The mother of an 8-year-old boy tells the practical nurse (PN) that he fell out of a tree and hurt his arm and shoulder. Which assessment finding should the PN note as the most significant indicator of possible child abuse?
The mother refuses to answer questions about family history.
The child has several abrasions on the chest and legs.
The child looks at the floor when answering the nurse's questions.
The mother's version of the injury is different from the child's version.
The Correct Answer is D
In cases of suspected child abuse, inconsistencies or discrepancies between the child's account of the injury and the caregiver's version are concerning. It raises questions about the credibility of the explanation provided by the caregiver and suggests a possible attempt to conceal the true cause of the injury. Such discrepancies may indicate that the injury was intentionally inflicted or that the child is being coerced or influenced to provide a false account.
While the other assessment findings may raise some level of concern, they are not as significant as the discrepancy between the child's and mother's versions of the injury:
A. "The mother refuses to answer questions about family history." While this behavior may raise some suspicion or cause for further investigation, it alone does not conclusively indicate child abuse. It may be related to other factors such as privacy concerns or cultural differences.
B. "The child has several abrasions on the chest and legs." While the presence of abrasions can be concerning, they alone do not provide sufficient evidence of child abuse. Children are prone to injuries and can obtain abrasions during normal play and activities.
C. "The child looks at the floor when answering the nurse's questions." This behavior may suggest shyness, anxiety, or discomfort, but it is not a definitive indicator of child abuse. Some children may exhibit such behaviors due to their personality or other factors unrelated to abuse. It is important to consider the child's overall behavior and communication patterns in conjunction with other assessment findings.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["591.4"]
Explanation
To calculate the total intake in milliliters (mL), we need to convert the given measurements from ounces to milliliters and then sum them up.
1 ounce (oz) is approximately equal to 29.57 milliliters (mL).
Given intake: 4 ounces apple juice = 4 oz * 29.57 mL/oz = 118.28 mL 8 ounces milk = 8 oz *
29.57 mL/oz = 236.56 mL 4 ounces broth = 4 oz * 29.57 mL/oz = 118.28 mL 4 ounces tea = 4 oz
* 29.57 mL/oz = 118.28 mL
Total intake = 118.28 mL + 236.56 mL + 118.28 mL + 118.28 mL = 591.4 mL
Correct Answer is A
Explanation
The prescription for Ampicillin 500 mg PO q8h means that the client should take 500 mg of Ampicillin orally every 8 hours. "PO" stands for "by mouth," indicating that the medication should be taken orally. The medication is prescribed at 1000, and the next dose is due at 1300 (1:00 PM).
The other options are as follows:
B. Lisinopril 5 mg PO every day: This medication is prescribed to be taken once a day, not every 8 hours. It is not due at 1300.
C. Metformin 1000 mg PO BID: This medication is prescribed to be taken twice a day (BID), but it is not due at 1300. The timing for the next dose depends on when the first dose was administered.
D. Pantoprazole 40 mg PO every day: This medication is also prescribed to be taken once a day, not every 8 hours. It is not due at 1300.
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