Hesi Patient Review - Intimate partner
violence with PTSD
Which is the best reason for the nurse to screen this client for intimate partner violence? -
ANSAll women of childbearing age should be screened for intimate partner violence.
Screening for intimate partner violence is recommended by the U.S. Preventive Service Task
Force for all women of childbearing age
Which is the best way for the nurse to screen for intimate partner violence? - ANSUse an
evidence-based tool such as the Abuse Assessment Screen.
Evidence-based tools like the Abuse Assessment Screen are the best way to screen for intimate
partner violence because they have been tested for reliability and validity. They also limit
interviewer bias.
Which behavior should the nurse avoid because it could make Brook less likely to disclose
violence to you? - ANSUsing probing language to press for a response.
Using probing language or pressing for more information than the client is ready to disclose will
decrease the likelihood of disclosure.
What risk factors for depression and anxiety you are evident in the client's health history? -
ANSFemale gender and history of physical abuse.
Female gender and history of physical abuse are risk factors for depression and anxiety.
What is the nurse most concerned about for this client, knowing her history of depression and
intimate partner violence? - ANSRisk for suicide or self-harm.
Because of the serious nature of suicide and self-harm, this would be the most concerning
outcome of depression and history of intimate partner violence for the nurse.
Based on the history of violence, which physical health conditions would the nurse expect the
healthcare provider to screen for? - ANSSexually transmitted disease due to forced sex.
Clients with a history of sexual abuse should be screened for sexually transmitted diseases if
they have not been screened since the assault.
, Now that the nurse knows that a specific violent event has occurred, what is the nurse's
responsibility to report the incident? - ANSThe nurse is not required to report the incident
because it may put the client at greater risk.
There is no law requiring nurses to report intimate partner violence. Involving the police without
the client's consent may put the client in more danger of violence by her intimate partner.
How should the nurse document an assault such as the one the client just described in the
record? - ANSWrite down verbatim the statements that the client makes related to who
assaulted her and when.
The notes taken about the incident may be used as evidence or future care. It is best to write
word for word what the clients says about the details of the incident, including the person who
assaulted her and when it happened.
What does the nurse know about Brook's level of danger, based on the strangulation incident? -
ANSStrangulation is an indication that her risk of being murdered by her husband is high.
Strangulation is an indication that the client's level of danger, including risk for murder, is high.
What other factors may affect Brook's risk for being murdered by her husband? - ANSShe will
have a higher risk of being murdered if she believes he is capable of killing her.
Women who have experienced intimate partner violence are often accurate in their own risk
assessment. Therefore, if a woman believes her intimate partner is capable of killing her, it is an
important indication that she has a high risk of being murdered by the abuser.
Based on Brook's experiences of physical and sexual abuse and her symptoms found during
the assessment, the nurse realizes that the priority nursing diagnosis is Post-Trauma syndrome
related to physical abuse. The nurse is ready to begin a plan of care for the client. Which is the
most important piece of information that the nurse needs at this point to inform the nursing
diagnosis? - ANSPrevious history of abuse in childhood and adulthood.
Cumulative trauma is an important factor in the severity and duration of Post-Trauma Syndrome.
The more traumatic incidences that the client has had in their lifetime, the greater risk they have
for more severe and lengthy problems after a traumatic event.
What information is most important in determining a plan of care for Post-Trauma syndrome for
this client? - ANSHer access to formal and informal social support.
The client's informal resources (such as a church group or friend) and formal resources (such as
an advocate at the shelter or a reduced cost clinic in her neighborhood) are the most important
factors in determining her plan of care. These resources will determine the emotional and
tangible support that she has to cope with the trauma.
violence with PTSD
Which is the best reason for the nurse to screen this client for intimate partner violence? -
ANSAll women of childbearing age should be screened for intimate partner violence.
Screening for intimate partner violence is recommended by the U.S. Preventive Service Task
Force for all women of childbearing age
Which is the best way for the nurse to screen for intimate partner violence? - ANSUse an
evidence-based tool such as the Abuse Assessment Screen.
Evidence-based tools like the Abuse Assessment Screen are the best way to screen for intimate
partner violence because they have been tested for reliability and validity. They also limit
interviewer bias.
Which behavior should the nurse avoid because it could make Brook less likely to disclose
violence to you? - ANSUsing probing language to press for a response.
Using probing language or pressing for more information than the client is ready to disclose will
decrease the likelihood of disclosure.
What risk factors for depression and anxiety you are evident in the client's health history? -
ANSFemale gender and history of physical abuse.
Female gender and history of physical abuse are risk factors for depression and anxiety.
What is the nurse most concerned about for this client, knowing her history of depression and
intimate partner violence? - ANSRisk for suicide or self-harm.
Because of the serious nature of suicide and self-harm, this would be the most concerning
outcome of depression and history of intimate partner violence for the nurse.
Based on the history of violence, which physical health conditions would the nurse expect the
healthcare provider to screen for? - ANSSexually transmitted disease due to forced sex.
Clients with a history of sexual abuse should be screened for sexually transmitted diseases if
they have not been screened since the assault.
, Now that the nurse knows that a specific violent event has occurred, what is the nurse's
responsibility to report the incident? - ANSThe nurse is not required to report the incident
because it may put the client at greater risk.
There is no law requiring nurses to report intimate partner violence. Involving the police without
the client's consent may put the client in more danger of violence by her intimate partner.
How should the nurse document an assault such as the one the client just described in the
record? - ANSWrite down verbatim the statements that the client makes related to who
assaulted her and when.
The notes taken about the incident may be used as evidence or future care. It is best to write
word for word what the clients says about the details of the incident, including the person who
assaulted her and when it happened.
What does the nurse know about Brook's level of danger, based on the strangulation incident? -
ANSStrangulation is an indication that her risk of being murdered by her husband is high.
Strangulation is an indication that the client's level of danger, including risk for murder, is high.
What other factors may affect Brook's risk for being murdered by her husband? - ANSShe will
have a higher risk of being murdered if she believes he is capable of killing her.
Women who have experienced intimate partner violence are often accurate in their own risk
assessment. Therefore, if a woman believes her intimate partner is capable of killing her, it is an
important indication that she has a high risk of being murdered by the abuser.
Based on Brook's experiences of physical and sexual abuse and her symptoms found during
the assessment, the nurse realizes that the priority nursing diagnosis is Post-Trauma syndrome
related to physical abuse. The nurse is ready to begin a plan of care for the client. Which is the
most important piece of information that the nurse needs at this point to inform the nursing
diagnosis? - ANSPrevious history of abuse in childhood and adulthood.
Cumulative trauma is an important factor in the severity and duration of Post-Trauma Syndrome.
The more traumatic incidences that the client has had in their lifetime, the greater risk they have
for more severe and lengthy problems after a traumatic event.
What information is most important in determining a plan of care for Post-Trauma syndrome for
this client? - ANSHer access to formal and informal social support.
The client's informal resources (such as a church group or friend) and formal resources (such as
an advocate at the shelter or a reduced cost clinic in her neighborhood) are the most important
factors in determining her plan of care. These resources will determine the emotional and
tangible support that she has to cope with the trauma.
