Choice A Reason: Bruises on the knees and elbows are common in children who are active and fall frequently. They are not necessarily indicative of abuse, unless they are in various stages of healing or have a pattern that suggests intentional injury.

Choice B Reason: A spiral fracture is caused by twisting or rotating force, which is unlikely to occur accidentally in children. It is a common sign of physical abuse, especially when there is no plausible explanation for the injury.

Choice C Reason: A burn mark in the shape of a cigarette is a clear evidence of intentional harm. It indicates that the child was exposed to a hot object, such as a cigarette, by the abuser.

Choice D Reason: A subdural hematoma is a collection of blood between the brain and the skull, which can result from blunt force trauma to the head. It is a serious and potentially life-threatening condition that requires immediate medical attention. If the child has no history of head trauma, such as a fall or an accident, it suggests that he was hit or shaken by the abuser.

Choice E Reason: A bite mark on the shoulder that matches the child's own dental impression is not indicative of abuse. It may be a result of self-injury, anxiety, or curiosity. However, if the bite mark matches someone else's dental impression, it should be reported as a sign of abuse.

Choice A Reason: Teaching children about their body parts and their proper names can help them understand their boundaries and rights. It can also help them communicate clearly if they experience any unwanted touch or sexual behavior.

Choice B Reason: Encouraging children to tell their parents if someone touches them inappropriately can help them feel safe and supported. It can also help the parents identify and report any potential abuse or exploitation.

Choice C Reason: Avoiding leaving children alone with strangers or unfamiliar adults can reduce their risk of being sexually abused or assaulted. It can also help the parents monitor their children's safety and well-being.

Choice D Reason: Monitoring children's online activities and social media accounts can help the parents protect them from online predators, cyberbullying, sexting, or exposure to inappropriate content. It can also help the parents educate their children about online safety and etiquette.

Choice E Reason: Allowing children to express their feelings and emotions without judgment can help them develop healthy self-esteem and coping skills. However, it is not directly related to preventing child sexual abuse.

Choice A Reason: This statement indicates that the mother praises and encourages the child, which is not consistent with emotional abuse.

Choice B Reason: This statement indicates that the child feels loved by his mother, which is not consistent with emotional abuse.

Choice C Reason: This statement indicates that the mother insults and criticizes the child frequently, which is consistent with emotional abuse. Emotional abuse involves verbal or nonverbal acts that reject, degrade, terrorize, isolate, or exploit the child.

Choice D Reason: This statement indicates that the mother shows affection and warmth to the child, which is not consistent with emotional abuse.

Choice A Reason: This statement is not appropriate because it implies that the child is responsible for his hygiene and appearance, which may make him feel ashamed or guilty. The nurse should avoid blaming or judging the child for his situation.

Choice B Reason: This statement is not appropriate because it may be too intrusive or threatening for the child, who may fear the consequences of disclosing his parents' neglect. The nurse should avoid asking direct or personal questions that may overwhelm or frighten the child.

Choice C Reason: This statement is not appropriate because it may be too vague or abstract for the child, who may not trust or understand the nurse's role. The nurse should avoid making promises or assumptions that may not be realistic or fulfilled.

Choice D Reason: This statement is appropriate because it shows interest and curiosity in the child's preferences and hobbies, which may help him feel valued and respected. The nurse should use open-ended questions and positive comments to engage the child in conversation and build trust.

Choice A Reason: This statement is false because the nurse does not need to have conclusive evidence of abuse or neglect before making a report. The nurse only needs to have Reasonable cause or suspicion to believe that a child is being maltreated.

Choice B Reason: This statement is true because the nurse has a legal and ethical obligation to report any suspected abuse or neglect to the appropriate authorities, such as child protective services, law enforcement, or health care providers. The nurse should follow the policies and procedures of his or her institution and state laws regarding reporting.

