Nokea
Several children are seen in the emergency department for treatment of illnesses and injuries. Which finding would create a high index of suspicion for child abuse?
- A. Repeated middle ear infections
- B. Severe colic
- C. Bite marks
- D. Croup
Correct Answer: C
Rationale: Injuries such as immersion or cigarette burns, facial fractures, whiplash, bite marks, traumatic injuries, bruises, and fractures in various stages of healing suggest the possibility of abuse. In older children, vague complaints such as back pain may also be suspicious. Ear infections, colic, and croup are not problems induced by violence.
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What feelings are most commonly experienced by nurses working with abusive families?
- A. Outrage toward the victim and sympathy for the abuser
- B. Sympathy for the victim and anger toward the abuser
- C. Unconcern for the victim and dislike for the abuser
- D. Vulnerability for self and empathy with the abuser
Correct Answer: B
Rationale: Intense protective feelings, sympathy for the victim, and anger and outrage toward the abuser are common emotions of a nurse working with an abusive family.
A victim of physical abuse by an intimate partner is treated for a broken wrist. The patient has considered leaving but says, 'You stay together, no matter what happens.' Which outcome should be met before the patient leaves the emergency department? The patient will:
- A. limit contact with the abuser by obtaining a restraining (protective) order.
- B. name two community resources that can be contacted.
- C. demonstrate insight into the abusive relationship.
- D. facilitate counseling for the abuser.
Correct Answer: B
Rationale: The only outcome indicator clearly attainable within this time is for a staff member to provide the victim with information about community resources that can be contacted. The development of insight into the abusive relationship requires time. Securing a restraining (protective) order can be quickly accomplished but not while the patient is in the emergency department. Facilitating the abuser's counseling may require weeks or months.
What is a nurse's legal responsibility if child abuse or neglect is suspected?
- A. Discuss the findings with the child's teacher, principal, and school psychologist.
- B. Report the suspected abuse or neglect according to state regulations.
- C. Document the observations and speculations in the medical record.
- D. Continue the assessment.
Correct Answer: B
Rationale: Each state has specific regulations for reporting child abuse that must be observed. The nurse is usually a mandated reporter. The reporter does not need to be sure that abuse or neglect has occurred but only that it is suspected. Speculation should not be documented; only the facts are recorded.
An older adult diagnosed with dementia lives with family and attends day care. After observing poor hygiene, the nurse at the center talks with the patient's adult child. This caregiver becomes defensive and says, 'It takes all my time and energy to care for my mother. She's awake all night. I never get any sleep.' Which nursing intervention has priority?
- A. Teach the caregiver more about the effects of dementia.
- B. Secure additional resources for the mother's evening and night care.
- C. Support the caregiver to grieve the loss of the mother's ability to function.
- D. Teach the family how to give physical care more effectively and efficiently.
Correct Answer: B
Rationale: The patient's child and family were coping with care until the patient began to stay awake at night. The family needs assistance with evening and night care to resume their pre-crisis state of functioning. Secondary prevention calls for the nurse to mobilize community resources to relieve overwhelming stress. The other interventions may then be accomplished.
An 11-year-old child is absent from school to care for siblings while the parents work. The family cannot afford a babysitter. When asked about the parents, the child reluctantly says, 'My parents don't like me. They call me stupid and say I never do anything right.' Which type of abuse is likely?
- A. Sexual
- B. Physical
- C. Emotional
- D. Economic
Correct Answer: C
Rationale: Examples of emotional abuse include having an adult demean a child's worth or frequently criticize or belittle a child. No data support physical battering or endangerment, sexual abuse, or economic abuse.