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Difficulty: Very hardAbuse and Neglect

An 8-year-old child is brought to an urgent care clinic by a stepparent for a painful right arm. The nurse observes faded bruising in various stages of healing on the child's torso, and a radiograph reveals a spiral fracture of the right humerus. The stepparent states, "He is so clumsy, he fell off his skateboard yesterday." The child remains completely silent, avoids eye contact, and shrinks away when the stepparent approaches. The attending physician examines the child, splints the arm, and states to the nurse, "The mechanism of injury does not match the fracture, but we lack concrete proof of abuse. Let's discharge them to outpatient orthopedics and have the clinic social worker follow up next week to avoid making a false accusation." Which of the following is the priority nursing action?

  1. Independently and immediately contact state child protective services to report the suspected abuse.Answer
  2. B
    Defer the abuse report and rely on the attending physician's clinical decision for social work follow-up.
  3. C
    Privately confront the stepparent about the inconsistencies between the physical findings and the reported mechanism of injury.
  4. D
    Delegate the continuous observation of the child's psychosocial behavior and interactions to the unlicensed assistive personnel (UAP).

Answer

The priority action is to independently and immediately contact state child protective services to report the suspected abuse, regardless of the physician's instructions.
The correct action is to independently and immediately contact child protective services. Healthcare professionals, including registered nurses, are mandatory reporters. The law requires reporting based purely on 'reasonable suspicion' (such as inconsistent injury mechanisms and fearful behavior). This legal obligation is an individual duty; a physician's disagreement or desire to wait for concrete proof does not relieve the nurse of their liability or duty to protect the child.

Step-by-Step Solution

1
Assess the clinical findings against the provided history.
The spiral fracture, bruising in various stages of healing, and fearful behavior are highly suspicious for abuse and do not match the reported mechanism of injury (falling off a skateboard).
Identifying discrepancies between physical evidence and caregiver reports establishes 'reasonable suspicion' of abuse.
2
Evaluate the legal responsibilities of the registered nurse in this scenario.
The nurse recognizes their role as an individual mandatory reporter.
Mandatory reporting laws require nurses to report suspected child abuse immediately. This duty is individual and cannot be overridden by a supervisor, physician, or facility policy.
3
Determine the safest and most appropriate intervention.
The nurse must file the report immediately to ensure the child is not discharged into a dangerous environment without protective services involvement.
Delaying the report for a social worker or trying to gather absolute proof places the vulnerable child at imminent risk of further harm or death.

Key Concept

Mandatory Reporting and Professional Accountability
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Topics

Abuse and Neglect

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