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 B
Explanation
A. The sensor should be applied to a site where it can provide accurate readings, but not specifically to the fingernail.
B. Repositioning the probe every 2 hours helps prevent skin irritation and ensures accurate readings.
C. Warming the skin prior to probe placement is not necessary and is not standard practice unless the client has circulatory compromise.
D. Taping the wire to the palm of the hand is not necessary and may cause discomfort or interfere with accurate readings.
Correct Answer is B
Explanation
A. Fiber intake should be maintained or increased to prevent constipation due to immobility.
B. Protective padding at the pin sites helps prevent infection and irritation.
C. Traction weights should never be lifted or removed unless ordered by a physician as it can disrupt alignment.
D. Passive range-of-motion exercises are important but should be performed on the unaffected extremity. Active or passive movement of the affected extremity should be done according to medical orders.
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