Choice A Reason: Reporting the suspected abuse to the appropriate authorities is an important action that the nurse should take, but it is not the first priority. The nurse should first ensure the safety and comfort of the child.

Choice B Reason: Documenting the findings and interventions in the medical record is an essential action that the nurse should take, but it is not the first priority. The nurse should first ensure the safety and comfort of the child.

Choice C Reason: Providing emotional support and reassurance to the child is the first action that the nurse should take, as it helps to establish trust and rapport with the child, reduce anxiety and fear, and prevent further psychological trauma.

Choice D Reason: Obtaining a detailed history of the injuries from the child and the caregiver is a necessary action that the nurse should take, but it is not the first priority. The nurse should first ensure the safety and comfort of the child.

Choice A Reason: Asking open-ended questions such as "How do you feel about what happened to you?" is an appropriate statement that the nurse should include in the therapeutic communication with the client, as it allows the client to express her feelings and emotions without judgment or interruption.

Choice B Reason: Telling the client what she should do, such as "You should leave your partner as soon as possible." is an inappropriate statement that the nurse should avoid in therapeutic communication with the client, as it implies that the nurse knows what is best for the client and does not respect her autonomy and decision-making.

Choice C Reason: Validating the client's experience and feelings, such as "It was not your fault that you were abused." is an appropriate statement that the nurse should include in the therapeutic communication with the client, as it helps to reduce guilt and shame and restore self-esteem and self-worth.

Choice D Reason: Blaming or criticizing the client for her situation, such as "What did you do to provoke your partner's anger?" is an inappropriate statement that the nurse should avoid in therapeutic communication with the client, as it reinforces negative self-image and self-blame and increases distress and anxiety.

Choice E Reason: Offering support and empathy, such as "I am here to listen and help you in any way I can." is an appropriate statement that the nurse should include in the therapeutic communication with the client, as it demonstrates respect and caring and fosters trust and rapport.

Choice A Reason: Recognizing that a child may become withdrawn or depressed if he is emotionally abused is a correct statement that indicates an understanding of the signs and symptoms of emotional abuse in children.

Choice B Reason: Recognizing that a child may have difficulty sleeping or eating if he is emotionally abused is a correct statement that indicates an understanding of the signs and symptoms of emotional abuse in children.

Choice C Reason: Recognizing that a child may show aggressive or disruptive behavior if he is emotionally abused is a correct statement that indicates an understanding of the signs and symptoms of emotional abuse in children.

Choice D Reason: Having frequent accidents or injuries is not a sign or symptom of emotional abuse in children, but rather of physical abuse. This statement indicates a need for further teaching about the differences between emotional and physical abuse in children.

Choice A Reason: Telling the child that the nurse will not tell anyone what the child says is an inappropriate statement that the nurse should avoid, as it implies that the nurse is hiding something and may break the trust and rapport with the child. The nurse should also inform the child that some information may need to be shared with other professionals who can help the child.

Choice B Reason: Telling the child that the child did nothing wrong and is not to blame for what happened is an appropriate statement that the nurse should include in the therapeutic communication with the child, as it helps to reduce guilt and shame and restore self-esteem and self-worth. However, it is not the most likely statement to elicit a response from the child, as it may be too direct or confrontational for a child who is reluctant to talk and appears fearful.

Choice C Reason: Telling the child that the child is safe and no one can hurt the child anymore is an appropriate statement that the nurse should include in the therapeutic communication with the child, as it helps to reduce anxiety and fear and promote a sense of security and safety. However, it is not the most likely statement to elicit a response from the child, as it may be too reassuring or unrealistic for a child who is reluctant to talk and appears fearful.

Choice D Reason: Praising the child for being brave and expressing pride for talking to the nurse is an appropriate statement that the nurse should include in the therapeutic communication with the child, as it helps to increase confidence and motivation and encourage further disclosure. It is also the most likely statement to elicit a response from the child, as it acknowledges the difficulty and courage of talking about abuse and shows respect and appreciation for the child's efforts.

