A client with a compound fracture of the left ankle is being discharged with a below-the-knee cast. Which

instruction should the practical nurse (PN) provide to the client prior to discharge?

- Child abuse is the intentional or neglectful physical, emotional, or sexual harm or injury of a child by a parent, caregiver, or another 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; behavioural changes, such as fear, anxiety, aggression, withdrawal, or depression; poor hygiene, nutrition, or growth; lack of supervision, medical care, or education; or sexualized behaviours 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 a 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.

- Option A is incorrect because the child looking at the floor when answering the nurse's questions may not be a sign of abuse, but rather a sign of shyness, embarrassment, pain, or discomfort.

Option B is incorrect because the mother describing in detail what she did for her injured child may not be a sign of abuse, but rather a sign of concern, care, or guilt.

Option C is incorrect because the abrasions on the child's arms, legs, and chest having healed may not be a sign of abuse, but rather a sign of normal wound healing or previous accidents.

Choice A reason: Providing total assistance with all ADLs is not an appropriate intervention for the client because it can decrease the client's independence and self-esteem, and increase the risk of complications such as pressure ulcers, contractures, and infections. The client should be encouraged to perform as much self-care as possible, with assistance as needeD.

Choice B reason: Ordering a low-residue diet is not an appropriate intervention for the client because it can cause constipation, which can worsen the client's bowel function and quality of lifE. The client should consume a balanced diet that includes adequate fiber, fluids, and nutrients.

Choice C reason: Encouraging the client to void every hour is not an appropriate intervention for the client because it can disrupt the client's normal bladder function and increase the risk of urinary tract infections. The client should follow a regular bladder training program that involves voiding at scheduled intervals, using pelvic floor exercises, and managing fluid intakE.

Choice D reason: Instructing the client on daily muscle stretching is an appropriate intervention for the client because it can improve the client's mobility, flexibility, and range of motion, as well as prevent muscle spasticity, stiffness, and pain. The client should perform gentle stretching exercises under the guidance of a physical therapist or nursE.