A nurse in a pediatric unit is assisting with providing care for multiple children. Which of the following physical findings and parental reports should cause the nurse to suspect child maltreatment?
A toddler has a spiral fracture, and the parent reports a fall from a swing.
A preschooler has bruises on the shins, and the parent reports a collision with furniture.
An adolescent has a head injury, and the parent reports a fall from a bike.
A school-age child has a black eye, and the parent reports a fight with a classmate.
The Correct Answer is A
Rationale:
A. Spiral fractures are often associated with child abuse, especially when they occur in non-ambulatory infants or toddlers who can't generate enough force to cause such injuries themselves.
B. Bruises from a collision with furniture can be common in preschoolers, and there's no immediate indication of child maltreatment.
C. Head injuries from falls, especially during adolescence, are common and may not necessarily indicate child maltreatment.
D. While a black eye could be concerning, it's not necessarily indicative of child maltreatment and could be the result of a fight with a classmate.
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Related Questions
Correct Answer is C
Explanation
Rationale:
A) Forcing the child to drink fluids when they have a fever is not recommended; instead, fluids should be offered frequently to prevent dehydration, but the child should not be forced to drink.
B) Using a dehumidifier in the child's room may help control humidity levels, but it is not specific to treating a bacterial upper respiratory infection.
C) Keeping the child's towels separate from those of the rest of the family helps prevent the spread of infection.
D) Ensuring the child eats three meals a day, even with reduced appetite, is important for maintaining adequate nutrition and energy levels during illness.
Correct Answer is C
Explanation
Rationale:
A) Morning stiffness in the joints is a common symptom of juvenile idiopathic arthritis and is expected in this client population. It does not require immediate reporting to the provider.
B) Taking a multivitamin containing iron is generally not concerning and may even be beneficial for clients with arthritis who may have dietary deficiencies. It does not require immediate reporting to the provider.
C) The presence of blood in the stool may indicate gastrointestinal bleeding, a potential adverse effect of long-term ibuprofen use. This symptom should be reported to the provider promptly for further evaluation.
D) Skipping ibuprofen doses occasionally, particularly if the client missed one dose, may not be concerning unless it becomes a pattern of non-compliance. It does not require immediate reporting to the provider, although it should be addressed during routine follow-up.
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