Chapter 23: Violence: Anger, Abuse, and Aggression My Nursing Test Banks

Fortinash: Psychiatric Mental Health Nursing, 5th Edition

Chapter 23: Violence: Anger, Abuse, and Aggression

Test Bank

MULTIPLE CHOICE

1. A young child is being evaluated in the Emergency Department for injuries her mother reports resulted from a fall down the stairs. Which of these findings indicates that physical abuse may be a chronic problem for the child?

a.

The mothers description of the child as being clumsy

b.

Several fractures revealed on x-ray in varying degrees of healing

c.

Clinging to her mother as she attempted to leave the examining room

d.

Struggling with the staff when attempts to obtain a blood specimen were made

ANS: B

Unhealed fractures indicate both numerous injuries and that medical intervention was not sought at the time of injury. Although unkind, the mothers description of the child is not reason to believe chronic abuse has occurred. The remaining options reflect normal behavior, especially if pain or separation is suspected.

DIF: Cognitive Level: Application REF: Page 539

TOP: Nursing Process: Assessment MSC: NCLEX: Psychological Integrity

2. A child was admitted to the childrens unit, having been sexually abused by an acquaintance of her family. The child refuses to talk and participate in unit activities, choosing to stay in her room with her stuffed animals. Which therapeutic intervention will best help the child release pent-up feelings about the abuse?

a.

Family therapy

b.

Play therapy

c.

Individual communication with the nurse

d.

Role-play with other children on the unit

ANS: B

Play helps communicate and release feelings about the childs problems. A child may have difficulty expressing feelings verbally. Family therapy may be useful, but it is not designed for releasing feelings. Role-playing is more effective with older children or adults.

DIF: Cognitive Level: Application REF: Page 541

TOP: Nursing Process: Implementation MSC: NCLEX: Psychological Integrity

3. The nurse is leading a support group for women who have experienced interpersonal violence. When a patient asks about the characteristics of the perpetrators of interpersonal violence, the nurse accurately responds that they are:

a.

Usually under the influence of alcohol

b.

Most often someone the victim knows

c.

A stranger to the victim in most cases

d.

Often in a psychotic state during the act

ANS: B

Statistics show that interpersonal violence is usually committed by someone the victim knows. Drugs and alcohol are not necessarily involved. The victim usually knows the perpetrator. The perpetrators are aware of what they are doing.

DIF: Cognitive Level: Application REF: Page 526

TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance

4. Which nursing intervention will assist a patient being treated in the Emergency Department for extensive soft tissue injuries to disclose an experience of domestic violence?

a.

Allowing the patient to initiate the topic of violence

b.

Speaking with the patient in the absence of her husband

c.

Providing a safe, nonintimidating, and supportive environment

d.

Interviewing her in the presence of another healthcare professional

ANS: C

Providing a safe environment is the first step in assisting a patient who is a victim of domestic violence. Including others in the conversation may increase anxiety and reluctance to disclose. Isolating the husband is assumed in providing a safe, nonintimidating environment. The patient may not disclose without prompting by the nurse.

DIF: Cognitive Level: Application REF: Page 534

TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment

5. A patient admits to having been battered by her live-in boyfriend several times over the past 2 years. She states to the nurse, We plan to get married next June, and I think things will be better then. He is always so sorry afterward, that I think I can trust him to change. Which intervention should be included in the patients teaching plan?

a.

Discourage her hope that the battering will end after they are married.

b.

Assist her in enrolling in a class to learn techniques of self-defense.

c.

Assist her in developing an emergency plan, because the pattern of violence is likely to continue.

d.

Emphasize that the battering pattern usually remains the same in frequency and severity over time.

ANS: C

Developing an emergency plan is critical for any battered woman. The battering is not likely to cease unless the batterer seeks help but stating that fact is not therapeutic by itself. This will not stop the violence, although it might afford her some protection. Violence usually increases over time.

DIF: Cognitive Level: Application REF: Pages 532-533

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

6. The nurse in the Emergency Department is taking a history from a family accompanying a child with suspicious traumatic injuries. The nurse should:

a.

