A client at 39 weeks gestation is admitted in early labor. During the focused assessment, the practical nurse (PN) reviews the obstetrical history of the client who states that she has been pregnant five times but has only two living children, both of whom were full-term. The other three pregnancies were miscarriages during the first trimester. Which parity should the PN document for the term, premature, abortion, and living children (TPAL) for this client?

- Child abuse is the intentional or neglectful physical, emotional, or sexual harm or injury of a child by a parent, caregiver, or other person who has a relationship of trust or responsibility with the child. Child abuse can have serious and long-lasting consequences for the child's health, development, and well-being.
- The practical nurse (PN) has a legal and ethical duty to identify, report, and prevent child abuse. The PN should be alert for any signs and symptoms of child abuse, such as unexplained or inconsistent injuries, bruises, burns, fractures, or scars; behavioral changes, such as fear, anxiety, aggression, withdrawal, or depression; poor hygiene, nutrition, or growth; lack of supervision, medical care, or education; or sexualized behaviors or knowledge .
- The PN should also conduct a thorough and sensitive assessment of the child and the family situation, using open-ended questions, active listening, and non-judgmental attitude. The PN should compare the history and physical findings of the child with the expected developmental milestones and normal variations for the child's age and stage. The PN should also document any relevant information in an objective and factual manner .
- When the mother of a school-aged boy tells the PN that he fell out of a tree and hurt his arm and shoulder, the PN should assess the child's injury and compare it with the mother's explanation. The most significant indicator of possible child abuse in this scenario is if the injury description by the mother varies from the child's version. This may suggest that the mother is lying or covering up the true cause of the injury, which may be intentional or accidental harm by herself or someone else. A discrepancy between the mother's and the child's stories may also indicate that the child is afraid or coerced to hide the truth about the abuse .

- Therefore, option D is the correct answer, while options A, B, and C are incorrect.

Taking oral prednisone with food helps to minimize gastrointestinal side effects such as stomach irritation and upset. Food acts as a protective barrier for the stomach lining, reducing the risk of irritation caused by the medication. Additionally, taking prednisone with food can help improve its absorption and distribution in the body.

The other options mentioned are incorrect:

A- "Take on an empty stomach": This is incorrect because taking prednisone on an empty stomach can increase the risk of gastrointestinal side effects. It is generally recommended to take prednisone with food to minimize these side effects.

B- "Take before bedtime": This is incorrect as there is no specific timing requirement for taking prednisone before bedtime. The timing of prednisone administration should be based on the individual's needs and the instructions provided by the healthcare provider.

C- "Take only as needed": This is incorrect because prednisone is typically prescribed with specific dosing instructions. It is important for the client to follow the prescribed dosing schedule and not take it "as needed" unless instructed otherwise by the healthcare provider.