A school nurse is assessing a child who has a fever and notices several bite marks on the child's arm. The nurse should submit a referral for suspected child maltreatment based on which of the following additional findings? Select all that apply)

A. Client smiles and nods at the nurse: Smiling and nodding can be polite social gestures that do not necessarily reflect comprehension, especially when the client and nurse do not share a common language. These nonverbal cues might simply indicate that the client is listening or being courteous, rather than fully understanding the teaching content.

B. Client makes eye contact with the nurse frequently: Eye contact varies significantly across cultures; some cultures view direct eye contact as respectful, while others may see it as disrespectful or confrontational. Therefore, frequent eye contact is not a reliable indicator of understanding, especially in cross-cultural communication.

C. Client has no questions for interpreter: The absence of questions could indicate multiple possibilities, such as the client feeling hesitant to speak up, lack of understanding of the information, or cultural norms that discourage questioning authority figures. Silence alone does not confirm comprehension of the teaching.

D. Client points to objects on printed resources when nurse is speaking: Active participation, such as pointing to objects on visual aids or printed materials, shows that the client is processing and connecting the teaching information to tangible items. This behavior demonstrates engagement and comprehension.

A. Neither of the child's parents are financially stable: Chronic financial instability can contribute to elevated stress levels in the household, which may overwhelm coping mechanisms and increase the likelihood of neglect or physical abuse. Limited access to support services and basic needs can further exacerbate family tensions.

B. The child spends the weekends with their grandparents: Regular visits with grandparents are a typical caregiving arrangement and do not, in themselves, suggest risk factors for abuse. This may instead provide additional support and oversight for the child’s well-being.

C. The child's family has an indoor cat that sleeps with the child: Pet ownership and animals sharing space with children are not associated with an increased risk of abuse. This may indicate a nurturing environment, as many families find emotional comfort in pets.

D. One of the child's parents appears frightened of the other parent: Fear in a partner often points to intimate partner violence, which can create an unsafe environment for children. Children in households with domestic abuse are at higher risk for both direct abuse and emotional trauma.

E. One of the child's parents has a history of alcohol use disorder: Alcohol use disorder can impair parenting ability, increase impulsivity and aggression, and reduce the capacity to provide a safe and stable environment. This raises the risk for both neglect and intentional harm toward children.