Chapter 23: Violence: A Social and Family Problem Nursing School Test Banks

Chapter 23: Violence: A Social and Family Problem
Test Bank


1. Why do nursing students study violent behavior?
a. Americans are fascinated by stories about violence.
b. Many nursing students are from families with a history of violence.
c. The media often portrays heroes who use violence to win.
d. Violence resulting in injury affects the whole community.
Although all of the options may be true, community/public health courses include content on violence because it is a major public health problem, not only because it is a major cause of death but also because violence, including suicide and homicide, is preventable.

DIF: Cognitive Level: Comprehension REF: p. 576

2. Members of the community state they are afraid of being attacked, robbed, beaten, or killed by a stranger. What would be an appropriate response by the nurse?
a. All Americans must band together to protect our families and our neighborhoods.
b. As the media clearly report, violence in our country is on the increase.
c. Most violent acts are committed by family and friends.
d. You are right to be concerned. There are many actions you can take to protect yourself.
Statistics from the Bureau of Justice Statistics (2003) demonstrate that the incidence of violence by strangers is exaggerated. Most violent acts are committed by family and people one knows. Violent crime has been steadily decreasing since 1994 to the lowest rate ever in 2000.

DIF: Cognitive Level: Application REF: p. 576

3. Which of the following groups is most often the victim of violence?
a. Adolescents
b. Adults aged 46 to 60
c. Elderly persons older than 65
d. Women aged 30 to 45
According to statistics, adolescents are at especially high risk.

DIF: Cognitive Level: Knowledge REF: p. 576

4. Which of the following explanations is supported by extensive research as to why a person might resort to violence?
a. Children learn violent approaches from their peers.
b. Violence is a fast way to resolve conflict, requiring minimal time.
c. Children observe how movie heroes resolve problems.
d. Violence is seen as a socially acceptable strategy to solve problems.
Although many heroes in all media, comics, books, movies, and television may use violence, violence is most prevalent when the culture accepts it as an appropriate strategy in the problem-solving process. Many American cultural institutions model and even encourage violence and aggression, as in sports, movies, television, and video games. Children may or may not be around peers who exhibit violent behaviors. Although childrens movies may demonstrate violence to resolve problems, this is not always the case.

DIF: Cognitive Level: Comprehension REF: p. 577

5. A school nurse is providing education about the consequences of bullying. What information would the nurse want to include?
a. Bullying has a significant and long-lasting effect on childrens health.
b. Children can be taught how to effectively deal with bullies.
c. Most bullying occurs in elementary schools, especially on playgrounds during recess.
d. Screening for bullying is almost impossible because no one wants to be seen as a tattletale.
Schools are the site of ongoing violence, from excessive teasing to pushing, shoving, bullying, intimidation, stalking, physical assault, and even murder. Because bullying is often accepted as a part of growing up, as temporary, and as having little effect, the nurse must stress that bullying has health consequences across the life span.

DIF: Cognitive Level: Application REF: p. 578

6. In which of the following places would violence most likely occur?
a. Public government buildings
b. Schools
c. Shopping malls
d. Workplaces
Schools are the site of ongoing violence, from excessive teasing to pushing, shoving, bullying, intimidation, stalking, physical assault, and even murder.

DIF: Cognitive Level: Comprehension REF: p. 577

7. What is a common finding related to violence in communities?
a. More than 25% of students in grades 9 to 12 report physical fighting during the past year.
b. Firearms are responsible for the majority of homicides in adults.
c. Homicide is the second leading cause of death for young people aged 10 to 24 years.
d. Most injuries caused by violence do not necessitate visits to the emergency department.
Homicide is the second leading cause of death in people aged 10 to 24; firearms are responsible for 84% of the homicides in people aged 10 to 24. Of youth in grades 9 to 12, 11% reported being in a physical fight in the previous 12 months. More than 656,000 people aged 10 to 25 were treated in emergency departments for injuries sustained through violence.

DIF: Cognitive Level: Knowledge REF: p. 578

8. Which of the following interventions demonstrates a community/public health nurse engaging in primary prevention related to adolescent violence?
a. Promoting youth engagement in social activities and employment opportunities
b. Educating gang members about the dangers of staying in the gang
c. Visiting jails or juvenile detention centers to see the consequences of violence
d. Screening youth for risk factors to identify if they have a tendency toward violence
Primary prevention includes preventing youth from dropping out of school and strengthening social institutions to better provide activities and legitimate economic opportunities for youth. As gang members often report nothing else to do, availability of recreational activities is crucial. The other interventions demonstrate use of secondary and tertiary prevention.