Choice A Reason: Referring the family to a social worker who can assist them with financial and housing resources is an appropriate intervention that the nurse should include in the plan of care to address the risk factors for neglect, as it helps to reduce stress and improve the family's living conditions and stability.

Choice B Reason: Educating the family about the effects of neglect on the child's development and well-being is an appropriate intervention that the nurse should include in the plan of care to address the risk factors for neglect, as it helps to increase awareness and motivation for change. However, it is not enough to address the underlying causes of neglect, such as poverty, substance abuse, mental illness, and domestic violence.

Choice C Reason: Providing the family with a list of community resources that offer counseling and support groups is an appropriate intervention that the nurse should include in the plan of care to address the risk factors for neglect, as it helps to enhance coping skills and social support. However, it is not enough to address the immediate needs of the family, such as financial and housing resources.

Choice D Reason: Monitoring the family's progress and compliance with the child protection services is an appropriate intervention that
the nurse should include in the plan of care to address the risk factors for neglect, as it helps to ensure safety and accountability. However, it is not enough to address the root causes of neglect, such as poverty, substance abuse, mental illness, and domestic violence.

The correct answer is A. Physical abuse is the intentional use of physical force against a child that results in or has a high likelihood of resulting in harm to the child’s health, survival, development, or dignity. Examples include hitting, kicking, shaking, burning, or poisoning a child¹. Bruises are one of the common signs of physical abuse, especially if they are in different locations and stages of healing².

Choice B Reason: Sexual abuse is the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent. Examples include fondling, penetration, exposure to pornography, or prostitution of a child¹. Bruises are not a specific sign of sexual abuse, although they may be present in some cases.

Choice C Reason: Emotional or psychological abuse is the intentional or unintentional acts or omissions that cause or have a high probability of causing harm to a child’s emotional development or self-esteem. Examples include humiliation, threats, isolation, rejection, or belittling a child¹. Bruises are not a sign of emotional abuse, although emotional abuse may co-occur with other types of maltreatment.

Choice D Reason: Neglect is the failure to provide for a child’s basic physical, emotional, educational, or medical needs. Examples include inadequate food, clothing, shelter, supervision, affection, education, or health care for a child¹. Bruises are not a sign of neglect, although neglect may increase the risk of accidental injuries.

Choice A Reason: Sexual abuse can involve non-contact activities such as exposure to pornography¹. This can be harmful to the child's sexual development and self-image.

Choice B Reason: Emotional abuse can be unintentional due to parental stress or mental illness¹. This does not excuse the behavior, but it may explain why some parents act in ways that hurt their children emotionally.

Choice C Reason: Neglect can be classified into physical, emotional, educational, and medical subtypes¹. Each subtype refers to the failure to provide for a specific aspect of the child's needs.

Choice D Reason: Physical abuse can occur even when there is no intention to harm the child³. For example, some parents may use excessive force or discipline methods that are inappropriate for the child's age or condition.

Choice E Reason: All types of maltreatment can have negative effects on the child's development and well-being¹. The effects may vary depending on the type, severity, frequency, duration, and context of the maltreatment.

The correct answer is D. Neglect is the failure to provide for a child’s basic physical, emotional, educational, or medical needs. Examples include inadequate food, clothing, shelter, supervision, affection, education, or health care for a child. Severe malnutrition and dehydration are signs of physical neglect.

Choice A Reason: Physical abuse is the intentional use of physical force against a child that results in or has a high likelihood of resulting in harm to the child’s health, survival, development, or dignity. Examples include hitting, kicking, shaking, burning, or poisoning a child. Severe malnutrition and dehydration are not specific signs of physical abuse, although they may be present in some cases.

Choice B Reason: Sexual abuse is the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent. Examples include fondling, penetration, exposure to pornography, or prostitution of a child. Severe malnutrition and dehydration are not signs of sexual abuse, although they may affect the child's sexual health and development.

Choice C Reason: Emotional or psychological abuse is the intentional or unintentional acts or omissions that cause or have a high probability of causing harm to a child’s emotional development or self-esteem. Examples include humiliation, threats, isolation, rejection, or belittling a child. Severe malnutrition and dehydration are not signs of emotional abuse, although they may affect the child's mental health and well-being.

