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Difficulty: MediumAbuse and Neglect

A registered nurse on a medical-surgical unit is completing an admission assessment for a 74-year-old client admitted with severe dehydration. The nurse observes bilateral, patterned bruising on the client's upper arms and back. When asked about the injuries, the client avoids eye contact and whispers, "Please do not tell my son I showed you; he gets so angry when I need help to the bathroom." Based on this interaction, the nurse suspects elder abuse but lacks conclusive evidence. Which action represents the nurse's appropriate legal and professional responsibility?

  1. Notify the designated state adult protective services agency immediately to report the suspected abuse.Answer
  2. B
    Delay filing an official report until an internal hospital committee can conduct a thorough investigation to confirm the abuse.
  3. C
    Initiate a direct conversation with the son about the bruises to encourage open family communication and address caregiver role strain.
  4. D
    Instruct the unlicensed assistive personnel (UAP) to question the client further about the son's behavior during morning care.

Answer

The nurse must report the suspected abuse immediately to the designated state adult protective services agency.
The correct action is to immediately notify the designated state agency. As a mandatory reporter, a nurse is legally required to report suspected abuse, neglect, or exploitation of vulnerable populations (children, elders, and dependent adults). The threshold for reporting is 'reasonable suspicion,' which is met here by the physical assessment findings and the client's direct, fearful statement. Conclusive proof is not required by the reporter; investigating the validity of the suspicion is the role of protective services and law enforcement.

Step-by-Step Solution

1
Analyze the clinical findings and the client's verbal statements.
The patterned bruising combined with the client's fearful statement regarding their son establishes a reasonable clinical suspicion of elder physical abuse.
Identifying indicators of abuse is the first step in recognizing a vulnerable adult in danger.
2
Determine the legal obligation of the registered nurse in this scenario.
The nurse identifies that they are a mandatory reporter under state and federal law.
Nurses must understand their individual legal responsibilities to protect vulnerable populations.
3
Select the appropriate intervention based on mandatory reporting laws.
The nurse reports the suspicion to the state authorities immediately without waiting for definitive proof or internal investigations.
Mandatory reporting requires only reasonable suspicion. Delaying the report for evidence gathering or confronting the abuser severely compromises client safety.

Key Concept

Mandatory reporting requires nurses to report suspected elder abuse immediately based on reasonable suspicion, without needing conclusive proof or prior internal facility investigation.
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Topics

Abuse and Neglect

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