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Several children come to the Emergency Department for treatment. The situation that would cause the nurse to have the highest suspicion of child abuse would be:

Several visits of the same child with varied injuries.

A 5-year-old child who broke his arm and clings to mother crying.

A 1-year-old child who has a dislocated shoulder from arm swinging.

Repeated visits of the same child with middle ear infections.

Answer and Explanation

The Correct Answer is A

a. Several visits of the same child with varied injuries.

Explanation of Choices

Choice A Reason: Several Visits of the Same Child with Varied Injuries

This scenario raises the highest suspicion of child abuse. Multiple visits with different injuries can indicate a pattern of harm rather than isolated accidents. Healthcare providers are trained to recognize that varied injuries over time, especially in different stages of healing, can be a red flag for abuse. This pattern suggests that the child may be experiencing ongoing harm rather than a single incident. The nurse should conduct a thorough assessment and consider involving child protective services to ensure the child’s safety.

Choice B Reason: A 5-Year-Old Child Who Broke His Arm and Clings to Mother Crying

While a broken arm in a child can be concerning, it is not uncommon for children to sustain such injuries during play or accidents. The child’s emotional response of clinging to the mother and crying is also typical for a young child in pain and distress. This scenario alone does not strongly indicate abuse without additional context or evidence. However, the nurse should still assess the situation carefully and consider any other signs or patterns that might suggest abuse.

Choice C Reason: A 1-Year-Old Child Who Has a Dislocated Shoulder from Arm Swinging

A dislocated shoulder in a 1-year-old is unusual and can be concerning. While it could result from an accident, such as arm swinging, it is also a potential sign of abuse, especially if the explanation does not match the injury. The nurse should investigate further, considering the child’s medical history and any other signs of potential abuse. However, this scenario alone does not provide as strong an indication of abuse as multiple varied injuries.

Choice D Reason: Repeated Visits of the Same Child with Middle Ear Infections

Repeated visits for middle ear infections are common in young children and are typically related to medical issues rather than abuse. Middle ear infections can occur frequently in children due to their anatomy and immune system development. This scenario does not raise immediate concerns about abuse unless there are other signs or patterns of harm. The nurse should focus on providing appropriate medical care and monitoring the child’s health.

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Correct Answer is ["A","B","C","E"]

Explanation

The correct answer is

a. Amenorrhea

b. Dental erosion

c. Dry oral mucosa

e. Presence of lanugo

Choice A Reason:

Amenorrhea is the absence of menstruation. It is a common finding in individuals with bulimia nervosa due to hormonal imbalances caused by malnutrition and extreme weight loss. The body’s reproductive system can be significantly affected by the lack of essential nutrients, leading to disruptions in the menstrual cycle. Additionally, the stress and anxiety associated with bulimia can further contribute to amenorrhea. In clinical practice, amenorrhea is often used as an indicator of the severity of an eating disorder and the need for medical intervention.

Choice B Reason:

Dental erosion is another expected finding in clients with bulimia nervosa. Frequent self-induced vomiting exposes the teeth to stomach acid, which can erode the enamel and lead to significant dental problems. Over time, this acid exposure can cause the teeth to become sensitive, discolored, and more prone to cavities and decay. Dental erosion is often one of the first physical signs that healthcare providers notice in individuals with bulimia, and it can serve as a critical clue in diagnosing the disorder. Regular dental check-ups and proper oral hygiene are essential for managing this condition.

Choice C Reason:

Dry oral mucosa is a common symptom in individuals with bulimia nervosa. The frequent vomiting and dehydration associated with the disorder can lead to a dry mouth. Additionally, the use of diuretics and laxatives, which are sometimes abused by individuals with bulimia, can further contribute to dehydration and dry oral mucosa. This condition can cause discomfort, difficulty swallowing, and an increased risk of oral infections. Proper hydration and oral care are crucial for managing dry oral mucosa in clients with bulimia nervosa.

Choice D Reason:

Icteric sclera refers to the yellowing of the whites of the eyes, typically associated with liver dysfunction or jaundice. This is not a common finding in individuals with bulimia nervosa and is not directly related to the disorder. While bulimia can have various physical effects on the body, icteric sclera is not one of the expected findings. If a client with bulimia presents with icteric sclera, it would warrant further investigation to determine the underlying cause, which may be unrelated to the eating disorder.

Choice E Reason:

Presence of lanugo is the growth of fine, soft hair on the body, which is a common finding in individuals with eating disorders, including bulimia nervosa. Lanugo develops as the body’s response to extreme weight loss and malnutrition, as it attempts to conserve heat and energy. This fine hair can appear on the face, arms, and other areas of the body. The presence of lanugo is a sign of severe malnutrition and indicates the need for immediate medical intervention to address the underlying eating disorder and restore proper nutrition.

A. Childhood depression B. Oppositional Defiant Disorder C. Conduct Disorder D. Autism Spectrum Disorder

Correct Answer is C

Explanation

Choice A Reason: Childhood Depression

Childhood depression is characterized by persistent sadness, irritability, and a lack of interest in activities. While it can lead to behavioral issues, it does not typically include the aggressive and antisocial behaviors described in the scenario. The symptoms of childhood depression include changes in sleep patterns, appetite, and energy levels, but these do not align with the client’s history of running away and abusive behavior towards parents.

Choice B Reason: Oppositional Defiant Disorder (ODD)

ODD is marked by a pattern of angry, irritable mood, argumentative, defiant behavior, or vindictiveness. While children with ODD may be defiant and hostile towards authority figures, the behaviors described in the scenario, such as running away and engaging in illegal activities like prostitution, are more severe and align more closely with Conduct Disorder. ODD does not typically involve the violation of societal norms to the extent seen in this case.

Choice C Reason: Conduct Disorder

Conduct Disorder is characterized by a repetitive and persistent pattern of behavior that violates the rights of others or major age-appropriate societal norms or rules. This includes aggressive behavior towards people and animals, destruction of property, deceitfulness or theft, and serious violations of rules. The client’s history of running away, abusive behavior towards parents, and involvement in illegal activities like prostitution strongly suggests Conduct Disorder. This diagnosis is supported by the presence of multiple behavioral issues that are severe and pervasive.

Choice D Reason: Autism Spectrum Disorder (ASD)

ASD is a developmental disorder that affects communication and behavior. Individuals with ASD may have difficulty with social interactions, exhibit repetitive behaviors, and have restricted interests. While ASD can sometimes be associated with challenging behaviors, it does not typically include the antisocial and aggressive behaviors described in the scenario. The client’s history of running away and abusive behavior is not characteristic of ASD.

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Several children come to the Emergency Department for treatment. The situation that would cause the nurse to have the highest suspicion of child abuse would be:

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a 22-year-old female client who has bulimia nervosa and frequently self-induces vomiting. Which of the following findings should the nurse expect? (SELECT ALL THAT APPLY)

Correct Answer is ["A","B","C","E"]

Explanation

A fifteen-year-old was referred to the adolescent mental health clinic after being arrested for prostitution. The client’s parents reported that they have run away several times and are abusive towards them. The nurse should anticipate that the diagnosis will be:

Correct Answer is C

Explanation

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