CHAPTER 36: CHILD ABUSE AND NEGLECT My Nursing Test Banks

CHAPTER 36: CHILD ABUSE AND NEGLECT

MULTIPLE CHOICE

1.Which of the following statements best defines the term child maltreatment?

a.

intentional injury of a child

c.

failure to provide what a child needs

b.

not giving a child what he or she wants

d.

accidental harm to a child by someone

ANS: A

Feedback

A

Correct: Child maltreatment is the intentional injury of a child.

B

Incorrect: Child maltreatment is not considered failure to give a child what the child wants.

C

Incorrect: Child maltreatment is not considered the failure to provide what a child needs.

D

Incorrect: Child maltreatment is not considered accidental harm to a child by someone else. The harm or injury is intentional, not accidental.

PTS:1REF:p. 1380 Child Abuse and Neglect

OBJ: Cognitive Level: Comprehension

2.Which of the following statements best defines the term physical abuse?

a.

bodily injury to a person that seems to have been inflicted by other than accidental means

b.

purposefully beating a child so that there are highly visible marks on the childs body

c.

use of the hands applied to a child in an excessively forceful manner

d.

any damage to a child that involves the use of muscle-applied force

ANS: A

Feedback

A

Correct: Physical abuse is defined as bodily injury to a person that seems to have been inflicted by other than accidental means. Such injuries may include damage to the skin, including bruise, burns, bite marks, and lacerations; damage to the head; or shaken baby syndrome.

B

Incorrect: In physical abuse, marks may not be visible on the childs body. For example, with shaken baby syndrome, there may not be any visible signs of injury.

C

Incorrect: Physical abuse may include more than the use of the hands applied to a child in an excessively forceful manner.

D

Incorrect: Muscle-applied force may not be the etiology of physical abuse in the child.

PTS:1REF:p. 1380 Child Abuse and Neglect

OBJ: Cognitive Level: Comprehension

3.The school nurse observes parents interacting with a school-aged child and notices that they do not show any affection toward the child and there is no evidence of emotional support or supervision. Later the nurse learns from the child that he must take care of all his own hygiene tasks, has to find something to eat on his own, and his parents never say anything nice about him. The nurse at this point believes that the parents are engaging in:

a.

physical abuse

c.

poor parenting

b.

psychological abuse

d.

withholding of love

ANS: B

Feedback

A

Incorrect: These characteristics are not specific for physical abuse.

B

Correct: Psychological abuse results from the recurrent lack of attention to the childs needs, and includes lack of affection, emotional support, or supervision.

C

Incorrect: These characteristics are not specific for poor parenting.

D

Incorrect: These characteristics are not specific for withholding of love.

PTS:1REF:p. 1380 Child Abuse and Neglect

OBJ: Cognitive Level: Comprehension

4.The majority of perpetrators of abuse to children reported to state Child Protective Service agencies as suspected victims of abuse and neglect are:

a.

neighbors within one block

c.

parents

b.

strangers

d.

relatives other than parents

ANS: C

Feedback

A

Incorrect: Neighbors within one block are not the majority of perpetrators.

B

Incorrect: Strangers are not the majority of perpetrators.

C

Correct: Three-fourths of all perpetrators of abuse to children reported to the Child Protective Service agencies are caregivers.

D

Incorrect: Relatives other than parents are not the majority of perpetrators.

PTS:1REF:p. 1386 Types of Child Abuse

OBJ: Cognitive Level: Comprehension

5.The majority of child abuse victims fall into which of the following age ranges?

a.

over 10 years

c.

6 to 8 years

b.

8 to 10 years

d.

under 6 years

ANS: D

Feedback

A

Incorrect: The majority of child abuse victims are under 6 years, not over 10 years.

B

Incorrect: The majority of child abuse victims are under 6 years, not 8 to 10 years.

C

Incorrect: The majority of child abuse victims are under 6 years, not 6 to 8 years.

D

Correct: The majority of child abuse victims are under 6 years.

PTS:1REF:p. 1380 Child Abuse and Neglect

OBJ: Cognitive Level: Comprehension

6.Which of the following is the most common type of mistreatment of children?

a.

physical abuse

c.

sexual abuse

b.

neglect

d.

emotional maltreatment

ANS: B

Feedback

A

Incorrect: The most common type of mistreatment of children is not physical abuse. Twenty-five percent of child victims are physically abused.

B

Correct: The most common type of mistreatment of children is neglect. Fifty-five percent of child victims suffer from neglect.

C

Incorrect: The most common type of mistreatment of children is not sexual abuse. Twelve percent of victims are sexually abused.

D

Incorrect: The most common type of mistreatment of children is not emotional maltreatment. Six percent of victims are emotionally abused.

PTS:1REF:p. 1380 Child Abuse and Neglect

OBJ: Cognitive Level: Comprehension

7.In the sociological model of family violence, family violence is viewed as:

a.

a pattern of behavior that is passed from generation to generation

b.

a pattern of harm within the nuclear family with no outside persons involved

c.

any harmful action(s) between related persons no matter how distant the relationship is

d.

harmful activities within a group designated as family no matter what the relationship

ANS: A

Feedback

A

Correct: In the sociological model of family violence, family violence is viewed as a pattern of behavior that is passed from generation to generation. Although the form of abuse may change, the pattern continues. In one generation the abuse may be physical, but may change to sexual abuse in the next generation. Caregivers will construct similar abusive relationships with their own children based on their experiences of having violent caregivers.

B

Incorrect: In the sociological model of family violence, family violence is not viewed as a pattern of harm within the nuclear family with no outside persons involved.

C

Incorrect: In the sociological model of family violence, family violence is not viewed as any harmful action(s) between related persons no matter how distant the relationship is.

D

Incorrect: In the sociological model of family violence, family violence is not viewed as harmful activities within a group designated as family no matter what the relationship.

PTS:1REF:p. 1381 Child Abuse and Neglect

OBJ: Cognitive Level: Comprehension

8.When family violence is passed from generation to generation, this type of abuse has which of the following characteristics?

a.

It continues without changing to another type.

b.

The form of abuse may change.

c.

It usually gets more violent.

d.

It is more detrimental to the child from generation to generation.

ANS: B

Feedback

A

Incorrect: Intergenerational patterns of violence do not necessarily continue without changing to another type of abuse.

