Old's Maternal-Newborn Nursing and Women's Health, 11e (Davidson/London/Ladewig)

Chapter 8 Violence Against Women

1. The client has been a victim of a violent, sadistic rape. She is crying and asks the nurse, "Why would someone do something like that?" The nurse should explain that which of the following is the primary purpose of sadistic rape?
2. Take pleasure from the victim's struggle and pain
3. Express feelings of rage
4. Feel a sense of power or mastery
5. Relieve intolerable anxiety

Page Ref: 150

Cognitive Level: Understanding

Client Need/Sub: Psychosocial Integrity: Crisis Intervention

Standards: Q S E N Competencies: Ⅰ. C. 9. Recognize that patient expectations influence outcomes in management of pain or suffering. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Appreciate the patient as a whole person, with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 8 Identify the phases of the rape trauma syndrome.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. The nurse is teaching an in-service educational presentation about working with battered women. The nurse should explain that it is often frustrating for nurses to work with battered women for which reasons?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. There is little the nurse can really do to help.
2. Healthcare policies and practices are not supportive of abused women.
3. Both husband and wife must agree to therapy.
4. These women might return to the abusive situation.
5. Women often believe that they are the cause of the abuse.

Page Ref: 142—143

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Abuse/Neglect

Standards: Q S E N Competencies: Ⅰ. C. 5. Recognize personally held attitudes about working with patients from different ethnic, cultural, and social backgrounds. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Appreciate the patient as a whole person, with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 3 Identify the phases of the cycle of violence.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. The nurse is planning a community education presentation on battering. Which statement about battering should the nurse include?
2. Battering occurs in a small percentage of the population.
3. Battering is mainly a lower-class, blue-collar problem.
4. Battered women are at greatest risk for severe violence when they leave the batterer.
5. If the batterer stops drinking, the violence usually stops.

Page Ref: 142

Cognitive Level: Understanding

Client Need/Sub: Psychosocial Integrity: Abuse/Neglect

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Identify factors that contribute to domestic violence.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. The nurse is interviewing a client who has admitted to being a victim of domestic violence. What is the most typical description of how the domestic violence developed in a relationship?
2. "He changed overnight. Everything was fine, and all of a sudden he flipped out and beat me up; he nearly killed me."
3. "It was severe from the beginning. As soon as we got married, he began hitting me and threatening to kill me."
4. "We've both always dated other people. I thought that was understood. He was as emotionally abusive in the beginning as he is now."
5. "I don't know when it started, really. It was gradual. First, just yelling, blaming, and shoving. Then the beatings started; and now they're more frequent."

Page Ref: 140—141

Cognitive Level: Understanding

Client Need/Sub: Psychosocial Integrity: Abuse/Neglect

Standards: Q S E N Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Relationship-Centered Care: Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 2 Identify factors that contribute to domestic violence.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. The nurse is presenting a session on intimate partner violence. Which statement by a client indicates a need for further education?
2. "My daughter is not to blame for the violence in her marriage."
3. "Everyone experiences anger and hitting in a relationship."
4. "Abusers can be either husbands or boyfriends or girlfriends."
5. "The 'honeymoon period' follows an episode of violence."

Page Ref: 140—141

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Abuse/Neglect

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 1 Describe the factors that contribute to the occurrence of domestic violence and sexual assault.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. When a woman seeks care for an injury, the nurse should be alert to which clues of abuse?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Defensive injuries
2. Immediate reporting of symptoms or seeking care for injuries
3. Lack of eye contact
4. Providing too much detailed information about the injury
5. Vague complaints without accompanying pathology

Page Ref: 144, 146

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Abuse/Neglect

Standards: Q S E N Competencies: Ⅰ. C. 1. Value seeing healthcare situations "through patients' eyes." | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 6 Specify physical and psychological signs that may indicate a woman is in an abusive relationship.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. A woman has come to the emergency department with multiple bruises on her body and a small laceration over her upper lip. She says she fell down the stairs while doing housework. Which observation would most cause the nurse to suspect that the client has been a victim of battering?
2. The client is hesitant to provide details about how the injuries occurred.
3. The client was accompanied to the emergency department by her mother instead of her partner.
4. The client has sought care quickly after the incident.
5. The client does not seem to be in pain.

