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Chapter 05: Violence Against Women
Lowdermilk: Maternity & Women’s Health Care, 11th Edition
MULTIPLE CHOICE
1. Historically, what was the justification for the victimization of women?

a. Women were regarded as possessions.
b. Women were the “weaker sex.”
c. Control of women was necessary to protect them.
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 to protect them is another
cultural and modern stereotype that contributes to the victimization of women. Yet another
cultural stereotype that contributes to the victimization of women is the idea that women were
created as subordinate to men.
DIF: Cognitive Level: Remember REF: pp. 98-99

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
2. What is the primary theme of the feminist perspective regarding violence against women?
a. Role of testosterone as the underlying cause of men’s violent behavior
b. Basic human instinctual drive toward aggression
c. Male dominance and coercive control over women
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 an 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, the basic human instinctual drive toward aggression, and the
cultural norm of violence in Western society are not associated with the feminist perspective
regarding violence against women.
DIF: Cognitive Level: Remember REF: p. 100

3. Which trait is least likely to be displayed by a woman experiencing intimate partner violence
(IPV)?
a. Socially isolated
b. Assertive personality
c. Struggling with depression
d. Dependent partner in a relationship
ANS: B
Every segment of society is represented among women who are suffering abuse. However,
traits of assertiveness, independence, and willingness to take a stand have been documented as
more characteristic of women who are in nonviolent relationships. Women who are financially
more dependent have fewer resources and support systems, exhibit symptoms of depression,
and are more often seen as victims.
DIF: Cognitive Level: Analyze REF: pp. 101-102

4. A woman who is 6 months pregnant has sought medical attention, saying she fell down the
stairs. What scenario would cause an emergency department nurse to suspect that the woman
has been a victim of IPV?
a. The woman and her partner are having an argument that is loud and hostile.
b. The woman has injuries on various parts of her body that are in different stages of
healing.
c. Examination reveals a fractured arm and fresh bruises.
d. She avoids making eye contact and is hesitant to answer questions.
ANS: B
The client may have multiple injuries in various stages of healing that indicates a pattern of
violence. An argument is not always an indication of battering. A fractured arm and fresh
bruises could be caused by the reported fall and do not necessarily indicate IPV. It may be
normal for the woman to be reticent and have a dull affect.
DIF: Cognitive Level: Analyze REF: p. 107

5. 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: Understand REF: p. 103

6. Intervention for the sexual abuse survivor is often 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. A nurse 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.

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity
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 perpetrator
was a very close friend. Which statement is most appropriate at this time?
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: Apply REF: p. 107

8. Nurses are often the first health care professional with whom a woman comes into contact
after being sexually assaulted. Which statement best describes the initial care of a rape victim?
a. All legal evidence is preserved during the physical examination.
b. The victim appreciates the legal information; however, 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 re-victimized.
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 the 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 but not a measure of evaluating
her care.
DIF: Cognitive Level: Understand REF: pp. 112-113 TOP: Nursing Process: Evaluation
MSC: Client Needs: Psychosocial Integrity
9. When the nurse is alone with a battered client, the client seems extremely anxious and says,
“It was all my fault. The house was so messy when he got home, and I know he hates that.”
What is the most suitable response by the nurse?
a. “No one deserves to be hurt. It’s not your fault. How can I help you?”
b. “What else do you do that makes him angry enough to hurt you?”
c. “He will never find out what we talk about. Don’t worry. We’re here to help you.”
d. “You have to remember that he is frustrated and angry so he takes it out on you.”
ANS: A
The nurse should stress that the client is not at fault. Asking what the client did to make her
husband angry is placing the blame on the woman and would be an inappropriate statement.
The nurse should not provide false reassurance. To assist the woman, the nurse should be
honest. Often the batterer will find out about the conversation.

10. Nurses who provide care to victims of IPV should be keenly aware of what?
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. Financial coercion is considered part of IPV.
d. Battered women are generally poorly educated and come from a deprived social
background.
ANS: C
Economic coercion may accompany 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.