Choice C Reason: This statement is false because the nurse does not need to obtain the consent of the child and the parents before making a report. The nurse should respect the confidentiality and privacy of the child and the family, but not at the expense of their safety and well-being.

Choice D Reason: This statement is false because the nurse does not need to confront the abuser and offer counseling before making a report. The nurse should avoid any confrontation or intervention that may endanger the child or himself or herself. The nurse should refer the child and the family to appropriate resources and services for further assessment and treatment.

Choice A Reason: The nurse should collect forensic evidence using a sexual assault kit, which may include swabs, slides, envelopes, labels, and instructions for collecting specimens from various body sites. The nurse should follow the protocol for preserving and labeling the evidence.

Choice B Reason: The nurse should document any physical findings using body maps or diagrams, which can provide visual evidence of any injuries, bruises, abrasions, lacerations, or scars on the child's body. The nurse should also describe any findings using objective and precise language.

Choice C Reason: The nurse should not ask the mother to leave the room during the examination, unless she is suspected of being involved in the abuse or interfering with the assessment. The mother can provide emotional support and comfort to the child during this stressful situation.

Choice D Reason: The nurse should use open-ended questions to elicit information from the child, such as "What happened?" or "How do you feel?" The nurse should avoid leading or suggestive questions that may influence or distort the child's responses.

Choice E Reason: The nurse should not perform a pelvic examination using a speculum on a 4-year-old girl, unless it is medically indicated or ordered by a physician. A speculum examination can be traumatic and painful for a young child, and it may not yield useful information in cases of sexual abuse.

Choice A Reason: This nursing diagnosis may be applicable for this child, but it is not the most appropriate one. Risk for infection is a potential problem that may or may not occur, whereas delayed growth and development is an actual problem that has already occurred.

Choice B Reason: This nursing diagnosis may be applicable for this child, but it is not the most appropriate one. Impaired social interaction is a psychosocial problem that may affect the child's emotional and mental well-being, whereas delayed growth and development is a physiological problem that affects the child's physical and cognitive well-being.

Choice C Reason: This nursing diagnosis is the most appropriate one for this child, because it reflects the main problem that he is facing. Delayed growth and development is a physiological problem that results from inadequate stimulation, nutrition, health care, and education in the child's environment. It can affect the child's physical, cognitive, language, motor, and social skills.

Choice D Reason: This nursing diagnosis may be applicable for this child, but it is not the most appropriate one. Ineffective coping is a psychosocial problem that may affect the child's emotional and mental well-being, whereas delayed growth and development is a physiological problem that affects the child's physical and cognitive well-being.

Choice A Reason: Bruises, burns, fractures, or bite marks are physical signs of maltreatment that may indicate physical abuse or neglect. They may vary in size, shape, color, location, and pattern depending on the type and severity of the injury.

Choice B Reason: Poor hygiene, malnutrition, or failure to thrive are physical signs of maltreatment that may indicate neglect. They may reflect the lack of adequate food, clothing, shelter, health care, or supervision for the child.

Choice C Reason: Genital injuries, sexually transmitted infections, or pregnancy are physical signs of maltreatment that may indicate sexual abuse. They may result from sexual contact or penetration by the perpetrator.

Choice D Reason: Anxiety, depression, aggression, or withdrawal are behavioral signs of maltreatment that may indicate any type of abuse or neglect. They may reflect the emotional and psychological impact of the trauma on the child.

Choice E Reason: Learning difficulties, developmental delays, or speech problems are behavioral signs of maltreatment that may indicate any type of abuse or neglect. They may reflect the cognitive and social impact of the trauma on the child.

Choice A Reason: The nurse should report the suspicion to the child protective services, which is a legal and ethical obligation for nurses who work with children. The nurse should follow the policies and procedures of his or her institution and state laws regarding reporting.

Choice B Reason: The nurse should document the findings and observations in the medical record, which is a legal and ethical obligation for nurses who work with children. The nurse should use objective and precise language to describe any signs or symptoms of abuse or neglect.