B

Correct: When family violence is passed from generation to generation, the form of abuse may change.

C

Incorrect: When family violence is passed from generation to generation, it does not necessarily get more violent.

D

Incorrect: This type of abuse is not more detrimental to the child from generation to generation.

PTS:1REF:p. 1381 Child Abuse and Neglect

OBJ: Cognitive Level: Comprehension

9.Which of the following children is in a high-risk family for less nurturing and more hurtful behavior?

a.

a child being raised by grandparents

b.

a child who is forbidden from playing with other children

c.

a child being raised by two men

d.

a child in a nuclear family there both parents have full-time jobs

ANS: B

Feedback

A

Incorrect: A child being raised by grandparents is not necessarily in a high-risk family for abuse. The characteristics of the grandparents would have to be known.

B

Correct: Children at high risk for less nurturing and more hurtful behavior live in a family system that has little contact with community groups such as school or church. These children are not involved in after-school activities and are not allowed to play with other neighborhood children.

C

Incorrect: A child being raised by two men is not necessarily in a high-risk situation for abuse.

D

Incorrect: A child in a nuclear family there both parents have full-time jobs is probably not in a high-risk family for abuse. One of the risk factors for abuse is stress. Families who spend increased time together under stressful conditions may not have appropriate social supports. Examples of this type of stress are poverty and unemployment.

PTS:1REF:p. 1381 Child Abuse and Neglect

OBJ: Cognitive Level: Application

10.The social-interactional systemic perspective of child abuse and neglect says that the legitimization of violence in the family is due to which of the following factors?

a.

family pathology of a genetic nature

b.

increased availability of pornography

c.

emphasis on hiding sexuality and not being open

d.

societys attitudes, beliefs, and values

ANS: D

Feedback

A

Incorrect: According to the social-interactional systemic perspective of child abuse, the legitimization of violence in the family is not due to family pathology of a genetic nature.

B

Incorrect: The legitimization of violence in the family is not due to increased availability of pornography.

C

Incorrect: The legitimization of violence in the family is not due to emphasis on hiding sexuality and not being open.

D

Correct: The social-interactional systemic perspective suggests society contains the attitudes, values, and beliefs that legitimize violence in families. For example, violent acts, interactions, and roles are part of society, and television, movies and videos demonstrate and illustrate the value society places on violence. Our society tends to accept violence as a matter of course, treating it casually or exploiting it to gain an audience.

PTS:1REF:p. 1381 Child Abuse and Neglect

OBJ: Cognitive Level: Comprehension

11.According to the social-interactional systemic perspective of child abuse and neglect, four factors place the family members at risk for abuse. These risk factors are the family itself, the caregiver, the child, and:

a.

chronic poverty

c.

the presence of a family crisis

b.

genetics

d.

the national emphasis on sex

ANS: C

Feedback

A

Incorrect: These four factors are the family itself, the caregiver, the child, but not chronic poverty.

B

Incorrect: These four factors are the family itself, the caregiver, the child, but not genetics.

C

Correct: These four factors are the family itself, the caregiver, the child, and the presence of a family crisis.

D

Incorrect: These four factors are the family itself, the caregiver, the child, but not the national emphasis on sex.

PTS:1REF:p. 1381 Child Abuse and Neglect

OBJ: Cognitive Level: Comprehension

12.When caregivers lack knowledge about parenting, lack parenting skills, and are emotionally immature, the child often assumes which of the following roles?

a.

victim

b.

caregiver role toward the caregiver

c.

regressed child of regressed caregivers

d.

scapegoat

ANS: B

Feedback

A

Incorrect: The child does not assume the role of victim in this situation.

B

Correct: When caregivers lack knowledge about parenting, lack parenting skills, and are emotionally immature, the child often assumes a caregiver role toward the caregiver. An example of this is then a 5-year old consoles an unemployed parent.

C

Incorrect: The child does not assume the role of regressed child of regressed caregivers.

D

Incorrect: The child does not assume the role of scapegoat.

PTS:1REF:p. 1381 Child Abuse and Neglect

OBJ: Cognitive Level: Application

13.Which of the following examples best defines the term role reversal?

a.

The child assumes a caregiver role toward the caregiver.

b.

The good child takes on a bad child role.

c.

A person who has been a good provider quits his or her job.

d.

A lazy person becomes very productive in the family.

ANS: A

Feedback

A

Correct: Role reversal occurs then the child assumes a caregiver role toward the caregiver.

B

Incorrect: Role reversal is not exemplified by the good child taking on a bad child role.

C

Incorrect: Role reversal is not defined as a person who has been a good provider quitting his or her job.

D

Incorrect: Role reversal is not defined as a lazy person becoming very productive in the family.

PTS: 1 REF: p. 1383 Theoretical Approaches to Child Abuse and Neglect

OBJ: Cognitive Level: Comprehension

14.When there is a depressed parent in the family, it is most likely that the depression will have which of the following effects?

a.

will not affect the persons ability or performance in parenting

b.

will cause the parent who is depressed to try harder to be a good parent

c.

places the parent at risk for physically or emotionally abusing the children

d.

will be seen in the child during the growing-up years

ANS: C

Feedback

A

Incorrect: Depression will affect the persons ability or performance in parenting.

B

Incorrect: Depression will not cause the parent who is depressed to try harder to be a good parent.

C

Correct: A depressed parent is at risk for physically or emotionally abusing the children. Such an individual may be irritable or withdrawn from family members, not have the emotional energy to manage the demanding needs of a child, or become provoked and use harsher punishment than is necessary or appropriate.

D

Incorrect: The most likely effect of depression in a parent is not that depression will be seen in the child during the growing-up years.

PTS: 1 REF: p. 1383 Theoretical Approaches to Child Abuse and Neglect

OBJ: Cognitive Level: Application

15.The nurse working in the pediatric clinic notices that a newborn seems particularly fussy. The mother verifies that this is a very fussy baby and that it is impossible to soothe the baby. In thinking through what to further assess and what to teach the mother, the nurse will keep in mind that fussy babies are:

a.

often in some kind of pain

c.

often victims of the mothers drug use

b.

somewhat neurologically unstable

d.

at greater risk for abuse

ANS: D

Feedback

A

Incorrect: Fussy babies are not necessarily in some kind of pain. Some infants are born with a fussy temperament.

