Warning signs of intimate partner violence
Question
Click to highlight the findings that require follow-up.
31-year-old client arrives with her partner. The partner answers most triage questions for her and declines to step out during the examination. Client says she "tripped on the stairs" 3 days ago; the partner says she "walked into a door." Bruises on both forearms, a yellow-green bruise along the jaw, and a newer purple bruise below the left eye. Record shows two earlier emergency visits this year for injuries and three missed primary care appointments. Oral temperature 98.2°F (36.8°C). Breath sounds clear in all lobes. Capillary refill less than 2 seconds in all fingers. Tetanus immunization is up to date.
Highlighted phrases are the correct selections.
Answer
The partner answers most triage questions for her and declines to step out during the examination. · Client says she "tripped on the stairs" 3 days ago; the partner says she "walked into a door." · Bruises on both forearms, a yellow-green bruise along the jaw, and a newer purple bruise below the left eye. · Record shows two earlier emergency visits this year for injuries and three missed primary care appointments.
Rationale
Several cues together should raise suspicion of intimate partner violence: a partner who speaks for the client and will not leave the room, accounts of the injury that conflict and a delay before seeking care, bruises of different ages on the face, forearm injuries that suggest she was defending herself, and repeated injury visits alongside missed appointments. The nurse finds a way to interview the client alone before asking about safety. Her temperature, lung sounds, circulation, and immunization status need no follow-up.
Sources
Sources marked “Adapted from” are licensed under CC BY 4.0. We changed the material: its facts are rewritten into an original question, answer options and rationale. The original authors and publishers do not endorse SwipeExam.
- Adapted from Open RN Nursing: Mental Health and Community Concepts, 2nd edition: TRAUMA, ABUSE, AND VIOLENCE
- Intimate Partner Violence (MedlinePlus health topic)
- Adapted from Open RN Nursing Health Promotion: HIGH-RISK PERINATAL CLIENT CARE
- Adapted from Open RN Nursing Health Promotion: MALADAPTIVE COPING BEHAVIORS
- About Intimate Partner Violence (Source: CDC)
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