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. The 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. An 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.
Phase III of the cycle is sometimes referred to as the honeymoon, kindness and contrite, and
loving behavior phase, during which the batterer feels remorseful and profusely apologizes.
He tries to help the woman and often showers her with gifts.
DIF: Cognitive Level: Analyze REF: p. 99 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. IPV
c. Diabetes
d. Abnormal Pap test
ANS: B
The prevalence of IPV during pregnancy is estimated at 6% 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, but this finding is not as common as IPV.
DIF: Cognitive Level: Understand REF: p. 105 TOP: Nursing Process: Diagnosis
13. In the 1970s, the rape-trauma syndrome (RTS) was identified as a cluster of symptoms and
related behaviors observed in the weeks and months after an episode of rape. Researchers
identified three phases related to this condition. Which phase is not displayed in a client with
RTS?
a. Acute Phase: Disorganization
b. Outward Adjustment Phase
c. Shock/Disbelief: Disorientation Phase
d. Long-Term Process: Reorganization Phase
ANS: C
Shock, disbelief, or disorientation is a component of the Acute Phase. The rape survivor feels
embarrassed, degraded, fearful, and angry. She may feel unclean and want to bathe and
douche repeatedly, even though doing so may destroy evidence. The victim relives the scene
over and over in her mind, thinking of things she “should have done.” During the Outward
Adjustment Phase, the victim may appear to have resolved her crisis and return to activities of
daily living and work. Other women may move, leave their job, and buy a weapon to protect
themselves. Disorientation is a reaction during which the victim may feel disoriented, have
difficulty concentrating, or have poor recall. The Long-Term Process is the reorganization
phase. This recovery phase may take years and may be difficult and painful.
DIF: Cognitive Level: Understand REF: pp. 111-112

14. Documentation of abuse can be useful to women later in court, should they elect to press
charges. It is of key importance for the nurse to document accurately at the time that the client
is seen. Which entry into the medical record would be the least helpful to the court?
a. Photographs of injuries
b. Clear and legible written documentation
c. Summary of information (e.g., “The client is a battered woman.”)
d. Accurate description of the client’s demeanor
ANS: C
A statement such as, “The client is a battered woman” lacks the supporting factual information
and will render the report inadmissible. More appropriate documentation would include exact
statements from the woman in quotations (e.g., “My husband kicked me in the stomach”). The
time and date of the examination should also be included.

15. Which statement regarding human trafficking is correct?

a. Human trafficking is a multibillion-dollar business that primarily exists in the
United States.
b. Victims often experience the Stockholm syndrome.
c. Vast majority of the victims are young boys and girls.
d. Human trafficking primarily refers to commercial sex work.
ANS: B
Although victims of sex trafficking can be young boys and girls, the vast majority are women
and girls. They are often lured by false promises, such as a job or marriage, sold by their
parents, or kidnapped by traffickers. These individuals are forced into sex work, hard labor,
and organ donation. This $32 billion business exists in the United States and internationally.
The Stockholm syndrome occurs when the slaves become attached to their enslavers. Health
care professionals may interact with victims who are in captivity should they require emergent
health care. The nurse is challenged to find an opportunity to speak with the client alone and
assess for victimization.

16. Which statement is the most comprehensive description of sexual violence?

a. Sexual violence is limited to rape.
b. Sexual violence is an act of force during which an unwanted and uncomfortable
sexual act occurs.
c. Sexual violence encompasses a number of sexual acts.
d. Sexual violence includes degrading sexual comments and behaviors.
ANS: C
Sexual violence is a broad term that includes a range of sexual victimization including sexual
assault, sexual harassment, and rape. It may include but is not limited to rape. Sexual assault
includes unwanted or uncomfortable touches, kisses, hugs, petting, intercourse, or other
sexual acts. It is a component of sexual violence. Unwelcome or degrading e-mail messages,
comments, contact, or behavior, such as exhibitionism, that makes any environment feel
unsafe is known as sexual harassment.

