A nurse is conducting a health screening of a school-age child. The nurse should recognize which of the following as a risk factor for child maltreatment?

Rationale for correct choice

• Fall risk: The client experiences sudden episodes of leg weakness, intermittent muscle spasms, and gait changes, all of which significantly increase the risk of falls. Falls in clients with multiple sclerosis can lead to serious injury and further functional decline. Addressing safety and fall prevention is the most immediate priority to prevent harm while other concerns, such as memory or employment, are addressed.

Rationale for incorrect choices

• Memory: Although the client reports struggling to remember things, cognitive issues are not immediately life-threatening. Memory deficits should be addressed through ongoing assessment and cognitive support interventions, but they are not the first priority compared with safety risks.

• Blood pressure: Vital signs are within normal limits, and there is no evidence of hypertensive crisis or acute cardiovascular instability. Blood pressure monitoring remains part of routine care but does not require immediate intervention.

• BMI: The client’s BMI indicates overweight status but does not pose an immediate safety threat. Weight management is important for long-term health but is not the first priority in the context of neurological deficits and fall risk.

• Employment: Reduced work hours due to exacerbation episodes reflect functional limitations and psychosocial impact. Employment concerns are important for quality of life but are secondary to preventing physical injury from falls.

A. High Fowler's: High Fowler’s position can assist with respiratory effort and comfort, but it does not specifically optimize cardiac output in a pregnant client. Upright positioning alone may not relieve pressure from the gravid uterus on major vessels.

B. Left lateral: Placing the client in the left lateral position relieves pressure of the uterus on the inferior vena cava and aorta, enhancing venous return to the heart and improving cardiac output. This position is especially important in clients with cardiac disease to reduce the risk of supine hypotensive syndrome and optimize maternal and fetal circulation.

C. Standing: Standing does not provide support for venous return and can increase the workload on the heart, potentially exacerbating cardiac compromise. It is not recommended for prolonged periods in clients with cardiac disease during pregnancy.

D. Supine: Supine positioning can compress the inferior vena cava and aorta, reducing venous return and cardiac output. This can lead to hypotension and decreased perfusion to both the mother and fetus, making it unsafe for pregnant clients with cardiac disease.