The correct answer is D. All of the above are common indicators of sexual abuse in children.

Choice A Reason: Difficulty walking or sitting may indicate that the child has been subjected to genital trauma or anal penetration.

Choice B Reason: Frequent urinary tract infections may indicate that the child has been exposed to sexually transmitted infections or has poor hygiene due to lack of care or supervision.

Choice C Reason: Changes in behavior or mood may indicate that the child is experiencing fear, anxiety, depression, anger, guilt, shame, or confusion as a result of the sexual abuse.

The correct answer is D. Neglect is the failure to provide for a child’s basic physical, emotional, educational, or medical needs. Examples include inadequate food, clothing, shelter, supervision, affection, education, or health care for a child. Failure to thrive is a condition characterized by poor growth and development due to inadequate nutrition and stimulation. It can be caused by neglect as well as other factors such as organic diseases or genetic disorders. Frequent infections and social withdrawal are also signs of neglect.

Choice A Reason: Physical abuse is the intentional use of physical force against a child that results in or has a high likelihood of resulting in harm to the child’s health, survival, development, or dignity. Examples include hitting, kicking, shaking, burning, or poisoning a child. Failure to thrive is not a specific sign of physical abuse, although it may be present in some cases.

Choice B Reason: Sexual abuse is the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent. Examples include fondling, penetration, exposure to pornography, or prostitution of a child. Failure to thrive is not a sign of sexual abuse, although they may affect the child's sexual health and development.

Choice C Reason: Emotional or psychological abuse is the intentional or unintentional acts or omissions that cause or have a high probability of causing harm to a child’s emotional development or self-esteem. Examples include humiliation, threats, isolation, rejection, or belittling a child. Failure to thrive is not a sign of emotional abuse, although it may affect the child's mental health and well-being.

The correct answer is D. Neglect is the failure to provide for a child’s basic physical, emotional, educational, or medical needs. Examples include inadequate food, clothing, shelter, supervision, affection, education, or health care for a child. A cluttered and dirty house, an empty refrigerator, and parental conflict are signs of neglect.

Choice A Reason: Physical abuse is the intentional use of physical force against a child that results in or has a high likelihood of resulting in harm to the child’s health, survival, development, or dignity. Examples include hitting, kicking, shaking, burning, or poisoning a child. A cluttered and dirty house, an empty refrigerator, and parental conflict are not specific signs of physical abuse, although they may increase the risk of accidental injuries.

Choice B Reason: Sexual abuse is the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent. Examples include fondling, penetration, exposure to pornography, or prostitution of a child. A cluttered and dirty house, an empty refrigerator, and parental conflict are not signs of sexual abuse, although they may increase the vulnerability of the child to sexual exploitation.

Choice C Reason: Emotional or psychological abuse is the intentional or unintentional acts or omissions that cause or have a high probability of causing harm to a child’s emotional development or self-esteem. Examples include humiliation, threats, isolation, rejection, or belittling a child. A cluttered and dirty house, an empty refrigerator, and parental conflict are signs of emotional abuse, as they may create a stressful and chaotic environment for the child.

Choice A Reason: Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing a traumatic event, such as sexual abuse. Symptoms of PTSD include re-experiencing the trauma through flashbacks, nightmares, or intrusive thoughts; avoiding reminders of the trauma; feeling numb or detached; and having increased arousal, such as being easily startled, irritable, or hypervigilant.

Choice B Reason: Depression is a mood disorder that causes persistent feelings of sadness, hopelessness, and loss of interest in activities that were once enjoyable. Symptoms of depression include low mood, low self-esteem, guilt, worthlessness, fatigue, insomnia or hypersomnia, appetite changes, weight changes, difficulty concentrating, and suicidal thoughts or behaviors.

Choice C Reason: Substance abuse is the harmful use of alcohol, drugs, or other substances that impair one's physical or mental health or social functioning. Substance abuse can be a coping mechanism for some survivors of sexual abuse, as they may use substances to numb their pain, escape their reality, or self-medicate their symptoms.

