Chapter 07: Domestic and Family Violence Assessment Jarvis: Physical Examination and Health Assessment, 8th Edition

Multiple Choice

1. As a mandatory reporter of older adult abuse, which must be present before a nurse should notify the authorities?

a. Statements from victim b. Statements from witnesses c. Proof of abuse and/or neglect d. Suspicion of older adult abuse and/or neglect

ANS: D

Many health care workers are under the erroneous assumption that proof is required before notification of suspected abuse can occur. Only the suspicion of older adult abuse or neglect is necessary.

DIF: Cognitive Level: Understanding (Comprehension)

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Physical abuse b. Financial neglect c. Psychological abuse d. Unintentional physical neglect

2. During a home visit, the nurse notices that an older adult woman is caring for her bedridden husband. The woman states that this is her duty, she does the best she can, and her children come to help when they are in town. Her husband is unable to care for himself, and she appears thin, weak, and exhausted. The nurse notices that several of his prescription medication bottles are empty. What term best describes this situation?

ANS: D

Unintentional physical neglect may occur, despite good intentions, and is the failure of a family member or caregiver to provide basic goods or services. Physical abuse is defined as violent acts that result or could result in injury, pain, impairment, or disease. Financial neglect is defined as the failure to use the assets of the older person to provide services needed by him or her. Psychological abuse is defined as behaviors that result in mental anguish. The scenario in the question is an example of unintentional physical neglect. Unintentional physical neglect may occur, despite good intentions, and is the failure of a family member or caregiver to provide basic goods or services.

DIF: Cognitive Level: Applying (Application)

MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control a. When intimate partner violence is suspected b. When a history of abuse in the family is known c. As a routine part of each health care encounter d. As part of the exam for a female with an unexplained injury

3. The nurse is caring for a 17-year-old female patient. In which situation should the nurse screen the patient for intimate partner violence (IPV)?

ANS: C

According to the latest guidelines published by the U.S. Preventive Services Task Force, all women of childbearing age (14 to 46 years) should be screened for IPV.

DIF: Cognitive Level: Applying (Application)

MSC: Client Needs: Health Promotion and Maintenance a. Hematoma b. Abrasion c. Contusion d. Laceration

4. Which term refers to a wound produced by the tearing or splitting of body tissue, usually from blunt impact over a bony surface?

ANS: D

The term laceration refers to a wound produced by the tearing or splitting of body tissue. An abrasion is caused by the rubbing of the skin or mucous membrane. A contusion is injury to tissues without breakage of skin, and a hematoma is a localized collection of extravasated blood. The description in the question describes a laceration.

DIF: Cognitive Level: Remembering (Knowledge)

MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control a. Blunt force b. Friction abrasion c. Stabbing from a kitchen knife d. Whipping from an extension cord

5. During an examination, the nurse notices a patterned injury on a patient’s back. What would cause such an injury?

ANS: D

A patterned injury is an injury caused by an object that leaves a distinct pattern on the skin or organ. The other actions do not cause a patterned injury. Blunt force often causes a hematoma. A friction abrasion is a wound caused by rubbing the skin or mucous membrane, like a rug burn. Stabbing from a kitchen knife would result in a penetrating, sharp, cutting injury that is deeper than it is wide.

DIF: Cognitive Level: Applying (Application)

MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control a. Photographic documentation of the injuries b. Summary of the abused patient’s statements c. General description of injuries in the progress notes d. Verbatim documentation of every statement made by the victim

6. What should the nurse include when documenting IPV and older adult abuse?

ANS: A

Documentation of IPV and older adult abuse needs to be detailed and nonbiased. Digital photographic documentation can be invaluable. Prior written consent to take photographs should be obtained from cognitively intact, competent adults. Written documentation needs to be verbatim, within reason. Not every statement can be documented. Written documentation of IPV and older adult abuse needs to be verbatim (within reason), not a summary of the patient’s statements. Documentation needs to be detailed and nonbiased.

DIF: Cognitive Level: Understanding (Comprehension)

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Asthma b. Confusion c. Depression d. Frequent colds

7. A female patient has denied any abuse when answering the questions on an abuse assessment screening tool, but what finding by the nurse during the interview process is associated with IPV?

ANS: C

Abuse victims have significantly more depression, suicidality, post-traumatic stress disorder (PTSD), and problems with substance abuse. Abused women also have been found to have more chronic health problems, such as cardiovascular, endocrine, immune, gastrointestinal, and gynecologic problems. Asthma, confusion, and frequent colds are not problems associated with abuse.

DIF: Cognitive Level: Understanding (Comprehension)

MSC: Client Needs: Psychosocial Integrity a. Red b. Purple-blue c. Greenish-brown d. Brownish-yellow

8. The nurse is assessing bruising on an injured patient. Which color indicates a new bruise that is less than 2 hours old?

ANS: A

A new bruise is usually red and will often develop a purple or purple-blue appearance 12 to 36 hours after blunt-force trauma. The color of bruises (and ecchymoses) generally progresses from purple-blue to bluish-green to greenish-brown to brownish-yellow before fading away.

DIF: Cognitive Level: Understanding (Comprehension)

MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control a. Rely on photographs of the injuries. b. Document what the child’s caregiver tells the nurse. c. Record what the nurse observes during the conversation. d. Use the words the child has said to describe how the injury occurred.

9. The nurse suspects abuse when a 10-year-old child is taken to the urgent care center for a leg injury. Which is the best way for the nurse to document the findings in the patient’s chart?

ANS: D

When documenting the history and physical findings of suspected child abuse and neglect, use the words the child has said to describe how his or her injury occurred. Remember, the abuser may be accompanying the child. Although photographs of injury can be invaluable, they are not the best method of documentation and should not be relied upon. Although the child’s caregiver may be able to provide information, that is also not the best way to document and the nurse needs to keep in mind that the caregiver could be the abuser. While the nurse will document what he or she observes, the best way to document the history and physical findings of a child suspected of being abused is to use the words the child has said to describe how his or her injury occurred.