Page Ref: 144

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Abuse/Neglect

Standards: Q S E N Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan and evaluation of care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Read and interpret data; apply health promotion/disease prevention strategies; apply health policy; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 6 Specify physical and psychological signs that may indicate a woman is in an abusive relationship.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. The client with limited English language skills has a black eye and bruises across her face and arms. The client's husband has been acting as an interpreter for her, and answers all of the questions the nurse asks, often without talking to his wife first. The nurse suspects the client has been a victim of domestic abuse. What should the nurse do next?
2. Ask the husband whether he has beaten his wife.
3. Ask the husband to have a female friend come in with his wife.
4. Provide written materials in English for the client to read at home.
5. Ask the husband to step out of the room, and obtain an interpreter.

Page Ref: 144

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Abuse/Neglect

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate effectively with different individuals (team members, other care providers, patients, families, etc.) so as to minimize risks associated with handoffs among providers and across transitions in care. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 5 Delineate the role of the nurse in caring for women who have experienced partner abuse.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. If a woman returns to an abusive situation, the nurse should encourage her to develop an exit, or safety, plan for herself and her children, if she has any. What should the plan include?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Identify friends and family who know about the situation and will help her.
2. Call the police if violence begins.
3. Pack a change of clothes for herself and the children.
4. Have a plan for where she will go.
5. Have a planned escape route.

Page Ref: 147

Cognitive Level: Understanding

Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 7 Describe the needs that women with abusive partners and their children may have beyond the healthcare setting.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. The nurse has been talking to a woman about the reorganization phase following a rape. Which response would indicate that the client understands this phase?
2. "By using denial and suppression in this phase, I will eventually be able to accept what has happened to me."
3. "During this time, I won't talk much about the rape, because I am examining my inward feelings regarding the rape."
4. "During this time, I will repeatedly replay the role of the victim until I come to terms with the experience."
5. "My perception of a normal sexual relationship will be similar to my perception prior to the rape."

Page Ref: 151

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Abuse/Neglect

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 8 Identify the phases of the rape trauma syndrome.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. Among women who have been sexually assaulted, which of the following are the most frequently diagnosed sexually transmitted infections (S T Is)?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Bacterial vaginosis
2. H I V
3. Chlamydia
4. Syphilis
5. Gonorrhea

Page Ref: 153

Cognitive Level: Understanding

Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: Q S E N Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan and evaluation of care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Relationship-Centered Care: Appreciate the patient as a whole person, with his or her own life story and ideas about the meaning of health and illness. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 9 Discuss the nurse's role as patient advocate with domestic violence and sexual assault survivors.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. When a woman who has been raped is admitted to the emergency department, the nurse caring for the woman knows that which of the following is the priority nursing intervention?
2. Explaining exactly what will need to be done to preserve legal evidence
3. Assuring the woman that everything will be all right
4. Creating a safe, secure environment for her
5. Contacting family members

Page Ref: 153

Cognitive Level: Understanding

Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 6. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology pharmacology, medical management, and nursing management across the health-illness continuum, across the lifespan and in all healthcare settings. | N L N Competencies: Relationship-Centered Care: Appreciate the patient as a whole person, with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 9 Discuss the nurse's role as patient advocate with domestic violence and sexual assault survivors.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. What is the most important aspect of care for the nurse to remember when screening a woman for partner abuse?
2. Ensuring privacy and confidentiality
3. Conveying warmth and empathy
4. Asking specific, direct questions about abuse
5. Clarifying her myths about battering

Page Ref: 144

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Abuse/Neglect

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 5 Delineate the role of the nurse in caring for women who have experienced partner abuse.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. A client comes to the reproductive health clinic and reports that she woke up in a strange room this morning, her perineal area is sore, and she can't clearly remember what happened the previous evening. The client says she is afraid that she was a victim of a drug-facilitated sexual assault. Which statement should the nurse include when discussing this possibility with the client?
2. "Drinking alcohol can lead to uninhibited sexual behavior, which is not the same as rape."
3. "Some men use drugs mixed into a drink to subdue a potential victim prior to a rape."
4. "It is rare that a woman doesn't remember what happened if she is actually raped."
5. "We need to check for forensic evidence of rape before we can be sure what happened."

