NB Practice Questions - Behavioral/Psychosocial

Max is a 6 year old admitted with abdominal pain. While assess Max, the nurse notes multiple bite marks to Max's legs and arms. The intercanine distance is measured to be 5cm. Which of the following is most likely true? A. An adult has been biting Max B. A younger sibling has been biting Max. C. An animal such as a large dog has been biting Max D. Max has been biting himself.

A - Bite marks that are measured to have an intercanine distance greater than 3cm indicates an adult bite.

Which of the following is the most common cause of child abuse related death? A. Head trauma B. Lung injuries secondary to rib fractures C. Abdominal trauma D. Thoracic trauma

A - Head trauma is the most common cause of child abuse related deaths.

Which of the following is true concerning sexual abuse? A. The perpetrator is usually a trusted adult B. The perpetrator is usually a teacher or child care worker C. The perpetrator is usually a complete stranger D. The perpetrator usually knows the child by means of stalking. The child usually does not know the perpetrator.

A - In most cases of sexual abuse, the perpetrator is known and trusted by the child.

When interacting with a parent of a child with Munchasen syndrome by proxy, the nurse would expect the parent to be: A. Loving and over-protective. B. Suspicious of all staff. C. Indifferent toward the child and staff. D. Defensive toward the staff.

A - Parents, typically the mother, tend to appear loving and over-protective of their child.

Simon is an infant with multiple bruises to all his extremities. While he is being evaluated for abuse which of the following tests is essential to rule out abuse? A. CT scan B. CBC C. MRI D. Electrolyte panel

B - A CBC can show abnormalities that would indicate coagulopathies.

Brittany has been admitted to the PICU with abdominal trauma secondary to abuse. Which of the following is characteristic of abdominal trauma caused from abuse? A. Abdominal trauma usually results from missile like injuries and produces massive blood loss. B. Abdominal trauma usually results from blunt injuries and can produce massive blood loss. C. Abdominal trauma usually results from missile like injuries and produces minimal blood loss and umbilical bruising D. Abdominal trauma usually results from blunt injuries and usually produces minimal blood loss.

B - Abdominal trauma usually results from blunt injuries and can produce massive blood loss.

Which of the following children demonstrates neglect? A. A child with cerebral palsy who misses a well child exam B. A 4 year old who consistently does not wear clothing appropriate for the weather C. A 13 year old who comes home alone after school D. A 4 year old who is made kneel in the corner for 90 minutes after spilling a cup of milk.

B - Failure to provide for a child's basic needs such as appropriate clothing constitutes neglect. Although medical neglect exists, missing a well child exam does not necessarily indicate neglect. It is not inappropriate for an adolescent to be alone after school. Forcing a child to kneel for an excessive time constitutes physical abuse, not neglect.

Christopher is being admitted with suspected Munchausen syndrome by proxy. Which of the following is an essential test for Christopher? A. CBC and electrolytes B. Toxicology panel C. CT scan D. Full body scan to detect fractures

B - It is essential to identify any poisons or toxins that have been administered prior to admission.

Which of the following is the most common type of child maltreatment? A. Physical B. Neglect C. Sexual D. Emotional

B - Neglect is the most common form of child maltreatment accounting for more than 60% of reported cases.

Kennedy is a 3 month old infant with a history of "not acting right". Her mother states that he has been feeding poorly and is very irritable. She also describes an episode of "shaking" earlier in the day. On further exam, retinal hemorrhages are noted. A subdural hematoma is noted on CT scan. When approached with these findings, Kennedy's mother becomes very tearful and states that she really fell from the changing table. Which of the following is Kennedy's likely diagnosis? A. TBI secondary to a fall B. Acute seizure, likely secondary to a fall C. Shaken baby syndrome D. Acute seizure secondary to hydrocephalus.

C - A child that presents with signs of irritability and poor feeding, retinal hemorrhages, and a head injury has likely experienced shaken baby syndrome

Morgan is a 6 year old who states that her mom's boyfriend "hurt her". It is suspected that Morgan was raped and evidence is needed to convict him. All of the following could be used to help Morgan with a pelvic exam except: A. Have Morgan express her concerns through puppets and drawings B. Administer conscious or deep sedation if necessary C. Gently restrain her hands and assign someone to distract her while doing the pelvic exam D. Reassure Morgan that she did nothing wrong.

C - A child who has been sexually abused should never be restrained or forced to comply with a pelvic exam. Puppets and drawings can assist a child to express and cope with concerns. In order to perform the pelvic exam, sedation, and anesthesia may be required. It is essential to reassure the child that she did not do anything wrong.

Which of the following is true of bruises associated with abuse? A. They tend to be small and non-specific. B. Exact dates can be determined by the coloring of the bruises. C. They tend to be in various stages of healing. D. They tend to be on extensor surfaces.

C - Bruises that are in various stages of healing are often associated with abuse. Small, nonspecific bruises that are located on extensor surfaces are often associated with accidental injuries. Although dates can be estimated from the coloring of bruises, more can be learned from the patterns of bruises.

Lucy is a 3 year old with a burn injury. Which of the following is not usually associated with accidental burns? A. A burn to only 1 extremity B. Splash marks extending up the entire extremity C. A lack of a crisp line of demarcation D. Glove-like burn distribution

D - A glove-like burn distribution likely indicates a non-accidental burn where a child's extremity was immersed in scalding water. A bur to one extremity, with splash marks and a lack of clear demarcation more likely indicates an accidental burn.

Which of the following is true? A. Health care professional are mandated to report only known abuse B. Litigations can be made against a reporter if the abuse investigation does not reveal any evidence. C. Only healthcare professionals are required to report suspected abuse. D. Fines and imprisonment can occur if child abuse is not reported when it is known to be occurring.

D - If known child abuse is not reported, fine and imprisonment can result. Healthcare professionals are mandated to report even suspected child maltreatment. If reports are made in good faith, the reporter is no subject to litigation even when false reports are made. In addition to healthcare professionals, those who have frequent contact with children such as teachers and child care workers are also mandated reporters.

Tamara is a 2 year old being investigated for suspected child abuse. The nurse would expect all of the following except: A. When admitted for seizures, a fracture was found. B. Tamara's mom states that Tamara is a clumsy child and is always hurting herself C. Tamara is a twin D. Tamara's mother is in her late thirties and works full time.

D - Younger maternal age and unemployment are considered to be risk factors for abuse. Discovering unknown, unexplained injuries and blaming the child can indicate maltreatment. Multiples are at higher risk for abuse.