DIF: Cognitive Level: Analysis REF: p. 578

9. Which of the following is a crucial risk factor associated with being a victim of violence?
a. Being very extroverted
b. Lacking social activities
c. Living in poverty
d. Possessing low self-esteem
Poverty is an important risk factor associated with victimization by violence.

DIF: Cognitive Level: Comprehension REF: p. 578

10. What known risk factors have been associated with violence internationally?
a. Censorship of media (newspaper, magazines, movies, television shows)
b. Drug, alcohol, and tobacco use
c. Monarchies, not democracies, as government
d. Strong-armed government militia
Drug, alcohol, and tobacco use is associated with increasing exposure to violence.

DIF: Cognitive Level: Knowledge REF: p. 579

11. A new child moved into a neighborhood. The children next door asked him to come over and play. He thanked them but stayed home. Which of the following is an explanation for the childs behavior?
a. He came from a violent neighborhood where children never played outdoors.
b. He does not believe he knows the next door kids well enough yet.
c. His mother works and does not want to be asked to take a turn babysitting.
d. He has to take care of an ill family member after school.
In violent neighborhoods, fear of violence has a tremendous effect, causing residents to be suspicious of one another. Parents increased concern and anxiety are related to lower levels of childrens outdoor play and physical activity.

DIF: Cognitive Level: Application REF: p. 579

12. Which of the following conclusions can be drawn from research on the effect of abuse on adults who become parents?
a. Adults who were abused are more likely to abuse their own children.
b. Adults who were abused avoid abusing their own children.
c. Adults who were abused are no more or less likely to abuse their own children.
d. There is no clear trend as to how previous abuse influences future abuse.
Adults abused as children are more likely to abuse their own children; intergenerational transmission of violence has been widely documented. Abused children are more likely to be abusive in later relationships, although not all children who grow up in violent homes become violent later in life.

DIF: Cognitive Level: Comprehension REF: p. 579

13. Which of the following is a rationale as to why abusive parents continue to abuse their children?
a. Children are born evil and have to have sin beaten out of them.
b. Good parents care enough to use physical discipline to teach their children.
c. Most parents consider strong physical punishment merely good discipline.
d. There are no repercussions, and other people rarely interfere.
People abuse family members because there are few or no repercussions. Even if the abuse is known, other people rarely interfere.

DIF: Cognitive Level: Comprehension REF: p. 579

14. During which period of life are young people at the greatest risk for dying from homicide?
a. First 5 years of life
b. First 2 years of life
c. First week of infancy
d. Teens (ages 13 to 19)
The most dangerous time in a childs life is the first day of life. The first week of infancy has the highest risk for death from homicide.

DIF: Cognitive Level: Knowledge REF: p. 579

15. Which child in a family is most likely to be abused?
a. The son who looks just like his father
b. The son who is handicapped
c. The daughter who is very personable
d. The daughter who is beautiful and brilliant
Sometimes abuse is inflicted on all the children in a family, but often one child is singled out or targeted to receive most or all of the abusive attention. In cases of abuse, usually a child who is different or who has a physical or emotional disability is at special risk for abuse.

DIF: Cognitive Level: Application REF: p. 579

16. A nurse practitioner was working in the emergency department when a child with a stab wound in the abdomen was brought in by his mother. The mother explained that the child apparently had gone quietly into the kitchen, climbed up on a chair, and was peeling an apple when he fell and the paring knife went into his tummy. She heard his screams and brought him to the emergency department. What will the advanced practice nurse want to be sure to do?
a. Ask the child what really happened.
b. Ask the mother why the child was still hungry after bedtime.
c. Examine the child carefully for evidence of past injuries.
d. Stitch the wound, order an antibiotic, and apply a small dressing.
Because abuse is rarely an isolated incident, evidence of past injuries may be present when a child is brought in for treatment. However, children rarely admit this in response to a direct question with the abuser in the room. Abused children typically protect their parents.

