Mental Health: Child Abuse NCLEX questions

You are a program director. A child in your program comes to you complaining about a toothache. You call the mother, who agrees to take the child to a dentist. Several weeks later the child again comes to your office, and this time the tooth is obviously abscessed. You again call the mother who says she could not get a dental appointment. You make an appointment for the next day with a dentist that works with your program and let the mother know when she can take her child for treatment. Three days later the child still has not received treatment, and now is presenting with a fever and severe swelling? Call ChildLine Make a GPS referral Provide community resource recommendations Call the police Take no action

Call ChildLine at (800) 932-0313 Yes. Despite your best efforts, this child is suffering significant pain and health effects due to her parent's failure to get medical attention. You have reason to suspect serious physical neglect. As a mandated reporter of child abuse, you must immediately call ChildLine at (800) 932-0313

A child in your program confides that his neighbor has been touching him inappropriately. You are a mandated reporter of suspected child abuse. Would You Do? Call ChildLine Make a GPS referral Provide community resource recommendations Call the police Take no action

Call ChildLine at (800) 932-0313 Yes. The CPSL now requires mandated reporters to call ChildLine even if the suspected abuser falls outside the CPSL's definition of a perpetrator. Suspected sexual abuse of a child by a person not defined as a perpetrator by the CPSL can also be reported to the police.

You are a school bus driver. While taking students to school you overhear a 16-year-old girl telling a classmate about an incident the previous evening with her father. She says her father was drinking and got so angry with her that he grabbed his hunting rifle and shot at the girl. She brags about her ability to "duck the shot," and run. You let the girl know you heard her, and ask if the story is actually true. She becomes a little more somber and says, "Yes." Would You Do? Call ChildLine Make a GPS referral Provide community resource recommendations Call the police Take no action

Call ChildLine at (800) 932-0313 Yes. The most recent added category of abuse to the Pennsylvania Child Protective Services Law is Imminent Risk, or threatened harm. You have reason to suspect that had the girl not "ducked," she would have been seriously injured. She may not be so lucky next time. As a mandated reporter of child abuse, and in accordance with organizational policy, you must immediately cause a report of suspected child abuse to be made to ChildLine. Report your suspicion to your administrator or the designee.

You are a grade school teacher. An 8-year old girl in your class tells you about how she has been "the mommy" to her little 2-year-old brother each night while her father (who is a single parent) is at work. You ask her if she has a babysitter to help her, and she says, "No." No harm has come to the children. You contact the father at work, and he tells you to "mind your own business."? Call ChildLine Make a GPS referral Provide community resource recommendations Call the police Take no action

Yes, GPS referral. Although there has been no specific harm to the children, you have reason to suspect potential for harm if the situation is allowed to continue. You are not mandated to make a GPS referral, but are encouraged to contact the county Child Protective Services agency.

The administrator has designated you, the school nurse, as the person responsible for reporting cases of suspected child abuse brought to your attention during school hours. A 12 year-old boy comes to your office asking for aspirin. He is wearing an oversized sweater on an unusually warm day. He reluctantly explains that his teammate's father "was angry with him for losing the game, grabbed him by the arm, and threw him into a fence." When the boy's sweater is removed you find several cuts and scrapes, and it appears that his shoulder may have been dislocated? Call ChildLine Make a GPS referral Provide community resource recommendations Call the police Take no action

Yes, There has been a serious injury, which is causing obvious pain and impairment. An adult other than those defined by CPSL has caused the injury, but you would still be obligated to call ChildLine.

You are seriously concerned about two children, ages 5 and 7, who live next to you. The children's clothes are usually dirty and torn. Often, the children only get one full meal a day and that is usually fast food. They otherwise fill up on potato chips, pretzels, and candy, which you know is not a healthy diet for growing children. As a registered nurse, you know you are a mandated reporter of child abuse. Would You Do? Call ChildLine Make a GPS referral Provide community resource recommendations Call the police Take no action

Yes. Although the children's living conditions may not be ideal, the circumstances do not warrant action at this time.

You are a daycare provider. One of your children tells you about the spanking she received from her mother last night. The girl tells you that her mother got very angry when she "talked-back" to her and this is what usually happens when she is "bad." You suspect the child has been maltreated, and following organizational policy, you take her to the administrator. There are no marks on the child and she says she is not in pain? Call ChildLine Make a GPS referral Provide community resource recommendations Call the police Take no action

Yes. Community resources may be available to the family to assist with some anger management and parenting skills development.

You are a school guidance counselor; however, according to school policy the nurse is the designated reporter of child abuse. A 12-year-old girl discloses to you that she was raped by her 14-year-old brother while he was babysitting her and their younger brother. Would You Do? Call ChildLine Make a GPS referral Provide community resource recommendations Call the police Take no action

Yes. Suspicion of sexual abuse by an individual 14 years of age or older who resides in the same home as the child and who is responsible for the welfare of the child should be immediately reported to ChildLine at (800 932-0313. According to school policy you would cause a report to be made by taking the child to the school nurse, who would immediately make the call. Your duties as a mandated reporter are discharged when the nurse accepts your report.