Be open, concerned, and honest.

b.

Obtain information as covertly as possible.

c.

Avoid responding to hints that abuse has occurred.

d.

Separate the family from the child during the interview.

ANS: A

The nurse serves as a role model for the parents and the child. Being open and honest and showing appropriate concern for the child is the most appropriate approach. Direct questioning is necessary to obtain the history. Concerns about the possibility of abuse must be addressed in a sensitive manner. The family will be able to remain with the child during history taking. It is helpful for the nurse to observe family interactions.

DIF: Cognitive Level: Application REF: Page 541

TOP: Nursing Process: Assessment MSC: NCLEX: Psychological Integrity

7. When an elderly patient is brought into the Emergency Department by family members who reported a fall the nurse became suspicious that the patient had suffered physical abuse. The patient denied that she had been abused. Her denial is most likely based on her:

a.

Feeling that she deserved the physical abuse

b.

Strong belief that nothing could be done to help her

c.

Lack of trust that the situation could ever be changed

d.

Fear of the possibility of being removed from her family

ANS: D

Fear of being separated from family and institutionalized is a powerful motive that keeps elders from revealing abuse. The other options may be factors in some cases but they are not primary motivators of silence.

DIF: Cognitive Level: Analysis REF: Page 544

TOP: Nursing Process: Assessment MSC: NCLEX: Psychological Integrity

8. A nurse planning a group to help batterers learn more effective ways to cope would teach participants that the key component in wife battering is:

a.

Their need for the batterer to control

b.

The role of alcohol in the pattern of abuse

c.

History of psychotic or paranoid behavior

d.

Failure of the woman involved to assert herself

ANS: A

The batterer uses violence as a means of controlling his partner to meet his own needs. Alcohol use is not the root cause of spousal abuse. There are no data to support mental illness as a factor in abusive relationships. Assertive behavior may result in increased abuse.

DIF: Cognitive Level: Application REF: Page 528 TOP: Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance

9. The nurse caring for a school-age child who has been sexually abused by a close family member demonstrates an understanding of communication barriers in this situation by:

a.

Realizing that repeated questioning by others will occur

b.

Assuring the child that the story they are telling is believed

c.

Reinforcing that the child will not be in trouble with the police

d.

Promising to tell only those who need to know about the incident

ANS: B

Fear of being blamed or of being disbelieved is a powerful motivator of silence. When the child fears that there will be no support, there is no reason to disclose the abuse. The other options are much more remote.

DIF: Cognitive Level: Analysis REF: Page 541

TOP: Nursing Process: Implementation MSC: NCLEX: Psychological Integrity

10. The nurse is considering making a child abuse or neglect report to protective services. To make the report, the nurse needs to:

a.

Have strong evidence that the abuse/neglect has occurred.

b.

Obtain the supervisors permission to make the report.

c.

Notify the parents of the intent to file the report.

d.

Have suspicions that the abuse has occurred.

ANS: D

Suspicions are all that are required by state mandatory child abuse and neglect reporting laws. The agency bears the burden of collecting evidence. As a mandated reporter, the nurse does not need anyones permission to make the report. Only a suspicion is required. Parent notification is unnecessary.

DIF: Cognitive Level: Application REF: Pages 540-541

TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance

11. A community health nurse is working with a family in which an elderly woman was neglected by her son and his wife but insists on remaining with the young couple despite the threat of future neglect. Which intervention should be given highest priority?

a.

Identifying community resources to decrease the caregivers stress

b.

Establishing patient rights and consequences of abuse and monitoring

c.

Providing stress management techniques for both of the caregivers

d.

Educating the caregivers on the aging process and how to cope with it

ANS: B

Securing the patients safety is the priority for care. This option sets forth expectations for the family and establishes the fact that the patients state will be monitored. The other options are appropriate interventions but are not the highest priority.

DIF: Cognitive Level: Analysis REF: Page 545 TOP: Nursing Process: Planning

MSC: NCLEX: Safe and Effective Care Environment

12. To provide nursing care to abused children and their families, the nurse must first:

a.

Recommend removal of the children from the family.

b.