DIF: Cognitive Level: Understanding (Comprehension)

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. “So you were abused?” b. “Do you know what caused this abuse?” c. “I need to report this abuse to the authorities.” d. “Tell me about the abuse in your relationship.”

10. During an interview, a woman has answered “yes” to two of the Slapped, Threatened, and Throw (STaT) questions. What should the nurse say next?

ANS: D

In any case of suspected abuse an open-ended question or statement is useful. If a woman answers “yes” to any of the Slapped, Threatened, and Throw (STaT) questions, then the nurse should ask a question such as “Tell me about the abuse in your relationship”. This is a good way to start and is designed to assess how recent or frequent the abuse and its severity. If a woman answers “yes” to any of the Abuse Assessment Screen questions, then the nurse should ask questions designed to assess how recent and how serious the abuse was. Asking the woman an open-ended question, such as “tell me about this abuse in your relationship” is a good way to start.

DIF: Cognitive Level: Applying (Application)

MSC: Client Needs: Psychosocial Integrity a. Bruises on the knee b. Bruises on the elbow c. Bruises on the abdomen d. Bruises on both of the shins

11. The nurse is examining a 3-year-old child who was brought to the emergency department after a fall. Which bruise, if found, would be of most concern?

ANS: C

Bruising in atypical places, such as the buttocks, hands, feet, and abdomen, is exceedingly rare and should arouse concern. In children younger than 4 years, bruising on the torso, ears, and neck are significantly correlated with abuse in the absence of a compelling history. Children who are walking often have bruises over the bony prominences of the front of their bodies, so bruises on the knees, elbows, and shins are not unusual.

DIF: Cognitive Level: Applying (Application)

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Notify the child’s caregivers of the findings. b. Document that the bruises appear to be caused by spanking. c. When the child is alone, ask “How did you get these sore areas on your butt?” d. Inform the child “You can tell me who did this to you and we will not allow them to see or hurt you again.”

12. The nurse is caring for an 8-year-old child who has several bruises of varying colors (some red, some bluish-green, and some brownish-yellow) the size of a hand on the buttocks. What action should the nurse take next?

ANS: C

If a child is verbal, a history should be obtained away from the caregivers through open-ended questions or spontaneous statements. Keeping the question short and using age-appropriate language and familiar words can help enrich the history taking. Children older than 11 years can generally be expected to provide a history at the level of most adults. The nurse should not confront the caregivers, as they may be the abusers. Documentation of finding should be objective, thorough, and unbiased; thus, the nurse should not document that the bruises appear to be caused by spanking. Children, even if abused by their caregivers, are usually afraid to be separated from their caregivers or get them into trouble, so if the nurse tells the child that they will not allow the person who did this to the child to see the child again, the child is very unlikely to admit it was the caregiver(s).

DIF: Cognitive Level: Applying (Application)

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. A 4-month-old with bruises on the arms b. A 2-year-old with bruises on the knees c. An 8-year-old with a broken right arm d. A 15-year-old football player with a broken leg

13. The nurse is caring for several patients on a pediatric unit. Which patient should the nurse be most concerned about possible abuse?

ANS: A

Accidental bruising in healthy, active children is common, but infants who are not yet walking with support (e.g. cruising around furniture) typically should not have bruises. Bruising in infants who are not yet cruising, usually infants younger than 9 months, should alert you to possible abusive mechanisms to the injury or an underlying medical illness.

DIF: Cognitive Level: Applying (Application)

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. An Asian female who speaks no English b. A female multi-racial illegal immigrant c. A non-Hispanic white female living in poverty d. A female American Indian living above the poverty line

14. The nurse is caring for several patients. Which patient is at highest risk for Intimate Partner Violence (IPV)?

ANS: B

IPV is a phenomenon that occurs universally in all populations. However, lifetime prevalence of IPV is significantly higher among ethnic and racial minorities than among non-Hispanic white women and men. Multiracial, American Indian/Alaskan native, and non-Hispanic black women and men are at higher risk for IPV than non-Hispanic white women and men. Some additional common themes that create barriers to treatment are societal stressor such as poverty, legal issues such as immigration status, and lack of access to culturally appropriate care. A multiracial illegal immigrant has two risk factors for IPV (multiracial and illegal immigrant). The other options only have one risk factor for IPV. An Asian female who speaks no English has one risk factor for IPV (speaks no English/lack of access to culturally appropriate care). A non-Hispanic white female living in poverty has one risk factor for IPV (poverty). A female American Indian living above the poverty line has one risk factor for IPV (American Indian).

DIF: Cognitive Level: Analyzing (Analysis)

MSC: Client Needs: Health Promotion and Maintenance

Multiple Response

1. The nurse assesses an older woman and suspects physical abuse. Which questions are appropriate for screening for abuse? (Select all that apply.)

a. “Has anyone made you afraid, touched you in ways that you did not want, or hurt you physically?” b. “Are you being abused?” c. “Have you relied on people for any of the following: bathing, dressing, shopping, banking, or meals?” d. “Have you been upset because someone talked to you in a way that made you feel shamed or threatened?” e. “Has anyone tried to force you to sign papers or to use your money against your will?”

ANS: A, C, D, E

Directly asking “Are you being abused?” is not an appropriate screening question for abuse because the woman could easily say “no,” and no further information would be obtained. The other questions are among the questions recommended by the Elder Abuse Suspicion Index (EASI) when screening for older adult abuse.

DIF: Cognitive Level: Applying (Application)

MSC: Client Needs: Safe and Effective Care Environment: Management of Care