Maternity & Women's Health Care 10th Edition by Kathryn Rhodes - ‎Deitra Leonard Lowdermilk - Test Bank

Maternity & Women’s Health Care 10th Edition by Kathryn Rhodes – ‎Deitra Leonard Lowdermilk – Test Bank

 

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Lowdermilk: Maternity & Women’s Health Care, 10th Edition

 

Chapter 05: Violence Against Women

 

Test Bank

 

MULTIPLE CHOICE

 

1. The justification for the victimization of women very early in history was that:

a.	Women were regarded as possessions
b.	Women were the “weaker sex”
c.	Control of women was necessary for protection
d.	Women were created subordinate to men

 

ANS: A

Misogyny, patriarchy, devaluation of women, power imbalance, a view of women as property, gender-role stereotyping, and acceptance of aggressive male behaviors as appropriate contributed and continue to contribute to the subordinate status of women in many of the world’s societies.

Viewing women as the “weaker sex” is a cultural and modern stereotype that contributes to the victimization of women.

Control of women in order to protect them is another cultural and modern stereotype that contributes to the victimization of women.

Women having been created as subordinate to men is yet another example of a cultural stereotype that contributes to the victimization of women.

 

DIF:   Cognitive Level: Knowledge        REF:  “95, 96”

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Assessment

 

2. The primary theme of the feminist perspective on violence against women recognizes the:

a.	Role of testosterone as the underlying cause of men’s violent behavior
b.	Basic human instinctual drive toward aggression
c.	Dominance and coercive control over women by men
d.	Cultural norm of violence in Western society

 

ANS: C

The contemporary social view of violence is derived from the feminist theory. With the primary theme of male dominance and coercive control, this view enhances our understanding of all forms of violence against women, including wife battering, stranger and acquaintance rape, incest, and sexual harassment in the workplace.

The role of testosterone as an underlying cause of men’s violent behavior is not associated with the feminist perspective of violence against women.

The basic human instinctual drive toward aggression is not associated with the feminist perspective.

The cultural norm of violence in Western society is not associated with the feminist perspective regarding violence against women.

 

DIF:   Cognitive Level: Knowledge        REF:  98

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Assessment

 

3. The nurse suspects that a client who comes to the maternity clinic for a pregnancy test is in an abusive relationship. The nurse includes the abuse assessment screen as part of the assessment. Although the woman was very emotional and hesitant in responding to the questions, verbally she denied abuse as being a problem. While waiting for the results of the pregnancy test, the nurse decides to teach the client about partner abuse anyway. The rationale for the nurse’s decision is that all women should be informed about:

a.	The nurse’s ethical responsibility to protect clients
b.	The cycle of violence, which continues and escalates over time once it begins
c.	Women’s legal right not to be controlled by men
d.	The masochistic nature of women who stay in abusive relationships

 

ANS: B

Because of the cycle of violence and the loving respite phase, denial is a coping mechanism often used by battered women. During pregnancy the nurse should assess for abuse at each prenatal visit and on admission to labor.

Although the nurse may feel an ethical responsibility to protect the client, it is not the best rationale for the nurse’s behavior.

Although women have a right not to be controlled by men, it is not the reason the nurse should continue the teaching with this client.

The belief that women are masochistic is simply a myth.

 

DIF:   Cognitive Level: Analysis             REF:  97

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Implementation

 

4. The primary responsibility of the nurse who suspects or confirms any type of violence against a woman is:

a.	Report the incident to legal authorities
b.	Provide information to social services
c.	Call a client advocate who can assist in the client’s decision making about what action to take
d.	Document the incident (or findings) accurately and concisely in the client’s record

 

ANS: D

Documentation can be useful to women later in court if they choose to press charges.

Although many states have mandatory reporting laws, the primary responsibility of the nurse is to document the incident and findings.

Social services is called only if a child also is a victim of violence or had witnessed the violence.

A client advocate usually is notified when legal action is to be taken or if the woman is seeking shelter. The nurse may assist in this endeavor, but it is not the first action to be taken.