Choice D Reason: Eating disorders are serious mental health conditions that involve abnormal eating behaviors and attitudes toward food and body weight. Eating disorders can be triggered by sexual abuse, as survivors may develop distorted body image, low self-esteem, shame, guilt, or a sense of loss of control over their lives. Eating disorders can include anorexia nervosa (restricting food intake to achieve extreme thinness), bulimia nervosa (binging on large amounts of food and then purging through vomiting, laxatives, or exercise), binge eating disorder (binging on large amounts of food without purging), or other specified feeding or eating disorder (OSFED) (having symptoms of an eating disorder that do not meet the full criteria for any specific diagnosis).

Choice E Reason: All of the above are possible signs and symptoms of sexual abuse in children and adolescents. However, not all survivors of sexual abuse will develop these conditions, and not all people with these conditions have experienced sexual abuse. Therefore, it is important to assess each individual case holistically and provide appropriate support and referrals as needed.

Choice A Reason: Child abuse and neglect can occur in any family, regardless of socioeconomic status. Poverty is not a cause of child abuse and neglect, but it may increase the stress and challenges faced by families.
Choice B Reason: Children with disabilities or special needs are more likely to be abused or neglected than children without disabilities. They may have increased dependency, communication difficulties, or behavioral problems that make them more vulnerable to maltreatment.
Choice C Reason: Parents who were abused or neglected themselves are more likely to repeat the cycle with their own children. This is because they may have learned abusive behaviors from their own parents, have unresolved trauma, or lack positive parenting skills.
Choice D Reason: Child abuse and neglect can cause physical, psychological, and social problems for the child. The consequences of maltreatment can vary depending on the type, frequency, duration, and severity of abuse or neglect, as well as the child's age, developmental stage, resilience, and coping skills.
Choice E Reason: Child abuse and neglect cannot be prevented by increasing social support and resources for families alone. Prevention requires a comprehensive approach that involves multiple levels of intervention, such as individual, family, community, and societal factors. Prevention also requires raising awareness, changing attitudes and behaviors, strengthening laws and policies, and improving services for children and families.

Choice A Reason: Physical abuse is the intentional use of physical force that results in injury, pain, or impairment to the child. Bruises, burns, and fractures are common signs of physical abuse.
Choice B Reason: Sexual abuse is the involvement of a child in sexual activity that he or she does not fully comprehend, consent to, or is developmentally inappropriate. Sexual abuse may cause genital injuries, sexually transmitted infections, or pregnancy.
Choice C Reason: Emotional abuse is the persistent emotional maltreatment of a child that causes severe and adverse effects on the child's emotional development. Emotional abuse may cause low self-esteem, withdrawal, anxiety, depression, or aggression.
Choice D Reason: Neglect is the failure to provide for a child's basic physical, emotional, educational, or medical needs. Neglect may cause poor hygiene, malnutrition, failure to thrive, or developmental delays.

Choice A Reason: The nurse should respond with empathy and validation to the client who has been sexually abused. The nurse should reassure the client that she is not to blame for what happened and that the abuser is the one who did something wrong.
Choice B Reason: The nurse should not question or challenge the client's feelings of guilt or blame. This may make the client feel defensive or ashamed and prevent her from opening up to the nurse.
Choice C Reason: The nurse should not ask the client how she tried to stop the abuser or imply that she could have done something differently. This may make the client feel responsible or inadequate for not preventing the abuse.
Choice D Reason: The nurse should not pressure the client to disclose the details of the abuse or make her feel that she has to tell everything to get help. This may make the client feel violated or overwhelmed and retraumatize her.

