A nurse in the ED suspects physical abuse when assessing a child's injury. Based on
that suspicion, which of the following is the nurse's most important legal responsibility?
A: Helping the family to identify sources of support
B: Reporting a case in which abuse is suspected to the local authorities
C: Providing detailed and accurate documentation of the child's physical assessment
findings
D: Refer the family to the hospital support group - ANSWER B: Report the case in which
the abuse is suspected to the local authorities
Nursing care of a child in the hospital with suspected abuse should include:
A: Assign a variety of nurses to the child so that he can get to know and trust the whole
staff
B: Praise the child's ability to minimize feelings of shame and guilt
C: Do not present the child as a victim of "abuse" but as one with a defined problem so
as to enhance self-esteem and reduce feelings of guilt.
D: Talk and question whenever possible showing interest to get to know him/her better -
ANSWER C: Do not present the child as a victim of "abuse" but as one with a defined
problem so as to enhance self-esteem and reduce feelings of guilt.
One of the most common causes of injury and death for a 7-month-old infant related to
which the parents should be enlightened?
1. Poisoning.
2. Child abuse
3. Aspiration.
4. Dog bites ANSWER 3. Aspiration.
,While working in the ED, a child presents for suspected child abuse. While trying to elicit
information, which approach is appropriate for the nurse to use?
1. The nurse should pledge the child that her parents will not know what she tells the
nurse.
2. If possible, reassure the child she won't have to see the suspected abuser again.
3. Always use correct anatomical terms for all body parts.
4. Reinforce for the child that the abuse was not her fault and she is a good person. -
ANSWER 4. Reinforce for the child that the abuse was not her fault and she is a good
person.
A 3-year-old boy is brought to the hospital following a fall down the stairs. His mother is
tearful and sates, "This is all my fault." The nurse responds best by stating:
1. "Accidents happen. You shouldn't blame yourself."
2. "Falls are one of the most common injuries in this age group."
3. "It may be a good idea to put a baby gate on the stairs."
4. "Your son should be proficient at walking down the stairs by now." - ANSWER 2. "Falls
are one of the most common injuries in this age group."
What is the most critical evaluation post any injury in a child?
1. History of loss of consciousness and length of time unconscious.
2. Serial assessments of level of consciousness.
3. Initial neurological assessment.
4. Initial vital signs and oxygen saturation level. - ANSWER 2. Serial assessments of level
of consciousness.
Which statement most accurately describes child abuse?
1. Intentional physical abuse and neglect.
,2. Intentional and unintentional physical and emotional abuse and neglect.
3. Sexual abuse of children, usually by an adult.
4. Intentional physical, emotional, and sexual abuse and neglect. - ANSWER 4.
Intentional physical, emotional, and sexual abuse and neglect.
Which of the following is most likely the cause of a child's illness that is unexplained,
prolonged, recurrent, and very rare, occurring when the mother is present?
1. Genetic disorder
2. Munchausen syndrome by proxy
3. Duchenne muscular dystrophy
4. Syndrome of inappropriate antidiuretic hormone. ANSWER 2. Munchausen syndrome
by proxy.
Which of the following statements would be most therapeutic for a child whom the nurse
suspects has been abused?
1. "Who did this to you? This is not right."
2. "This is wrong that your mother didn't protect you."
3. "This is not your fault; you are not to blame for this."
4. "I will not tell anyone." - ANSWER 3. "This is not your fault; you are not to blame for
this."
A 6-month-old infant's mother states that since yesterday, the infant cries when anyone
touches her arm. Once the airway, breathing, and circulation had been assessed and
found stable, which of the following would be the priority assessment?
1. Ask the mother if she knows what happened.
2. Assess infant for other signs of potential physical abuse.
3. Prepare for radiological diagnostic studies.
, 4. Establish intravenous access and draw blood for diagnostic studies. - ANSWER 1. Ask
the mother what happened.
Which of the following assessments of an 18-month-old with burns of the feet would
raise suspicion of child abuse?
1. Splash marks on his right lower leg.
2. Burns noted on right arm.
3. Symmetrical burns on both feet.
4. Burns mainly noted on right foot. - ANSWER 3. Symmetrical burns on both feet.
Which would be the nurse's priority intervention if a 7 year old's mother tells the nurse
she has noticed excessive masturbation?
1. Instruct her it is normal development for children of this age.
2. Ask the mother if anyone is abusing the child
3. Talk with the child and find out why she is touching herself down there.
4. Investigate the circumstances surrounding her masturbation thoroughly. - ANSWER
2. Ask mother if anyone is abusing the child.
Which of the following statements by the mother would raise a suspicion of sexual abuse
in a 4-year-old?
1. "She has just started masturbation."
2. "She has lots more temper tantrums."
3. "She now has an invisible friend."
4. "She wants to spend time with her sister." - ANSWER 2. "She has lots more temper
tantrums."
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