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.

Answer and Explanation

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.

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Correct Answer is A

Explanation

A. Pulmonary tuberculosis. This is correct because tuberculosis is a highly contagious airborne disease that must be reported to the health department for tracking, treatment, and public health intervention.
B. Fibromyalgia syndrome. This is incorrect because fibromyalgia is a chronic pain condition that is not infectious and does not require mandatory reporting.
C. Herpes simplex virus. This is incorrect because herpes simplex, though contagious, is not a reportable disease.
D. Methicillin-resistant Staphylococcus aureus. This is incorrect because MRSA infections are not universally required to be reported, though some states may have specific regulations for outbreaks in healthcare settings.

A. Lubricate the catheter with water-soluble gel. B. Attach a prefilled syringe to the catheter inflation hub. C. Cleanse the client's meatus with antiseptic solution. D. Position the sterile drape leaving the perineum exposed.

Correct Answer is D

Explanation

A. Lubricating the catheter with water-soluble gel is important but is done after preparing the sterile field.
B. Attaching a prefilled syringe to the catheter inflation hub is performed after insertion to secure the catheter, not before.
C. Cleansing the client’s meatus with antiseptic solution is essential for infection prevention but is done after the sterile field is set up.
D. Positioning the sterile drape while leaving the perineum exposed is the first step because it maintains a sterile field and provides a clean working area for catheter insertion. This prevents contamination and reduces the risk of infection.

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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?

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