Nokea
A nurse is working with a female client who is anticipating the possibility of leaving an abusive relationship. In helping the client make the decision to leave or to stay in the abusive situation, which of the following would be most important for the nurse to do?
- A. Ensure that the client can effectively describe the behaviors inherent in each phase of the cycle of domestic violence.
- B. Inform the client that if she leaves the abusive situation, there is a possibility her partner will attempt to murder her.
- C. Assist the client in finding a new apartment and a new job so she will be safe after she leaves her current situation.
- D. Suggest that the client legally change her name and move out of state so she will be safe from future harm.
Correct Answer: C
Rationale: Assisting the client in finding a new apartment and job (C) provides practical support to ensure safety and independence, critical for leaving an abusive relationship. Describing the cycle of violence (A) is educational but less immediate, warning of murder (B) may heighten fear, and changing identity (D) is extreme and less feasible.
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A nurse is assessing a client who is a survivor of abuse. Which of the following would be most appropriate to use when conducting a lethality assessment?
- A. Danger Assessment Screen
- B. Abuse Assessment Screen
- C. Burgess-Partner Abuse Scale
- D. Beck Depression Inventory
Correct Answer: A
Rationale: The Danger Assessment Screen (A) is specifically designed to assess the risk of lethal violence in abuse survivors, focusing on factors like threats or weapon use. The Abuse Assessment Screen (B) identifies abuse but not lethality, the Burgess scale (C) is less specific, and the Beck Depression Inventory (D) assesses depression, not lethality.
A nurse is interviewing a client who is a survivor of abuse. The client is telling the nurse about how the violence occurred. Which statement would the nurse interpret as reflecting phase 3 of the cycle of violence?
- A. He threw me against the wall and started punching my face.
- B. He yells at me for not having dinner waiting for him when he came home.
- C. He calls me stupid and incompetent, asking himself why he ever married me.
- D. He tells me that he is sorry and that he will never hit me again.
Correct Answer: D
Rationale: Phase 3 of the cycle of violence, the honeymoon phase, involves the abuser expressing remorse and promising not to repeat the violence (D). Phase 1 (tension-building) includes yelling or verbal abuse (B, C), and phase 2 (acute battering) involves physical violence (A).
The emergency department nurse is assessing a female client with traumatic injuries. To assess whether or not the client?s injuries have resulted from abuse, which question would be most appropriate for the nurse to ask the client?
- A. Is your partner being mean to you?
- B. Why do you think your husband has beaten you?
- C. It looks like someone has hurt you. Tell me about it.
- D. Can you describe the person who did this to you?
Correct Answer: C
Rationale: The open-ended, nonjudgmental question 'It looks like someone has hurt you. Tell me about it.' (C) encourages the client to share details without assuming abuse or blaming her. Option A is vague, option B implies blame, and option D focuses on the perpetrator rather than the client?s experience.
A nurse is working with a client who is a survivor of violence on developing a safety plan. Which of the following would the nurse address first?
- A. Devising an escape route
- B. Recognizing the signs of danger
- C. Identifying a safe place to hide
- D. Identifying a signal to indicate it is safe to leave
Correct Answer: B
Rationale: Recognizing the signs of danger (B) is the first step in a safety plan, as it enables the survivor to identify escalating risks and act proactively. Devising an escape route (A), finding a safe place to hide (C), or identifying a signal (D) are subsequent steps that rely on first recognizing danger.
The nurse is talking to a female client who is a survivor of intimate partner violence. The woman relates that her husband has been told that he has the characteristics of an antisocial personality disorder. The woman also informs the nurse that her husband has an extensive criminal record. The nurse interprets this information and suspects that the woman?s husband would most likely demonstrate which behavior?
- A. A risk for moderate to severe violence with people both within and outside his family
- B. Intermittent remorse for the violence and abuse that he commits
- C. Symptoms of depression along with harboring feelings of inadequacy
- D. Purposefully remain socially isolated from people other than those in his family
Correct Answer: A
Rationale: Antisocial personality disorder is characterized by a disregard for others' rights, often leading to a risk for moderate to severe violence both within and outside the family (A), especially given the husband's criminal record. Intermittent remorse (B) is unlikely, as lack of remorse is a hallmark of the disorder. Depression and inadequacy (C) are not typical, and social isolation (D) contradicts the manipulative social tendencies of antisocial personality.