 

DIF:   Cognitive Level: Comprehension            REF:  107

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Implementation

 

5. Intimate partner violence (IPV) is seen in all races, ethnicities, religions, and socioeconomic backgrounds. Which statement is most accurate regarding the reporting of IPV in the United States?

a.	Asian women report more IPV than do other minority groups.
b.	Caucasian women report less IPV than do non-Caucasians.
c.	Native-American women report IPV at a rate similar to other groups.
d.	African-American women are less likely to report IPV than Caucasian women.

 

ANS: B

Caucasian women report less IPV than other ethnic groups.

Asian women report significantly less IPV than do other racial groups.

Native-American and Alaska Native women report significantly more IPV than do women of any other racial background.

African-American women tend to report violence at a slightly higher rate than Caucasian women.

 

DIF:   Cognitive Level: Comprehension            REF:  101

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Assessment

 

6. Intervention for the sexual abuse survivor often is not attempted by maternity and women’s health nurses because of the concern about increasing the distress of the woman and the lack of expertise in counseling. What initial intervention is appropriate and most important in facilitating the woman’s care?

a.	Initiating a referral to an expert counselor
b.	Setting limits on what the client discloses
c.	Listening and encouraging therapeutic communication skills
d.	Acknowledging the nurse’s discomfort to the client as an expression of empathy

 

ANS: C

The survivor needs support on many different levels, and a women’s health nurse may be the first person to whom she relates her story. Therapeutic communication skills and listening are initial interventions.

Referring this client to a counselor is an appropriate measure but not the most important initial intervention.

A client should be allowed to disclose any information she feels the need to discuss. As a nurse you should provide a safe environment in which she can do so.

Either verbal or nonverbal shock and horror reactions from the nurse are particularly devastating. Professional demeanor and professional empathy are essential.

 

DIF:   Cognitive Level: Analysis             REF:  105

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Implementation

 

7. A young woman arrives at the emergency department and states that she thinks she has been raped. She is sobbing and expresses disbelief that this could happen because the man was her best friend. In an effort to calm the client in order to perform a thorough assessment and physical examination, the nurse acknowledges the client’s fear and anxiety and tells her:

a.	“Rape is not limited to strangers and frequently occurs by someone who is known to the victim.”
b.	“I would be very upset if my best friend did that to me; that is very unusual.”
c.	“You must feel very betrayed. In what way do you think you might have led him on?”
d.	“This does not sound like rape. Didn’t you just change your mind about having sex after the fact?”

 

ANS: A

Acquaintance rape involves individuals who know one another. Sexual assault occurs when the trust of a relationship is violated. Victims may be less prone to recognize what is happening to them because the dynamics are different from those of stranger rape.

It is not at all unusual for the victim to know and trust the perpetrator.

Stating that the woman might have led the man to attack her indicates that the sexual assault was somehow the victim’s fault. This type of mentality is not constructive. Nurses must first reflect on their own feelings and learn to be unbiased when dealing with victims. A statement of this type can be very psychologically damaging to the victim.

Nurses must display compassion by first believing what the victim states. The nurse is not responsible for deciphering the facts involving the victim’s claim.

 

DIF:   Cognitive Level: Application        REF:  109

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Assessment

 

8. The nurse’s best measure of evaluating care of a rape victim is that:

a.	All legal evidence is preserved during the physical examination
b.	The victim appreciates the legal information but decides not to pursue legal proceedings
c.	The victim states that she is going to advocate against sexual violence
d.	The victim leaves the health care facility without feeling revictimized

 

ANS: D

Nurses can assist clients through an examination that is as nontraumatic as possible with kindness, skill, and empathy. The initial care of the victim affects her recovery and decision to receive follow-up care.

Preservation of all legal evidence is very important; however, this may not be the best measure in terms of evaluating care of a rape victim.

Offering legal information is not the best measure of evaluating the care that this victim received. The victim may well decide not to pursue legal proceedings.

Advocating against sexual violence may be extremely therapeutic for the client after her initial recovery. This is not a measure of evaluating her care.

 

DIF:   Cognitive Level: Comprehension            REF:  115

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Evaluation

 

9. Proper documentation of the abuse as reported by the victim is a crucial role of the nurse. Evaluate the following data, which include information from the victim, and choose the best documentation by the nurse.

