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Flashcards in Chapter 5 Deck (32):

1. Historically, what was the justification for the victimization of women?
a. Women were regarded as possessions.
b. Women were the “weaker sex.”
c. Control of women was necessary to protect them.
d. Women were created subordinate to men.

Misogyny, patriarchy, devaluation of women, power imbalance, a view of women as property, gender-role stereotyping, and acceptance of aggressive male behaviors as appropriate contributed and continue to contribute to the subordinate status of women in many of the world’s societies. Viewing women as the “weaker sex” is a cultural and modern stereotype that contributes to the victimization of women. Control of women to protect them is another cultural and modern stereotype that contributes to the victimization of women. Yet another cultural stereotype that contributes to the victimization of women is the idea that women were created as subordinate to men.


2. What is the primary theme of the feminist perspective regarding violence against women?
a. Role of testosterone as the underlying cause of men’s violent behavior
b. Basic human instinctual drive toward aggression
c. Male dominance and coercive control over women
d. Cultural norm of violence in Western society

The contemporary social view of violence is derived from the feminist theory. With the primary theme of male dominance and coercive control, this view enhances an understanding of all forms of violence against women, including wife battering, stranger and acquaintance rape, incest, and sexual harassment in the workplace. The role of testosterone as an underlying cause of men’s violent behavior, the basic human instinctual drive toward aggression, and the cultural norm of violence in Western society are not associated with the feminist perspective regarding violence against women.


3. Which trait is least likely to be displayed by a woman experiencing intimate partner violence (IPV)?
a. Socially isolated
b. Assertive personality
c. Struggling with depression
d. Dependent partner in a relationship

Every segment of society is represented among women who are suffering abuse. However, traits of assertiveness, independence, and willingness to take a stand have been documented as more characteristic of women who are in nonviolent relationships. Women who are financially more dependent have fewer resources and support systems, exhibit symptoms of depression, and are more often seen as victims.


4. A woman who is 6 months pregnant has sought medical attention, saying she fell down the stairs. What scenario would cause an emergency department nurse to suspect that the woman has been a victim of IPV?
a. The woman and her partner are having an argument that is loud and hostile.
b. The woman has injuries on various parts of her body that are in different stages of healing.
c. Examination reveals a fractured arm and fresh bruises.
d. She avoids making eye contact and is hesitant to answer questions.

The client may have multiple injuries in various stages of healing that indicates a pattern of violence. An argument is not always an indication of battering. A fractured arm and fresh bruises could be caused by the reported fall and do not necessarily indicate IPV. It may be normal for the woman to be reticent and have a dull affect.


5. Which statement is most accurate regarding the reporting of IPV in the United States?
a. Asian women report more IPV than do other minority groups.
b. Caucasian women report less IPV than do non-Caucasians.
c. Native-American women report IPV at a rate similar to other groups.
d. African-American women are less likely to report IPV than Caucasian women.

Caucasian women report less IPV than other ethnic groups. Asian women report significantly less IPV than do other racial groups. Native-American and Alaska Native women report significantly more IPV than do women of any other racial background. African-American women tend to report violence at a slightly higher rate than Caucasian women.


6. Intervention for the sexual abuse survivor is often not attempted by maternity and women’s health nurses because of the concern about increasing the distress of the woman and the lack of expertise in counseling. What initial intervention is appropriate and most important in facilitating the woman’s care?
a. Initiating a referral to an expert counselor
b. Setting limits on what the client discloses
c. Listening and encouraging therapeutic communication skills
d. Acknowledging the nurse’s discomfort to the client as an expression of empathy

The survivor needs support on many different levels, and a women’s health nurse may be the first person to whom she relates her story. Therapeutic communication skills and listening are initial interventions. Referring this client to a counselor is an appropriate measure but not the most important initial intervention. A client should be allowed to disclose any information she feels the need to discuss. A nurse should provide a safe environment in which she can do so. Either verbal or nonverbal shock and horror reactions from the nurse are particularly devastating. Professional demeanor and professional empathy are essential.