B

Incorrect: Fussy babies are not somewhat neurologically unstable.

C

Incorrect: Fussy babies are not necessarily the victim of the mothers drug use.

D

Correct: Infants with a fussy, unsoothable, difficult temperament are most likely to resist a caregivers attempt at comforting, placing them at greater risk for abuse.

PTS: 1 REF: p. 1383 Theoretical Approaches to Child Abuse and Neglect

OBJ: Cognitive Level: Comprehension

16.Which of the following children are at greatest risk of abuse or neglect by the parents?

a.

postmaturity babies

b.

13-year-old children

c.

children with high intelligent quotient (IQ)

d.

premature infants

ANS: D

Feedback

A

Incorrect: Postmature babies are not at greatest risk of abuse or neglect by the parents.

B

Incorrect: 13-year-old children are not at greatest risk of abuse or neglect by the parents. Instead young children (particularly those younger than 3 years) are at high risk for abuse or neglect.

C

Incorrect: Children with high intelligent quotient (IQ) are not at greatest risk of abuse or neglect by the parents.

D

Correct: Premature infants are at greatest risk of abuse or neglect by the parents because they place great demands on the parents.

PTS: 1 REF: p. 1383 Theoretical Approaches to Child Abuse and Neglect

OBJ: Cognitive Level: Application

17.An infant is separated from his parents for a few minutes while the nurse weighs him. The infant seems distressed and looks around for the mother. The mother soothes the infant then the nurse is through weighing him. This type of attachment between mother and baby is most likely which of the following types of attachment?

a.

avoidant

c.

secure

b.

disorganized

d.

strange

ANS: C

Feedback

A

Incorrect: This type of attachment between mother and baby is not likely an avoidant attachment. In avoidant attachment the infant realizes the caregiver will not always be available to provide comfort. The infant exhibits independent behavior without acknowledging the caregiver prior to separation, exhibits minimal distress during separation, and avoids emotional support offered by the caregiver upon reunion.

B

Incorrect: This type of attachment is not disorganized attachment. In this situation the infant is confused and cannot understand how to get physiological and psychological needs met by the caregiver. This infant may be rejected or comforted by the caregiver.

C

Correct: This type of attachment between mother and baby is most likely a secure attachment.

D

Incorrect: This type of attachment is not strange attachment. Strange is not a type of attachment.

PTS: 1 REF: p. 1384 Theoretical Approaches to Child Abuse and Neglect

OBJ: Cognitive Level: Comprehension

18.The nurse is caring for an infant who shows no distress then her parents leave, and then they return the infant ignores her parents. There was no evidence of distress while the parents were gone. This type of attachment between the infant and parents is most likely which of the following types of attachment?

a.

secure

c.

ambivalent

b.

avoidant

d.

detached

ANS: B

Feedback

A

Incorrect: This is not a secure attachment.

B

Correct: This is a description of avoidant attachment.

C

Incorrect: This is not an ambivalent attachment. In this type of attachment the infant understands the caregiver is not reliable in meeting physiological and psychological needs and remains close before separation, is distressed during separation, demonstrates a combination of contact-seeking behaviors with temper tantrums during reunion, and may display indifference then comforted by the caregiver.

D

Incorrect: This is not a detached attachment. Detached is not a type of attachment.

PTS: 1 REF: p. 1384 Theoretical Approaches to Child Abuse and Neglect

OBJ: Cognitive Level: Application

19.Asian parents bring their child to the hospital with what appears to be burns or abrasions on the neck, spines, and ribs. The parents use the words cao gao. The nurse is aware that these physical findings and the term cao gao refers to:

a.

an Asian practice of burning and inflicting pain on children who wont obey

b.

parents rubbing a pumice stone over a childs body to sand off evil spirits

c.

rubbing a coin or a spoon heated in oil on an ill childs neck, spine, and ribs

d.

burning incense on a rice paper on a childs upper body to bring good luck

ANS: C

Feedback

A

Incorrect: The term cao gao does not refer to an Asian practice of burning and inflicting pain on children who wont obey.

B

Incorrect: The term cao gao does not refer to parents rubbing a pumice stone over a childs body to sand off evil spirits.

C

Correct: The term cao gao or coining refers to a practice of Southeast Asians to treat minor ailments and involves rubbing a coin or a spoon heated in oil on an ill childs neck, spine, and ribs. It may create a burn or abrasions.

D

Incorrect: The term cao gao does not refer to burning incense on a rice paper on a childs upper body to bring good luck.

PTS: 1 REF: p. 1384 Theoretical Approaches to Child Abuse and Neglect

OBJ: Cognitive Level: Comprehension

20.A child of Russian parentage is brought to the hospital with what appears to be second-degree burns. The nurse is aware of a Russian practice of treating headaches and abdominal pain by creating a vacuum under a cup or glass then a small amount of burning material is placed on the skin. This practice is called:

a.

tassos

c.

ventosos

b.

mal de vaso

d.

veritas

ANS: C

Feedback

A

Incorrect: This practice is not called tassos.

B

Incorrect: This practice is not called mal de vaso.

C

Correct: Ventosos or cupping involves creating a vacuum under a cup or glass then a small amount of burning material is placed on the skin.

D

Incorrect: This practice is not called veritas.

PTS: 1 REF: p. 1384 Theoretical Approaches to Child Abuse and Neglect

OBJ: Cognitive Level: Comprehension

21.A child is brought to the pediatric clinic for immunizations for school. The parent wants the immunizations to be given in the arm. The nurse explains that at least one of the injections has to be given in the buttocks. When the nurse pulls the diaper down, the nurse sees bite marks around the genital and buttock area. Which of the following explanations is most likely?

a.

A neighborhood toddler is in a biting stage.

b.

This child is in a biting stage, and the parents bit him back to get him to stop biting.

c.

The child is a victim of sexual or physical abuse.

d.

This must have happened then the dog slept with the child.

ANS: C

Feedback

A

Incorrect: This is not a credible explanation. Children tend to bite other children on areas other than the genitals or buttocks.

B

Incorrect: This is not a likely explanation of the bite marks.

C

Correct: Bite marks around the genital and buttock area are indicators of physical or sexual abuse. Lesions from bites are oval or semicircular. If the diameter across the lesion is greater than 3 cm, it was probably inflicted by an adult.