 

A 34-year-old Caucasian arrives at the emergency department with a black right eye; she also is bleeding from the left side of her head. She reports that her boyfriend has been abusing her physically. The nurse performs a history and physical examination and documents her findings.

a.	“Client alleges that her boyfriend beat her up.”
b.	“Client reports that her boyfriend hit her in the eye and head.”
c.	“Client is a 34-year-old Caucasian female. Presents with periorbital ecchymosis on right side. Laceration of left parietal area, 3 cm long with tissue bridging. Approximately 1 cm deep. Client states that her boyfriend ‘threw a brick from 10 feet away, aiming at my head. The corner of the brick hit the left side of my head.’ She reports that he also ‘hit me in the eye.’ Client indicates that the hit was with her boyfriend’s closed left fist.”
d.	“Client presents with a black eye and a cut on the left side of her head. Reports being abused.”

 

ANS: C

It is important to list the name of the abuser, if possible, because a defense strategy is to portray the victim as having more than one partner. Listing the name eliminates any confusion as to who the abuser was. In addition, using accurate medical terminology is crucial. If you are unsure of the proper descriptive terms to use in documentation, simply describe what you see without labeling the injury. Photographs should be taken.

Documenting only that the client states that her boyfriend beat her lacks specificity and important details related to the event. In addition, improper medical terminology is used. This type of documentation would be detrimental to the victim’s case if she were to pursue legal recourse against the abuser.

Documenting only that the client states that her boyfriend hit her in the eye and head lacks specificity and important details related to the event. In addition, improper medical terminology is used. This type of documentation would be detrimental to the victim’s case if she were to pursue legal recourse against the abuser.

Documenting only that the client reports being abused lacks specificity and important details related to the event. In addition, improper medical terminology is used. This type of documentation would be detrimental to the victim’s case if she were to pursue legal recourse against the abuser.

 

DIF:   Cognitive Level: Evaluation          REF:  107

OBJ:  Client Needs: Safe and Effective Care Environment

TOP:  Nursing Process: Implementation

 

10. With regard to violence against women, intimate partner violence (IPV) nurses should be aware that:

a.	Relationship violence usually consists of a single episode that the couple can put behind them
b.	Violence often declines or ends with pregnancy
c.	Economic coercion is considered part of IPV
d.	Battered women generally are poorly educated and come from a deprived social background

 

ANS: C

Economic coercion accompanies physical assault and psychologic attacks.

IPV almost always follows an escalating pattern. It rarely ends with a single episode of violence.

IPV often begins with and escalates during pregnancy. It may include both psychologic attacks and economic coercion.

Race, religion, social background, age, and education level are not significant factors in differentiating women at risk.

 

DIF:   Cognitive Level: Comprehension  REF:  96

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Assessment

 

11. In 1979, Lenore Walker pioneered the cause of women as victims of violence when she published her book The Battered Woman. While Walker conducted her research she found a similar pattern of abuse among many of the women. This concept is now referred to as the Cycle of Violence. Which phase does not belong in this three-cycle pattern of violence?

a.	Tension-building state
b.	Frustration followed by violence
c.	Acute battering incident
d.	Kindness and contrite, loving behavior

 

ANS: B

Frustration followed by violence is not part of the Cycle of Violence.

Tension-building state is also known as phase I of the cycle. The batterer expresses dissatisfaction and hostility with violent outbursts. The woman senses anger and anxiously tries to placate him.

Acute battering incident is phase II of the cycle. It results in the man’s uncontrollable discharge of tension toward the woman. Outbursts can last from several hours to several days and may involve kicking, punching, slapping, choking, burns, broken bones, and the use of weapons.

Sometimes referred to as the honeymoon, kindness and contrite, loving behavior is the third phase of the cycle. The batterer feels remorseful and apologizes profusely. He tries to help the woman and often showers her with gifts.

