Deck 10: Violence and Elder Mistreatment

Question 1

An older patient has been brought into the emergency department with injuries caused by suspected physical abuse. Which tools would the nurse use to assess this patient's injuries? Select all that apply.
1) Indicators of abuse screen
2) AMA assessment protocol
3) Adult protective services report
4) Brief abuse screen for the elderly
5) Hwalek-Sengstock elder abuse screening test

Answer 1

1, 2, 4, 5

Question 2

An 85-year-old client is admitted to the emergency room with a fractured arm and bruises on the chest and back. The nurse should assess? Select all that apply
1) Hygiene
2) Marital status
3) Their caretaker
4) History of falls
5) Financial status

Answer 2

1, 2, 3, 4

Question 3

An older patient is being abused by family members in the home and asks about adult protective services. What should the nurse explain about these services?
1) They are an organization that prosecutes those persons who abuse the elderly.
2) They provide services to protect older people who may be abused or neglected.
3) They provide a way to permanently keep the older patient separated from the abuser.
4) They place older patients who cannot adequately care for themselves in nursing homes.

Answer 3

2

Question 4

Which patients seen by a nurse working in the emergency department identify a situation that suggests a case of elder mistreatment?
1) A 77-year-old patient who fell at home
2) A 73-year-old patient found to be anemic after vomiting blood
3) An 86-year-old patient who has three dime-size burned areas on the upper inner thigh
4) An 85-year-old patient who has several small areas of bruising on the back of the hands

Question 5

An older patient is experiencing self-neglect. A nurse recognizes this after the client states:
1) "My son sometimes calls me stupid and annoying."
2) "Those bruises are from my grandson; he gets frustrated with me sometimes."
3) "Yes, my clothes are a bit dirty, but I live alone and I haven't done laundry in a while."
4) "My nephew had to borrow quite a bit of money, leaving me not enough to buy medication this month."

Question 6

The home care nurse is preparing to visit an older female patient who lives in her son's home. The medical record indicates that the client has a high socioeconomic status. It also indicates that the son is Hispanic and is slightly cognitively impaired. Which risk factors for elder abuse would be most concerning?
1) Male gender
2) Hispanic race
3) Impaired cognitive status
4) High socioeconomic status

Question 7

The nurse is concerned that specific families in a community are at increased risk for transgenerational violence. Which family situation exemplifies the transgenerational theory of violence?
1) Family with a daughter who has severe arthritis and finds it increasingly difficult to deal with her forgetful, frail mother
2) Family with a daughter who abuses alcohol whose father was a chronic alcoholic and is currently suffering from cirrhosis
3) Family with a daughter who is working two jobs with significant debts and cares for her father, who is becoming more confused and dependent
4) Family with a son who, as a teenager and young adult, had serious arguments with both of his parents, who were emotionally and sexually abusive to him

Question 8

When documenting suspected abuse of an older patient, it is important that the nurse document:
1) The nurse's subjective data and opinion.
2) The nurse's suspicion and personal conclusions.
3) Photographic evidence provided by the family and friends.
4) Objective data of the older patient's reaction when the suspected abuser is present.

Question 9

The home healthcare nurse is preparing an educational program for other healthcare providers regarding elder abuse. What information should the nurse include? Select all that apply.
1) The typical abuser is the spouse.
2) The typical abuser is the adult child.
3) The typical elder who is abused is a woman.
4) The majority of abuse occurs in the home setting.
5) The majority of abuse occurs in the long-term care setting.

Question 10

A visitor to a long-term care institution witnesses an attendant psychologically abusing a client with dementia. What actions are suggestive of this type of abuse?
1) Scolding them after an incontinent incident
2) Insisting the client help them with their tuition
3) Not helping a client eat when they need assistance
4) The attendant stating "I cannot work here anymore because of you."

Question 11

During a home visit of an elderly married patient, the nurse observes listlessness, dry and cracked skin, and skin irritation on both inner thighs; what type of neglect should the nurse be concerned with?
1) Self-neglect
2) Sexual abuse
3) Caregiver neglect
4) Financial exploitation

Question 12

The daughter of an older patient is researching viable skilled facilities to have the patient admitted. Institutional abuse information on facilities is difficult to find. What are some reasons for this? Select all that apply.
1) Residents fear retribution.
2) Managers fear adverse publicity.
3) Staff members fear losing their jobs.
4) Billing department members fear not getting paid for services.
5) Family members fear needing to find a new agency for the patient.

Question 13

A nursing manager is assessing a nursing home over concerns regarding institutional mistreatment of older patients. Which situation would warrant further concern over this issue?
1) A client refuses to take her morning shower.
2) A client screams at a patient care technician.
3) A client denies taking his morning medication.
4) A client curses out another nursing home patient.

