9Chapter 08: Interpersonal Violence Assessments

Jarvis: Physical Examination & Health Assessment, 3rd Canadian edition

MULTIPLE CHOICE

1. During admission assessment of a 72-year-old patient with dementia from a long-term care facil-
ity, the nurse notices multiple signs of old bruising to the patient’s wrists and arms. The nurse
should assess for:
a. Functional capabilities
b. Fall risk
c. Normal aging
d. Elder abuse
ANS: D
With increasing numbers of older adults in Canada and the greater need for institutionalization of
these older adults, recognition of abuse has become important and may include rough or violent
handling during personal care, force feeding or withholding food, and neglect.

DIF: Cognitive Level: Applying (Application)

MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control

2. During a home visit, the nurse notices that an older adult woman is caring for her bedridden hus-
band. The woman states that this is her duty, she does the best she can, and her children come to
help when they are in town. Her husband is unable to care for himself, and she appears thin,
weak, and exhausted. The nurse notices that several of his prescription medication bottles are
empty. This situation is best described by the term:
a. Physical abuse
b. Financial neglect
c. Psychological abuse
d. Unintentional physical neglect
ANS: D
Unintentional physical neglect may occur despite good intentions and is the failure of a family
member or caregiver to provide basic goods or services. Physical abuse is defined as violent acts
that result or could result in injury, pain, impairment, or disease. Financial neglect is defined as
the failure to use the assets of the older person to provide services needed by him or her. Psycho-
logical abuse is defined as behaviours that result in mental anguish.

DIF: Cognitive Level: Applying (Application)

MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control

3. The nurse is aware that screening for intimate partner violence (IPV) using the trauma- and vio-
lence-informed care (TVIC) approach should occur with which type of situation?
 a. When IPV is suspected
b. When a woman has an unexplained injury
c. As a routine part of each health care en-
counter
d. When a history of abuse in the family is
known
ANS: C
Many nursing professional organizations have called for routine, universal screening for IPV to
assist women in getting help for the problem.

DIF: Cognitive Level: Applying (Application)

MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control

4. Using the TVIC approach during patient assessment, the nurse focuses on:
a. Assessing for violence in high-risk popu-
lations
b. Obtaining evidence of abuse by a family
member
c. Gathering information of violence
d. Creating a safe, nonjudgmental environ-
ment
ANS: D
The TVIC approach builds on the idea of trauma-informed practice, to take into account ongoing
and historical violence and how structural violence (e.g., systemic racism, poverty, discrimina-
tory policies) is related to interpersonal violence. TVIC focuses on creating a safe environment,
not on getting a “disclosure.”

DIF: Cognitive Level: Applying (Application)

MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control

5. The nurse is interviewing the parents of a 5-year-old patient who seriously physically hurt an-
other child. The parents inform the nurse that they adopted the patient when he was removed
from his parents’ custody at 8 months of age. What does the nurse ask?
a. “Is he the only child you have adopted?”
b. “Did he have issues with the child he
hurt?”
c. “Can you tell me anything about his par-
ents and the family situation?”
d. “Did he have siblings when you adopted
him?”
 ANS: C
For children of all ages, being exposed to abuse (e.g., hearing abuse, directly witnessing abuse),
seeing the effect of abuse on their mothers, and living under conditions of chronic stress can lead
them to experience a wide range of problems (e.g., physical, behavioural, emotional, and social
problems). An infant living in such an environment can experience the stress and physical vio-
lence. It is important that the nurse determine if there was family violence of any sort in the pa-
tient’s history.

DIF: Cognitive Level: Remembering (Knowledge)

MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control

6. A patient has come to the clinic with persistent abdominal pains. During the interview, the pa-
tient tells the nurse that her husband controls the finances, gives her a minimal allowance, and
makes her account for what she spends to the penny. The patient constantly looks down and will
not make eye contact with the nurse. What will the nurse assess for?
a. Situational violence
b. Chronic ulcerative colitis
c. Stomach flu
d. Intimate partner terrorism
ANS: D
“Intimate partner terrorism” is characterized by coercive control in which one partner tries to
control the other; it results in the most severe health consequences and is most commonly perpe-
trated by men.

