A nurse in a well-child clinic is collecting data from four clients. Which of the following findings should the nurse report to the provider as a potential indication of child maltreatment?
A 34-month-old child who has several small bruises on the shins.
A 6-year-old child who has a fracture of the arm from a bicycle injury.
A 15-month-old child who bites other children while at daycare.
A 4-year-old child who has a history of frequent urinary tract infections.
The Correct Answer is D
A history of frequent urinary tract infections (UTIs) is a sign of child maltreatment. It may indicate sexual abuse, which can introduce bacteria into the urinary tract. Sexual abuse may also cause genital or anal trauma, sexually transmitted infections, or pregnancy1. UTIs are uncommon in children, especially in boys. The normal frequency of UTIs in children is around 1 in 10 girls and 1 in 30 boys by the age of 16 years
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Related Questions
Correct Answer is A
Explanation
Choice A rationale:
The nurse should report the finding of a 6-month-old infant with a spiral fracture to a lower extremity to local authorities. Spiral fractures in infants, especially those who are not yet independently mobile, raise concerns about possible child abuse or non-accidental trauma. The unique pattern of spiral fractures is often associated with twisting forces, which are unlikely to occur accidentally in infants who cannot perform such movements. Reporting such cases is essential to ensure the safety and well-being of the child.
Choice B rationale:
A 9-month-old infant exposed to bedbugs and cellulitis is not an emergency that requires reporting to local authorities. While cellulitis can be serious, it is not an immediate threat to the child's safety, and the focus should be on providing appropriate medical care.
Choice C rationale:
A 4-year-old preschooler with rivalry among siblings does not indicate a need for reporting to local authorities. Sibling rivalry is a common occurrence in families and does not pose a threat to the child's safety. It is a social and developmental issue that can be addressed within the family.
Choice D rationale:
A 24-month-old toddler experiencing occasional incontinence does not require reporting to local authorities. Occasional incontinence can be a normal part of toddler development as they learn to control their bladder. It does not indicate abuse or immediate danger to the child.
Correct Answer is A
Explanation
Choice A rationale:
A positive leukocyte esterase test indicates the presence of white blood cells (leukocytes) in the urine, which can be an indicator of a urinary tract infection (UTI). White blood cells are part of the body's immune response and their presence in the urine suggests inflammation and infection in the urinary tract.
Choice B rationale:
Deep gold-colored urine is not typically associated with a urinary tract infection. Normally, urine color can vary based on hydration, diet, and other factors, but color alone is not a reliable indicator of a UTI.
Choice C rationale:
The osmolality of 700 mOsm/L is not a specific finding related to urinary tract infections. Osmolality measures the concentration of particles in the urine and can vary based on hydration status. While it might be elevated in a concentrated urine sample, it is not a direct indicator of a UTI.
Choice D rationale:
A specific gravity of 1.015 is within the normal range and does not necessarily indicate a urinary tract infection. Specific gravity measures the concentration of solutes in the urine and can be influenced by hydration levels and kidney function. A UTI would primarily be indicated by the presence of white blood cells and other signs of infection in the urine.
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