Question 14

The home care nurse asks an older patient's caregiver to complete a questionnaire regarding caregiver strain. The caregiver states, "You are here to see my mom. Why do you need information about me?" Which is the most appropriate response by the nurse?
1) "We need to make sure you don't abuse your mother."
2) "It's just something that the insurance companies make us fill out."
3) "We need to gather information about how you are dealing with caring for your mother."
4) "We fill out this paperwork for all caregivers; we have to assess your psychological well-being."

Question 15

Which nursing assessment findings would support a nursing diagnosis of caregiver role strain?
1) An older client has multiple wounds on both arms in various stages of healing.
2) An older client is hard of hearing and has difficulty completing ADL's; he lives with his son.
3) An older client states, "I really am becoming a burden on my family; they don't love me anymore."
4) An older client is accompanied to a physician's office visit with an adult daughter who he lives with. She refuses to take him to bingo every week.

Question 16

Which older patient is at greatest risk for mistreatment in the home?
1) An older patient who is retired from owning a business and lives with an adult married son
2) An older patient with a history of coronary bypass surgery, is active, and lives with his spouse
3) An older patient with severe osteoarthritis who lives with his daughter who has a son with cerebral palsy
4) An older patient with well-controlled diabetes and heart disease who lives alone, his wife died a year ago

Question 17

An older patient is experiencing exploitation. The nurse recognizes this when the client states:
1) "My son, who I live with, only helps me bathe once a week."
2) "Sometimes, my daughter, gets frustrated with me and hits me."
3) "My neighbor will not drive me to the grocery store unless I buy their groceries too."
4) "My daughter said she will stay and take care of me, but goes out every night with her friends."

Question 18

The nurse suspects that an older patient has been physically abused. What must be included in the medical workup for this patient?
1) Pelvic examination
2) Toxicological screening
3) Complete blood count and blood chemistries
4) Complete visual examination with clothing removed

Question 19

An older patient is accompanied by an adult daughter who is the patient's primary caregiver for a routine clinic visit. During the examination, what would indicate caregiver role strain in the daughter?
1) She expresses concerns over medication usage.
2) She is reading a magazine during the vital sign assessment.
3) She is on the phone with her husband discussing evening plans for dinner.
4) She does not ask any questions during the physical assessment done by the nurse.

Question 20

The nurse is caring for an older patient who has been the victim of elder abuse by his adult son. Which assessment finding would support the transgenerational violence theory of elder mistreatment?
1) The son drinks 6-8 beers every night of the week.
2) The son watched his father consistently beating his mother.
3) The son has given up his full-time job to care for his father.
4) The son suffered physical beatings frequently when he was a child.

Question 21

An emergency room nurse is caring for an older patient brought in by a neighbor. The neighbor states that the patient lives with a son who "drinks a lot." What does the nurse assess that suggests elder neglect? Select all that apply.
1) Thick, yellow fingernails
2) Dry, cracked lips and tongue
3) Pressure ulcer on the sacrum
4) Small skin tears to the right elbow
5) Cracked, dry skin on the lower legs bilaterally

Question 22

The daughter of an older patient who is a resident of a nursing home suspects the patient is a victim of abuse. What should the nurse suggest that the daughter do about this situation? Select all that apply.
1) Visit the facility at varied times.
2) Do nothing until evidence is obtained.
3) Realize that the patient can be confused.
4) Participate in the resident's council.
5) Actively participate in care plan meetings.

Question 23

The nurse is concerned that an older client who lives with her son is at risk for psychopathology abuse. What assessment findings are consistent with this theory?
1) The son tends to yell at her if she does not fully assist him with her bathing.
2) The son does not allow her to go to any of her quilting group classes.
3) The son witnessed his mother endure frequent beatings from his father.
4) The son who she lives with drinks 10-12 beers every night of the week.

Question 24

An older patient comes to the emergency room with a black eye and is diagnosed with a broken right arm. What nursing assessment findings are indicative of potential physical abuse?
1) The patient is 65 years old and has no history of falls.
2) The client states "I fell on a shovel while clearing snow from a walkway."
3) The patient is confused about how they broke their arm and cannot recount events.
4) The patient is African American and states "I have broken many bones in my lifetime."

Question 25

The nurse is caring for a patient who has been the victim of elder abuse by her son. Which assessment finding would support the situational violence theory of elder mistreatment?
1) The son is having a hard time staying employed.
2) The son went off to live at a boarding school for many years as a child.
3) The son witnessed several young boys being beat up in the neighborhood.
4) The son has lost his girlfriend and friends due to having to care for his mother full time.