 

DIF:   Cognitive Level: Analysis             REF:  97

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Diagnosis

 

12. Nurses must remember that pregnancy is a time of risk for all women. Which condition is likely the biggest risk for the pregnant client?

a.	Preeclampsia
b.	Intimate partner violence (IPV)
c.	Diabetes
d.	Abnormal Pap test

 

ANS: B

The prevalence of IPV during pregnancy is estimated at 4% to 8% of all pregnant women. The risk for IPV and even IPV-related homicide is more common than all of the other pregnancy-related conditions.

Although preeclampsia poses a risk to the health of the pregnant client, it is less common than IPV.

Gestational diabetes continues to be a complication of pregnancy; however, it is less common than IPV during pregnancy.

Some women are at risk for an abnormal Pap screening during pregnancy. This finding is not as common as IPV.

 

DIF:   Cognitive Level: Comprehension            REF:  103

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Diagnosis

 

 

 

 

 

 

 

 

 

MULTIPLE RESPONSE

 

1. The nurse who is evaluating the client for potential abuse should be aware that intimate partner violence includes (choose all that apply):

a.	Physical abuse
b.	Sexual abuse
c.	Emotional abuse
d.	Psychologic abuse
e.	Economic abuse

 

ANS: A, B, C, D, E

Physical, sexual, emotional, psychologic, and economic abuse can be factors in intimate partner violence.

 

DIF:   Cognitive Level: Comprehension            REF:  115

OBJ:  Client Needs: Psychosocial and Physiologic Integrity

TOP:  Nursing Process: Assessment

 

2. Common characteristics of a potential batterer include (choose all that apply):

a.	High level of self-esteem
b.	High frustration tolerance
c.	Substance abuse problems
d.	Excellent verbal skills
e.	Personality disorders

 

ANS: C, E

Substance abuse and personality disorders are often seen in batterers.

Typically the batterer has low self-esteem. Batterers usually have a low frustration level (i.e., they lose their temper easily). Batterers characteristically have poor verbal skills and especially can have difficulty expressing their feelings.

 

DIF:   Cognitive Level: Comprehension            REF:  98

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Diagnosis

 

3. Which nursing diagnosis would be most applicable for battered women? Choose all that apply.

a.	Loss of trust
b.	Ineffective family coping
c.	Situational low self-esteem
d.	Risk for self-directed violence
e.	Enhanced communication

 

ANS: A, B, C, D

Loss of trust, ineffective family coping, situational low self-esteem, and risk for self-directed violence are potential nursing diagnoses associated with battered women.

A more appropriate nursing diagnosis for this client would be impaired communication.

 

DIF:   Cognitive Level: Evaluation          REF:  106

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Diagnosis

 

4. A thorough abuse assessment screen should be done on all clients. This screen includes (choose all that apply):

a.	Asking the client if she has ever been slapped, kicked, punched, or physically hurt by her partner
b.	Asking the client if she is afraid of her partner
c.	Asking the client if she has been forced to perform sexual acts
d.	Diagramming the client’s current injuries on a body map
e.	Asking the client what she did wrong to elicit the abuse

 

ANS: A, B, C, D

Asking the client if she has been slapped, kicked, punched, or physically hurt by her partner, if she is afraid of her partner, or if she has been forced to perform sexual acts are questions that should be posed to all clients. If any physical injuries are present, they should be marked on a form that indicates their location on the body.

Implying that a client did something wrong can be very emotionally damaging. Many victims of violence are not aware that they are in an abusive relationship. They may not respond to questions about abuse. It is best to use general descriptive words, such as “slap,” “kick,” or “punch” to elicit information.

 

DIF:   Cognitive Level: Analysis             REF:  104

OBJ:  Client Needs: Safe and Effective Care Environment

TOP:  Nursing Process: Assessment

 

COMPLETION

 

1. Nurses who are part of a collaborative team that cares for victims of sexual assault and who have special education and training in forensic nursing are called ______________.

 

ANS:

SANE (nurses)

Sexual assault nurse examiners

 

DIF:   Cognitive Level: Comprehension            REF:  111

OBJ:  Client Needs: Safe and Effective Care Environment

TOP:  “Nursing Process: Assessment, Diagnosis, Planning, Implementation, Evaluation”