D

Incorrect: A bite from an animal such as a dog has sharp, puncture, slash or tear marks. This is not a likely explanation.

PTS: 1 REF: p. 1385 Theoretical Approaches to Child Abuse and Neglect

OBJ: Cognitive Level: Application

22.A parent brings a toddler to the pediatric clinic. The nurse observes a number of bruises on the child in various stages of healing. The parent claims the toddler bruises easily. The best action on the part of the pediatrician and the nurse would be to:

a.

believe the parents and schedule an appointment in 2 weeks

b.

report this to child and family services and order a screening battery of bleeding and clotting blood work

c.

check with the other parent or another caregiver to see what he or she might be able to add to this history

d.

tell the parent that it is clear that he or she is lying and to tell the truth

ANS: B

Feedback

A

Incorrect: A number of bruises in various stages of healing is a red flag indicator for abuse. So the best action to be suspicious of the parents explanation.

B

Correct: Physical abuse indicators include bruises in various stages of healing. The color of the bruises helps determine if the injury occurred as a single episode or over a period of time. Bruises resulting from physical abuse will be various colors, from reddish blue or purple to yellow, brown and fading. To avoid errors in diagnosis, children who present with multiple bruises that do not reflect the use of an object should be reported to child and family services. Screening tests of bleeding and clotting should be ordered to evaluate for a bleeding disorder.

C

Incorrect: A number of bruises in various stages of healing is a red flag indicator for abuse. So checking with the other parent or another caregiver to see what he or she might be able to add to this history is not the best action.

D

Incorrect: This is an inappropriate action. It is important to establish a trusting relationship with the parent so a supportive, nonblaming approach is best.

PTS: 1 REF: p. 1385 Theoretical Approaches to Child Abuse and Neglect

OBJ: Cognitive Level: Application

23.When the nurse sees a child who has burns on the backs of the legs and the top of the buttocks, and an area that is not burned in the center of the buttocks, the nurse will:

a.

tend to believe the parents who say the child got into the tub accidentally before it cooled off

b.

suspect that the childs buttocks were held forcibly against the bottom of the tub

c.

suspect that the parents poured hot liquids on some areas of the legs and buttocks

d.

think that the child backed up against a heater or was held there by the parents

ANS: B

Feedback

A

Incorrect: An accidental burn as a result of a child getting into a bathtub before the water cooled off will occur on the childs feet. So the nurse should be suspicious because the explanation of burn doesnt seem consistent with the injury.

B

Correct: The description of this burn indicates an immersion burn often used as a form of punishment for problem behaviors in toilet training. It is caused by purposefully placing the childs buttocks in hot water and holding her or him against the bottom of the tub.

C

Incorrect: When a parent pours hot liquids on a child, it usually involves the back, lateral side of the face, or shoulder, not the legs and buttocks.

D

Incorrect: The description of this burn is inconsistent with this explanation of how it occurred.

PTS:1REF:p. 1386 Types of Child Abuse

OBJ: Cognitive Level: Application

24.A child comes to the clinic with bruises that are yellow-brown and fading. Based on the characteristics of these bruises, how old is the injury?

a.

3 days

c.

6 days

b.

4 days

d.

over 1 week

ANS: D

Feedback

A

Incorrect: A bruise that occurred 3 to 5 days ago will be yellowish-green to brown.

B

Incorrect: A bruise that occurred 3 to 5 days ago will be yellowish-green to brown.

C

Incorrect: A bruise that occurred 6 days ago will be yellow-fading.

D

Correct: A bruise that is yellow-brown and fading indicates an injury over 1 week old.

PTS:1REF:p. 1388 Types of Child Abuse

OBJ: Cognitive Level: Comprehension

25.The nurse notices that a child has reddish blue to purple bruises that have margins. How old are these bruises?

a.

5 days

c.

more than 10 days

b.

7 days

d.

less than 1 day

ANS: D

Feedback

A

Incorrect: Bruises that are 5 days old are yellowish-green to brown.

B

Incorrect: Bruises that are 7 days old are yellow-fading in color.

C

Incorrect: Bruises that are more than 10 days old are yellow-brown-fading in color.

D

Correct: Reddish blue to purple bruises are less than 1 day old.

PTS:1REF:p. 1388 Types of Child Abuse

OBJ: Cognitive Level: Comprehension

26.Which of the following explains why children between the ages of 1 and 5 are more at risk than older children for getting serious burn injuries?

a.

They tend to aggravate and make their parents angry more than older children do.

b.

Children this age are small and cannot fight back then parents are abusive.

c.

The skin of a child is thinner and much more sensitive than an adults skin.

d.

Children this age are more curious and tend to get into things very quickly.

ANS: C

Feedback

A

Incorrect: This is not a factor explaining why children between the ages of 1 and 5 are more at risk for getting serious burn injuries.

B

Incorrect: This is not a factor explaining why children between the ages of 1 and 5 are more at risk for getting serious burn injuries.

C

Correct: Children between the ages of 1 and 5 are more at risk than older children for getting serious burn injuries because their skin is thinner and much more sensitive than an older child or adults skin.

D

Incorrect: Children this age may have a number of bruises, not burns, as a result of being more curious and getting into things very quickly.

PTS:1REF:p. 1388 Types of Child Abuse

OBJ: Cognitive Level: Application

27.Which of the following statements best describes the term stocking or glove type burn?

a.

The burn has the look of a stocking or glove because the child tried to protect him- or herself from being immersed in hot scalding water.

b.

The parents have dipped the child into hot liquid while he or she was asleep.

c.

The child was wearing a stocking or a glove then immersed in hot liquid.

d.

The parent was wearing heavy gloves or stockings on his or her hands while immersing the child in hot liquids or hot scalding water.

ANS: A

Feedback

A

Correct: A stocking or glove type burn has the look of a stocking or glove because the child tried to protect him- or herself from being immersed in hot scalding water.

B

Incorrect: If the parents dipped a child into hot liquid while he or she was asleep, the burns would depend on what part of the body came in contact with the water.

C

Incorrect: A stocking or glove type burn has the look of a stocking or glove because the child tried to protect him- or herself from being immersed in hot scalding water.

D

Incorrect: This statement does not accurately describe how a stocking or glove type burn occurred.

