Test Bank For Foundations of Mental Health Care, 7th Edition
(Morrison-Valfre, 2021), 9780323661829 Chapter 1-33 | All
Chapters with Answers and Rationals
1. A kindergarten student is frequently violent toward other children. A school nurse notices bruises
and burns on the child's face and arms. What other symptom should indicate to the nurse that the
child may have been physically abused?
A. The child shrinks at the approach of adults.
B. The child begs or steals food or money.
C. The child is frequently absent from school.
D. The child is delayed in physical and emotional development. - ANSWER: Answer: A
Rationale: The nurse should determine that a child who shrinks at the approach of adults in addition
to having bruises and burns may be a victim of abuse. Maltreatment is considered, whether or not the
adult intended to harm the child.
2. A woman presents with a history of physical and emotional abuse in her intimate relationships.
What should this information lead a nurse to suspect?
A. The woman may be exhibiting a controlled response pattern.
B. The woman may have a history of childhood neglect.
C. The woman may be exhibiting codependent characteristics.
D. The woman may be a victim of incest. - ANSWER: Answer: D
Rationale: The nurse should suspect that this client may be a victim of incest. Many women who are
battered have low self-esteem and have feelings of guilt, anger, fear, and shame. Women in abusive
relationships often grew up in an abusive home.
3. A nursing instructor is developing a lesson plan to teach about domestic violence. Which
information should be included?
A. Power and control are central to the dynamic of domestic violence.
B. Poor communication and social isolation are central to the dynamic of domestic violence.
C. Erratic relationships and vulnerability are central to the dynamic of domestic violence.
D. Emotional injury and learned helplessness are central to the dynamic of domestic violence. -
ANSWER: Answer: A
Rationale: The nursing instructor should include the concept that power and control are central to the
dynamic of domestic violence. Battering is defined as a pattern of coercive control founded on
physical and/or sexual violence or threat of violence. The typical abuser is very possessive and
perceives the victim as a possession.
4. A client is brought to an emergency department after being violently raped. Which nursing action is
appropriate?
A. Discourage the client from discussing the rape, because this may lead to further emotional trauma.
B. Remain nonjudgmental while actively listening to the client's description of the violent rape event.
C. Meet the client's self-care needs by assisting with showering and perineal care.
D. Probe for further, detailed description of the rape event. - ANSWER: Answer: B
Rationale: The most appropriate nursing action is to remain nonjudgmental and actively listen to the
client's description of the event. It is important to also communicate to the victim that he/she is safe
and that it is not his/her fault. Nonjudgmental listening provides an avenue for catharsis, which
contributes to the healing process.
5. A raped client answers a nurse's questions in a monotone voice with single words, appears calm,
and exhibits a blunt affect. How should the nurse interpret this client's responses?
A. The client may be lying about the incident.
, B. The client may be experiencing a silent rape reaction.
C. The client may be demonstrating a controlled response pattern.
D. The client may be having a compounded rape reaction. - ANSWER: Answer: C
Rationale: This client is most likely demonstrating a controlled response pattern. In the controlled
response pattern, the client's feelings are masked or hidden, and a calm, composed, or subdued affect
is seen. In the expressed response pattern, feelings of fear, anger, and anxiety are expressed through
crying sobbing, smiling, restlessness, and tension.
6. A client who is in a severely abusive relationship is admitted to a psychiatric inpatient unit. The
client fears for her life. A staff nurse asks, "Why doesn't she just leave him?" Which is the nursing
supervisor's most appropriate response?
A. "These clients don't know life any other way, and change is not an option until they have improved
insight."
B. "These clients have limited cognitive skills and few vocational abilities to be able to make it on their
own."
C. "These clients often have a lack of financial independence to support themselves and their children,
and most have religious beliefs prohibiting divorce and separation."
D. "These clients are paralyzed into inaction by a combination of physical threats and a sense of
powerlessness." - ANSWER: Answer: D
Rationale: The nursing supervisor is accurate when stating that clients who are in abuse relationships
are paralyzed into inaction by a combination of physical threats and a sense of powerlessness.
Women often choose to stay with an abusive partner: for the children, for financial reasons, for fear
of retaliation, for lack of a support network, for religious reasons, or because of hopefulness.
7. A woman comes to an emergency department with a broken nose and multiple bruises after being
beaten by her husband. She states, "The beatings have been getting worse, and I'm afraid, next time,
he will kill me." Which is the appropriate nursing response?
A. "Leopards don't change their spots, and neither will he."
B. "There are things you can do to prevent him from losing control."
C. "Let's talk about your options so that you don't have to go home."
D. "Why don't we call the police so that they can confront your husband with his behavior?" -
ANSWER: Answer: C
Rationale: The most appropriate response by the nurse is to talk with the client about options so that
the client does not have to return to the abusive environment. It is essential that clients make
decisions on their own without the nurse being the "rescuer." Imposing judgments and giving advice
is nontherapeutic.
8. A college student was sexually assaulted when out on a date. After several weeks of crisis
intervention therapy, which client statement should indicate to a nurse that the student is handling
this situation in a healthy manner?
A. "I know that it was not my fault."
B. "My boyfriend has trouble controlling his sexual urges."
C. "If I don't put myself in a dating situation, I won't be at risk."
D. "Next time I will think twice about wearing a sexy dress." ANSWER: Answer: A
Rationale: The client who realizes that sexual assault was not her fault is handling the situation in a
healthy manner. The nurse should provide nonjudgmental listening and communicate statements
that instill trust and validate self-worth.
-
9. A client asks, "Why does a rapist use a weapon during the act of rape?" Which is the most
appropriate nursing response?