DIF: Cognitive Level: Application REF: p. 579

17. The emergency department personnel were amazed when a child did not complain or flinch as the physician cleaned a rather nasty cut and then stitched it. What observation would cause the nurse even more concern?
a. After the bandage was applied, the child ran immediately back to his mother and hugged her very tightly.
b. The child said, These things happen because Im so bad.
c. The mother held the child throughout the procedure saying, Its my entire fault. I left the knife out.
d. The mother said, He is going through a growth spurt. Ill have to have more snacks around that dont require preparation.
The focus on being a bad child is suggestive of constant criticisms, a form of emotional abuse. The other responses all suggest either a strong motherchild bond or the mothers willingness to accept responsibility and possibly accept help.

DIF: Cognitive Level: Application REF: p. 580

18. The school nurse suspects that a child has been abused after observing several bruises. What action should the nurse take next?
a. The nurse should contact protective services as a mandatory reporter.
b. The nurse should contact the classroom teacher to collect additional information.
c. The nurse should not contact anyone and keep the information private.
d. The nurse should contact the family for an explanation of the childs bruises.
All 50 states specifically require mandatory reporting of child abuse by health professionals, a category that includes nurses. The law requires that all suspected cases be reported. In every state, the law protects the health care professionals from legal action if the charges are unproved.

DIF: Cognitive Level: Application REF: p. 580

19. A woman who is 4 months pregnant states that she has not told her husband that she is pregnant because he is upset enough over having lost his job a few months ago. Which of the following questions would the nurse want to ask the woman?
a. How much does she know about pregnancy and childbirth?
b. How does her husband react to stress?
c. Is she concerned that her husband will possibly hurt her when he finds out?
d. What are her plans for obtaining financial resources for the family?
Although the nurse will want to educate the woman about pregnancy and childbirth, the family situation sounds at high risk for abuse. The husband has been unemployed for some time. The woman is fearful. It is known that a woman is most at risk for abuse when pregnant, when preparing to leave the home, or after having left the home.

DIF: Cognitive Level: Synthesis REF: p. 580

20. Which of the following activities would put a woman most at risk of being abused, injured, or killed?
a. Being submissive and obedient
b. Having an affair with a friend of her husband
c. Being pregnant or threatening to leave the home
d. Walking in a downtown urban area wearing a short skirt and high-heeled shoes
A woman is most at risk when pregnant, when preparing to leave the home, or after having left the home. The other behaviors do not put the woman at most risk for abuse or violence.

DIF: Cognitive Level: Application REF: p. 582

21. In addition to size and strength differences, what leads men to choose to batter women?
a. They want more sex than women want to give them.
b. They want the power and control in the relationship.
c. They realize it is the only way to ensure that the woman acts appropriately.
d. They recognize how women drive them to it.
Physical violence is primarily aimed at maintaining power and control.

DIF: Cognitive Level: Knowledge REF: p. 581

22. What is the relationship between socioeconomic class and intimate partner abuse?
a. Abuse is prevalent at all income levels in the United States.
b. High income is a risk factor for intimate partner abuse.
c. Families below the poverty level are at the lowest risk for intimate partner violence.
d. Families in the middle socioeconomic classes are better at hiding abuse.
Abuse is prevalent at all income levels. There is, however, greater risk among poverty-level families. Risk factors for abuse include low income, low self-esteem, poor academic achievement, and alcohol use.

DIF: Cognitive Level: Comprehension REF: p. 584

23. The husband was worried about losing his job and had been very tense all week. His wife was surprised when that night he picked up his supper plate and threw it against the wall. He screamed, You cant even cook decently! What might the wife expect her husband to do next?
a. Apologize profusely after he calms down.
b. Ask her to go to work to improve their economic prospects.
c. Be fired when his anger flares at work.
d. Return to school to improve his employment prospects.
Domestic violence occurs in a classic cyclic pattern known as the cycle of violence. The cycle consists of tension-building (being tense all week), battering (yelling and throwing the plate), and apologizing.

DIF: Cognitive Level: Application REF: p. 584

24. After a husband slapped his wife, he apologized to her saying that his boss had been giving him impossible tasks and he had stopped for a drink after work. When the woman laughingly shared this story during a routine visit at the clinic, the nurse became concerned. What would have concerned the nurse?
a. The husband had a drink after work rather than coming right home.
b. The husband refused to take responsibility for his own actions.
c. The woman felt this episode was worth sharing.
d. The woman was laughing as she told the story.
Batterers typically refuse to acknowledge responsibility for abuse; instead, they blame anything from alcohol and work problems to stress and the spouse. Abusers blame the victim until the victim actually starts believing that he or she is responsible for the abuse.