Complete a comprehensive physical and mental assessment.

c.

Refer each case to the appropriate social worker for follow-up.

d.

Examine personal feelings regarding the trauma of child abuse and neglect.

ANS: D

Self-examination is required in order for the nurse to be objective and therapeutic in providing care. Although important, an assessment is not the initial step in this situation. Removal is not always recommended. A social service referral may not be required, depending on the situation.

DIF: Cognitive Level: Application REF: Page 537

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

13. According to statistical research data, which of these children currently being followed by the pediatric nurse practitioner is at the greatest risk for fatal abuse?

a.

A child who is 2 years old and has cerebral palsy

b.

A child who is 5 years old and has chicken pox

c.

A child who is 8 years old and has appendicitis

d.

A child who is 11 years old and has a fractured humerus

ANS: A

At highest risk for fatal abuse are children under 3 years of age and those with disabilities. The remaining options do not present children meeting the criteria.

DIF: Cognitive Level: Application REF: Page 529

TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment

14. A patient has been physically abused by her boyfriend frequently since moving in together. During her last discussion with the nurse, the patient stated, I probably should not keep going back to him, because he continues to abuse me. The nurse is aware that the final decision to leave a batterer is:

a.

Usually a gradual process that occurs over time

b.

Likely to occur after the victim suffers a serious injury

c.

More likely if the patient has approval from her family

d.

Made when the batterer gives her permission to do so

ANS: A

The victim usually moves slowly when making the decision to leave the batterer because of many self-imposed constraints and many environmental factors that must be considered. It is unlikely that a batterer will give permission for the victim to leave. The remaining options are not supported by current research.

DIF: Cognitive Level: Application REF: Page 533

TOP: Nursing Process: Assessment MSC: NCLEX: Psychological Integrity

15. A patient has been chronically battered by her husband since they were married. Until now she had avoided dealing with her situation, but she now expresses a desire to deal with the problem since the attacks are occurring more frequently. Which outcome is realistic for the patient?

a.

Setting a goal date for divorcing her husband

b.

Verbalizing an awareness of her increasingly dangerous situation

c.

Citing possible ways she may have contributed to the abusive episodes

d.

Employing methods of retaliating in order to gain experience being assertive

ANS: B

Because the abuse has been long-term and is increasing in intensity, the patient needs to state her awareness of being in danger. When the patient accepts this fact, she may be increasingly ready to make further plans to extricate herself. The victim is not at fault for abuse. Setting a divorce date is not practical because she has not begun to pursue litigation. Retaliation is not an effective means of resolving the problem.

DIF: Cognitive Level: Application REF: Page 532

TOP: Nursing Process: Outcome Identification

MSC: NCLEX: Psychological Integrity

16. The nurse who sees a number of battered elderly females each year decides to put together a set of guidelines for nurses. An appropriate guideline to include would be to:

a.

Make protective services aware of the abuse.

b.

Take at least two photographs of each trauma area.

c.

Begin the interview by asking the least sensitive questions.

d.

Assess for the presence of sexually transmitted diseases.

ANS: C

During the assessment and when taking the womans history, it is recommended that in all cases the nurse begins with the least sensitive questions and gradually progress to the more sensitive ones. The remaining options may be appropriate but depend on the circumstances.

DIF: Cognitive Level: Application REF: Page 531

TOP: Nursing Process: Assessment MSC: NCLEX: Psychological Integrity

17. A nurse planning teaching for a parent group concerned with preventing family violence can discuss the fact that exposure to violence in the media:

a.

Desensitizes people to the violence around them

b.

Has no effect on the increase of violence in society

c.

Broadens the viewers knowledge about world happenings

d.

Helps to distinguish appropriate behaviors from inappropriate behaviors

ANS: A

Violence in the media has been shown to desensitize people to environmental violence. Desensitization to violence results in people being apathetic about the violence going on around them. The remaining options are not true statements.

DIF: Cognitive Level: Application REF: Page 528 TOP: Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance

18. Which symptom reported by an adult patient, who was sexually abused as a child, reflects the diagnosis of posttraumatic stress disorder (PTSD)?

a.