DIF: Cognitive Level: Applying (Application)

MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control

7. During a home visit with an 80-year-old patient cared for by family, the nurse notices that the pa-
tient is in severe pain. The nurse knows that the patient was prescribed medication for the pain
and family administered all medications. When asked, the patient states not receiving any medi-
cations for the past week. The nurse recognizes this situation as:
a. Caregiver burden
b. Criminal neglect
c. Malnourishment
d. Unintentional neglect
ANS: B
Some family members or caregivers working with older persons consciously and with malice
withhold food, water, medication, and appropriate necessities, often concurrently stealing the fi-
nancial assets of the older, dependent person. This type of neglect is by definition, criminal in na-
ture.

DIF: Cognitive Level: Applying (Application)

MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control
8. The 25-year-old female Indigenous patient in for her first prenatal checkup appears despondent
and unhappy. The nurse finds numerous old bruises on the patient during the physical examina-
tion. With use of a relational approach and further questioning, the patient admits that her hus-
band has been hitting her when he is frustrated with work. The best response by the nurse is:
a. “What do you do that makes him angry?
Maybe avoiding saying things to frustrate
him will stop the hitting.”
b. “You need to leave him. Don’t be weak.”
c. “I am really concerned for you and your
baby, and I really want to help you. Can
you tell me how I can best support you?”
d. “Are you sure you are not imagining this?
Is it just your normal fighting?”
ANS: C
Specific clinical contexts have assessment approaches that integrate attention to violence. In the
perinatal context, the possibility that being in an abusive relationship may be a challenge for a
pregnant woman.

DIF: Cognitive Level: Understanding (Comprehension)

MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control

9. During assessment of a 38-year-old patient with chronic headaches of no known cause, and diag-
nosed with depression, the nurse notes the despondent and flat affect. How should the nurse re-
spond?
a. “You must be experiencing abuse. You
need to leave your partner.”
b. “Do you really have these headaches? Are
you just wanting sympathy from your
spouse?”
c. “You seem to be getting worse. Do you
need more medications for your depres-
sion?”
d. “Depression and headaches can be related
to violence in a relationship. For your
safety, I need to ask you if this is the
case.”
ANS: D
When you identify social vulnerabilities, health issues commonly associated with abuse, or signs
of possible abuse, a thorough assessment of interpersonal violence is needed. Inquire in safe and
appropriate ways about their needs and concerns followed by appropriate and timely referral.
Depending on the presentation, use questions that are direct and tailored to the person and situa-
 tion.

DIF: Cognitive Level: Applying (Application)

MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control

10. The nurse is using the Danger Assessment (DA) tool to evaluate the risk for violence. Which of
these statements best describes its use?
a. The DA tool is to be administered by law
enforcement personnel.
b. The DA tool should be used in every as-
sessment of suspected abuse.
c. The number of “yes” answers indicates
the woman’s understanding of her situa-
tion.
d. The higher the number of “yes” answers,
the more serious is the danger of the
woman’s situation.
ANS: D
No predetermined cutoff scores exist on the DA. The higher the number “yes” answers, the more
serious is the danger of the woman’s situation. This tool is used extensively by nurses and advo-
cates in various settings.

DIF: Cognitive Level: Applying (Application)

MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control

11. The nurse suspects abuse when a 10-year-old child is admitted to the urgent care centre for a leg
injury. The best way to document the history and physical findings is to:
a. Document what the child’s caregiver tells
the nurse.
b. Use the words the child has said to de-
scribe how the injury occurred.
c. Record what the nurse observes during the
conversation.
d. Rely on photographs of the injuries.
ANS: B
When documenting the history and physical findings of suspected child abuse and neglect, use
the words the child has used to describe how his or her injury occurred. Remember, the abuser
may be accompanying the child.

DIF: Cognitive Level: Applying (Application)

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

12. The nurse observes bruises of various stages on a 6-year-old child and suspects child abuse.
 What should the nurse do?
a. Ask the parents what they did to their
child
b. Consult with a child protection social
worker
c. Report the parent for child abuse
d. Document and photograph the abuse
ANS: B
Many health care settings have access to social workers who are specifically trained in dealing
with child maltreatment. They are often the first point of contact for reporting suspected abuse. It
is important to know that you can consult confidentially with child protection social workers, be-
fore deciding whether the situation warrants a formal report.

