아동학대

Which nursing assessment findings are physical signs of sexual abuse of a female child? (Select all that apply). a. Enuresis b. Red and swollen labia and rectum c. Vaginal tears d. Injuries in different stages of healing e. Lice infestation f. Cigarette burns

A, B, and C are all indications that a female child has been the victim of sexual abuse. Options D, E, and F are signs of physical abuse of a child, not sexual abuse.

The mother of a 4 month-old infant reports that the baby was subdued when she picked him up from the babysitter the previous evening, and his lethargy has worsened over the past eight hours. The triage nurse suspects possible abusive head trauma when observing which other sign or symptom? a. Unequal carotid pulses b. Wheezing c. Vomiting d. Sunken fontanel

c Vomiting Can indicate increased intracranial pressure due to a subdural hematoma that can occur as a result of shaking the infant or blunt force trauma to the head.

Under Pennsylvania's Safe Haven Law, parents can avoid criminal prosecution when abandoning an infant: a. who is up to 28 days old. b. who is up to 90 days old. c. outside a police or fire station. d. only by providing their name and address.

a who is up to 28 days old.

A group of nursing students is learning about family violence. Which of the following is true? a. Family violence affects every socioeconomic level. b. Family violence is caused by drugs and alcohol abuse. c. Family violence predominantly occurs in lower socioeconomic levels. d. Family violence rarely occurs during pregnancy.

a Family violence affects every socioeconomic level. Family violence occurs in all socioeconomic levels, races, religions, and cultural groups. Although violence is associated with substance abuse, it is not the singular cause. The statement that the family violence predominantly occurs in lower socioeconomic levels is false. Abuse often occurs during pregnancy; about 23% of all pregnant women seeking prenatal care are victims of abuse.

The school nurse notices that a 6-year-old female child has a bruise on her right ear and three bruises on her right cheek. The child says that she fell while playing with her brother's skateboard. She has no other bruises or abrasions on her face, palms, or legs. She lives with her mother and her teenage brother. She is an average student and is occasionally disruptive in the classroom. Which factor might lead the nurse to make a mandated report of suspected abuse? a. The pattern of injuries on the patient's body is inconsistent with a fall from a skateboard. b. The patient's injuries were sustained while engaging in an activity that is not developmentally appropriate. c. The patient has displayed occasional disruptive behavior in the classroom. d. The patient was not being supervised at the time of her injury.

a The pattern of injuries on the patient's body is inconsistent with a fall from a skateboard.

During a well-child checkup, a mother tells the nurse about a recent situation in which her child was slapped in the face for not getting her husband breakfast. All of the following factors contribute to this family dysfunction EXCEPT: a. conflictual relationships of parents. b. inconsistent communication patterns. c. rigid, authoritarian roles. d. use of violence to establish control.

a conflictual relationships of parents. There is no evidence in this situation that the parents are in conflict; in fact, the mother is describing that the child "needed to be disciplined." Often, in dysfunctional families, one child is singled out to be the victim and is the recipient of blame for problems. The inconsistent communication pattern is that the child received conflicting messages regarding preparation of food. The rigid authoritarian roles demonstrated by the mother's indicate that the child needs discipline from the father. This is an example of a rigid role expectation of the father as disciplinarian. Also, the father used violence to retain the position of control.

Which of the following types of injuries may be suspicious for child abuse? (Select all that apply). a. Bruises on the ears, neck, feet, buttocks, or torso (torso includes chest, back, abdomen, genitalia). b. Bruises on the front of the body and/or overlying bone. c. Fractures in various stages of healing. d. Retinal hemorrhage or detachment. e. Seeks affection from any adult. f. Immersion burns by scalding water (sock-like, glove-like, doughnut-shaped on buttocks or genitalia; "dunking syndrome").

a, c, d, e, f

Which is a true statement about child sexual abuse? a. Detecting child sexual abuse is a relatively straighforward process b. Victims may develop eating disorders that persist into adulthood. c. Boys are more likely than girls to report being sexually abused. d. The negative effects of child sexual abuse are nearly identical for each person.

b Victims may develop eating disorders that persist into adulthood.

The nurse is assessing a parent who abused her child. Which of the following risk factors would the nurse expect to find in this case? a. Flexible role functioning between parents b. History of the parent having been abused as a child c. Single-parent home situation d. Presence of parental mental illness

b History of the parent having been abused as a child One of the most important risk factors is a history of childhood abuse in the parent who abuses. Family violence follows a multigenerational pattern. Parents who are flexible in their roles are characteristic of healthy functioning, not abuse. Single-parent households and a history of mental illness are not established risk factors for child abuse by a parent.

