# A 29-year-old client arrives at an outpatient clinic with a partner for treatment of a painful left wrist. The partner answers most questions, insists on staying in the room, and keeps the client's phone. The client avoids eye contact and looks at the partner before answering. Bruises of different colors are visible on both upper arms, and the explanation of the injury changes when the partner speaks. The client takes no anticoagulants and reports no nosebleeds, gum bleeding, or easy bruising in the past. The client described being comfortable in social settings before this relationship began. Complete the diagram by selecting the condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=617402&lang=en > language: en > subject: Abuse or Neglect > category: PSI ## Question A 29-year-old client arrives at an outpatient clinic with a partner for treatment of a painful left wrist. The partner answers most questions, insists on staying in the room, and keeps the client's phone. The client avoids eye contact and looks at the partner before answering. Bruises of different colors are visible on both upper arms, and the explanation of the injury changes when the partner speaks. The client takes no anticoagulants and reports no nosebleeds, gum bleeding, or easy bruising in the past. The client described being comfortable in social settings before this relationship began. Complete the diagram by selecting the condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress. Condition Select 1 Accidental injury with an overprotective partner Intimate partner violence with coercive control Bleeding disorder causing easy bruising Social anxiety disorder Actions to take Select 2 Confront the partner about the pattern of injuries Give printed hotline materials to take home Interview the client alone in a private area Request coagulation studies for the bruising Assess immediate danger with a validated tool Parameters to monitor Select 2 Platelet count and PT/INR Danger Assessment score Wrist range of motion Body-map injury findings GAD-7 anxiety score ## Explanation A controlling partner who keeps the client's phone and will not leave, a changing injury story, and bruises of different ages indicate intimate partner violence with coercive control. The nurse arranges to interview the client alone and assesses immediate danger with a validated tool. The Danger Assessment score and body-map documentation of injuries track risk and injury pattern over time. ## In-depth explanation Quick answer Condition: 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 correct Controlling 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 picture Asking 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 hook Alone, then danger, then document: private room, danger score, body map. NCLEX decision rule When 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 wrong Accidental 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 ## Clinical scenario Scenario Outpatient visit: controlling partner, inconsistent history, and bruises at different stages of healing. ## Key concepts - **Coercive control** — A pattern of controlling behavior, such as monitoring communication and isolating the person, used to dominate a partner. - **Danger Assessment** — A validated instrument that estimates the risk of severe or lethal intimate partner violence. - **Body map** — A diagram used to document the location, size, and appearance of injuries objectively. ## Related questions - [A nurse cares for a 30-year-old female client in the emergency department whose partner ac…](https://mymerci.kr/pages/nclex_q.php?qn_id=365842&lang=en) - [A nurse in a busy outpatient pediatric clinic is performing a well-child visit on a 5-year…](https://mymerci.kr/pages/nclex_q.php?qn_id=368303&lang=en) - [A 19-year-old patient with anorexia nervosa is admitted for medical stabilization with a B…](https://mymerci.kr/pages/nclex_q.php?qn_id=372729&lang=en) - [A 28-year-old patient with bipolar I disorder is admitted with acute mania: pressured spee…](https://mymerci.kr/pages/nclex_q.php?qn_id=372754&lang=en) - [For each nursing response to a client who discloses intimate partner violence, identify wh…](https://mymerci.kr/pages/nclex_q.php?qn_id=547050&lang=en) ## Read in another language - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=617402&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=617402&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=617402&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=617402&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=617402&lang=vi) --- More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en) _For study reference only. 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