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Difficulty: HardAbuse and Neglect

A registered nurse (RN) in a long-term care facility assesses a nonverbal older adult client with advanced Alzheimer's disease. The RN observes bilateral, patterned fingertip bruising on the inner aspects of the client's upper arms. The unlicensed assistive personnel (UAP) assigned to the client states, "The client gets highly aggressive during perineal care, so I have to grip their arms tightly to finish the task." Which of the following is the priority action for the RN?

  1. Separate the UAP from the client immediately and report the suspected abuse to the designated state regulatory agency.Answer
  2. B
    Complete an internal facility incident report and defer the decision to contact external authorities to the nursing director.
  3. C
    Review the client's medication administration record to determine if the bruising is a physiological response to anticoagulant therapy.
  4. D
    Provide immediate remediation to the UAP regarding gentle handling techniques and observe a return demonstration.

Answer

The correct action is to separate the UAP from the client immediately and report the suspected abuse to the designated state regulatory agency.
When physical abuse is suspected, especially involving a vulnerable, nonverbal adult, the nurse's primary responsibility is to secure the immediate safety of the client by separating them from the suspected perpetrator. Concurrently, the nurse has a strict, individual legal mandate to report the reasonable suspicion of abuse to the appropriate external protective agency. Waiting for conclusive proof or an internal investigation is a violation of this legal duty.

Step-by-Step Solution

1
Analyze the clinical findings and the caregiver's statement.
The patterned fingertip bruising and the UAP's admission of gripping the client tightly indicate the application of excessive force.
Recognizing signs of non-accidental trauma or physical abuse is the first step in protecting vulnerable populations.
2
Determine the immediate priority according to Maslow's hierarchy and basic safety principles.
The client must be protected from further harm by removing the suspected abuser (the UAP) from the immediate care environment.
Client safety is always the highest priority in suspected abuse scenarios.
3
Apply the legal requirements of nursing practice regarding suspected abuse.
The RN must initiate a formal report to the appropriate state agency (e.g., Adult Protective Services) based on reasonable suspicion.
Nurses are mandatory reporters. This is an individual, non-delegable duty that cannot be bypassed by relying solely on internal facility incident reports.

Key Concept

Mandatory Reporting and Immediate Client Safety
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Topics

Abuse and Neglect

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