Choice B Reason: The nurse should say something that expresses empathy and support for the parents who are neglecting their children. The nurse should acknowledge that the parents may be facing difficulties or barriers that prevent them from providing adequate care for their children. The nurse should also invite the parents to share their concerns or challenges and offer assistance or referrals to appropriate resources.
Choice A Reason: The nurse should not say something that criticizes or scolds the parents for neglecting their children. This may make the parents feel defensive, angry, or hopeless and damage the therapeutic relationship with the nurse.
Choice C Reason: The nurse should not say something that judges or shames the parents for neglecting their children. This may make the parents feel guilty, worthless, or depressed and reduce their motivation or confidence to change their situation.
Choice D Reason: The nurse should not say something that threatens or intimidates the parents for neglecting their children. This may make the parents feel fearful, hostile, or distrustful and hinder the cooperation or collaboration with the nurse.

Choice A Reason: The nurse should state that children who are abused or neglected may show physical, behavioral, or emotional changes that indicate maltreatment. These changes may include injuries, bruises, burns, fractures, head trauma, organ damage, impaired growth and development, chronic pain, disability, death, emotional distress, fear, anger, guilt, shame, sadness, depression, anxiety, post-traumatic stress disorder (PTSD), attachment problems, low self-esteem, withdrawal, aggression, substance abuse, delinquency, suicide attempts, poor school performance, learning difficulties, cognitive impairment, social isolation, or difficulty trusting others.
Choice B Reason: The nurse should not state that children who are abused or neglected may have injuries or illnesses that are consistent with their age and developmental level. This is incorrect because children who are abused or neglected may have injuries or illnesses that are inconsistent with their age and developmental level. For example, a child who has a fracture that does not match the explanation given by the parent or caregiver may be a victim of physical abuse.
Choice C Reason: The nurse should not state that children who are abused or neglected may have positive relationships with their peers and teachers at school. This is incorrect because children who are abused or neglected may have negative relationships with their peers and teachers at school. For example, a child who is isolated, bullied, or rejected by his or her classmates may be a victim of emotional abuse or neglect.
Choice D Reason: The nurse should not state that children who are abused or neglected may have normal academic performance and cognitive abilities. This is incorrect because children who are abused or neglected may have poor academic performance and cognitive abilities. For example, a child who has difficulty concentrating, remembering, or solving problems may be a victim of sexual abuse or neglect.

Choice A Reason: Physical abuse is intentionally causing an injury to a child, such as hitting, burning, shaking, or otherwise harming them. It is not the most common type of maltreatment reported in 2018.
Choice B Reason: Sexual abuse is any inappropriate sexual behavior with a child, such as touching or taking photographs. It is not the most common type of maltreatment reported in 2018.
Choice C Reason: Emotional abuse is rejecting, blaming, or constantly scolding children, particularly for problems beyond their control. It is not the most common type of maltreatment reported in 2018.
Choice D Reason: Neglect is failing to provide for a child's basic needs, such as food, water, shelter, love, and attention. It is the most common type of maltreatment reported in 2018, accounting for about 61% of all victims.

Choice A Reason: Having a disability is a risk factor for child maltreatment at the child level, as it may increase the child's vulnerability or dependency on others.
Choice B Reason: Experiencing marital conflict, divorce, or death is a risk factor for child maltreatment at the family level, as it may disrupt the family stability or cohesion.
Choice C Reason: Living in a rural or urban area is not a risk factor for child maltreatment by itself, as it depends on other factors such as poverty, unemployment, or social isolation.
Choice D Reason: Having a history of abuse or neglect, mental illness, substance abuse, domestic violence, stress, or poor parenting skills is a risk factor for child maltreatment at the parent or caregiver level, as it may impair the caregiver's ability or willingness to provide adequate care for the child.
Choice E Reason: Attending preschool is not a risk factor for child maltreatment by itself, as it may provide the child with opportunities for socialization and education.

Choice A Reason: This response is accusatory and confrontational, which may make the mother defensive or angry. It does not explore the Reasons behind the mother's behavior or offer any help or guidance.

Choice B Reason: This response is informative but not empathetic or supportive. It does not acknowledge the mother's feelings or perspective and may make her feel guilty or ashamed.

Choice C Reason: This response is curious but not relevant or helpful. It does not address the issue of neglect or offer any solutions or resources.