Page Ref: 150

Cognitive Level: Analyzing

Client Need/Sub: Psychosocial Integrity: Abuse/Neglect

Standards: Q S E N Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Respect the patient's dignity, uniqueness, integrity, and self-determination, and his or her own power and self-healing process. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 9 Discuss the nurse's role as patient advocate with domestic violence and sexual assault survivors.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. The emergency department nurse is admitting a client who has been sexually assaulted. The nurse is explaining how the physical evidence will be collected. Which statement by the client indicates that teaching has been effective?
2. "All the evidence will be kept in a locked cupboard until the police arrive."
3. "You collect urine samples to make sure the rapist did not get me pregnant."
4. "The evidence you collect might be able to identify the rapist."
5. "Blood samples are taken to help identify whether the rapist had H I V."

Page Ref: 152

Cognitive Level: Understanding

Client Need/Sub: Psychosocial Integrity: Abuse/Neglect

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 10 Summarize the procedures for collecting and preserving physical evidence of sexual assault.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. The nurse is preparing an educational seminar about the frequency of intimate partner violence against females. Using the chart below, which age group should the nurse identify as experiencing the most intimate partner violence in 2010?
2. 12-17
3. 18-24
4. 25-34
5. 35-49

Page Ref: 140

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation; Teaching/Learning.

Learning Outcome: 1 Describe the factors that contribute to the occurrence of domestic violence and sexual assault.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. The nurse is helping a victim of domestic violence create a safety plan. In which order should the nurse recommend that the steps of the plan be completed?
2. Decide where to go regardless of the day or time
3. Establish a code word that is shared with family and friends
4. Have money, identification, and bank account information prepared
5. Determine a planned escape route with emergency telephone numbers
6. Pack a change of clothes, toilet articles, and keys stored away from the home

Page Ref: 147

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation; Teaching/Learning.

Learning Outcome: 5 Delineate the role of the nurse in caring for women who have experienced partner abuse.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. A female comes into the emergency department seeking treatment for possible rape. The patient recalls having a cocktail with friends at a local club but woke up in an alley three blocks away from the business. For which date rape drugs should the nurse prepare to have this patient tested?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Atropine
2. Ketamine
3. Scopolamine
4. Flunitrazepam
5. Gamma hydroxybutyrate

Page Ref: 150

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Planning: Nursing Process.

Learning Outcome: 9 Discuss the nurse's role as patient advocate with domestic violence and sexual assault survivors.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. The nurse is participating in the collection of evidence from a victim of rape. In which order should the evidence be collected from this victim?
2. Oral swabs are obtained
3. Blood samples are drawn for syphilis
4. Hair samples and fingernail scrapings taken
5. Clothing is removed and bagged for evidence
6. Swabs of body stains and secretions are taken

Page Ref: 152—153

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Nursing Process.

Learning Outcome: 9 Discuss the nurse's role as patient advocate with domestic violence and sexual assault survivors.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. The nurse is identifying a plan to help a rape victim work through the phases of recovery. In which order should the nurse perform the following actions to help this victim?
2. Clarify the victim's feelings
3. Establish a trusting relationship
4. Acknowledge the victim's success
5. Provide advocacy as requested by the victim
6. Allow the victim to grieve and express feelings

Page Ref: 154

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Nursing Process.

Learning Outcome: 9 Discuss the nurse's role as patient advocate with domestic violence and sexual assault survivors.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. The nurse is preparing a female client for a scheduled pelvic examination. During the health history interview, the client states, "My husband constantly criticizes me and calls me stupid. I am afraid that he will begin to hit me one of these days." Which type of intimate partner violence is the client experiencing based on the assessment data?
2. Sexual abuse
3. Physical abuse
4. Economic abuse
5. Emotional abuse

Page Ref: 140

Cognitive Level: Understanding

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅲ. B. 3. Base individualized care plan on patient values, clinical expertise and evidence. | A A C N Essentials Competencies: Ⅷ. 1. Assess protective and predictive factors, including genetics, which influence the health of individuals, families, groups, communities and populations. | N L N Competencies: Knowledge and Science: Knowledge: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 6 Specify physical and psychological signs that may indicate a woman is in an abusive relationship.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. The nurse is teaching a class about domestic violence to enhance education within the community. Which statement regarding the cycle of violence should the nurse include in the presentation?
2. "The tension-building phase lasts a few hours."
3. "The batterer often feels remorse during the tension-building phase."
4. "The acute battery incident is often triggered by an external event, such as the loss of a job."
5. "The acute battery incident often finds the victim hoping the relationship will change for the better."