A history of substance abuse

b.

Refusing to go to public places from which escape may be difficult

c.

Seeking advice and guidance prior to making any significant decision

d.

Ruminating easily concerning the abuse with friends and acquaintances

ANS: A

Substance abuse to help manage the unpleasant symptoms is characteristic of PTSD. Being uncomfortable in certain locations refers to agoraphobia. Seeking extensive support characterizes a dependent person. Ease in talking about the experience is uncharacteristic of PTSD.

DIF: Cognitive Level: Application REF: Page 537

TOP: Nursing Process: Assessment MSC: NCLEX: Psychological Integrity

19. While planning care for a preschool child who has been physically and sexually abused, the nurse includes play therapy because it assists the child to:

a.

Learn adaptive behaviors through acting.

b.

Express feelings that cannot easily be verbalized.

c.

Act out aggression in a sociably acceptable manner.

d.

Interact with other children in the appropriate age group.

ANS: B

Abused children, especially young children, are unable to put feelings into words as they describe events. Play therapy affords the tools through which the child can access and work through feelings. The other options are not purposes of play therapy.

DIF: Cognitive Level: Application REF: Page 541 TOP: Nursing Process: Planning

MSC: NCLEX: Psychological Integrity

20. A new nurse asks the experienced nurse, Why did you ask about culture when it was obvious you needed to focus on the battering? The experienced nurse should respond:

a.

Its just a habit I got into awhile ago.

b.

It helps me focus on whether to do a complete physical assessment.

c.

Culture is a determinant of how women interpret and respond to violence.

d.

If I know more I can refer her to a shelter that caters to her cultural group.

ANS: C

Understanding the womans culture not only helps understand how the woman will view and respond to violence but also is essential to developing an effective treatment plan. Some ethnic women are isolated and would not be able to seek assistance from police or community agencies. The remaining options are made-up responses and have no basis in theory or practice.

DIF: Cognitive Level: Application REF: Page 531

TOP: Nursing Process: Implementation MSC: NCLEX: Psychological Integrity

21. The experienced nurse assessing a battered woman patient uses many open-ended questions during the interview. The rationale for this is that:

a.

The woman will feel more in charge of the interview.

b.

Patients cant refuse to answer when sensitive information is being probed.

c.

The questions are direct and easily understood by the anxious individuals.

d.

Such questions allow for simple yes or no answers when the patient is upset.

ANS: A

Open-ended questions reflecting what the woman is disclosing give the patient the sense of being in control of the interview, and she is likely to reveal more than when direct questions are used exclusively. Open-ended questions are not easily answered yes or no. Open-ended questions are indirect. Patients can refuse to answer any question, so this is not an acceptable rationale.

DIF: Cognitive Level: Application REF: Page 531

TOP: Nursing Process: Assessment MSC: NCLEX: Psychological Integrity

22. The nurse is interviewing a patient who presents with a dislocated shoulder and demonstrates signs of anxiety although relying on her partner for answers. Although the partner is out of the room, which question is most important to ask?

a.

Have you been with your partner long?

b.

Are you being abused by your partner?

c.

Shall I notify the police that you would like to press charges?

d.

Have you ever been physically or emotionally hurt by someone?

ANS: D

When the victim is alone, the nurse must seek information about abuse. Phrasing the question to avoid use of such terms as abuse or battered is essential. These terms are too emotionally charged, and patients often respond in the negative. The length of the relationship is not a priority. Asking to call the police is premature.

DIF: Cognitive Level: Application REF: Page 531

TOP: Nursing Process: Assessment MSC: NCLEX: Psychological Integrity

23. A woman whose husband physically abuses her mentions to the nurse, Someday Ill have to leave him. Which of the following would be the nurses best response?

a.

Yes, you should, before he harms you badly.

b.

Could we talk about developing a safety plan?

c.

Are you afraid of what your family will say?

d.

I dont know why you would stay with him.

ANS: B

It is well known that the woman is at high risk for being killed or seriously injured when she leaves the abuser. Having a safety plan lowers the risk and makes leaving a less nebulous idea. The patient must make up her own mind. Asking about the familys response sidesteps the issue of safety. The patient needs empowerment, not criticism.