PTS:1REF:p. 1388 Types of Child Abuse

OBJ: Cognitive Level: Application

28.What is meant by the term flexion burns?

a.

a burn caused by a cigarette or other hot object applied to the elbow of a bent arm

b.

the body part immersed in hot liquids is held in a flexed position

c.

the burn is so serious the child cannot flex his or her extremity

d.

the parent flexed his or her own arms to avoid being burned while burning the child

ANS: B

Feedback

A

Incorrect: This is not an accurate description of a flexion burn.

B

Correct: A flexion burn occurs then a caregiver purposefully immerses a child in hot water and the body part immersed is held in a flexed position.

C

Incorrect: This is not an accurate description of a flexion burn.

D

Incorrect: This is not an accurate description of a flexion burn.

PTS:1REF:p. 1388 Types of Child Abuse

OBJ: Cognitive Level: Comprehension

29.What is the characteristic pattern of the burn in a flexion burn?

a.

tiger pattern

c.

concentric circles

b.

zigzag

d.

zebra pattern

ANS: D

Feedback

A

Incorrect: A tiger pattern is not the characteristic pattern of the burn in a flexion burn.

B

Incorrect: A zigzag pattern is not the characteristic pattern of the burn in a flexion burn.

C

Incorrect: Concentric circles are not the characteristic pattern of the burn in a flexion burn.

D

Correct: A zebra pattern is the characteristic pattern of the burn in a flexion burn. For example, a child who has hot coffee thrown on his arm may flex the arm so that only the top parts of the forearm and upper arm are burned, and the inside of the arm is protected by flexion in response to oncoming hot liquid.

PTS:1REF:p. 1388 Types of Child Abuse

OBJ: Cognitive Level: Comprehension

30.Most child abuse deaths occur for which of the following reasons?

a.

neurological injuries, with most of these being head injuries

b.

bleeding from cuts

c.

smothering or serious lack of oxygen for any number of reasons

d.

abdominal injuries

ANS: A

Feedback

A

Correct: Most child abuse deaths occur from neurological injuries, with most of these being head injuries, involving skull fractures and intracranial hemorrhage.

B

Incorrect: Most child abuse deaths do not occur from bleeding from cuts.

C

Incorrect: Most child abuse deaths do not occur from smothering or serious lack of oxygen for any number of reasons.

D

Incorrect: Most child abuse deaths do not occur from abdominal injuries. Abdominal injuries rank second to neurological injuries as the major cause of abuse-related deaths.

PTS:1REF:p. 1388 Types of Child Abuse

OBJ: Cognitive Level: Comprehension

31.Which of the following is a classic sign of shaken baby syndrome?

a.

chills and fever

b.

fear and withdrawal

c.

edema of the extremities and bloated appearance to the abdominal area of the body

d.

retinal hemorrhage, usually bilaterally with subdural or subarachnoid hemorrhages

ANS: D

Feedback

A

Incorrect: These symptoms are not a classic sign of shaken baby syndrome.

B

Incorrect: These symptoms are not a classic sign of shaken baby syndrome.

C

Incorrect: These symptoms are not a classic sign of shaken baby syndrome.

D

Correct: A classic sign of shaken baby syndrome is retinal hemorrhage, usually bilaterally with subdural or subarachnoid hemorrhages.

PTS:1REF:p. 1388 Types of Child Abuse

OBJ: Cognitive Level: Application

32.A father calls emergency medical services (EMS) for his 1-year-old infant who was vomiting and then experienced a series of seizures. Upon admission to the hospital, the infant was listless and irritable, had bradycardia, and had periods of apnea. The infant has now lapsed into a coma. Which of the following conditions will the nurse and the health care team members suspect and most want to rule out?

a.

spinal meningitis

c.

fever-induced seizures

b.

encephalitis

d.

shaken baby syndrome (SBS)

ANS: D

Feedback

A

Incorrect: These manifestations are similar to those seen in spinal meningitis, but the health care team members would be most concerned and want to rule out SBS. The infant is at risk for additional injuries (death) from shaking if abuse has occurred. One-third of children with SBS die from their injuries; and one-third experience permanent injury.

B

Incorrect: Some of these manifestations also occur in encephalitis. However, health care team members would be most concerned and want to rule out SBS. The infant is at risk for additional injuries (death) from shaking if abuse has occurred.

C

Incorrect: Fever-induced seizures are brief, clonic, or tonic, clonic in nature. The other manifestations in this situation would not be evident with fever-induced seizures.

D

Correct: Infants should be suspected of SBS with any signs of head injury, including poor feeding or vomiting, irritability, listlessness, lethargy, bradycardia, apnea, seizures coma, bulging fontanels, large head circumference, hypothermia, or failure to thrive. The classic triad of SBS is hematoma, brain edema and retinal hemorrhages, usually bilateral.

PTS:1REF:p. 1388 Types of Child Abuse

OBJ: Cognitive Level: Application

33.Risk factors for shaken baby syndrome include:

a.

stressful life events

b.

gender with women mostly responsible

c.

multiple births within a family

d.

age of parents, especially elder parents

ANS: A

Feedback

A

Correct: Risk factors for shaken baby syndrome include stressful life events such as social, physical or financial problems.

B

Incorrect: Men are mostly responsible for SBS and deaths attributed to SBS.

C

Incorrect: Multiple births within a family are not risk factors for SBS.

D

Incorrect: Elder parents are not a risk factor for any type of abuse. Instead caregivers who abuse their children tend to be young.

PTS:1REF:p. 1388 Types of Child Abuse

OBJ: Cognitive Level: Comprehension

34.Which of the following is the second major cause of abuse-related deaths?

a.

burns

c.

falls due to pushing or dropping

b.

abdominal injuries

d.

poisoning

ANS: B

Feedback

A

Incorrect: Burns are not the second major cause of abuse-related deaths.

B

Correct: The second major cause of abuse-related deaths is abdominal injuries.

C

Incorrect: Falls due to pushing or dropping are not the second major cause of abuse-related deaths.

D

Incorrect: Poisoning is not the second major cause of abuse-related deaths.