7. A young woman arrives at the emergency department and states that she thinks she has been raped. She is sobbing and expresses disbelief that this could happen because the perpetrator was a very close friend. Which statement is most appropriate at this time?
a. “Rape is not limited to strangers and frequently occurs by someone who is known to the victim.”
b. “I would be very upset if my best friend did that to me; that is very unusual.”
c. “You must feel very betrayed. In what way do you think you might have led him on?”
d. “This does not sound like rape. Didn’t you just change your mind about having sex after the fact?”

Acquaintance rape involves individuals who know one another. Sexual assault occurs when the trust of a relationship is violated. Victims may be less prone to recognize what is happening to them because the dynamics are different from those of stranger rape. It is not at all unusual for the victim to know and trust the perpetrator. Stating that the woman might have led the man to attack her indicates that the sexual assault was somehow the victim’s fault. This type of mentality is not constructive. Nurses must first reflect on their own feelings and learn to be unbiased when dealing with victims. A statement of this type can be very psychologically damaging to the victim. Nurses must display compassion by first believing what the victim states. The nurse is not responsible for deciphering the facts involving the victim’s claim.


8. Nurses are often the first health care professional with whom a woman comes into contact after being sexually assaulted. Which statement best describes the initial care of a rape victim?
a. All legal evidence is preserved during the physical examination.
b. The victim appreciates the legal information; however, decides not to pursue legal proceedings.
c. The victim states that she is going to advocate against sexual violence.
d. The victim leaves the health care facility without feeling re-victimized.

Nurses can assist clients through an examination that is as nontraumatic as possible with kindness, skill, and empathy. The initial care of the victim affects her recovery and decision to receive follow-up care. Preservation of all legal evidence is very important; however, this may not be the best measure in terms of evaluating the care of a rape victim. Offering legal information is not the best measure of evaluating the care that this victim received. The victim may well decide not to pursue legal proceedings. Advocating against sexual violence may be extremely therapeutic for the client after her initial recovery but not a measure of evaluating her care.


9. When the nurse is alone with a battered client, the client seems extremely anxious and says, “It was all my fault. The house was so messy when he got home, and I know he hates that.” What is the most suitable response by the nurse?
a. “No one deserves to be hurt. It’s not your fault. How can I help you?”
b. “What else do you do that makes him angry enough to hurt you?”
c. “He will never find out what we talk about. Don’t worry. We’re here to help you.”
d. “You have to remember that he is frustrated and angry so he takes it out on you.”

The nurse should stress that the client is not at fault. Asking what the client did to make her husband angry is placing the blame on the woman and would be an inappropriate statement. The nurse should not provide false reassurance. To assist the woman, the nurse should be honest. Often the batterer will find out about the conversation.


10. Nurses who provide care to victims of IPV should be keenly aware of what?
a. Relationship violence usually consists of a single episode that the couple can put behind them.
b. Violence often declines or ends with pregnancy.
c. Financial coercion is considered part of IPV.
d. Battered women are generally poorly educated and come from a deprived social background.

Economic coercion may accompany physical assault and psychologic attacks. IPV almost always follows an escalating pattern. It rarely ends with a single episode of violence. IPV often begins with and escalates during pregnancy. It may include both psychologic attacks and economic coercion. Race, religion, social background, age, and education level are not significant factors in differentiating women at risk.