Choice C Reason: The nurse should not confront the mother and ask her to stop abusing her daughter, which is not a legal or ethical obligation for nurses who work with children. The nurse should avoid any confrontation or intervention that may endanger the child or himself or herself.

Choice D Reason: The nurse should provide support and education to the mother and the daughter, which is a legal and ethical obligation for nurses who work with children. The nurse should offer empathy and compassion to the child and the family and provide information about available resources and services.

Choice E Reason: The nurse should refer the mother and the daughter to a mental health professional, which is a legal and ethical obligation for nurses who work with children. The nurse should recognize his or her scope of practice and collaborate with other health care providers to ensure holistic care for the child and the family.

Choice A Reason: This statement is appropriate because it shows empathy and reassurance to the boy. It also helps him understand that he is not responsible for the abuse and that he is not alone.

Choice B Reason: This statement is not appropriate because it puts pressure on the boy to disclose his experience. It also implies that his cooperation is a condition for receiving help.

Choice C Reason: This statement is not appropriate because it shifts the focus from the boy's feelings to his uncle's feelings. It also suggests that his uncle has some justification or remorse for his actions.

Choice D Reason: This statement is not appropriate because it blames and criticizes the boy for his experience. It also reinforces his sense of shame and guilt.

Choice A Reason: This statement is not appropriate because it dismisses and invalidates the girl's feelings. It also implies that the girl is responsible for her abuse and that she can change her father's behavior.

Choice B Reason: This statement is not appropriate because it judges and labels the girl's feelings and her father's character. It also creates a dichotomy between good and bad, which may not reflect the complexity of the situation.

Choice C Reason: This statement is not appropriate because it minimizes and rationalizes the girl's abuse. It also shifts the blame from the father to his anger, which may not address the underlying causes of his violence.

Choice D Reason: This statement is appropriate because it acknowledges and validates the girl's feelings. It also explains that ambivalence is a common reaction among children who are abused by their parents, who may love them but also hurt them.

Choice A Reason: This statement is true because the legal obligation of the nurse to report child abuse and neglect is based on federal and state laws that mandate certain professionals who work with children to report any Reasonable suspicion of maltreatment to the appropriate authorities and agencies. These laws vary by state, but they generally define who is required to report, what constitutes abuse or neglect, how to make a report, and what are the penalties for failing to report.

Choice B Reason: This statement is false because the ethical obligation of the nurse to report child abuse and neglect is based on professional codes of conduct that require nurses to uphold the principles of beneficence, nonmaleficence, justice, fidelity, veracity, advocacy, and accountability. These principles guide the moral decision-making and behavior of nurses in their practice.

Choice C Reason: This statement is false because the legal and ethical obligations of the nurse to report child abuse and neglect are consistent with the nursing standards of practice that state that nurses have a duty to protect the health, safety, and rights of their clients. These standards define the expectations and responsibilities of nurses in their practice.

Choice D Reason: This statement is false because the legal obligation of the nurse to report child abuse and neglect is not based on institutional policies and procedures that specify the steps and guidelines for reporting child abuse and neglect within the health care setting. These policies and procedures may vary by institution, but they should comply with the federal and state laws regarding reporting.

Choice A Reason: This question is not appropriate because it is leading and suggestive. It may influence or distort the boy's response by implying that his mother's boyfriend hit him with a belt.

Choice B Reason: This question is appropriate because it is open-ended and neutral. It allows the boy to describe his experience in his own words without imposing any assumptions or expectations.

Choice C Reason: This question is not appropriate because it is not directly related to the boy's bruises. It may be relevant to assess his living situation and caregivers, but it does not address the cause of his injury.

Choice D Reason: This question is not appropriate because it is not directly related to the boy's bruises. It may be relevant to assess his relationship with his mother's boyfriend, but it does not address the cause of his injury.