Page Ref: 143

Cognitive Level: Analyzing

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅲ. B. 3. Base individualized care plan on patient values, clinical expertise and evidence. | A A C N Essentials Competencies: Ⅷ. 1. Assess protective and predictive factors, including genetics, which influence the health of individuals, families, groups, communities and populations. | N L N Competencies: Knowledge and Science: Knowledge: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Teaching and Learning.

Learning Outcome: 3 Identify the phases of the cycle of violence.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. Which is a known characteristic of domestic violence batterers?
2. Feeling inferior to others
3. Working in a low-paying job
4. Having a low socioeconomic status
5. Being diagnosed with posttraumatic stress disorder

Page Ref: 143—144

Cognitive Level: Remembering

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅲ. B. 3. Base individualized care plan on patient values, clinical expertise and evidence. | A A C N Essentials Competencies: Ⅷ. 1. Assess protective and predictive factors, including genetics, which influence the health of individuals, families, groups, communities and populations. | N L N Competencies: Knowledge and Science: Knowledge: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Caring.

Learning Outcome: 4 Summarize the characteristics of batterers and perpetrators of sexual assault.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. The nurse is conducting a health maintenance assessment for a female client. Which neurologic data would cause the nurse to further assess for intimate partner abuse?
2. Anxiety
3. Depression
4. Weight gain
5. Tension headaches

Page Ref: 144

Cognitive Level: Analyzing

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅲ. B. 3. Base individualized care plan on patient values, clinical expertise and evidence. | A A C N Essentials Competencies: Ⅷ. 1. Assess protective and predictive factors, including genetics, which influence the health of individuals, families, groups, communities and populations. | N L N Competencies: Knowledge and Science: Knowledge: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 6 Specify the physical and psychological signs that may indicate a woman is in an abusive relationship.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. The nurse is conducting a health maintenance assessment for a new female client who recently moved to the city. Which finding would indicate the need for further assessment for intimate partner violence?
2. A miscarriage two years ago noted during the reproductive history.
3. A sprained ankle one year ago noted during the health history interview.
4. A history of delaying treatment for a concussion and fractured extremity.
5. A scar noted on the abdomen from a previous surgery during the physical examination.

Page Ref: 144

Cognitive Level: Analyzing

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅲ. B. 3. Base individualized care plan on patient values, clinical expertise and evidence. | A A C N Essentials Competencies: Ⅷ. 1. Assess protective and predictive factors, including genetics, which influence the health of individuals, families, groups, communities and populations. | N L N Competencies: Knowledge and Science: Knowledge: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 6 Specify the physical and psychological signs that may indicate a woman is in an abusive relationship.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. The nurse is providing care to a female client who presents in the emergency department (E D) with multiple bruises and lacerations. The nurse suspects the client is the victim of domestic violence. Which action by the nurse is appropriate?
2. Reporting the incident to the police to enhance safety
3. Documenting domestic violence in the medical record
4. Avoiding photographs of the injuries to prevent embarrassment
5. Communicating the level of confidentiality that can be expected

Page Ref: 146

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Relationship-Centered Care: Practice: Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 5 Delineate the role of the nurse in caring for women who have experienced partner abuse.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. Which action by the nurse is appropriate when providing care to a female client who is the victim of domestic violence?
2. Providing adequate time for the client to tell her story
3. Reporting the incident to the police to protect the client
4. Telling the spouse about the client's accusations of abuse
5. Stressing to the client that the abuse could have been avoided

Page Ref: 147

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Relationship-Centered Care: Practice: Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 5 Delineate the role of the nurse in caring for women who have experienced partner abuse.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. The nurse is helping a victim of domestic abuse to develop a safety plan. Which client action would require intervention by the nurse?
2. Asking a neighbor to call police if violence begins
3. Establishing a code word for danger with family and friends
4. Keeping a bag packed in the home in case the need to leave arises
5. Having a planned escape route and emergency phone numbers if violence occurs

Page Ref: 147

Cognitive Level: Evaluating

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Relationship-Centered Care: Practice: Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 7 Describe the needs that women with abusive partners and their children may have beyond the healthcare setting.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. The nurse is providing care to a female client who is the victim of domestic violence. Which referral by the nurse is most appropriate?
2. Group therapy
3. Physical therapy
4. Nutrition therapy
5. Occupational therapy

Page Ref: 149

Cognitive Level: Understanding

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Relationship-Centered Care: Practice: Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 7 Describe the needs that women with abusive partners and their children may have beyond the healthcare setting.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. Which myth regarding rape will the community health nurse include in a teaching session within the community?
2. Rape is a type of sexual assault.
3. Women lie about rape as an act of revenge.
4. Both men and women can be victims of rape.
5. Rape is one of the most underreported violent crimes.