11. In 1979, Lenore Walker pioneered the cause of women as victims of violence when she published her book The Battered Woman. While Walker conducted her research, she found a similar pattern of abuse among many of the women. This concept is now referred to as the “cycle of violence.” Which phase does not belong in this three-cycle pattern of violence?
a. Tension-building state
b. Frustration, followed by violence
c. Acute battering incident
d. Kindness and contrite, loving behavior

Frustration, followed by violence, is not part of the cycle of violence. The tension-building state is also known as phase I of the cycle. The batterer expresses dissatisfaction and hostility with violent outbursts. The woman senses anger and anxiously tries to placate him. An acute battering incident is phase II of the cycle. It results in the man’s uncontrollable discharge of tension toward the woman. Outbursts can last from several hours to several days and may involve kicking, punching, slapping, choking, burns, broken bones, and the use of weapons. Phase III of the cycle is sometimes referred to as the honeymoon, kindness and contrite, and loving behavior phase, during which the batterer feels remorseful and profusely apologizes. He tries to help the woman and often showers her with gifts.


12. Nurses must remember that pregnancy is a time of risk for all women. Which condition is likely the biggest risk for the pregnant client?
a. Preeclampsia
b. IPV
c. Diabetes
d. Abnormal Pap test

The prevalence of IPV during pregnancy is estimated at 6% of all pregnant women. The risk for IPV and even IPV-related homicide is more common than all of the other pregnancy-related conditions. Although preeclampsia poses a risk to the health of the pregnant client, it is less common than IPV. Gestational diabetes continues to be a complication of pregnancy; however, it is less common than IPV during pregnancy. Some women are at risk for an abnormal Pap screening during pregnancy, but this finding is not as common as IPV.


13. In the 1970s, the rape-trauma syndrome (RTS) was identified as a cluster of symptoms and related behaviors observed in the weeks and months after an episode of rape. Researchers identified three phases related to this condition. Which phase is not displayed in a client with RTS?
a. Acute Phase: Disorganization
b. Outward Adjustment Phase
c. Shock/Disbelief: Disorientation Phase
d. Long-Term Process: Reorganization Phase

Shock, disbelief, or disorientation is a component of the Acute Phase. The rape survivor feels embarrassed, degraded, fearful, and angry. She may feel unclean and want to bathe and douche repeatedly, even though doing so may destroy evidence. The victim relives the scene over and over in her mind, thinking of things she “should have done.” During the Outward Adjustment Phase, the victim may appear to have resolved her crisis and return to activities of daily living and work. Other women may move, leave their job, and buy a weapon to protect themselves. Disorientation is a reaction during which the victim may feel disoriented, have difficulty concentrating, or have poor recall. The Long-Term Process is the reorganization phase. This recovery phase may take years and may be difficult and painful.


14. Documentation of abuse can be useful to women later in court, should they elect to press charges. It is of key importance for the nurse to document accurately at the time that the client is seen. Which entry into the medical record would be the least helpful to the court?
a. Photographs of injuries
b. Clear and legible written documentation
c. Summary of information (e.g., “The client is a battered woman.”)
d. Accurate description of the client’s demeanor

A statement such as, “The client is a battered woman” lacks the supporting factual information and will render the report inadmissible. More appropriate documentation would include exact statements from the woman in quotations (e.g., “My husband kicked me in the stomach”). The time and date of the examination should also be included


15. Which statement regarding human trafficking is correct?
a. Human trafficking is a multibillion-dollar business that primarily exists in the United States.
b. Victims often experience the Stockholm syndrome.
c. Vast majority of the victims are young boys and girls.
d. Human trafficking primarily refers to commercial sex work.

Although victims of sex trafficking can be young boys and girls, the vast majority are women and girls. They are often lured by false promises, such as a job or marriage, sold by their parents, or kidnapped by traffickers. These individuals are forced into sex work, hard labor, and organ donation. This $32 billion business exists in the United States and internationally. The Stockholm syndrome occurs when the slaves become attached to their enslavers. Health care professionals may interact with victims who are in captivity should they require emergent health care. The nurse is challenged to find an opportunity to speak with the client alone and assess for victimization.


16. Which statement is the most comprehensive description of sexual violence?
a. Sexual violence is limited to rape.
b. Sexual violence is an act of force during which an unwanted and uncomfortable sexual act occurs.
c. Sexual violence encompasses a number of sexual acts.
d. Sexual violence includes degrading sexual comments and behaviors.

