A nurse is caring for a client who has Parkinson's disease and is starting to display bradykinesi

- Child abuse is the intentional or neglectful physical, emotional, or sexual harm or injury of a child by a parent, caregiver, or another person who has a relationship of trust or responsibility with the child. Child abuse can have serious and long-lasting consequences for the child's health, development, and well-being.

- The practical nurse (PN) has a legal and ethical duty to identify, report, and prevent child abuse. The PN should be alert for any signs and symptoms of child abuse, such as unexplained or inconsistent injuries, bruises, burns, fractures, or scars; behavioural changes, such as fear, anxiety, aggression, withdrawal, or depression; poor hygiene, nutrition, or growth; lack of supervision, medical care, or education; or sexualized behaviours or knowledge.

- The PN should also conduct a thorough and sensitive assessment of the child and the family situation, using open-ended questions, active listening, and a non-judgmental attitude. The PN should compare the history and physical findings of the child with the expected developmental milestones and normal variations for the child's age and stage. The PN should also document any relevant information in an objective and factual manner.

- When the mother of a school-aged boy tells the PN that he fell out of a tree and hurt his arm and shoulder, the PN should assess the child's injury and compare it with the mother's explanation. The most significant indicator of possible child abuse in this scenario is if the injury description by the mother varies from the child's version. This may suggest that the mother is lying or covering up the true cause of the injury, which may be intentional or accidental harm by herself or someone else. A discrepancy between the mother's and the child's stories may also indicate that the child is afraid or coerced to hide the truth about the abuse.

- Therefore, option D is the correct answer, while options A, B, and C are incorrect.

- Option A is incorrect because the child looking at the floor when answering the nurse's questions may not be a sign of abuse, but rather a sign of shyness, embarrassment, pain, or discomfort.

Option B is incorrect because the mother describing in detail what she did for her injured child may not be a sign of abuse, but rather a sign of concern, care, or guilt.

Option C is incorrect because the abrasions on the child's arms, legs, and chest having healed may not be a sign of abuse, but rather a sign of normal wound healing or previous accidents.

Choice A reason: Advances in surgical techniques and procedures have improved the quality of life and survival rates for many patients, but they are not the main factor for the increase in life expectancy in the twentieth century.

Choice B reason: Sanitation and other public health activities, such as vaccination, safe water supply, sewage disposal, and food safety, have reduced the incidence and mortality of infectious diseases, which were the leading causes of death in the past. These activities have had a significant impact on increasing life expectancy in the twentieth century.

Choice C reason: Technology increases in the field of medical laboratory research have enabled better diagnosis and treatment of diseases, but they are not the primary reason for the increase in life expectancy in the twentieth century.

Choice D reason: Use of antibiotics to fight infections has saved many lives and prevented complications from bacterial diseases, but they are not the most important factor for the increase in life expectancy in the twentieth century. Moreover, antibiotics were not widely available until after World War II, which means they did not contribute much to the increase in life expectancy before that perioD.