PTS:1REF:p. 1388 Types of Child Abuse

OBJ: Cognitive Level: Comprehension

35.The school nurse notices a child who has a frightened look then adults approach, appears sad, hangs around after school, and seems reluctant to go home. This child seemed very distressed then a classmate was crying after falling on the playground. The nurse tried to console this child while consoling the injured child. The school nurse realizes that this child has some of the classic symptoms of:

a.

a physically abused child

c.

mental retardation

b.

autism

d.

early mental illness

ANS: A

Feedback

A

Correct: The child who has been physically abused may exhibit passive behaviors such as withdrawal, depression or a sad mood. Other behaviors can include anger, hostility, or being frightened then approached by an adult. The child has a fear or reluctance to go home and displays anxiety and distress when hearing other children cry. This child has some of the classic symptoms of a physically abused child.

B

Incorrect: This child does not have the classic symptoms of autism.

C

Incorrect: This child does not have the classic symptoms of mental retardation.

D

Incorrect: This child does not have the classic symptoms of early mental illness.

PTS:1REF:p. 1389 Types of Child Abuse

OBJ: Cognitive Level: Comprehension

36.The nurse assessing a child who is suspected of being a victim of abuse will interview the child privately and will:

a.

find out what the child was doing before the injuries occurred

b.

reassure the child that he or she is not in trouble and that the child has not done anything wrong

c.

tell the child that he or she has nothing to fear from the parents or the legal system

d.

see what the child has done in response to any abusive behavior from the parents

ANS: B

Feedback

A

Incorrect: This is an inappropriate intervention and assumes the child did something wrong and deserved the abuse.

B

Correct: When interviewing a child suspected of being abused, it is important to reassure the child that he or she is not in trouble and that the child has not done anything wrong. Children often assume they are to blame for the caregivers actions; therefore, it is important to remind them the injuries are not their fault.

C

Incorrect: Telling the child that he or she has nothing to fear from the parents is not an appropriate intervention. Some parents may become angry that the child talked with the nurse and react by injuring the child again.

D

Incorrect: Seeing what the child has done in response to any abusive behavior from the parents is not significant information to obtain.

PTS:1REF:p. 1391 Types of Child Abuse

OBJ: Cognitive Level: Application

37.The nurse is developing a care plan for the parents of a toddler who was born prematurely and was in the neonatal intensive care unit for 2 months. The mother has been using a belt to discipline the child. The father is not very attentive to the needs of the mother or the baby. Which of the following nursing diagnoses would best fit this situation?

a.

interrupted family processes due to disrupted attachment

b.

deficient knowledge related to lack of parenting instructions

c.

high risk for injury to others related to mood disturbance

d.

marital discord in need of therapy related to lack of information

ANS: A

Feedback

A

Correct: The nursing diagnosis that would best fit this situation is interrupted family processes due to disrupted attachment. An infant who was separated from his parents for the first 2 months of life due to prematurity and hospitalization has not established a nurturing bond or appropriate attachment. Weak attachment bonds can result in caregivers viewing the child as an imperfect child and place him at risk for abuse.

B

Incorrect: This nursing diagnosis does not best fit this situation.

C

Incorrect: This nursing diagnosis does not best fit this situation.

D

Incorrect: This nursing diagnosis does not best fit this situation.

PTS:1REF:p. 1393 Types of Child Abuse

OBJ: Cognitive Level: Application

38.Which of the following outcomes is most important in the nursing care plan for a family engaging in physical abuse of the children?

a.

The child will remain safe with no evidence of physical abuse or neglect.

b.

The parents will demonstrate at least one nurturing behavior.

c.

The parents will discuss normal growth and development for the age of the child.

d.

The child will report all instances of threatened or actual abuse and neglect.

ANS: A

Feedback

A

Correct: The most important outcome is that the child will remain safe with no evidence of further physical abuse or neglect.

B

Incorrect: This is not the most important outcome. The childs safety is paramount.

C

Incorrect: This is not the most important outcome. The childs safety is paramount.

D

Incorrect: This is not the most important outcome. The childs safety is paramount.

PTS:1REF:p. 1394 Types of Child Abuse

OBJ: Cognitive Level: Application

39.Which of the following statements best describes Munchausen syndrome by proxy?

a.

The child has uncontrollable facial and vocal tics as a result of emotional abuse by caregivers.

b.

Caregivers make up signs and symptoms of disease or unnecessarily expose their child to harmful medical interventions and painful invasive procedures.

c.

The parents give the children no attention unless they are exhibiting signs and symptoms of illness.

d.

Relatives of a child get all the attention in the family and the child is forced to fake illness to get any attention at all.

ANS: B

Feedback

A

Incorrect: This is not a description of Munchausen syndrome by proxy.

B

Correct: Munchausen syndrome by proxy refers to caregivers who fabricate signs and symptoms of disease or unnecessarily expose their child to harmful medical interventions and painful invasive procedures. The perpetrator uses the disease to escape from marital, physical, or emotional problems, or poor self-esteem. By attending to the supposed needs of the child, the caregiver escapes the reality of her problems.

C

Incorrect: This is not a description of Munchausen syndrome by proxy.

D

Incorrect: This is not a description of Munchausen syndrome by proxy.

PTS:1REF:p. 1391 Types of Child Abuse

OBJ: Cognitive Level: Comprehension

40.The adult abuser who receives a diagnosis of Munchausen syndrome by proxy:

a.

is the victim of unnecessary medical treatment at the hands of another adult

b.

was the victim of unnecessary treatment in the past and now carries this pattern on

c.

uses this disease to escape from poor self-esteem, marital, physical, or mental problems

d.

is an uncaring and cunning individual who has psychological problems similar to antisocial behavior

ANS: C

Feedback

A

Incorrect: The adult abuser is not the victim of unnecessary medical treatment at the hands of another adult.

B

Incorrect: The adult abuser was not the victim of unnecessary treatment in the past and now carries this pattern on.

C

Correct: The adult abuser who receives a diagnosis of Munchausen syndrome by proxy uses this disease to escape from poor self-esteem, marital, physical, or mental problems. This disorder includes the intentional production or feigning of psychological or physical symptoms in the child for the purpose of indirectly assuming the sick role.

D

Incorrect: The adult abuser is not an uncaring and cunning individual who has psychological problems similar to antisocial behavior. Many abusers fulfill the diagnostic criteria for borderline personality disorder with a rigid defensive structure and a poor identity formation.

