A nurse in an urgent care clinic is collecting data from a group of clients. Which of the following findings should alert the nurse to the possibility of child maltreatment?
A 6-year-old child who is toilet trained and bedwetting
An 8-month-old infant who has stranger anxiety
An 18-month-old child who has several bruises on their shins
A 2-year-old child who kicks and screams when their parent leaves
The Correct Answer is A
A. Bedwetting in a toilet-trained child can be a sign of emotional distress or trauma, which may indicate maltreatment and should be further investigated.
B. Stranger anxiety is a normal developmental stage for an 8-month-old infant and does not suggest maltreatment.
C. Bruises on the shins of an 18-month-old child are common due to normal toddler activity and do not necessarily indicate maltreatment.
D. Separation anxiety, including kicking and screaming when a parent leaves, is typical behavior for a 2-year-old child and does not suggest maltreatment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Many states allow minors to consent to contraceptive services without parental consent.
B. Many states allow minors to consent to prenatal care without parental consent.
C. A biopsy is a medical procedure that typically requires parental consent for minors.
D. Many states allow minors to consent to testing and treatment for STIs without parental consent.
Correct Answer is C
Explanation
A. Nasal discharge negative for glucose indicates that there is no cerebrospinal fluid (CSF) leakage, which is a positive sign. While it is important to note, it is not the priority in this situation.
B. A negative Babinski reflex is a normal finding in children older than 2 years. It does not indicate an acute issue and is not the priority.
C. Asymmetric pupils can be a sign of increased intracranial pressure or a serious brain injury, making this the priority finding. It requires immediate attention to prevent further complications.
D. A 2 cm scalp laceration, while needing medical attention, is not life-threatening and is not the highest priority compared to potential brain injury indicated by asymmetric pupils.
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