Answer Choices:
a. Outrage toward the victim and sympathy for the abuser
b. Sympathy for the victim and anger toward the abuser
c. Unconcern for the victim and dislike for the abuser
d. Vulnerability for self and empathy with the abuser
Answer:
B
Question: An older adult diagnosed with dementia lives with family and attends an adult day care center. A nurse at the center notices the adult has a disheveled appearance, a strong odor of urine, and bruises on the limbs and back. What type of abuse is the nurse most likely to suspect?
Answer Choices:
a. Financial
b. Psychological
c. Physical
d. Sexual
Answer:
C
Question: A rape victim tells the nurse, “I should not have been out on the street alone.” Which is the nurse’s most therapeutic response?
Answer Choices:
a. “Rape can happen anywhere.”
b. “Blaming yourself only increases your anxiety and discomfort.”
c. “You believe this would not have happened if you had not been alone.”
d. “You are right. You should not have been alone on the street at night.”
Answer:
A
Question: A rape victim tells the emergency department nurse, “I feel so dirty. Please let me take a shower before the doctor examines me.” How should the nurse respond to the request?
Answer Choices:
a. Arrange for the patient to shower.
b. Explain that washing would destroy evidence.
c. Give the patient a basin of hot water and towels.
d. Instruct the victim to wash above the waist only.
Answer:
B
Question: 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:
Answer Choices:
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.
Answer:
B
Question: An older adult, diagnosed with Alzheimer’s disease, lives with family and has multiple bruises. The home health nurse talks with the older adult’s daughter, who becomes defensive and says, “My mother often wanders at night. Last night she fell down the stairs.” Which nursing diagnosis has priority?
Answer Choices:
a. Risk for injury, related to cognitive impairment and lack of caregiver supervision
b. Noncompliance, related to confusion and disorientation as evidenced by lack of cooperation
c. Impaired verbal communication, related to brain impairment as evidenced by the confusion
d. Insomnia, related to cognitive impairment as evidenced by wandering at night
Answer:
A
Question: A nurse works with a person who was raped 4 years ago. This person says, “It took a long time for me to recover from that horrible experience.” Which term should the nurse use when referring to this person?
Answer Choices:
a. Victim
b. Survivor
c. Plaintiff
d. Perpetrator
Answer:
B
Question: What is the primary motivator for most rapists?
Answer Choices:
a. Anxiety
b. Need for humiliation
c. Overwhelming sexual desires
d. Desire to inflict violence or control others
Answer:
D
Question: A clinic nurse interviews an adult patient accompanied by a partner who reports fatigue, back pain, headaches, tension, and sleep disturbances. The patient then becomes reluctant to provide more information and wants to leave. How can the nurse best serve the patient?
Answer Choices:
a. Explore the possibility of patient social isolation.
b. Have the partner leave the patient alone to continue the assessment.
c. Ask whether the patient has ever had psychiatric counseling in the past.
d. Ask the patient to disrobe so that assessment for signs of physical abuse may occur.
Answer:
B
Question: A rape victim asks an emergency department nurse, “Maybe I did something to cause this attack. Was it my fault?” Which response by the nurse is the most therapeutic?
Answer Choices:
a. Pose questions about the rape, helping the patient explore why it happened.
b. Reassure the victim that the outcome of the situation will be positive.
c. Make decisions for the victim because of the temporary confusion.
d. Support the victim to separate issues of vulnerability from blame.
Answer:
D
Question: An older adult diagnosed with Alzheimer’s disease lives with family. During the week, the person attends a day care center while the family is at work. In the evenings, members of the family provide care. Which factor makes this patient most vulnerable to abuse?
Answer Choices:
a. Dementia
b. Living in a rural area
c. Being part of a busy family
d. Being home only in the evening
Answer:
A
Question: Which coping mechanism is characteristic of the acute phase of rape trauma syndrome?
Answer Choices:
a. A victim of sexual assault is discharged from the emergency department after reporting that their underwear is missing.
b. A rape victim is silent and withdrawn during the history and physical exam.
c. A rape victim verbalizes anxiety and is willing to discuss the attack.
d. A rape victim does not want to talk about the assault and refuses to provide referral information verbally and in writing.
Answer:
B
Question: A patient tells the nurse, “My husband is abusive only when he drinks too much. His family was like that when he was growing up. He always apologizes and regrets hurting me.” What risk factor was most predictive for the husband to become abusive?
Answer Choices:
a. History of family violence
b. Loss of employment
c. Abuse of alcohol
d. Poverty
Answer:
A
Question: A nurse interviews a person abducted and raped at gunpoint by an unknown assailant. The person says, “I can’t talk about it. Nothing happened. I have to forget!” What is the person’s present coping strategy?
Answer Choices:
a. Somatic reaction
b. Repression
c. Projection
d. Denial
Answer:
D
Question: When an emergency department nurse teaches a victim of rape about reactions that may occur during the long-term organization (delayed) phase, which symptoms should be included? (Select all that apply.)
Answer Choices:
a. Development of fears and phobias
b. Decreased motor activity
c. Feelings of numbness
d. Flashbacks, dreams
e. Syncopal episodes
Answer:
A, C, D
Question: A survivor in the long-term organization (delayed) phase of the rape trauma syndrome has experienced intrusive thoughts of the rape and developed a fear of being alone. Which finding demonstrates this survivor has made improvement?
Answer Choices:
a. The survivor expresses a need to regularly withdraw from social situations.
b. The survivor describes personal coping strategies for fearful situations.
c. The survivor uses increased activity to reduce feelings of fear.
d. The survivor expresses a deep desire to be with others.
Answer:
B