DIF: Cognitive Level: Application REF: p. 584

25. A woman was at the emergency department with a broken arm and bruises all over her torso. Radiographs showed evidence of previous broken bones. Which behavior exhibited by the woman would be most worrisome to the nurse?
a. Asking the nurse, Do you know where I can go to get away from him?
b. Accepting the blame for the incident, saying Im such a rotten housekeeper. I cant do anything right.
c. Crying, moaning, and begging for pain medication
d. Saying, Do you think I should tell the police?
With long-term abuse, the victim accepts responsibility for maintaining the relationship and accepts blame for the abusive behavior.

DIF: Cognitive Level: Application REF: p. 584

26. What is the typical effect of a restraining order?
a. It depends; it would work only if the woman went to a shelter and stayed there.
b. Negative; such an order will only make the man angrier and consequently more abusive.
c. Positive; statistics suggest such orders do reduce contact, threats, violence, and injury.
d. It will have a minimal effect one way or the other.
Evidence suggests that restraining orders actually are effective in reducing contact, threats, violence, and injury from an abusive partner, although certainly they sometimes do not have these effects.

DIF: Cognitive Level: Comprehension REF: pp. 584-585

27. The emergency department nurse listened as the woman said, I know that this sounds stupid, but I was leaning on the door handle and I fell out of the car right into the traffic. The woman had a broken leg in addition to scrapes and bruises. What should the nurse be sure to ask?
a. Have you been hit, slapped, kicked, or physically hurt by someone during the last year?
b. Were you been wearing your seatbelt before this incident?
c. Have you been in an abusive relationship before?
d. Were you using drugs or alcohol at the time of this incident?
The nurse should always be alert to possible abuse, particularly when the type of injury and the supposed circumstances under which it occurred are suggestive of abuse. One of the four best questions to ask is, Within the last year, have you ever been hit, slapped, kicked, or otherwise physically hurt by someone?

DIF: Cognitive Level: Application REF: p. 585

28. A 15-year-old mother brought her 2-month-old infant to the clinic, complaining that he was a bad baby. When she fed him cereal, the infant spit it back out. This frustrated the new mother and then she stated she would spank the infant. What important instructions should this mother receive?
a. Education about how to control her temper
b. Information about normal infant behaviors
c. Information about local support groups for teenage mothers
d. Education about how to find a positive role model
Abusive parents often have unrealistic expectations of age-appropriate behavior for children. It is important to review child development so parents can recognize age-appropriate behavior. The nurse can validate realistic expectations for the child with the parent and dispel unrealistic ones.

DIF: Cognitive Level: Application REF: p. 586

29. What is the most common form of elder abuse?
a. Emotional abuse
b. Financial abuse
c. Physical abuse
d. Sexual abuse
Financial exploitation of vulnerable elderly persons is identified as the most common form of elder abuse.

DIF: Cognitive Level: Knowledge REF: p. 586

30. A home care nurse was caring for an elderly gentleman who lived with his son. The client kept falling asleep. Which action is most important for the nurse to take?
a. Call the physician and ask for a daytime stimulant.
b. Check the medications for consistency between pills and prescribed doses.
c. Suggest that the client get a TV to keep himself entertained.
d. Suggest that the client sit up or even try to walk and then try to sleep at night.
Overmedication, whether inadvertent or deliberate, may be used to control an elderly person. The nurse should review medications at every visit. The existing supply should be tallied to see whether the remaining medication matches what would be expected if the medication were taken as prescribed.

DIF: Cognitive Level: Application REF: p. 586

31. A home care nurse cared for an elderly client who lived with her daughter and was incontinent and sometimes confused. The nurse found her lying in wet linens. The elderly woman asked the nurse to change the sheets and not worry about it. Why would the elderly woman sound so unconcerned?
a. She may be ashamed that she has accidents.
b. She knows she mistreated her daughter early in life, so this is just justice.
c. She may have nowhere else to live and prefers being at home with wet linens to a nursing home.
d. She thinks all children treat their parents like this.
Many elderly persons who are abused are afraid of the caretakers, ashamed of the problem, or have limited alternatives. If they have nowhere else to live or feel that they will die in a nursing home, they will not complain about the abuse. Health professionals sometimes do not report incidents because of concern that alternative living arrangements might be less tolerable than the current one.

