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An adult tells the nurse, 'My partner abuses me only when drinking. The drinking has increased lately, but I always get an apology afterward and a box of candy. I've considered leaving but haven't been able to bring myself to actually do it.' Which phase in the cycle of violence prevents the patient from leaving?
- A. Tension building
- B. Acute battering
- C. Honeymoon
- D. Recovery
Correct Answer: C
Rationale: The honeymoon stage is characterized by kindly, loving behaviors toward the abused spouse when the perpetrator feels remorseful. The victim believes the promises and drops plans to leave or seek legal help. The tension-building stage is characterized by minor violence in the form of abusive verbalization or pushing. The acute battering stage involves the abuser beating the victim. The violence cycle does not include a recovery stage.
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A 10-year-old child cares for siblings while the parents work because the family cannot afford a babysitter. This child says, 'My father doesn't like me. He calls me stupid all the time.' The mother says the father is easily frustrated and has trouble disciplining the children. The community health nurse should consider which resources to stabilize the home situation? (Select all that apply.)
- A. Parental sessions to teach child-rearing practices
- B. Anger management counseling for the father
- C. Continuing home visits to provide support
- D. Safety plan for the wife and children
- E. Foster placement of the children in foster care
Correct Answer: A,B,C
Rationale: Anger management counseling for the father is appropriate. Support for this family will be an important component of treatment. By the wife's admission, the family has deficient knowledge of parenting practices. Whenever possible, the goal of intervention should be to keep the family together; thus, removing the children from the home should be considered a last resort. Physical abuse is not suspected, so a safety plan is not a priority at this time.
After treatment for a detached retina, a victim of intimate partner violence says, 'My partner only abuses me when intoxicated. I've considered leaving, but I was brought up to believe you stay together, no matter what happens. I always get an apology, and I can tell my partner feels bad after hitting me.' Which nursing diagnosis applies?
- A. Social isolation, related to lack of community support system
- B. Risk for injury, related to partner's physical abuse when intoxicated
- C. Deficient knowledge, related to resources for escape from the abusive relationship
- D. Disabled family coping, related to uneven distribution of power within a relationship
Correct Answer: B
Rationale: Risk for injury is the priority diagnosis because the partner has already inflicted physical injury during violent episodes. The episodes are likely to become increasingly violent. Data are not present that show social isolation or disabled family coping, although both are common among victims of violence. Deficient knowledge does not apply to this patient's use of defense mechanisms.
Several children are seen in the emergency department for treatment of illnesses and injuries. Which finding would create a high index of suspicion for child abuse?
- A. Repeated middle ear infections
- B. Severe colic
- C. Bite marks
- D. Croup
Correct Answer: C
Rationale: Injuries such as immersion or cigarette burns, facial fractures, whiplash, bite marks, traumatic injuries, bruises, and fractures in various stages of healing suggest the possibility of abuse. In older children, vague complaints such as back pain may also be suspicious. Ear infections, colic, and croup are not problems induced by violence.
Which family scenario presents the greatest risk for family violence?
- A. An unemployed husband with low self-esteem, a wife who loses her job, and a developmentally delayed 3-year-old child
- B. A husband who finds employment 2 weeks after losing his previous job, a wife with stable employment, and a child diagnosed with attention deficit disorder
- C. A single mother with an executive position, a gifted and talented child, and a widowed grandmother living in the home to provide child care
- D. A single homosexual male parent and an adolescent son who has just begun dating girls
Correct Answer: A
Rationale: The family with an unemployed husband with low self-esteem, a newly unemployed wife, and a developmentally challenged young child has the greatest number of stressors. The other families described have fewer negative events occurring.
A victim of physical abuse by an intimate partner is treated for a broken wrist. The patient has considered leaving but says, 'You stay together, no matter what happens.' Which outcome should be met before the patient leaves the emergency department? The patient will:
- A. limit contact with the abuser by obtaining a restraining (protective) order.
- B. name two community resources that can be contacted.
- C. demonstrate insight into the abusive relationship.
- D. facilitate counseling for the abuser.
Correct Answer: B
Rationale: The only outcome indicator clearly attainable within this time is for a staff member to provide the victim with information about community resources that can be contacted. The development of insight into the abusive relationship requires time. Securing a restraining (protective) order can be quickly accomplished but not while the patient is in the emergency department. Facilitating the abuser's counseling may require weeks or months.