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Difficulty: Very hardLegal Rights and Responsibilities

An outpatient clinic registered nurse (RN) is assessing a 78-year-old client with a history of severe major depressive disorder. The RN observes bilateral, thumb-sized contusions on the client's inner upper arms. The client's adult child, who serves as the primary caregiver, interrupts to state, 'My parent is just getting clumsy and bumps into door frames.' The client remains silent, then calmly hands the RN a cherished family watch, stating with a sudden, serene expression, 'I finally feel completely at peace; I will not be needing this anymore.' Based on legal and professional responsibilities, which of the following is the priority action for the RN?

  1. Interview the client privately to assess for a suicide plan, implement continuous supervision, and subsequently file a mandatory report for suspected elder abuse.Answer
  2. B
    Implement emergency psychiatric protocols for imminent self-harm risk and document the contusions as accidental blunt trauma based on the caregiver's provided history.
  3. C
    File an immediate report with Adult Protective Services regarding the suspicious contusions and document the client's sudden serene expression as an indicator of therapeutic improvement.
  4. D
    Delegate the completion of the suicide lethality assessment to the clinic's unlicensed assistive personnel (UAP) while the RN immediately steps out to contact Adult Protective Services.

Answer

The RN must interview the client privately to assess for a suicide plan, implement continuous supervision, and subsequently file a mandatory report for suspected elder abuse.
The correct answer addresses the two concurrent, high-priority legal and safety issues without violating scope of practice. Sudden peace and giving away possessions in a severely depressed client are hallmark signs of an active suicide plan, requiring the RN to immediately prioritize life safety through a private assessment. Simultaneously, the bilateral thumb-sized contusions (classic grab marks) and the caregiver's dismissive explanation create a reasonable suspicion of physical elder abuse, invoking a non-delegable, mandatory legal duty to report.

Step-by-Step Solution

1
Analyze the client's physical findings and the caregiver's statements.
Identified bilateral upper arm contusions inconsistent with the caregiver's explanation of 'bumping into door frames', raising high suspicion for physical elder abuse (grab marks).
RNs are mandatory reporters and must recognize signs of non-accidental trauma in vulnerable populations.
2
Evaluate the client's psychological presentation and actions.
Recognized that a sudden serene expression and giving away a cherished watch in a severely depressed client are critical warning signs of an imminent, lethal suicide plan.
Immediate life safety (risk of suicide) takes precedence over all other interventions.
3
Determine the legal and professional priorities based on the assessment.
Prioritized securing the client's immediate safety through a private suicide assessment and continuous supervision, followed by fulfilling the mandatory legal requirement to report suspected elder abuse.
Delegation of unstable assessments is illegal, and failing to report suspected abuse violates mandatory reporting laws.

Key Concept

Mandatory Reporting and Imminent Self-Harm Prioritization
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Topics

Legal Rights and Responsibilities

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