DIF: Cognitive Level: Application REF: Page 532

TOP: Nursing Process: Implementation MSC: NCLEX: Psychological Integrity

24. The nurse is planning care for a battered woman who has mentioned, Someday Ill have to leave him. Which outcome should the nurse include in the plan of care for this patient?

a.

Patient will leave husband for a safe environment within 3 weeks.

b.

Patient will verbalize awareness of the dangerousness of her situation.

c.

Patient will state that she feels strong enough to return to the situation.

d.

Patient will state that she feels more relaxed after consultation with nurse.

ANS: B

This is a realistic outcome for a patient who is beginning to consider leaving the abusive situation. Setting a timeline is premature. Feeling relaxed is more related to a problem of anxiety than to abuse. Returning is not an outcome that is in the patients best interest.

DIF: Cognitive Level: Application REF: Page 532

TOP: Nursing Process: Outcome Identification

MSC: NCLEX: Psychological Integrity

25. A patient who has been battered by her partner sobs, It was my own fault. Which of the following would be the priority response by the nurse?

a.

Why do you think he does it?

b.

What did you do to deserve this?

c.

No one has the right to abuse another.

d.

Tell me about when you were growing up.

ANS: C

The patient must understand that as a human being she has the right not to be abused. Victims of abuse should be given this information in a respectful way to counteract their feelings of guilt and shame. Asking about behaviors suggests that the patient had a role in provoking the battery. Asking why sidesteps the real issue. Enquiring about her childhood continues to look at factors within the patient.

DIF: Cognitive Level: Application REF: Page 530

TOP: Nursing Process: Implementation MSC: NCLEX: Psychological Integrity

26. The care plan for a battered woman will be most successful if the nurse:

a.

Empowers the patient to make her own decisions

b.

Develops the plan and presents it to the woman

c.

Obtains photo evidence of the battery for use in court

d.

Has a family conference and mediates among the parties

ANS: A

The nurses attitudes, values, and choices cannot be imposed upon the patient. The nurse must empower the patient to make her own decisions. Empowerment will help the patient develop strength to make growth-producing decisions independently. The remaining options would be counterproductive or have no bearing on the success of the care plan.

DIF: Cognitive Level: Application REF: Page 532 TOP: Nursing Process: Planning

MSC: NCLEX: Psychological Integrity

27. A teenage boy has been periodically beaten by his father. The boy tells the nurse, Hell pay for this one way or another. The nurse treating his contusions should assess for behaviors suggesting:

a.

Aggression

b.

Depression

c.

Regression

d.

Withdrawal

ANS: A

Research suggests that children who are abused are at high risk for antisocial behavior and associated aggressive behaviors for a period of at least 2 years after the battering incident. The boys remark is not consistent with any of the other options.

DIF: Cognitive Level: Application REF: Page 538

TOP: Nursing Process: Assessment MSC: NCLEX: Psychological Integrity

28. A patient in her early teens who is being treated for irritable bowel syndrome has just disclosed that she has been the victim of child abuse for 8 years. For what other condition should the nurse assess this patient?

a.

Schizophrenia

b.

Agoraphobia

c.

Posttraumatic stress disorder

d.

Obsessive-compulsive disorder

ANS: C

The state of chronic hyperarousal caused by the abuse is the basis for three common outcomes of childhood abuse: PTSD, depression, and irritable bowel syndrome. The conditions mentioned in the other options are not related to child abuse.

DIF: Cognitive Level: Application REF: Page 539

TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance

29. Which statement regarding the various types of child offender is correct?

a.

The physical offender lacks remorse, although the sexual offender usually shows guilt and shame.

b.

The physical offender has diverse characteristics, although the sexual offender has lack of remorse.

c.

The physical offender has a mature ego, although the sexual offender has a rigid, overdeveloped superego.

d.

The physical offender has poor self-esteem and unrealistic expectations of children, although the sexual offender has diverse characteristics.

