A nurse in an emergency department (ED) is assessing a preschooler who has a fractured arm. For which of the following should the nurse further investigate as a warning sign of child maltreatment?
The guardian wants to accompany the child from the ED to the radiology department.
The guardian states the child fell off the swing in the backyard.
The child was brought to the ED 2 days after the injury occurred.
The child cries loudly when their arm is moved or manipulated.
The Correct Answer is C
A. The guardian wants to accompany the child from the ED to the radiology department. This is a typical parental response and does not indicate maltreatment. Parents often want to stay with their child for reassurance.
B. The guardian states the child fell off the swing in the backyard. This is a plausible explanation for an injury in a preschooler, though the consistency of the story with the injury should still be assessed.
C. The child was brought to the ED 2 days after the injury occurred. A delay in seeking medical care for a significant injury is a potential warning sign of child maltreatment and warrants further investigation.
D. The child cries loudly when their arm is moved or manipulated. Pain with movement is expected with a fracture and does not indicate maltreatment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. A bluish-white colored pupil. This is correct because cataracts cause clouding of the lens, leading to a grayish or bluish-white appearance of the pupil. This opacity gradually impairs vision.
B. Decrease in peripheral vision. This is incorrect because a loss of peripheral vision is characteristic of glaucoma, not cataracts.
C. Increased intraocular pressure. This is incorrect because increased intraocular pressure is a hallmark of glaucoma, not cataracts.
D. Loss of central vision. This is incorrect because central vision loss is associated with macular degeneration rather than cataracts.
Correct Answer is B
Explanation
A. Protective environment. This is incorrect because a protective environment is used for immunocompromised clients, not for those with bacterial meningitis.
B. Droplet. This is correct because bacterial meningitis is transmitted through respiratory secretions. Droplet precautions, including wearing a mask when within 3 to 6 feet of the client, are necessary to prevent the spread of infection.
C. Contact. This is incorrect because bacterial meningitis is not primarily transmitted through direct contact with surfaces or bodily fluids, making contact precautions unnecessary.
D. Airborne. This is incorrect because bacterial meningitis does not spread through airborne particles that remain suspended in the air, so airborne precautions are not required.
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