Sexual violence is a broad term that includes a range of sexual victimization including sexual assault, sexual harassment, and rape. It may include but is not limited to rape. Sexual assault includes unwanted or uncomfortable touches, kisses, hugs, petting, intercourse, or other sexual acts. It is a component of sexual violence. Unwelcome or degrading e-mail messages, comments, contact, or behavior, such as exhibitionism, that makes any environment feel unsafe is known as sexual harassment.


17. Women with severe and persistent mental illness are likely to be more vulnerable to being involved in controlling and/or violent relationships; however, many women develop mental health problems as a result of long-term abuse. Which condition is unlikely to be a psychologic consequence of continued abuse?
a. Substance abuse
b. Posttraumatic stress disorder (PTSD)
c. Eating disorders
d. Bipolar disorder

Bipolar disorder is a specific illness (also known as manic depressive disorder) not related to abuse. Substance abuse is a common method of coping with long-term abuse. The abuser is also more likely to use alcohol and other chemical substances. PTSD is the most prevalent mental health sequela of long-term abuse. The traumatic event is persistently re-experienced through distress recollection and dreams. Eating disorders, depression, psychologic-physiologic illness, and anxiety reactions are all mental health problems associated with repeated abuse.


1. The nurse who is evaluating the client for potential abuse should be aware that IPV includes a number of different forms of abuse, including which of the following? (Select all that apply.)
a. Physical
b. Sexual
c. Emotional
d. Psychologic
e. Financial

ANS: A, B, D, E
Physical, sexual, financial, and psychologic abuse can all be components in a relationship with IPV. Emotional abuse is a form of psychologic abuse.


2. What are some common characteristics of a potential male batterer? (Select all that apply.)
a. High level of self-esteem
b. High frustration tolerance
c. Substance abuse problems
d. Excellent verbal skills
e. Personality disorders

Substance abuse and personality disorders are often observed in batterers. Typically, the batterer has low self-esteem. Batterers usually have a low frustration level (i.e., they easily lose their temper). Batterers characteristically have poor verbal skills and can especially have difficulty expressing their feelings.


3. Which nursing diagnoses would be most applicable for battered women? (Select all that apply.)
a. Loss of trust
b. Ineffective family coping
c. Situational low self-esteem
d. Risk for self-directed violence
e. Enhanced communication

ANS: A, B, C, D
Loss of trust, ineffective family coping, situational low self-esteem, and risk for self-directed violence are potential nursing diagnoses associated with battered women. A more appropriate nursing diagnosis for a battered woman would be impaired communication.


4. A thorough abuse assessment screen should be completed on all female clients. This screen should include which components? (Select all that apply.)
a. Asking the client if she has ever been slapped, kicked, punched, or physically hurt by her partner
b. Asking the client if she is afraid of her partner
c. Asking the client if she has been forced to perform sexual acts
d. Diagramming the client’s current injuries on a body map
e. Asking the client what she did wrong to elicit the abuse

ANS: A, B, C, D
Asking the client if she has been slapped, kicked, punched, or physically hurt by her partner, if she is afraid of her partner, or if she has been forced to perform sexual acts are questions that should be posed to all clients. If any physical injuries are present, then they should be marked on a form that indicates their locations on the body. Implying that a client did something wrong can be very emotionally damaging. Many victims of violence are not aware that they are in an abusive relationship. They may not respond to questions about abuse. Using general descriptive words such as “slap,” “kick,” or “punch” to elicit information is best.


5. What are the responsibilities of the nurse who suspects or confirms any type of violence against a woman? (Select all that apply.)
a. Report the incident to legal authorities.
b. Provide resources for domestic violence shelters.
c. Call a client advocate who can assist in the client’s decision about what actions to take.
d. Accurately and concisely document the incident (or findings) in the client’s record.
e. Reassure and support the client.

