusive relationship may be a challenge for a pregnant woman
The nurse is using the Danger Assessment (DA) tool to evaluate the risk for violence. Which of these statements best describes its use?
a. The DA tool is to be administered by law enforcement personnel.
b. The DA tool should be used in every assessment of suspected abuse.
c. The number of “yes” answers indicates the woman’s understanding of her situation.
d. The higher the number of “yes” answers, the more serious is the danger of the woman’s situation
ANS: D
No predetermined cutoff scores exist on the DA. The higher the number “yes” answers, the more serious is the danger of the woman’s situation. This tool is used extensively by nurses and advocates in various settings
The nurse suspects abuse when a 10-year-old child is admitted to the urgent care centre for a leg injury. The best way to document the history and physical findings is to:
a. Document what the child’s caregiver tells the nurse.
b. Use the words the child has said to describe how the injury occurred.
c. Record what the nurse observes during the conversation.
d. Rely on photographs of the injuries.
ANS: B
When documenting the history and physical findings of suspected child abuse and neglect, use the words the child has used to describe how his or her injury occurred. Remember, the abuser may be accompanying the child.
The nurse observes bruises of various stages on a 6-year-old child and suspects child abuse. What should the nurse do?
a. Ask the parents what they did to their child
b. Consult with a child protection social worker
c. Report the parent for child abuse
d. Document and photograph the abuse
ANS: B
Many health care settings have access to social workers who are specifically trained in dealing with child maltreatment. They are often the first point of contact for reporting suspected abuse. It is important to know that you can consult confidentially with child protection social workers, before deciding whether the situation warrants a formal report.
The nurse is examining a 3-year-old child who was brought to the emergency department after a fall. Which finding would be of most concern?
a. Bruise on the knee
b. Bruise on the elbow
c. Bruising on the abdomen
d. Bruise on the shin
ANS: C
Studies have shown that children who are walking often have bruises over the bony prominences of the front of their bodies. Other studies have found that bruising in atypical places, such as the buttocks, hands, feet, and abdomen, were exceedingly rare and should arouse concern
During assessment of a 9-year-old patient, the nurse notes purple-blue bruises to both knees. The mother and patient separately inform the nurse that the patient got the bruises playing soccer the day before. From the colour of the bruises the nurse:
a. Is convinced the child is being abused.
b. Recognizes that the objective data validates the subjective data.
c. Questions when the bruises actually occurred.
d. Is unable to identify the time frame for when the bruises were attained
ANS: B
A new bruise is usually red and often turns purple or purple-blue 12 to 36 hours after blunt-force trauma. The colour of bruises (and ecchymoses) generally progresses from purple-blue to bluish green to greenish brown to brownish yellow before the bruise fades away. Bruises are noted more often to the front of children’s bodies when they are walking and running. Recognizing that the progression of the bruises is the objective data validating the subjective data
While working with a 27-year-old transgender patient, the nurse takes an approach to facilitate trust and safety for the patient to assess for abuse. What will the nurse do? (Select all that apply.)
a. Reflect on personal views of IPV to not be judgemental.
b. Inquire about patient history of abuse to initiate the conversation.
c. Listen with interest and observe for cues of violence.
d. Tell patient to leave the abuser.
e. Recognize and commend patient on strengths
ANS: A, C, E
The TVIC approach is needed for people of all gender identities, including those who identify as transgender or two-spirit. In line with the 2014 World Health Organization (WHO) guidelines, health care providers should respond to disclosure and assess using the WHO’s LIVES approach: Listen, Inquire, Validate, Enhance safety, and Support. This approach can support assessment with or without the patient disclosing a history of IPV. A relational approach lets the patient take the lead in choosing to disclose, or not, the abuse. Inquiring their abuse history to initiate a conversation does not develop a safe and open environment for them to share and assumes abuse before disclosure.
The nurse is conducting a follow-up assessment of a 6-year-old patient 2 years after removal from his parents’ home as a result of physical violence between the parents. The nurse will assess the patient for: (Select all that apply.)
a. Developmental progress.
b. Favourite foods.
c. Social interactions in school.
d. Musical talents.
e. Clothing trends
ANS: A, C
For children, being exposed to abuse (e.g., hearing abuse, directly witnessing abuse), seeing the effect of abuse on their mothers, and living under conditions of chronic stress can lead them to experience a wide range of problems (e.g., physical, behavioural, emotional and social problems)
As a nurse working with many different populations, which of the following individuals can be at increased risk for abuse? (Select all that apply.)
a. The 70-year-old confined to a wheelchair
b. The 45-year-old female bank manager
c. The 21-year-old living with a boyfriend who uses harmful amounts of alcohol
d. The 35-year-old stay-at-home mother with a controlling spouse
e. The 21-year-old university student living at home
ANS: A, C, D
Although some populations may be more vulnerable to abuse, everyone the nurse encounters can be experiencing abuse. All patients should be observed for potential signs of abuse. Some patients are more vulnerable to abuse: those who are isolated, economically dependent on others (e.g., immigrants sponsored as spouses, children, and adolescents), or dependent on others for care (e.g., people with disabilities). Actively consider IPV when a person is vulnerable in other ways