DIF: Cognitive Level: Application REF: pp. 586-587

32. The nurse was caring for an elderly gentleman who lived with his son. The nurse is concerned about elder abuse. Which of the following would be the most important intervention to be implemented by the nurse?
a. Counsel and recognize the sons efforts in relation to being a caregiver.
b. Encourage the son to consider respite care or adult daycare for his father.
c. Provide information to the son regarding nursing home placement.
d. Suggest that other family members assist with caregiving.
Any and all of the options might be useful because all are aspects of counseling and supporting the son in relation to his caregiving. However, the most useful intervention is to obtain respite care in order to reduce stress on the caregiver.

DIF: Cognitive Level: Application REF: p. 586


1. Which of the following factors are associated with increased risk of violence? (Select all that apply.)
a. Access to guns in the home
b. Extensive involvement in community activities
c. High levels of stress in the family
d. Low socioeconomic status
e. Rigid sex role expectations
f. Use of TV as a free babysitter
ANS: A, C, D, E, F
Factors associated with risk of violence are sociologic (such as poverty, drug dealing, access to guns, media exposure), developmental (rigid sex role expectations, peer pressure, high stress level), and family environment (social isolation, history of intergenerational abuse).

DIF: Cognitive Level: Comprehension REF: p. 587

2. Which of the following are possible reasons for an adolescent to join a gang? (Select all that apply.)
a. Best protection from violence by others
b. Employment so dull in comparison
c. Friends all joined gangs (peer pressure)
d. More fun than going to work
e. Sense of belonging, family, and stability
f. Sheer excitement about being involved
ANS: A, C, E, F
Gangs are often the only social option for adolescents, since no employment opportunities are available; peer pressure, protection, companionship, and excitement are also reasons for joining a gang. Gangs offer stability when families may not be stable.

DIF: Cognitive Level: Comprehension REF: p. 591

3. What conclusions concerning firearms in the United States can be drawn? (Select all that apply.)
a. No data support the assertion that gun-control laws decrease violence.
b. Firearms are the second leading cause of death among 10- to 19-year-olds.
c. Higher rates of family ownership of guns are associated with lower homicide rates.
d. Laws have prevented sales of assault weapons but not handguns.
e. Regulations concerning firearms are more restrictive in the United States than in other industrialized nations.
f. Zero-tolerance laws have decreased firearm violence in schools.
According to a systematic literature review conducted by the National Research Council, no data supported the assertion that gun-control laws had an effect on reducing violence. Firearms are the second leading cause of death among 10- to 19-year-olds. Regulations related to firearms are more lenient in the United States than in other developed countries, and so firearms are accessible. Higher rates of ownership are associated with higher homicide rates. Evaluation of legislation has not demonstrated that legislation reduces firearm violence.

DIF: Cognitive Level: Comprehension REF: p. 591

4. Why are colleges establishing programs about appropriate dating behaviors? (Select all that apply.)
a. As a media campaign to assure parents that their children are safe in their college environment
b. As an attempt to emphasize that women have the right to say no
c. Because of feminist demands that men learn better self-control and appropriate social behavior
d. Because the majority of victims know their assailants
e. As public recognition that almost 25% of college-age women report an attempted or completed rape
f. Because most college women report physical or sexual violence during their adolescent or college years
Violence during dating relationships is quite common during adolescence and the college years. Up to 25% of female college students reported an attempted or complete rape, 13% to 20% reported being stalked, and 88% reported at least one incidence of physical or sexual violence. Ninety percent of the assailants were known to their victims.