ANS: B, C, D, E
Domestic violence is considered a crime in all states; however, mandatory reporting remains controversial. Nurses must become knowledgeable on the laws that apply in the state in which they practice. Caring for a client who may be a victim of domestic abuse is an ideal opportunity to provide the woman with information for safe houses or support groups for herself and her children. The nurse may assist in reaching out to a client advocate, which often occurs when potential legal action is taken or if the woman is seeking shelter. Documentation must be accurate and timely to be useful to the client later in court if she chooses to press charges. The primary functions for the nurse are to reassure the client and to provide her with emotional support.


Sexual assault is:
A. Limited to rape.
B. An act of force in which an unwanted and uncomfortable sexual act occurs.
C. A legal term for sexual violence.
D. An act of violence in which the partner is unknown.

Ans: B
Sexual assault is a broad term that encompasses a wide range of sexual victimization, including unwanted or uncomfortable touches, kisses, hugs, petting, intercourse, or other sexual acts. It may include but is not limited to rape. Sexual violence is a term for rape, not sexual assault, which encompasses a broader range of activities. A sexual act of violence, or rape, may be categorized as sexual assault. Statistically, the victim of sexual assault knows the assailant.


During a health history interview, a woman tells the nurse that her husband physically abuses her. The nurse’s first response should be to:
A. Advise the woman of mandatory state reporting laws pertaining to abuse and confidentiality.
B. Reassure the woman that the abuse is not her fault.
C. Give the woman referrals to local agencies and shelters where she can obtain help.
D. Formulate an escape plan for the woman that she can use the next time her husband abuses her.

Ans: A
Although all of these responses are appropriate when dealing with an abused woman, the nurse first should discuss the legal implications of this type of situation. Many states have mandatory reporting laws for health care providers. It is important to inform the woman that you may need to report what she has told you. Nurses should be knowledgeable about the reporting requirements of the state in which they practice.


Women with severe and persistent mental illness are likely to be more vulnerable to being involved in controlling and/or violent relationships. However, many women experience mental health problems as a result of long-term abuse. The psychologic consequences of continued abuse do not include:
A.Substance abuse.
B. Posttraumatic stress disorder (PTSD).
C. Eating disorders.
D. Bipolar disorder.

Ans: D
Substance abuse is a common method of coping with long-term abuse. The abuser is also more likely to use alcohol and other chemical substances. PTSD is the most prevalent mental health sequela of long-term abuse. The traumatic event is persistently reexperienced through distress recollection and dreams. Eating disorders, depression, psychophysiologic illness, and anxiety reactions are all mental health problems associated with repeated abuse. Bipolar disorder is a specific illness (also known as manic depressive disorder) not related to abuse.


The nurse’s best measure when evaluating the care of a woman in an abusive situation is based on the:
A. Woman’s decision to leave her partner.
B. Woman’s declaration of a safety plan.
C. Couple’s follow-through on a referral for counseling.
D. Woman’s gratitude to the nurse for the helpful information.

Ans: B
Safety is the most significant part of the intervention. A decision to leave the partner would be a positive step for the woman, but it is not the most significant part of the intervention. In addition, many women choose to return to the relationship. The woman may express her gratitude to the nurse in an effort to end the conversation; this does not indicate the woman’s readiness to leave the relationship or to make a plan for safety. Couples counseling generally is not recommended. Initially, individual counseling would be more beneficial. Neither would be a measure of success in the evaluation of the care plan of an abused woman.