PTS:1REF:p. 1391 Types of Child Abuse

OBJ: Cognitive Level: Comprehension

41.The nurse will establish which of the following kinds of relationships with the family and the person suspected of having Munchausen syndrome by proxy?

a.

distant

c.

uninvolved

b.

trusting

d.

opponent

ANS: B

Feedback

A

Incorrect: The nurse will not establish distant relationships with the family and the person suspected of having Munchausen syndrome by proxy.

B

Correct: The nurse will establish trusting relationships with the family and the person suspected of having Munchausen syndrome by proxy. A trusting, therapeutic relationship is vital to the success of treatment, given the clients resistance to the concept that no physical cause for the symptoms exist. Therapeutic interventions must address ways to assist the client to get needs met without fabricating signs and symptoms in their child.

C

Incorrect: The nurse will not establish uninvolved relationships with the family and the person suspected of having Munchausen syndrome by proxy.

D

Incorrect: The nurse will not establish opponent relationships with the family and the person suspected of having Munchausen syndrome by proxy.

PTS:1REF:p. 1391 Types of Child Abuse

OBJ: Cognitive Level: Application

42.The school nurse is working with a child who seems angry and hits or hurts other children. Children who hurt other children are most often:

a.

victims of abuse themselves

b.

victims of manic depressive illness

c.

individuals who are neurologically impaired

d.

persons with brain damage

ANS: A

Feedback

A

Correct: Children who hurt their siblings, peers, pets, or neighborhood animals are most often victims of abuse themselves.

B

Incorrect: Children who hurt other children are not most often victims of manic depressive illness.

C

Incorrect: Children who hurt other children are not most often individuals who are neurologically impaired.

D

Incorrect: Children who hurt other children are not most often persons with brain damage.

PTS:1REF:p. 1392 Types of Child Abuse

OBJ: Cognitive Level: Comprehension

43.Which of the following statements best describes child abandonment?

a.

leaving town quickly and never looking back

b.

failure to pick up children promptly then others are caring for them or failure to let the children know there you are

c.

desertion of a child without arranging for reasonable care and providing no communication about caregivers location

d.

caregivers intentionally withholding, without cause or excuse, care, presence, love, protection, maintenance, and affection

ANS: C

Feedback

A

Incorrect: Child abandonment is not defined as leaving town quickly and never looking back.

B

Incorrect: Child abandonment is not defined as failure to pick up children promptly then others are caring for them or failure to let the children know there you are.

C

Correct: Child abandonment is defined as desertion of a child without arranging for reasonable care and providing no communication about caregivers location.

D

Incorrect: Child abandonment is not defined as caregivers intentionally withholding, without cause or excuse, care, presence, love, protection, maintenance, and affection.

PTS:1REF:p. 1392 Types of Child Abuse

OBJ: Cognitive Level: Comprehension

44.Which of the following statements best describes child neglect?

a.

not giving ones child all the toys and advantages that other parents provide

b.

not sending a brilliant child to college or otherwise providing for the childs future

c.

not providing special dance lessons or music lessons then the child asks for these lessons

d.

then a child experiences predictable injury or impairment because of caregiver inattention

ANS: D

Feedback

A

Incorrect: Child neglect is not described as failure to give ones child all the toys and advantages that other parents provide.

B

Incorrect: Child neglect is not described as failure to send a brilliant child to college or otherwise providing for the childs future.

C

Incorrect: Child neglect is not described as failure to provide special dance lessons or music lessons then the child asks for these lessons.

D

Correct: Child neglect occurs then a child experiences predictable injury or impairment because of caregiver inattention. Neglect is often suspected in children who are not of normal height and weight for age.

PTS:1REF:p. 1392 Types of Child Abuse

OBJ: Cognitive Level: Comprehension

45.The school nurse notices a child who is wearing old, dirty, poor-fitting clothes; is always hungry; has no lunch money; and is always tired. When the nurse asks the boy about his tiredness, he talks of playing outside until midnight. The nurse will suspect that this child is:

a.

a victim of child neglect

b.

the victim of poverty

c.

an orphan

d.

being raised by a parent of low intelligence quotient (IQ)

ANS: A

Feedback

A

Correct: The nurse will suspect that this child is a victim of child neglect.

B

Incorrect:The nurse not will suspect that this child is a victim of poverty.

C

Incorrect: The nurse not will suspect that this child is an orphan.

D

Incorrect: The nurse not will suspect that this child is being raised by a parent of low intelligence quotient (IQ).

PTS:1REF:p. 1392 Types of Child Abuse

OBJ: Cognitive Level: Application

46.Which of the following is the best example of psychological abuse that is an act of commission?

a.

not attending parents night at the school

b.

telling a child that he or she is dumb and will not amount to anything

c.

forgetting to give a child money or food for lunch

d.

not getting a child his or her vaccinations for school and having problems from this

ANS: B

Feedback

A

Incorrect: This is not an example of commission, but of omission.

B

Correct: Psychological abuse is defined as acts of omission or commission. It also involves the presence of hostile behavior as well as the absence of positive parenting behaviors. The best example of commission is telling a child that he or she is dumb and will not amount to anything.

C

Incorrect: This is not an example of commission, but of omission.

D

Incorrect: This is not an example of commission, but of omission.

PTS:1REF:p. 1392 Types of Child Abuse

OBJ: Cognitive Level: Application

47.Theorists believe that the behavior of caregivers who psychologically abuse their children stem from:

a.

not having experienced warm, caring parenting as children, not having their emotional needs met, and getting low levels of support

b.

criminal minds who are cunning and calculate how to be mean to children and punish them

c.

biochemical changes in the brain causing some people to have increased and even insatiable sexual urges toward children

d.

a childish mind that relates better to children than to adults who engage in problem solving and more adult behaviors

ANS: A

Feedback

A

Correct: Theorists believe that the behavior of caregivers who psychologically abuse their children stem from not having experienced warm, caring parenting as children, not having their emotional needs met, and getting low levels of support. The caregivers behavior may represent a re-creation of patterns of psychological abuse experienced as a child.

B

Incorrect: The behavior of caregivers who psychologically abuse their children does not stem from criminal minds that are cunning and calculate how to be mean to children and punish them.

C

Incorrect: The behavior of caregivers who psychologically abuse their children does not stem from biochemical changes in the brain causing some people to have increased and even insatiable sexual urges toward children.

