A 4-year-old girl is brought to the emergency room with a fractured arm. Which information should be a basis for the practical nurse (PN) to suspect child abuse?
The family is poorly dressed, has poor eye contact, and seems overwhelmed by the hospital.
The child has had 4 previous visits to 3 different emergency departments.
The child clings to her mother and does not want the PN to examine her.
The child's step-father is extremely concerned and refuses to leave the child alone.
The Correct Answer is B
Repeated visits to multiple emergency departments for various injuries or complaints can be a red flag for possible child abuse. The other options may indicate other issues or concerns, but they do not provide as much reason to suspect child abuse as the history of repeated visits to different emergency departments. It is important for healthcare providers to remain vigilant for signs of child abuse and to report any suspicions to the appropriate authorities.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
The practical nurse (PN) should first massage the fundus and expel retained lochia and clots to help the uterus contract and prevent postpartum hemorrhage.
Taking the vital signs and opening the IV infusion rate of oxytocin (A) may be necessary but not as urgent as massaging the fundus.
Notifying the registered nurse (RN) that the client's bladder is distended (B) is not relevant to addressing the client's boggy and displaced fundus.
Putting the infant to breast to suckle and stimulate oxytocin secretion (C) is a valid intervention, but it is not the first priority when the client's fundus becomes boggy and displaced above the umbilicus.
Correct Answer is B
Explanation
The PN should report the injury details to the charge nurse. This is important because the charge nurse needs to be aware of any changes in the patient's condition and can help determine the appropriate course of action. The other options are not the most appropriate actions for the PN to take in this situation.
Obtaining a heel stick glucose (A) may be necessary if hypoglycemia is suspected, but it is not the most immediate concern.
Initiating strict intake and output measurements (C) may be necessary for monitoring fluid balance, but it is not the most immediate concern.
Swaddling the infant in a blanket (D) may provide comfort, but it does not address the underlying issue of the head injury and seizure episode.
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