As the school principal, school district policy has designated you as the person responsible for reporting all cases of suspected child abuse presented to you during school hours. The school nurse comes to your office with a 6-year-old girl who has many red dots and small welts on her body. The child explains that there are bugs in her house that bite her, especially at night. The girl appears to be in no pain, and the bites are not infected. The nurse informs you that she had made several previous attempts to address the situation with the girl's mother, who is single and recently lost her job? Call ChildLine Make a GPS referral Provide community resource recommendations Call the police Take no action

Yes. The nature of the child's injuries and her statement lead you to suspect that her mother's failure to act could cause potentially serious harm to the child if the situation is allowed to continue. Although you are not mandated to make a GPS referral, you know that the family could receive needed assistance if Children and Youth Services accept this case for services.

A 15-year-old client who is pregnant and unwed tells the nurse, "My life was unbearable before I met Johnny. My mother beats me up every day, and my dad has been sleeping with me since I was 10 years old!" Which response is appropriate for the nurse to make? 1. "Why didn't you just report your parents for abuse?" 2. "What are you saying? Your parents abused you so you got pregnant?" 3. "Sounds like you decided to have a baby so you'd have someone for yourself." 4. "It seems that you needed help to separate from your family. Do you feel you are ready to have a baby with Johnny?"

4,,Rationale: Adolescent pregnancy outside of marriage can arise from female low self-esteem, fears of inadequacy, and desperation to escape from an abusive and dysfunctional family. The most therapeutic communication technique is the one that uses restatement and repeats the main thought that the client expressed. This assures the client that the nurse is listening and is attempting to validate what the client has said.

Neglect of children occurs in various ways. In which family below would you suspect neglect? A father encourages his son to play high school football.orrect! A father allows his child to stay home from school whenever she chooses. A woman worries that immunizations will be painful for her son. A woman feeds her daughter a total vegetarian diet.

A father allows his child to stay home from school whenever she chooses.

A teacher brings a 10-year-old boy to you who says he cannot participate in physical education because his feet hurt. He is limping, but won't let the teacher look at his feet. At your insistence, the boy removes his shoes and socks and reveals three distinct round burns on the soles of his feet. One of the burns is infected. When you ask him how the burns happened, the boy's only comment is that, "My dad said I was bad." Would You Do? Call ChildLine Make a GPS referral Provide community resource recommendations Call the police Take no action

Call ChildLine at (800) 932-0313. Yes. The injury is serious and causing obvious pain and impairment. Although you don't have a complete disclosure or explanation of the circumstances, the boy's statement and the distinct nature of the burns should lead you to suspect abuse. As a mandated reporter of child abuse and the school's designated reporter, you must immediately call ChildLine with any case of suspected abuse. We suggest you do not call the parents, but allow the reporting process to manage your report.

The nurse at a well-baby clinic is assessing the language and communication developmental milestones of a 4-month-old infant. On the basis of the age of the infant, what should the nurse expect to note as the highest-level developmental milestone? 1. Cooing sounds 2. Use of gestures 3. Babbling sounds 4. Increased interest in sounds

Rationale: Babbling sounds are common between the ages of 3 and 4 months. Additionally, during this age, crying becomes more differentiated. Between the ages of 1 and 3 months, the infant will produce cooing sounds. The use of gestures occurs between 9 and 12 months. An increased interest in sounds occurs between 6 and 8 months.

A 10-year-old girl who has been referred for evaluation for drawing sexually explicit scenes in her textbooks says to the psychiatric nurse, "I just felt like it." Which response is therapeutic for the nurse to make in order to assess abuse-related symptoms? 1. "Well, a picture paints a thousand words." 2. "You just felt like destroying your textbooks?" 3. "Your parents and teachers are very concerned about your drawings." 4. "I am concerned about you. Are you now or have you ever been abused?"

Rationale: The behaviors that this child engaged in are a warning signal of distress. The correct option is the only one that specifically addresses abuse. In option 1, the nurse is insensitive, sarcastic, and intrusive. In option 2, the nurse is assessing the client's destructive behaviors, not the possible sexual abuse history. In option 3, although the nurse is trying to assess the client's abuse-related symptoms, the nurse uses indirect means rather than straightforward expressions of the nurse's concern.

The responsibility of the nurse caring for a victim of child abuse in the emergency room would include which of the following? Asking the child what was happening that led to the abuse. Prohibiting parents from visiting until more facts are obtained.orrect! Suggesting to the attending physician that the child be admitted for observation. Prohibiting the babysitter from staying to offer support.

Suggesting to the attending physician that the child be admitted for observation.

A 6-month-old infant is brought to the emergency room. The parents report that he "just won't wake up." Upon physical exam, the only other sign besides the level of consciousness is the presence of retinal hemorrhages. The nurse would suspect what has occurred: ! The infant has been shaken. The infant has ingested a medication. The infant has been dropped. The infant has meningitis.

The infant has been shaken.