Choice A Reason: This intervention is appropriate because it can help the girl develop social skills and form positive relationships with other children. It can also provide her with a sense of belonging and acceptance.

Choice B Reason: This intervention is appropriate because it can help the girl recognize and appreciate her strengths and abilities. It can also boost her confidence and self-worth.

Choice C Reason: This intervention is appropriate because it can help the girl reduce her anxiety and fear. It can also enhance her resilience and problem-solving skills.

Choice D Reason: This intervention is appropriate because it combines all of the above interventions, which can have a synergistic effect on the girl's emotional and psychological well-being.

Choice A Reason: The nurse should report the suspicion to the child protective services, which is a legal and ethical obligation for nurses who work with children. The nurse should follow the policies and procedures of his or her institution and state laws regarding reporting.

Choice B Reason: The nurse should document the findings and observations in the medical record, which is a legal and ethical obligation for nurses who work with children. The nurse should use objective and precise language to describe any signs or symptoms of neglect.

Choice C Reason: The nurse should provide the boy with clean clothes, food, and a place to rest, which is a legal and ethical obligation for nurses who work with children. The nurse should address the immediate needs of the boy and ensure his comfort and safety.

Choice D Reason: The nurse should educate the parents about the importance of meeting their child's basic needs, which is a legal and ethical obligation for nurses who work with children. The nurse should offer support and guidance to the parents and provide information about available resources and services.

Choice E Reason: The nurse should refer the boy to a counselor or a social worker, which is a legal and ethical obligation for nurses who work with children. The nurse should recognize his or her scope of practice and collaborate with other health care providers to ensure holistic care for the boy and his family.

The correct answer is B. A spiral fracture of the femur is a common injury caused by twisting or jerking the leg, which can indicate physical abuse. The other options are not necessarily indicative of abuse, as they can be caused by normal childhood activities or accidents.

Choice A Reason: Bruises on the knees and elbows are common in children who are active and fall or bump into things. They are not usually a sign of abuse unless they are in unusual patterns or locations, such as the face, neck, abdomen, or genitals.

Choice B Reason: A spiral fracture of the femur is a common injury caused by twisting or jerking the leg, which can indicate physical abuse. This type of fracture is unlikely to occur from normal play or accidental falls, and should raise suspicion of abuse.

Choice C Reason: A small burn on the finger from touching a hot stove is an example of a minor injury that can happen to any child who is curious and exploring their environment. It is not a sign of abuse unless there are other burns or injuries that suggest intentional harm.

Choice D Reason: A rash on the buttocks from wearing a wet diaper is a common skin condition that can affect infants and toddlers who are not changed frequently enough. It is not a sign of abuse unless there is evidence of neglect, such as poor hygiene, malnutrition, or lack of medical care.

The correct answers are A, B, C, and E. Child abuse and neglect can have negative effects on various aspects of children's development and well-being, both in the short-term and long-term. Child abuse and neglect are also influenced by multiple factors that can create stress or challenges for families, such as poverty, addiction, mental health problems, or violence. Child abuse and neglect can be prevented or reduced by addressing these factors and providing support and resources to families who need them.

Choice A Reason: Child abuse and neglect can affect the physical development of children by causing injuries, illnesses, growth delays, or disabilities. Child abuse and neglect can also affect the emotional development of children by causing low self-esteem, poor attachment, fear, anger, guilt, or shame. Child abuse and neglect can affect the cognitive development of children by impairing their learning abilities, memory, attention, language, or problem-solving skills. Child abuse and neglect can affect the social development of children by impairing their communication skills, trust, empathy, or relationships with others.

Choice B Reason: Child abuse and neglect are more likely to occur in families with low income, substance abuse, mental illness, or domestic violence. These factors can create stress or difficulties for parents or caregivers who may lack the resources, skills, or support to cope with them. These factors can also impair the parents' or caregivers' ability to provide adequate care, supervision, protection, or affection to their children.