Page Ref: 149—150

Cognitive Level: Understanding

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅲ. B. 3. Base individualized care plan on patient values, clinical expertise and evidence. | A A C N Essentials Competencies: Ⅷ. 1. Assess protective and predictive factors, including genetics, which influence the health of individuals, families, groups, communities and populations. | N L N Competencies: Knowledge and Science: Knowledge: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Teaching and Learning.

Learning Outcome: 1 Describe the factors that contribute to the occurrence of domestic violence and sexual assault.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. A female client presents in the emergency department (E D) after being sexually assaulted at a party. Which assessment finding indicates that the client may have been drugged?
2. Attending the party with a large group of friends
3. Accepting a beverage from a stranger at the party
4. Dancing and kissing several men during the party
5. Drinking large amounts of alcohol during the party

Page Ref: 150

Cognitive Level: Analyzing

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅲ. B. 3. Base individualized care plan on patient values, clinical expertise and evidence. | A A C N Essentials Competencies: Ⅷ. 1. Assess protective and predictive factors, including genetics, which influence the health of individuals, families, groups, communities and populations. | N L N Competencies: Knowledge and Science: Knowledge: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 1 Describe the factors that contribute to the occurrence of domestic violence and sexual assault.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. The nurse is providing care to a client who is the victim of sexual assault. Which assessment finding does the nurse anticipate during the disorganization phase of rape trauma syndrome?
2. Anxiety
3. Insomnia
4. Dyspepsia
5. Depression

Page Ref: 151

Cognitive Level: Understanding

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅲ. B. 3. Base individualized care plan on patient values, clinical expertise and evidence. | A A C N Essentials Competencies: Ⅷ. 1. Assess protective and predictive factors, including genetics, which influence the health of individuals, families, groups, communities and populations. | N L N Competencies: Knowledge and Science: Knowledge: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 8 Identify the phases of the rape trauma syndrome.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. The nurse is assisting with the collection of evidence for a female client who is the victim of sexual assault. Which actions by the nurse are appropriate?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Drawing blood to test for gonorrhea
2. Placing each piece of clothing in a plastic bag
3. Pulling hair from the head and pubic region as evidence
4. Collecting a urine sample if drug-facilitated rape is suspected
5. Obtaining informed consent prior to photographing the injured areas

Page Ref: 152—153

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅲ. B. 3. Base individualized care plan on patient values, clinical expertise and evidence. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Knowledge and Science: Knowledge: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 10 Summarize the procedures for collecting and preserving physical evidence of sexual assault.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. The nurse is providing care for a female client who is the victim of sexual assault. Which sexually transmitted infections (S T Is) does the nurse anticipate medication prescriptions to prevent?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Syphilis
2. Gonorrhea
3. Chlamydia
4. Bacterial vaginosis
5. Herpes simplex virus

Page Ref: 153

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: Q S E N Competencies: Ⅲ. B. 3. Base individualized care plan on patient values, clinical expertise and evidence. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Knowledge and Science: Knowledge: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 10 Summarize the procedures for collecting and preserving physical evidence of sexual assault.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. The nurse is planning care for a client who is the victim of rape. Which psychosocial nursing diagnoses does the nurse include in the client's plan of care?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Fear
2. Fatigue
3. Powerlessness
4. Risk for infection
5. Readiness for enhanced knowledge

Page Ref: 153

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Relationship-Centered Care: Practice: Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 9 Discuss the nurse's role as patient advocate with domestic violence and sexual assault survivors.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.

1. The nurse is providing care to a female client in the acute phase of recovery following a sexual assault. Which nursing actions are appropriate?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Clarifying feelings
2. Creating a safe environment
3. Supporting advocacy efforts
4. Establishing a trusting relationship
5. Providing care for significant others

Page Ref: 154

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Relationship-Centered Care: Practice: Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 9 Discuss the nurse's role as patient advocate with domestic violence and sexual assault survivors.

M N L L O: Demonstrate use of the nursing process in the care of women experiencing violence.