DIF: Cognitive Level: Analyzing (Analysis)

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

13. The nurse is examining a 3-year-old child who was brought to the emergency department after a
fall. Which finding would be of most concern?
a. Bruise on the knee
b. Bruise on the elbow
c. Bruising on the abdomen
d. Bruise on the shin
ANS: C
Studies have shown that children who are walking often have bruises over the bony prominences
of the front of their bodies. Other studies have found that bruising in atypical places, such as the
buttocks, hands, feet, and abdomen, were exceedingly rare and should arouse concern.

DIF: Cognitive Level: Analyzing (Analysis)

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

14. During assessment of a 9-year-old patient, the nurse notes purple-blue bruises to both knees. The
mother and patient separately inform the nurse that the patient got the bruises playing soccer the
day before. From the colour of the bruises the nurse:
a. Is convinced the child is being abused.
b. Recognizes that the objective data vali-
dates the subjective data.
c. Questions when the bruises actually oc-
curred.
d. Is unable to identify the time frame for
when the bruises were attained.
 ANS: B
A new bruise is usually red and often turns purple or purple-blue 12 to 36 hours after blunt-force
trauma. The colour of bruises (and ecchymoses) generally progresses from purple-blue to bluish
green to greenish brown to brownish yellow before the bruise fades away. Bruises are noted
more often to the front of children’s bodies when they are walking and running. Recognizing that
the progression of the bruises is the objective data validating the subjective data.

DIF: Cognitive Level: Analyzing (Analysis)

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

MULTIPLE RESPONSE

1. While working with a 27-year-old transgender patient, the nurse takes an approach to facilitate
trust and safety for the patient to assess for abuse. What will the nurse do? (Select all that apply.)
a. Reflect on personal views of IPV to not be
judgemental.
b. Inquire about patient history of abuse to
initiate the conversation.
c. Listen with interest and observe for cues
of violence.
d. Tell patient to leave the abuser.
e. Recognize and commend patient on
strengths.
ANS: A, C, E
The TVIC approach is needed for people of all gender identities, including those who identify as
transgender or two-spirit. In line with the 2014 World Health Organization (WHO) guidelines,
health care providers should respond to disclosure and assess using the WHO’s LIVES approach:
Listen, Inquire, Validate, Enhance safety, and Support. This approach can support assessment
with or without the patient disclosing a history of IPV. A relational approach lets the patient take
the lead in choosing to disclose, or not, the abuse. Inquiring their abuse history to initiate a con-
versation does not develop a safe and open environment for them to share and assumes abuse be-
fore disclosure.

DIF: Cognitive Level: Analyzing (Analysis)

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

2. The nurse is conducting a follow-up assessment of a 6-year-old patient 2 years after removal
from his parents’ home as a result of physical violence between the parents. The nurse will assess
the patient for: (Select all that apply.)
a. Developmental progress.
b. Favourite foods.
c. Social interactions in school.
 d. Musical talents.
e. Clothing trends.
ANS: A, C
For children, being exposed to abuse (e.g., hearing abuse, directly witnessing abuse), seeing the
effect of abuse on their mothers, and living under conditions of chronic stress can lead them to
experience a wide range of problems (e.g., physical, behavioural, emotional and social prob-
lems).

DIF: Cognitive Level: Understanding (Comprehension)

MSC: Client Needs: Safe and Effective Care Environment: Reduction of Risk Potential

3. As a nurse working with many different populations, which of the following individuals can be
at increased risk for abuse? (Select all that apply.)
a. The 70-year-old confined to a wheelchair
b. The 45-year-old female bank manager
c. The 21-year-old living with a boyfriend
who uses harmful amounts of alcohol
d. The 35-year-old stay-at-home mother with
a controlling spouse
e. The 21-year-old university student living
at home
ANS: A, C, D
Although some populations may be more vulnerable to abuse, everyone the nurse encounters can
be experiencing abuse. All patients should be observed for potential signs of abuse. Some pa-
tients are more vulnerable to abuse: those who are isolated, economically dependent on others
(e.g., immigrants sponsored as spouses, children, and adolescents), or dependent on others for
care (e.g., people with disabilities). Actively consider IPV when a person is vulnerable in other
ways.

DIF: Cognitive Level: Understanding (Comprehension)

MSC: Client Needs: Safe and Effective Care Environment: Reduction of Risk Potential