Several children are seen in the ER for treatment of illnesses and injuries daily. The situation that would cause the nurse to have a high suspicion of child abuse would be:
a 1-year-old child who has a dislocated shoulder from arm swinging.
several visits of the same child with varied injuries.
a 5-year-old child who broke his arm and clings to mother crying
repeated visits of the same child with middle ear infections.
The Correct Answer is B
B. Multiple visits of the same child with different injuries could be a significant red flag for possible child abuse. Patterns of repeated injuries or injuries inconsistent with the child's developmental stage or reported activities may indicate a pattern of maltreatment.
A. While accidental injuries can occur, a dislocated shoulder in a 1-year-old child from arm swinging seems unlikely and may warrant further investigation.
C. Breaking a bone, such as an arm, can occur accidentally during childhood play or activities and the behavior of the child clinging to the mother is expected in moments of pain.
D. Middle ear infections are common in childhood and typically do not raise suspicion of abuse on their own.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
D. This response is consistent with the characteristics of antisocial personality disorder, which include a lack of remorse, as well as a tendency to rationalize behavior or blame others. Individuals with this disorder often fail to accept responsibility for their actions and may exhibit behaviors that are impulsive, reckless, and violate the rights of others without feeling guilty.
A. Individuals with antisocial personality disorder often lack remorse or empathy for the consequences of their actions and may not experience feelings of shame or guilt, even when their behavior results in harm to others.
B. Expressing genuine remorse or empathy for the harm caused to others is uncommon in individuals with antisocial personality disorder.
C. Claiming to have no memory of the behavior or the events leading up to it is a common defense mechanism used. This may serve to avoid accountability or responsibility for their actions, rather than indicating genuine memory impairment. However, it is not characteristic for antisocial personality disorder.

Correct Answer is D
Explanation
D. This behavior suggests the possibility of suicidal ideation, which is a medical emergency in mental health care. The nurse should assess the client for suicidal thoughts, intentions, and plans, and provide a safe environment to prevent self-harm. It's crucial to address this as a priority to ensure the safety and well- being of the client.
A. Withdrawing from social interactions can be a symptom of depression. However, it may not always be the highest priority intervention
B. This behavior suggests agitation and potential delusional thinking, which can be indicative of a severe depressive episode or a mixed state in bipolar disorder. This however, does not indicate the need for immediate intervention.
C. Non-adherence to prescribed medication, particularly mood stabilizers, can significantly impact the management of bipolar disorder and increase the risk of mood destabilization. However, addressing adherence is not the priority intervention.
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