In the 1970s rape-trauma syndrome (RTS) was identified as a cluster of characteristics, symptoms, and related behaviors seen in the weeks and months after a rape. Which pattern of responses would not apply to a victim of rape?
A. Acute phase: disorganization
B. Acute phase: rearranging
C. Outward adjustment phase
D. Long-term process: reorganization phase

Ans: B
Reorganization is not a phase of RTS. Disorganization is the first phase of RTS, which can last for several days up to 3 weeks. Reactions such as shock, denial, and disbelief are common. The rape survivor feels embarrassed, degraded, angry, and vengeful. The outward adjustment phase is next. The survivor appears to have resolved her crisis. She needs to regain control over her life and may return to work, move, or buy a weapon to defend herself. The third phase is reorganization. Suppression of feelings and emotions starts to deteriorate, and the woman may become depressed and anxious.


A patient has been sexually assaulted and presents to the Emergency Department for a sexual assault examination. Which action would be a priority for the nurse assigned to take care of the patient?
A. Provide the patient with a washcloth and allow her to provide needed hygiene measures.
B. Ask the patient for her insurance card so that you can validate information.
C. Maintain chain of custody for collection of evidence.
D. Provide the patient with contact information regarding psychological resources that may help her with dealing with this situation.

Ans: C
The nurse should place priority on maintaining the chain of custody for the collection of evidence. Because the sexual assault examination is used as part of the evidentiary process when a suspected crime has been committed, the nurse should be mindful not to invalidate physical findings that might affect the course of legal action, such as washing. Psychological referrals may be necessary, but the priority action is to preserve the evidence and assess physical and emotional well-being. Although it is important to obtain information relevant to insurance coverage, this is not the priority action at this time in the context of a sexual assault victim.


Another name for human sex trafficking is:
A. Sex games.
B. Licensed sexual act.
C. Modern-day slavery.
D. Prostitution.

Ans: C
Human sex trafficking has been referred to as “modern-day slavery” according to current literature. It is performed with coercion, and “licensure” does not apply. Sex games refers to “sexual game playing” during the course of sexual activity. Prostitution refers to the trade whereby an individual provides sexual activity for monetary remuneration.


A patient has been sexually assaulted and is receiving an initial evaluation in the Emergency Department. She is concerned that she may become pregnant. Which priority action should the nurse implement so as to address the patient’s concern?
A. Ask the patient to provide information about the date of her LMP.
B. Perform a pregnancy test, and as long as the results are negative, the patient does not have to worry about pregnancy.
C. Have the patient sign a consent form for a dilatation and curettage to be performed.
D. Determine the length of time after assault, and if it is less than 120 hours, emergency contraception may be provided.

Ans: D
It would be most important for the nurse to determine when the assault occurred so as to interpret this information relative to the pregnancy test results. Even if results of a pregnancy test are negative, the patient may still be pregnant, and further evaluation should be performed. Although the nurse may want to ask about the LMP, it will not provide evidence about whether or not the patient may be pregnant. A D&C may prove to be needed but not at this time.


A sexual assault victim is brought into the Emergency Department for triage. Which health care provider should be contacted to perform the assessment?
A. Emergency Room physician

Ans: D
Although the ER doctor may be needed to examine any patient brought into the ED setting, and an RN or LPN can interact with the patient, a sexual assault nurse examiner (SANE), if available, would be the most appropriate choice to care for the patient. A SANE is someone who has been trained and credentialed to care for assault victims.


Which of the following lab tests would be indicated for a victim of sexual assault? (Select all that apply.)
A. Chemistry profile and complete blood count
B. Screening test for hepatitis B
C. Fecal occult blood testing
D. Oral swab DNA testing
E. Serum blood pregnancy test
F. Gonorrhea culture

Ans: B, D, E
Testing for Hepatitis B would be warranted because of blood transmission. Testing for confirmation of DNA would be indicated in a sexual assault case. Testing for pregnancy, urine or blood would be indicated in a sexual assault case. Typically, gonorrhea cultures would not be indicated because treatment would be given prophylactically to a sexual assault victim and therefore the results would not affect clinical practice. There is no need for fecal occult blood testing unless there is some other presenting clinical indication. Unless there is evidence of blood loss, a chemistry profile and complete blood count may not be needed.