DIF: Cognitive Level: Comprehension REF: p. 591

5. A woman returns to an abusive relationship despite being referred to a shelter by the community/public health nurse. Which of the following explains why the client would not accept this referral? (Select all that apply.)
a. If she attempts to leave, the mans reprisals may be even worse.
b. She may lack money, skill, or employment opportunities.
c. She secretly enjoys being dominated, like many victims of abuse.
d. She believes marriage is forever and divorce demonstrates failure.
e. If she moves to a shelter, she will not be safe there.
f. She enjoys having a strong man be responsible for her life.
ANS: A, B, D, E
Women have many reasons for staying, including hopes that the man will reform, there being no other place to go, having children (which makes it harder to find adequate financial resources or appropriate housing), and a belief that divorce is shameful. The woman may be emotionally dependent on the abusive spouse or may fear living alone. Finally, reprisals may indeed be worse, since women are at greater risk of being killed when they leave an abusive partner. Thus, the fear of not being safe when she moves to the shelter is valid.

DIF: Cognitive Level: Application REF: p. 592

6. Which of the following has been successfully used to combat abuse and stalking? (Select all that apply.)
a. Encouraging victims to stand up for themselves and gain self-confidence
b. Concentrating on the offender, with mandatory arrests at the first episode
c. Encouraging men to teach nonviolence to the next generation of boys
d. Improving supportive services for abused spouses, such as transitional housing
e. Educating families about separation until the abuse is resolved
f. Training professionals to recognize and intervene in abusive situations
ANS: B, C, D, F
New initiatives include training health care providers, encouraging men to teach nonviolence to the next generation, and improving crisis services for victims of rape and sexual assault. The federal Violence Against Women Act, reauthorized in 2005, also includes improving supportive services such as transitional housing.

DIF: Cognitive Level: Comprehension REF: p. 593

7. A nurse working in obstetrics helps new mothers bond with their children. Which of the following observations would be of concern to the nurse? (Select all that apply.)
a. The mother appears frightened of her newborn and avoids touching him.
b. The mother continually praises her newborn and his nursing and sleeping.
c. The mother constantly looks at and talks to her newborn.
d. The mother touches her newborn, patting, hugging, and smiling at him.
e. The mother says Boys are tough as she rather carelessly changes his diaper.
f. The mother states that the newborn does not seem to like her.
ANS: A, E, F
Parental behaviors consistent with strong bonding with the newborn include making good eye contact; caring, gentle handling; talking to the infant; giving positive feedback with praising remarks; and showing affection with hugs, smiles, and pats. Poor bonding behaviors include having little contact, handling the infant roughly or carelessly, avoiding physical contact, and leaving the child alone.

DIF: Cognitive Level: Application REF: p. 594

8. The teenage mothers behavior seemed consistent with a fantasy that the newborn was rather like a doll who would love her forever. Which of the following would be the most appropriate nursing intervention? (Select all that apply.)
a. Enrolling the mother in a foster grandmother program
b. Demonstrating that screaming will help calm the newborn
c. Providing the mother a set of how to be a parent books
d. Inviting the mother to join a support group with other teenage mothers
e. Planning nursing assessment visits every 3 months during the first year
f. Explaining appropriate maternal behaviors before hospital discharge
ANS: A, D, E
The new mother will need social support and information, which may be successfully implemented through foster grandmother programs, mother support groups, and nursing visits every 3 months during early life. Books might be useful for some women; however, in view of the low literacy rate, there is a strong possibility that the books would not be read or understood. Although the nurses explaining appropriate behavior in the hospital might seem helpful, new mothers are under a high level of adjustment and stress, and this is not the best time for learning. Furthermore, new mothers are rarely in the hospital more than 2 days after a normal delivery. Screaming at an infant is an at-risk behavior and not an appropriate behavior for a new mother.

DIF: Cognitive Level: Synthesis REF: p. 594

9. Which of the following actions should a nurse take to help decrease violence against women? (Select all that apply.)
a. Conduct public health campaigns about violence.
b. Educate colleagues about the effects of violence against women.
c. Establish appropriate outcome measures.
d. Fight to publicize victim health records so others know the damage abusers cause.
e. Help create appropriate protocol and documentation guidelines with local agencies.
f. Support accreditation requirements for appropriate violence care.
ANS: A, B, C, E, F
Nurses may become discouraged at the continuation of violence in society. Change takes time. Nurses can effect more long-term outcomes by supporting political change through campaigns, providing one-on-one education, changing accreditation systems to support local efforts, and voting for increased funding for improving care. Under the Health Insurance Portability and Accountability Act (HIPAA), no nurse should share patients records publicly.

DIF: Cognitive Level: Analysis REF: pp. 595-596

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