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Difficulty: Very hardAbuse or Neglect

A practical nurse (PN) at a family medicine clinic is helping to evaluate a 4-year-old client accompanied by a guardian. The guardian states that the child tripped over a living room rug, causing an injury to the left arm. A subsequent X-ray reveals a spiral fracture of the humerus. While preparing the client for a splint, the PN observes numerous bruises in varying stages of healing across the child's abdomen and back. Which of the following actions should the PN take? Select all that apply.

  1. Record the guardian's explanation of the injury verbatim using quotation marks in the client's medical record.Answer
  2. Notify the supervising registered nurse (RN) and the healthcare provider immediately regarding the inconsistent injury patterns.Answer
  3. C
    Delay contacting the designated state child welfare agency until the healthcare provider formally diagnoses the injuries as non-accidental trauma.
  4. D
    Ask the guardian directly, 'Why did you not bring the child to the clinic immediately after the fall occurred?'
  5. E
    Accept a delegated task from the RN to independently conduct a comprehensive psychosocial abuse assessment interview with the guardian.

Answer

The correct actions are to record the guardian's explanation verbatim in the medical record and to immediately notify the supervising RN and healthcare provider regarding the inconsistent injury patterns.
The practical nurse must objectively document the guardian's exact words in quotation marks to maintain an accurate, unbiased legal medical record. Additionally, the PN must immediately notify the supervising RN and healthcare provider because the combination of a spiral fracture (a twisting injury) and torso bruising is highly inconsistent with a simple fall, indicating possible child abuse that requires immediate intervention.

Step-by-Step Solution

1
Analyze the clinical findings and the provided history.
The PN identifies that a spiral fracture and multiple torso bruises in various stages of healing strongly contradict the guardian's report of a simple trip over a rug.
Spiral fractures typically result from a twisting motion, and torso bruises are classic indicators of non-accidental trauma, raising high suspicion for child physical abuse.
2
Determine the appropriate scope of practice for the PN in this highly acute psychosocial scenario.
The PN must objectively document all findings and report suspicions up the chain of command, while recognizing that comprehensive psychosocial assessments are beyond the PN scope of practice.
Client safety is the priority. The PN fulfills their role by securing objective data and ensuring the primary care team is alerted to initiate mandated reporting and protection protocols.
3
Evaluate the distractors against therapeutic communication and legal guidelines.
Asking 'why' questions is non-therapeutic, waiting for a formal diagnosis violates mandated reporting timelines, and conducting complex abuse interviews exceeds the PN's scope.
Safe nursing practice requires immediate, within-scope actions while avoiding confrontational, delaying, or out-of-scope behaviors.

Key Concept

Recognizing and Reporting Suspected Child Abuse
Estimated Time:1m 30s
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Topics

Abuse or Neglect

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