Quick answerCondition: intimate partner violence with coercive control. Actions: interview the client alone in a private area and assess immediate danger with a validated tool. Monitor: Danger Assessment score and body-map injury findings.
Why this is correctControlling behavior (answering for the client, refusing privacy, keeping the phone), an explanation that shifts when the partner speaks, and bruises in different stages of healing form a pattern of repeated injury with coercion. Disclosure is only possible without the partner present, and the immediate question is whether the client is in danger today. A validated danger tool gives a score that can be repeated, and a body map with the client's own words documents injuries objectively for care and any future legal need.
Easy analogy or mental pictureAsking about abuse with the partner in the room is like asking a hostage to describe the kidnapper while he holds the phone. First create a room with one voice in it.
Memory hookAlone, then danger, then document: private room, danger score, body map.
NCLEX decision ruleWhen abuse is suspected, create privacy before screening, prioritize immediate safety, and document objective findings; never confront the suspected abuser or take actions that could increase danger.
Why the other choices are wrongAccidental injury is tempting because a wrist injury is common, but bruises of different ages and a changing story do not fit a single accident; wrist range of motion tracks only the fracture or sprain. A bleeding disorder is excluded by no anticoagulants and no bleeding history, so coagulation studies and platelet/INR monitoring pursue the wrong cause. Social anxiety disorder is tempting because of avoided eye contact, but she was comfortable socially before this relationship and looks to the partner before answering; a GAD-7 score does not measure safety. Confronting the partner can escalate violence. Printed materials sent home can be found by the partner and increase risk unless safe storage is discussed.
References
1USPSTF — Intimate Partner Violence Screening RecommendationScreening women of reproductive age and referring those who screen positive to ongoing support services
2AHRQ — A Better Approach to Screening for Intimate Partner ViolencePrivate, confidential screening approaches in clinical settings