D

Incorrect: The behavior of caregivers who psychologically abuse their children does not stem from a childish mind that relates better to children than to adults who engage in problem solving and more adult behaviors.

PTS:1REF:p. 1392 Types of Child Abuse

OBJ: Cognitive Level: Comprehension

48.Which of the following signs or symptoms would most lead the nurse to believe a child is being psychologically abused?

a.

working hard to get along well with other children

b.

high self-esteem and good academic performance

c.

a close peer group since preschool

d.

self-defeating and self-mutilating behaviors

ANS: D

Feedback

A

Incorrect: Working hard to get along well with other children are not indicators suggesting psychological abuse.

B

Incorrect: High self-esteem and good academic performance are not indicators suggesting psychological abuse. Instead, low self-esteem and poor academic performance are indicators of psychological abuse.

C

Incorrect: A close peer group since preschool is not an indicator suggesting psychological abuse. Rather, a child who has been psychologically abused lacks friends or a peer group.

D

Correct: Self-defeating and self-mutilating behaviors in a child are indicators suggesting psychological abuse.

PTS:1REF:p. 1397 Types of Child Abuse

OBJ: Cognitive Level: Comprehension

49.The nurse is working with a teenage girl who has been having sex with an adult male. The nurse is aware that this constitutes

a.

statutory rape

c.

sex with permission

b.

permissive sex

d.

an offense

ANS: A

Feedback

A

Correct: A teenage girl who has been having sex with an adult male constitutes statutory rape which is defined as consensual sexual relations between a minor and an adult.

B

Incorrect: A teenage girl who has been having sex with an adult male does not constitute permissive sex.

C

Incorrect: A teenage girl who has been having sex with an adult male does not constitute sex with permission.

D

Incorrect: A teenage girl who has been having sex with an adult male is not an offense but is a legal matter.

PTS:1REF:p. 1397 Types of Child Abuse

OBJ: Cognitive Level: Application

50.Which of the following statements best describes acquaintance rape or date rape?

a.

then two people dont love each other and engage in sexual activities

b.

sexual intercourse committed with force or the threat of force without a persons consent

c.

then someone on a date tricks the other person into having sexual intercourse

d.

sexual intercourse then one person engaging in the activity is unsure about wanting to do so

ANS: B

Feedback

A

Incorrect: Acquaintance rape or date rape is not described as then two people dont love each other and engage in sexual activities.

B

Correct: Acquaintance rape or date rape is best described as sexual intercourse committed with force or the threat of force without a persons consent. The victim and perpetrator know one another either socially or professionally.

C

Incorrect: Acquaintance rape or date rape is not described as then someone on a date tricks the other person into having sexual intercourse.

D

Incorrect: Acquaintance rape or date rape is not described as sexual intercourse then one person engaging in the activity is unsure about wanting to do so.

PTS:1REF:p. 1397 Types of Child Abuse

OBJ: Cognitive Level: Application

51.Incest is most likely to occur between:

a.

family members in a household of poverty

b.

parents and children

c.

high achievers

d.

siblings

ANS: D

Feedback

A

Incorrect: Incest is not most likely to occur between family members in a household of poverty.

B

Incorrect: Incest is not most likely to occur between parents and children.

C

Incorrect: Incest is not most likely to occur between high achievers.

D

Correct: Incest is most likely to occur between siblings. Incest is defined as sexual intercourse between closely related persons. Sibling incest has been estimated to be at least five times more common than parent-child incest.

PTS:1REF:p. 1398 Types of Child Abuse

OBJ: Cognitive Level: Comprehension

52.Nudity, disrobing, and genital exposure by an adult in front of a child, as well as observing a child undressed, sexual touching, and contact for prostitution or child pornography, are said to be:

a.

traumatization

c.

exploitation

b.

familiarization

d.

fraternization

ANS: C

Feedback

A

Incorrect: These behaviors are not said to be traumatization.

B

Incorrect: These behaviors are not said to be familiarization.

C

Correct: Nudity, disrobing, and genital exposure by an adult in front of a child, as well as observing a child undressed, sexual touching, and contact for prostitution or child pornography, are said to be exploitation. The childs emotional development is affected by this type of abuse, resulting in shame, guilt, depression, anxiety, psychosomatic disorders, substance abuse, ADHD, and conduct or oppositional disorders.

D

Incorrect: These behaviors are not said to be fraternization.

PTS:1REF:p. 1398 Types of Child Abuse

OBJ: Cognitive Level: Comprehension

MULTIPLE RESPONSE

1.Nurses have an integral role in preventing child abuse and family violence through which of the following interventions? Select all that apply.

a.

educating the public

c.

becoming involved in health policy

b.

supporting mental health initiatives

d.

supporting family health initiatives

ANS: A, B, C, D

Feedback

Correct

Nurses have an integral role in the prevention of child abuse and family violence through educating the public.

Nurses have an integral role in the prevention of child abuse and family violence through supporting mental health initiatives.

Nurses have an integral role in the prevention of child abuse and family violence through becoming involved in health policy.

Nurses have an integral role in the prevention of child abuse and family violence through supporting family health initiatives.

Incorrect

All options are correct.

PTS:1REF:p. 1380 Child Abuse and Neglect

OBJ: Cognitive Level: Application

2.A nurse is asked to describe the concept of attachment between a young child and the caregiver to a group of families planning to adopt internationally. Which of the following statements made by the nurse describes the qualities involved in attachment of the parent and child? Select all that apply.

a.

being emotionally available

b.

allowing the child to grieve independently for the loss of his or her familiar surroundings

c.

offer protection and warmth to the child despite attachment challenges

d.

set firm parameters and allow the child to deal with disappointment

ANS: A, C

Feedback

Correct

To promote attachment between a child and the caregiver, it is necessary for the caregiver to be emotionally available for the child.

To promote attachment between a child and the caregiver, the caregiver should offer protection and warmth to the child despite attachment challenges.

Incorrect

Allowing the child to grieve independently would not offer comfort and a sense of security, both important components for facilitating attachment.

Setting parameters and allowing the child to deal with disappointment would not likely facilitate attachment, as such actions would not facilitate the development of security and trust.

PTS: 1 REF: p. 1384 Theoretical Approaches to Child Abuse and Neglect

OBJ: Cognitive Level: Application

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