A community nurse conducts a home-visit assessment for a newborn and mother. The mother has three other children, the oldest of whom is age 12. She tells the nurse that her 12-year-old daughter is expected to prepare family meals, to look after the young children, and to clean the house once a week. Which of the following is the most appropriate nursing diagnosis for this family situation? a. Delayed growth and development, related to performance expectations of child. b. Anxiety (moderate), related to difficulty managing home situation. c. Impaired parenting, related to role reversal of mother and child. d. Social isolation, related to lack of extended family assistance.

c Impaired parenting, related to role reversal of mother and child. The role of a 12-year-old child in a family should not be that of a parent. In this situation, the child and mother have reversed roles. There is no evidence that the child has delayed growth or development, the mother in this situation is not demonstrating signs of anxiety, and there is no evidence in this situation that the family is socially isolated.

9. A mother brings her 2-month-old female baby into the emergency department at 10 p.m. She tells the triage nurse that the baby has been vomiting ever since dinnertime. The nurse notes a bruise on the baby's right temple, and the mother explains that the baby hit her head on the doorframe while being carried earlier that day. Which statement describes an accurate nursing assessment by the triage nurse? a. The history of how the injury occurred is not consistent with a bruise to the temple. b. This type of bruising is normal for a 2-month-old baby. c. An injury to the head of any baby is suspicious for abuse. d. The baby's bruise could be a result of vomiting.

c An injury to the head of any baby is suspicious for abuse.

The nurse knows that the priority nursing intervention for a victim of child abuse is: a. Assess the scope of the abuse problem. b. Analyze family dynamics. c. Implement measures to ensure the victim's safety. d. Teach appropriate coping skills.

c Implement measures to ensure the victim's safety. The priority intervention when a child or elderly person is involved in a situation of abuse is establishing the safety of the victim. Legislation in most states mandates the reporting of such abuse to ensure prompt intervention and safety. The question is asking about implementing a specific nursing action, not assessing the problem or analyzing the family dynamics. Teaching coping skills is important; however, the priority action involves ensuring safety.

During a home visit to a family of three: a mother, a father, and their child, the mother tells the community nurse that the father (who is not present) has hit the child on several occasions when he was drinking. The mother further explains that she has talked her husband into going to Alcoholics Anonymous and asks the nurse not to interfere so her husband won't get angry and refuse treatment. Which of the following is the best response of the nurse? a. The nurse agrees not to interfere if the husband attends an Alcoholics Anonymous meeting that evening. b. The nurse commends the mother's efforts and agrees to let her handle things. c. The nurse commends the mother's efforts and also contacts protective services. d. The nurse confronts the mother's failure to protect the child.

c The nurse commends the mother's efforts and also contacts protective services. The nurse would validate and reinforce the mother's efforts to seek help; however, the nurse must also report the abuse to the appropriate protective services. The priority is to maintain the child's safety. The responses in options 1 and 2 are inappropriate; the nurse is failing to provide for the child's safety and is not following legal guidelines. In option 4, the nurse is alienating the mother, as well as failing to follow legal guidelines and ensure the child's safety.

A 12-year-old child, complains to the school nurse about nausea and dizziness. While assessing the child, the nurse notices a black eye that looks like an injury. This is the third time in 1 month that the child has visited the nurse. Each time, the child provides vague explanations for various injuries. Which of the following is the school nurse's priority intervention? a. Contact the child's parents and ask about the child's injury. b. Encourage the child to be truthful with her. c. Question the teacher about the parent's behavior. d. Report suspicion of abuse to the proper authorities.

d Report suspicion of abuse to the proper authorities. The nurse is obligated to report suspicion of child abuse to the appropriate protective services. Failure to do so can risk further endangerment of the child, and failure to report is a misdemeanor violation on the part of the nurse. The parents will be contacted and an investigation will proceed under the legal authority of the child protective service agency. Although the nurse would expect to establish rapport with the child, encouraging the child to be truthful would send the message that the nurse believes the child is lying; therefore, this intervention would be inappropriate. Questioning the teacher may or may not provide validation of the nurse's suspicions; regardless, this intervention does not ensure the child's safety, which is the priority.

The nurse is observing an 8-year-old girl during a community visit. Which of the following findings would lead the nurse to suspect that the child is a victim of sexual abuse? a. The child is fearful of the caregiver and other adults. b. The child has a lack of peer relationships. c. The child has self-injurious behavior. d. The child has interest in things of a sexual nature.

d The child has interest in things of a sexual nature. An 8-year-old child is in the latency phase of development; in this stage, the child's interest in peers, activities, and school is priority. Interest in sex and things of a sexual nature would occur appropriately during the age of puberty, not at this time. A child who is the victim of sexual abuse, however, may show unusual interest in sex. The assessments in the other answer choices may indicate abuse, but not necessarily sexual abuse.