Choice C Reason: Child abuse and neglect can increase the risk of depression, anxiety, substance abuse, suicide, and criminal behavior in adulthood. These outcomes are related to the trauma and stress that children experience from being abused or neglected. These outcomes can also be influenced by the lack of positive role models, coping skills, or social support that children may have as a result of being abused or neglected.

Choice D Reason: Teaching children self-defense skills and how to report any suspicious incidents is not an effective way to prevent child abuse and neglect. This approach puts the responsibility on the children to protect themselves from harm instead of addressing the root causes of abuse and neglect. This approach may also make children feel more fearful or distrustful of others.

Choice E Reason: Providing support and resources to families who are experiencing stress or difficulties can help reduce child abuse and neglect. This can include offering counseling, education, parenting classes, respite care, financial assistance, or referrals to other services. This can help families cope with their challenges and improve their parenting skills and practices. This can also help families enhance their bond and communication with their children.

The correct answer is B. The nurse should make a statement that expresses empathy, support, and praise for the child who is suspected of being sexually abused. This can help the child feel more comfortable, confident, and willing to share his or her experience.

Choice A Reason: This statement may sound reassuring, but it may also imply that the child has a Reason to be afraid or that the nurse already knows what happened. This may make the child feel more anxious or pressured to disclose something that he or she may not be ready to.

Choice B Reason: This statement expresses empathy, support, and praise for the child who is suspected of being sexually abused. This can help the child feel more comfortable, confident, and willing to share his or her experience.

Choice C Reason: This statement may intend to normalize the child's experience and make him or her feel less isolated, but it may also make the child feel more ashamed or stigmatized by implying that he or she is part of a group of victims.

Choice D Reason: This statement may intend to reduce the child's guilt or self-blame, but it may also suggest that the nurse has already made a judgment about what happened or who is responsible. This may make the child feel more defensive or reluctant to talk.

The correct answer is A. The nurse should make a statement that expresses empathy, respect, and openness to the mother who has neglected her child. This can help establish rapport and trust with the mother and encourage her to participate in her child's care.

Choice A Reason: This statement expresses empathy, respect, and openness to the mother who has neglected her child. It acknowledges her feelings and invites her to share her concerns or questions about her child's care.

Choice B Reason: This statement is accusatory, judgmental, and confrontational to the mother who has neglected her child. It implies that she is a bad parent who does not love her child. It may make her feel more defensive, angry, or guilty.

Choice C Reason: This statement is harsh, disrespectful, and insulting to the mother who has neglected her child. It shames her for her actions and blames her for her child's condition. It may make her feel more humiliated, resentful, or hopeless.

Choice D Reason: This statement is authoritative, demanding, and rigid to the mother who has neglected her child. It tells her what to do without explaining why or how. It may make her feel more overwhelmed, confused, or resistant.

The correct answer is C. The nurse should document any evidence of abuse or neglect in detail using objective and factual language. This can include physical findings, behavioral observations, statements from the child or the child or the parents, and any actions taken by the nurse or other professionals. This can help provide accurate and reliable information for the investigation and intervention of the case.

Choice A Reason: The nurse should report any case of suspected or confirmed abuse or neglect to the appropriate authorities within 24 hours. This is a legal and ethical obligation of the nurse to protect the child from further harm and to comply with the mandatory reporting laws of the state or country.

Choice B Reason: The nurse should not obtain written consent from the parents or guardians before reporting any case of suspected or confirmed abuse or neglect. This is not a legal or ethical requirement of the nurse, and it may jeopardize the safety of the child or the nurse. The nurse should report the case without notifying the parents or guardians, unless it is in the best interest of the child.

Choice D Reason: The nurse should not confront the suspected abuser directly and demand an explanation for the abuse or neglect. This is not a legal or ethical responsibility of the nurse, and it may endanger the child or the nurse. The nurse should leave the investigation and intervention of the case to the appropriate authorities, such as child protective services, law enforcement, or social workers.