17. Women with severe and persistent mental illness are likely to be more vulnerable to being
involved in controlling and/or violent relationships; however, many women develop mental
health problems as a result of long-term abuse. Which condition is unlikely to be a
psychologic consequence of continued abuse?
a. Substance abuse
b. Posttraumatic stress disorder (PTSD)
c. Eating disorders
d. Bipolar disorder
ANS: D
Bipolar disorder is a specific illness (also known as manic depressive disorder) not related to
abuse. Substance abuse is a common method of coping with long-term abuse. The abuser is
also more likely to use alcohol and other chemical substances. PTSD is the most prevalent
mental health sequela of long-term abuse. The traumatic event is persistently re-experienced
through distress recollection and dreams. Eating disorders, depression, psychologic-
physiologic illness, and anxiety reactions are all mental health problems associated with
repeated abuse.
DIF: Cognitive Level: Analyze REF: pp. 99-100 TOP: Nursing Process: Diagnosis
MULTIPLE RESPONSE
1. The nurse who is evaluating the client for potential abuse should be aware that IPV includes a
number of different forms of abuse, including which of the following? (Select all that apply.)
a.Physical
b.Sexual
c.Emotional
d.Psychologic
e.Financial
ANS: A, B, D, E
Physical, sexual, financial, and psychologic abuse can all be components in a relationship with
IPV. Emotional abuse is a form of psychologic abuse.
TOP: Nursing Process: Assessment
MSC: Client Needs: Psychosocial and Physiologic Integrity
2. What are some common characteristics of a potential male batterer? (Select 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 observed in batterers. Typically, the
batterer has low self-esteem. Batterers usually have a low frustration level (i.e., they easily
lose their temper). Batterers characteristically have poor verbal skills and can especially have
difficulty expressing their feelings.
DIF: Cognitive Level: Understand REF: p. 100 TOP: Nursing Process: Diagnosis
3. Which nursing diagnoses would be most applicable for battered women? (Select 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 a battered woman would be impaired communication.
DIF: Cognitive Level: Analyze REF: p. 108 TOP: Nursing Process: Diagnosis
4. A thorough abuse assessment screen should be completed on all female clients. This screen
should include which components? (Select 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, then they should be marked
on a form that indicates their locations 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. Using general
descriptive words such as “slap,” “kick,” or “punch” to elicit information is best.

TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment
5. What are the responsibilities of the nurse who suspects or confirms any type of violence
against a woman? (Select all that apply.)
a. Report the incident to legal authorities.
b. Provide resources for domestic violence shelters.
c. Call a client advocate who can assist in the client’s decision about what actions to
take.
d. Accurately and concisely document the incident (or findings) in the client’s
record.
e. Reassure and support the client.
ANS: B, C, D, E
Domestic violence is considered a crime in all states; however, mandatory reporting remains
controversial. Nurses must become knowledgeable on the laws that apply in the state in which
they practice. Caring for a client who may be a victim of domestic abuse is an ideal
opportunity to provide the woman with information for safe houses or support groups for
herself and her children. The nurse may assist in reaching out to a client advocate, which often
occurs when potential legal action is taken or if the woman is seeking shelter. Documentation
must be accurate and timely to be useful to the client later in court if she chooses to press
charges. The primary functions for the nurse are to reassure the client and to provide her with
emotional support.


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Chapter 05: Violence Against Women

Lowdermilk: Maternity & Women’s Health Care, 11th Edition

1. Historically, what was the justification for the victimization of women?

DIF: Cognitive Level: Remember REF: pp. 98-99

DIF: Cognitive Level: Remember REF: p. 100

DIF: Cognitive Level: Analyze REF: pp. 101-102

DIF: Cognitive Level: Analyze REF: p. 107

DIF: Cognitive Level: Understand REF: p. 103

DIF: Cognitive Level: Analyze REF: p. 107

DIF: Cognitive Level: Apply REF: p. 107

DIF: Cognitive Level: Apply REF: p. 107

DIF: Cognitive Level: Understand REF: p. 98

DIF: Cognitive Level: Analyze REF: p. 99 TOP: Nursing Process: Diagnosis

DIF: Cognitive Level: Understand REF: pp. 111-112

DIF: Cognitive Level: Apply REF: p. 107

15. Which statement regarding human trafficking is correct?

DIF: Cognitive Level: Understand REF: p. 115

16. Which statement is the most comprehensive description of sexual violence?

DIF: Cognitive Level: Understand REF: p. 110

DIF: Cognitive Level: Analyze REF: p. 106

DIF: Cognitive Level: Apply REF: p. 107

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