ANS: D

The child physical offender often is assessed as having poor self-esteem, poor impulse control, unrealistic expectations of children, immaturity, and minimal external supports. The child sexual offender has diverse characteristics, with no profile becoming apparent. The child sexual offender often does not show remorse for the acts.

DIF: Cognitive Level: Application REF: Pages 536-537

TOP: Nursing Process: Assessment MSC: NCLEX: Psychological Integrity

30. A toddler was brought to the hospital with a broken humerus and upper arm bruising. The childs father states that he shook the child while disciplining him to teach him to be quiet. An appropriate family-related nursing diagnosis is:

a.

Anxiety related to physical abuse

b.

Powerlessness related to inability to keep child quiet

c.

Impaired parenting related to unrealistic expectations for child

d.

Risk for impaired parenting related to harsh disciplinary methods

ANS: C

This diagnosis is supported by data in the scenario. Violence has occurred, so a risk diagnosis is not appropriate. The remaining diagnoses are not supported by data.

DIF: Cognitive Level: Application REF: Page 540 TOP: Nursing Process: Diagnosis

MSC: NCLEX: Psychological Integrity

31. An experienced nurse correctly notes that an important factor in assessing survivors of childhood sexual abuse is to be aware that they often experience long-term symptoms most closely resembling DSM-IV-TR criteria for:

a.

Adjustment disorders

b.

Schizophreniform reaction

c.

Posttraumatic stress disorder

d.

Obsessive-compulsive personality disorder

ANS: C

Although childhood sexual abuse produces a wide variety of long-term sequelae, the most common psychosocial problems are PTSD, self-damaging behavior, mood disturbances, interpersonal problems, and sexual difficulties. The other options are rarely noted.

DIF: Cognitive Level: Application REF: Page 541

TOP: Nursing Process: Assessment MSC: NCLEX: Psychological Integrity

32. An elderly patient who lives with her daughter, son-in-law, and their three children reveals that her daughter sometimes slaps her when she does not move fast enough or spills things. The daughter states, I have so much to do that I become frustrated when my mother cant move fast enough or causes me extra work. The nurse caring for the mother could appropriately suggest:

a.

Moving the mother to an adult ambulatory care facility

b.

Employing an aide to provide care and stimulation for the mother

c.

Enrolling in a therapeutic group that addresses stress management

d.

Reading the elder law of the state to learn the penalties for elder abuse

ANS: C

The daughter has many stressors and has few external supports. Enrolling in a stress management group would provide support as well as teach new adaptive coping strategies. Being required to read the law is threatening. The remaining options are premature.

DIF: Cognitive Level: Application REF: Page 546 TOP: Nursing Process: Planning

MSC: NCLEX: Psychological Integrity

33. After being raped, a woman was told by her aunt, Im not surprised that happened to you. You always dress to show off your figure. The victim states, I cant believe that people can think that way. The rape crisis nurse correctly hypothesizes that the patient is:

a.

Being revictimized by society

b.

Overly sensitive to others views

c.

Overreacting to not resisting more strongly

d.

Unaware of the normalcy of male sexual aggression

ANS: A

Victim blaming is common following a rape. Instead of blaming the rapist, many individuals lack knowledge and empathy and revictimize the woman. Rape education programs can be helpful in changing attitudes. The other options are hypotheses that continue to place blame on the victim.

DIF: Cognitive Level: Application REF: Page 546

TOP: Nursing Process: Assessment MSC: NCLEX: Psychological Integrity

34. Which of the following would be an appropriate outcome for a patient diagnosed with rape-trauma syndrome?

a.

Patient will sleep 8 hours without medication by week 6 of therapy.

b.

Patient will develop better self-esteem by week 8 of therapy.

c.

Patient will accept nurses word that her reactions are normal.

d.

Patient will verbalize that recovery may never happen totally.

ANS: D

Rape trauma victims require time to process what has happened to them and to reorganize their lives, just as an individual who is grieving must do. The remaining options are not realistic nor therapeutic.

DIF: Cognitive Level: Application REF: Page 550

TOP: Nursing Process: Outcome Identification

MSC: NCLEX: Psychological Integrity

Copyright 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

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