Physical Examination and Health Assessment CANADIAN 3rd Edition Jarvis Test Bank

Chapter 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
facility, 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
husband. 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 NURSINGTB.COM
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. Psychological 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
violence-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 encounter
d. When a history of abuse in the family is known
ANS: C

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 Physical Examination and Health Assessment CANADIAN 3rd Edition Jarvis Test Bank

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 populations
b. Obtaining evidence of abuse by a family member
c. Gathering information of violence
d. Creating a safe, nonjudgmental environment
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,
discriminatory 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
another 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 parents and the family situation?”
d. “Did he have siblings whenNUyou
RSI NGTB.C
adopted him?”OM
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 violence. It is important that the nurse determine if there was family
violence of any sort in the patient’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
patient 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

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 Physical Examination and Health Assessment CANADIAN 3rd Edition Jarvis Test Bank

“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
perpetrated 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
patient 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
medications 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
financial assets of the older, dependent person. This type of neglect is by definition, criminal
in nature.

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 examination. With useNUof
RSa Irelational
NGTB.C OM and further questioning, the patient
approach
admits that her husband 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
diagnosed with depression, the nurse notes the despondent and flat affect. How should the
nurse respond?
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?”

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 Physical Examination and Health Assessment CANADIAN 3rd Edition Jarvis Test Bank

c. “You seem to be getting worse. Do you need more medications for your
depression?”
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 situation.

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 assessment of suspected abuse.
c. The number of “yes” answers indicates the woman’s understanding of her
situation.
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
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and advocates 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 describe 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

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 Physical Examination and Health Assessment CANADIAN 3rd Edition Jarvis Test Bank

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, before 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

N R patient,
I G the nurseMnotes purple-blue bruises to both knees.
B.C
U Sinform
The mother and patient separately N T O that the patient got the bruises playing
the nurse
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 validates the subjective data.
c. Questions when the bruises actually occurred.
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.)

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 Physical Examination and Health Assessment CANADIAN 3rd Edition Jarvis Test Bank

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 conversation does not develop a safe and open environment for them
to share and assumes abuse before 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.
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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 problems).

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

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Physical Examination and Health Assessment CANADIAN 3rd Edition Jarvis Test Bank

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
patients 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

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