A nurse is caring for a toddler who has a fractured right femur and is in Bryant traction. When determining that the traction is appropriately assembled, the nurse should observe which of the following?

Choice A reason: Asking the parents what caused the bruises is not the best action, as it may not elicit truthful or accurate information. The parents may be the perpetrators of the abuse, or they may be unaware or in denial of the abuse. The nurse should not confront or accuse the parents without sufficient evidence or support.

Choice B reason: Notifying social services is an important action, but not the first one. The nurse should first gather more information and document the findings before making a report. The nurse should also follow the policies and procedures of the health care facility regarding child abuse reporting.

Choice C reason: Asking the toddler what caused the bruises is the best action, as it may provide valuable clues about the source and nature of the injuries. The nurse should use a gentle and nonjudgmental approach, and ask open-ended questions, such as "How did you get these bruises?" or "Who hurt you?" The nurse should also observe the child's behavior and body language, and reassure the child that they are not in trouble.

Choice D reason: Notifying the provider is a necessary action, but not the first one. The nurse should first assess and interview the child, and document the findings. The nurse should also consult with the provider about the appropriate medical care and follow-up for the child. The provider may also assist the nurse in making a report to social services.

Choice A reason: Changes in the voice signal the beginning of puberty is incorrect, as voice changes usually occur in the middle or late stages of puberty, not the beginning. The first sign of puberty in boys is usually testicular enlargement, followed by pubic hair growth and penile enlargement.

Choice B reason: Growth spurts in height occur toward the end of mid-puberty is correct, as this is the typical pattern of growth for boys during puberty. Boys usually start their growth spurt later than girls, but grow faster and for a longer period of time.

Choice C reason: Puberty might be delayed if scrotal changes have not occurred by the age of 11 years is incorrect, as this is not a definitive indicator of delayed puberty. Puberty can vary widely among individuals, and some boys may start later than others without any underlying problem. Delayed puberty is usually diagnosed if there is no sign of puberty by the age of 14 years.

Choice D reason: Gynecomastia commonly occurs during late puberty is incorrect, as gynecomastia, or the enlargement of breast tissue in males, usually occurs in the early or middle stages of puberty, not the late stage. It is caused by hormonal changes and usually resolves on its own within a few months or years.