You are a high school teacher. While coming to work one day you notice one of your 15-year-old students getting out of another teacher's car about one block from the school. When you mention it to the student, he gets a little flustered and struggles to find an appropriate answer. After a few moments, he says that he is in love with the teacher. You suspect the student and teacher are having an intimate relationship. Call ChildLine Make a GPS referral Provide community resource recommendations Call the police Take no action

Yes. You have reason to suspect another school employee is sexually abusing a student. You are mandated to cause a report of suspected student abuse to be made. In accordance with the law, you should report your suspicions to your school administrator, who must immediately make a report of student abuse to law enforcement officials and the district attorney.

Which of the following is a possible indicator of Munchausen syndrome by proxy type of child abuse? a. Bruises found at odd locations, with different stages of healing b. STD's and genital discharges c. Unexplained symptoms of diarrhea, vomiting and apnea with no organic basis d. Constant hunger and poor hygiene

c...Munchausen syndrome by Proxy is the fabrication or inducement of an illness by one person to another person, usually mother to child. It is characterized by symptoms such as apnea and siezures, which may be due to suffocation, drugs or poisoning, vomiting which can be induced with poisons and diarrhea with the use of laxatives. Letter A can be seen in a Physical abuse, Letter B for sexual abuse and Letter C is for Physical Neglect.

A parent brings a preschooler to the emergency department for treatment of a dislocated shoulder, which allegedly happened when the child fell down the stairs. Which ACTION should make the nurse suspect that the child was abused? A. The child cries uncontrollably throughout the examination. B. The child pulls away from contact with the physician. C. The child doesn't cry when the shoulder is examined. D. The child doesn't make eye contact with the nurse.

c...Rationale: A characteristic behavior of abused children is lack of crying when they undergo a painful procedure or are examined by a health care professional. Therefore, the nurse should suspect child abuse. Crying throughout the examination, pulling away from the physician, and

When interviewing the parents of an injured child, which of the following is the strongest indicator that child abuse may be a problem? A. The injury isn't consistent with the history or the child's age. B. The mother and father tell different stories regarding what happened. C. The family is poor. D. The parents are argumentative and demanding with emergency department personnel.

A...Rationale: When the child's injuries are inconsistent with the history given or impossible because of the child's age and developmental stage, the emergency department nurse should be suspicious that child abuse is occurring. The parents may tell different stories because their perception may be different regarding what happened. If they change their story when different health care workers ask the same question, this is a clue that child abuse may be a problem. Child abuse occurs in all socioeconomic groups. Parents may argue and be demanding because of the stress of having an injured child. strongest indicator that child abuse may be a problem?

When assessing a family for potential child abuse risks, the nurse would observe for which of the following? a. Periodic exposure to stress b. Low socio-economic status c. High level of self esteem d. Problematic pregnancies

Answer is D, Typical factors that may be risk for Child abuse are problematic pregnancies, chronic exposure to stress not periodic, low level of self esteem not high level. Also child abuse can happen in all socio-economic status not just on low socio-economic status.

In a toddler, which of the following injuries is MOST likely the result of child abuse? A. A hematoma on the occipital region of the head B. A 1-inch forehead laceration C. Several small, dime-sized circular burns on the child's back D. A small isolated bruise on the right lower extremity

C. Several small, dime-sized circular burns on the child's back Rationale: Small circular burns on a child's back are no accident and may be from cigarettes. Toddlers are injury prone because of their developmental stage, and falls are frequent because of their unsteady gait; head injuries aren't uncommon. A small area of ecchymosis isn't suspicious in this age-group.

You are the art teacher, and one of your seventh-grade students is a gifted artist you have befriended. Over the last several months you have noticed his work becoming very dark in nature, which is matched by his increasingly sullen and withdrawn behavior. One day, while reaching for art supplies, his sleeves pull up to reveal cut marks on his arms. When confronted, he admits he cut himself intentionally. He explains that he is "evil" and that bad things happen to anyone with whom he associates; that is what his mother has told him. A call to his mother confirms that she feels the boy is "evil." Your concerns that he may be suicidal are met with the statement, "...well, maybe that would be for the best." Call ChildLine Make a GPS referral Provide community resource recommendations Call the police Take no action

Call ChildLine at (800) 932-0313 Yes. Both the student's and mother's statements and actions lead you to suspect serious mental abuse, which is causing a psychological condition that could be diagnosed by a physician or psychologist. As a mandated reporter of child abuse, and in accordance with school policy, you should immediately cause a report of suspected child abuse to be made to ChildLine. Report your suspicion to your administrator or the designee. Your local crisis intervention hotline could also be called, if you suspect a suicide attempt is imminent.

Which statement by a parent of a 4-year-old is most likely to suggest child abuse? "He doesn't seem to like strangers. "He has his father's eyes." "He is constantly on the go."orrect! He doesn't ever help me clean house."

He doesn't ever help me clean house."Rational: The expectation for a 4-year-old to clean the house does not correlate with growth and development for a 4-year-old.

The parents of a 2-year-old bring him into the physician's office in December for the complaint of cold symptoms for 4 days. The nurse notices that the child does not have shoes or socks on. The parents are upset when the physician orders a social services consult. What is the rationale for the consult? The parents waited 4 days to bring the child into the office. The parents are upset with the physician.orrect! The child does not have shoes or socks on in December. The child has a viral illness.

The child does not have shoes or socks on in December.