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A school nurse is educating a group of adolescent girls about rape and sexual assault. The nurse evaluates the students' understanding when they report which of the following as a high-risk factor regarding the incidence of rape?
- A. The highest incidence of rape occurs in adolescents and young adult women.
- B. Most rapes are committed by strangers.
- C. Most rapes are random acts of violence.
- D. A victim is at highest risk in unfamiliar neighborhoods.
Correct Answer: A
Rationale: The highest incidence of rape occurs in girls and women aged 16-24, often by acquaintances, not strangers, and in familiar settings.
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The nurse is collecting assessment data on a client who is suspected to be a victim of violence. Which assessment data would support the suspicion that the client is a victim of abuse? Select all that apply.
- A. The client has few friends.
- B. The client holds a dominant role in the family.
- C. The client is in charge of the family finances.
- D. There is a moderate amount of alcohol use in the home.
- E. The client reports that the father was abusive during childhood.
Correct Answer: A,D,E
Rationale: Social isolation, alcohol use, and a history of childhood abuse are indicators of potential abuse, as they align with characteristics of violent families.
The nurse is assessing an elderly female in the emergency department. There are many bruises present on her body in varying stages of healing. After documenting the bruising in the assessment, what should the nurse do next?
- A. Ask the client when and how the bruises occurred
- B. Call the nursing supervisor immediately
- C. Follow the facility's policy and procedures for reporting abuse
- D. Notify the physician that abuse is suspected
Correct Answer: A
Rationale: Asking the client about the bruises is the next step to assess potential abuse before reporting or involving others.
Which one of the following statements regarding intimate partner violence is true?
- A. Males are never the victim in intimate partner violence.
- B. It is common for abusers to use one type of abuse only.
- C. Intimate partner violence can exist with former partners.
- D. Psychological abuse is not as harmful as physical abuse.
Correct Answer: C
Rationale: Intimate partner violence can occur in estranged relationships and includes various forms of abuse, with 5-10% of victims being male, and all abuse is harmful.
Which characteristic of the abuser should the nurse look for when completing the family assessment of a victim of intimate partner violence?
- A. Encourages the partner to have a life outside the intimate relationship
- B. An inflated sense of self-esteem
- C. Needy and possessive of the partner
- D. An ability to feel remorse for the abuse
Correct Answer: C
Rationale: Abusers are typically needy, possessive, and view their partner as property, with low self-esteem rather than inflated self-esteem or genuine remorse.
The school nurse is teaching a health class about recognizing the signs of abusive relationships. The nurse describes the cycle of violence. The nurse would document effective teaching if the students identify the cycle of violence to be which of the following patterns? Select the order in which the events occur.
- A. Tension building
- B. Honeymoon period
- C. Violent behavior
- D. Period of remorse
Correct Answer: A,C,D,B
Rationale: The cycle of violence follows the pattern of tension building, violent behavior, period of remorse, and then a honeymoon period, repeating thereafter.