A. "To decrease the victimizer's insecurity."
B. "To inflict physical harm with the weapon."
(Morrison-Valfre, 2021), 9780323661829 Chapter 1-33 | All
Chapters with Answers and Rationals
1. A kindergarten student is frequently violent toward other children. A school nurse notices bruises
and burns on the child's face and arms. What other symptom should indicate to the nurse that the
child may have been physically abused?
A. The child shrinks at the approach of adults.
B. The child begs or steals food or money.
C. The child is frequently absent from school.
D. The child is delayed in physical and emotional development. - ANSWER: Answer: A
Rationale: The nurse should determine that a child who shrinks at the approach of adults in addition
to having bruises and burns may be a victim of abuse. Maltreatment is considered, whether or not the
adult intended to harm the child.
2. A woman presents with a history of physical and emotional abuse in her intimate relationships.
What should this information lead a nurse to suspect?
A. The woman may be exhibiting a controlled response pattern.
B. The woman may have a history of childhood neglect.
C. The woman may be exhibiting codependent characteristics.
D. The woman may be a victim of incest. - ANSWER: Answer: D
Rationale: The nurse should suspect that this client may be a victim of incest. Many women who are
battered have low self-esteem and have feelings of guilt, anger, fear, and shame. Women in abusive
relationships often grew up in an abusive home.
3. A nursing instructor is developing a lesson plan to teach about domestic violence. Which
information should be included?
A. Power and control are central to the dynamic of domestic violence.
B. Poor communication and social isolation are central to the dynamic of domestic violence.
C. Erratic relationships and vulnerability are central to the dynamic of domestic violence.
D. Emotional injury and learned helplessness are central to the dynamic of domestic violence. -
ANSWER: Answer: A
Rationale: The nursing instructor should include the concept that power and control are central to the
dynamic of domestic violence. Battering is defined as a pattern of coercive control founded on
physical and/or sexual violence or threat of violence. The typical abuser is very possessive and
perceives the victim as a possession.
4. A client is brought to an emergency department after being violently raped. Which nursing action is
appropriate?
A. Discourage the client from discussing the rape, because this may lead to further emotional trauma.
B. Remain nonjudgmental while actively listening to the client's description of the violent rape event.
C. Meet the client's self-care needs by assisting with showering and perineal care.
D. Probe for further, detailed description of the rape event. - ANSWER: Answer: B
Rationale: The most appropriate nursing action is to remain nonjudgmental and actively listen to the
client's description of the event. It is important to also communicate to the victim that he/she is safe
and that it is not his/her fault. Nonjudgmental listening provides an avenue for catharsis, which
contributes to the healing process.
5. A raped client answers a nurse's questions in a monotone voice with single words, appears calm,
and exhibits a blunt affect. How should the nurse interpret this client's responses?
A. The client may be lying about the incident.
, B. The client may be experiencing a silent rape reaction.
C. The client may be demonstrating a controlled response pattern.
D. The client may be having a compounded rape reaction. - ANSWER: Answer: C
Rationale: This client is most likely demonstrating a controlled response pattern. In the controlled
response pattern, the client's feelings are masked or hidden, and a calm, composed, or subdued affect
is seen. In the expressed response pattern, feelings of fear, anger, and anxiety are expressed through
crying sobbing, smiling, restlessness, and tension.
6. A client who is in a severely abusive relationship is admitted to a psychiatric inpatient unit. The
client fears for her life. A staff nurse asks, "Why doesn't she just leave him?" Which is the nursing
supervisor's most appropriate response?
A. "These clients don't know life any other way, and change is not an option until they have improved
insight."
B. "These clients have limited cognitive skills and few vocational abilities to be able to make it on their
own."
C. "These clients often have a lack of financial independence to support themselves and their children,
and most have religious beliefs prohibiting divorce and separation."
D. "These clients are paralyzed into inaction by a combination of physical threats and a sense of
powerlessness." - ANSWER: Answer: D
Rationale: The nursing supervisor is accurate when stating that clients who are in abuse relationships
are paralyzed into inaction by a combination of physical threats and a sense of powerlessness.
Women often choose to stay with an abusive partner: for the children, for financial reasons, for fear
of retaliation, for lack of a support network, for religious reasons, or because of hopefulness.
7. A woman comes to an emergency department with a broken nose and multiple bruises after being
beaten by her husband. She states, "The beatings have been getting worse, and I'm afraid, next time,
he will kill me." Which is the appropriate nursing response?
A. "Leopards don't change their spots, and neither will he."
B. "There are things you can do to prevent him from losing control."
C. "Let's talk about your options so that you don't have to go home."
D. "Why don't we call the police so that they can confront your husband with his behavior?" -
ANSWER: Answer: C
Rationale: The most appropriate response by the nurse is to talk with the client about options so that
the client does not have to return to the abusive environment. It is essential that clients make
decisions on their own without the nurse being the "rescuer." Imposing judgments and giving advice
is nontherapeutic.
8. A college student was sexually assaulted when out on a date. After several weeks of crisis
intervention therapy, which client statement should indicate to a nurse that the student is handling
this situation in a healthy manner?
A. "I know that it was not my fault."
B. "My boyfriend has trouble controlling his sexual urges."
C. "If I don't put myself in a dating situation, I won't be at risk."
D. "Next time I will think twice about wearing a sexy dress." ANSWER: Answer: A
Rationale: The client who realizes that sexual assault was not her fault is handling the situation in a
healthy manner. The nurse should provide nonjudgmental listening and communicate statements
that instill trust and validate self-worth.
-
9. A client asks, "Why does a rapist use a weapon during the act of rape?" Which is the most
appropriate nursing response?
A. "To decrease the victimizer's insecurity."
B. "To inflict physical harm with the weapon."
