# A nurse cares for a 30-year-old female client in the emergency department whose partner accompanied her. The nurse notes bruises in various stages of healing, the partner answers questions for the client, and the client appears withdrawn. Which actions are part of an evidence-based response to suspected intimate partner violence (IPV)? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=365842&lang=en  
> language: en  
> subject: Abuse or Neglect  
> category: PSI

## Question

A nurse cares for a 30-year-old female client in the emergency department whose partner accompanied her. The nurse notes bruises in various stages of healing, the partner answers questions for the client, and the client appears withdrawn. Which actions are part of an evidence-based response to suspected intimate partner violence (IPV)? Select all that apply.

1

Interview the client privately, away from the partner

2

Use a validated IPV screening tool such as HITS or HARK

3

Assess immediate safety and discuss options for a safety plan

4

Provide information about national hotlines and local shelters

5

Insist on calling the police regardless of the client wishes

## Explanation

Suspected IPV requires private interviewing without the partner present, validated screening, immediate safety assessment with a safety plan, and resource provision (hotlines, shelters). Mandatory police reporting in adult IPV is generally NOT required in the US (unlike child or elder abuse) and overriding client wishes violates autonomy and may escalate the violence at home. Nurses must follow state-specific mandatory reporting laws and respect adult client autonomy when not required to report.

## In-depth explanation

Clinical Judgment
IPV nursing response: private interview, validated screen, safety plan, resources, documentation. Adult IPV is generally NOT mandatory to report in the US (varies by state); empower the client to make decisions. Children, elders, and disabled adults DO have mandatory reporting requirements. Document factual observations, photographs of injuries with consent, and direct quotes.

Memory Tip
IPV: Private + Screen + Safety + Resources — never override autonomy

KR vs US
WHO + USPSTF universal screening, with privacy and resources, is shared globally. US National Domestic Violence Hotline 1-800-799-7233. Korean Women Hotline 1366 and Korean Domestic Violence Counseling Hotline operate similar 24/7 services. Both jurisdictions require mandatory reporting for child and vulnerable adult abuse.

## Clinical scenario

Clinical Practice Guide
USPSTF + ANA IPV bundle:
- Privacy: separate the client from the partner using a routine reason (urine sample, x-ray, exam)
- Validated screening: HITS, HARK, WAST, AAS
- Safety assessment: lethality screening (Danger Assessment), access to weapons, escalation, threats to children
- Safety plan: bag with documents, emergency contacts, code word, exit route
- Resources: National Domestic Violence Hotline 1-800-799-7233, local shelters, advocacy
- Documentation: factual observations, photographs with consent, direct quotes, body diagram
- Mandatory reporting: per state law for children, elders, vulnerable adults; not required for competent adult IPV in most jurisdictions

Caution
Lethality risk increases sharply at separation. Avoid asking the client to leave on the day of disclosure unless safe to do so. Provide a safety plan and follow up; respect the client decision-making process.

## Key concepts

- **Intimate partner violence (IPV)** — Pattern of physical, sexual, psychological, or financial abuse by a current or former partner. Affects 1 in 4 women and 1 in 9 men in their lifetime. Signs: bruises in various stages, partner controlling interview, withdrawn client, frequent ED visits.
- **HITS / HARK** — Validated brief IPV screening tools. HITS: Hurt, Insult, Threaten, Scream — 4 items, score >10 positive. HARK: Humiliation, Afraid, Raped, Kicked — 4 items, score 1+ positive. Use in private; positive score triggers safety assessment and resource referral.
- **Safety plan** — Personalized plan to enhance safety while in or leaving an abusive relationship. Includes a packed bag with IDs, money, medications, important documents; emergency contacts and code word; planned exit route; safe location; legal protection options. Created with the client; do not impose.

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