Choice D Reason: This response is empathetic and supportive. It shows interest and concern for the mother and her children and invites her to share her difficulties and needs. It may help the nurse to identify the factors that contribute to neglect and offer appropriate interventions.

Choice A Reason: This response is not wrong, but it may not be realistic or feasible for some parents. It may also imply that the parent has a serious mental health problem, which may not be the case.
Choice B Reason: This response is appropriate and helpful. It suggests a simple and effective way to cope with stress and reduce the risk of abuse or neglect. It also acknowledges the parent's need for self-care and well-being.
Choice C Reason: This response is not wrong, but it may not be enough to prevent abuse or neglect. Talking to someone may provide emotional support, but it may not address the underlying causes of stress or offer practical solutions.
Choice D Reason: This response is not wrong, but it may not be suitable or accessible for some parents. Joining a support group or a parenting class may provide social support and education, but it may also require time, money, or transportation that some parents may not have.

Choice A Reason: Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing a traumatic event, such as sexual abuse. It can cause symptoms such as nightmares, flashbacks, anxiety, or avoidance of reminders of the trauma.
Choice B Reason: Depression is a mood disorder that can cause persistent feelings of sadness, hopelessness, or loss of interest in activities. It can be triggered or worsened by stressful or traumatic events, such as sexual abuse.
Choice C Reason: Substance abuse is the misuse of alcohol or drugs to cope with negative emotions or problems. It can be influenced by genetic, environmental, or psychological factors, such as sexual abuse.
Choice D Reason: All of the above are possible long-term outcomes of child abuse and neglect, as they can affect the child's physical, mental, emotional, and social development and well-being.

Choice A Reason: The police are not the appropriate agency to report child neglect, unless there is an immediate danger or threat to the child's safety.
Choice B Reason: Child protective services (CPS) are the agency responsible for investigating and responding to reports of child abuse and neglect. They can provide services and interventions to protect the child and support the family.
Choice C Reason: The school nurse is not the appropriate person to report child neglect, unless the child is enrolled in school and shows signs of neglect at school.
Choice D Reason: The family doctor is not the appropriate person to report child neglect, unless the child has medical issues related to neglect.

Choice A Reason: Asking the mother to leave the room and interviewing the child alone may be helpful, but it is not the first priority. The nurse should ensure the safety of the child and follow the mandatory reporting laws for child abuse.

Choice B Reason: This is the correct answer. The nurse has a legal and ethical obligation to document the findings and report the suspected abuse to the appropriate authorities, such as child protective services or law enforcement. This will initiate an investigation and protect the child from further harm.

Choice C Reason: Confronting the mother about the possibility of physical abuse and offering her counseling is not appropriate at this stage. The nurse should not accuse or judge the mother, as this may escalate the situation and endanger the child. The nurse should focus on providing support and resources to both the child and the mother, but only after reporting the abuse.

Choice D Reason: Discharging the child with a referral to a social worker and a follow-up appointment is not sufficient to address the situation. The child may be at risk of further abuse or even death if returned to the abusive environment. The nurse should not discharge the child until an investigation is conducted and a safety plan is established.

Choice A Reason: This is a correct answer. The nurse should administer antibiotics as prescribed to treat chlamydia, which is a sexually transmitted infection that can cause serious complications if left untreated.

Choice B Reason: This is a correct answer. The nurse should provide pain relief as needed to help the client cope with genital pain, which may be caused by trauma, infection, or inflammation.

Choice C Reason: This is a correct answer. The nurse should collect forensic evidence as indicated, such as swabs, blood samples, or clothing, to assist with legal prosecution of the perpetrator. The nurse should follow proper protocols for handling and documenting evidence.

Choice D Reason: This is not a correct answer. Educating the client about safe sex practices is not appropriate at this time, as it may imply blame or judgment on the client. The client was not engaging in consensual sex, but was coerced or forced by a relative. The nurse should focus on providing emotional support and validating the client's feelings.

Choice E Reason: This is a correct answer. The nurse should refer the client to a mental health professional, such as a counselor or therapist, who can provide ongoing psychological care for the client. The client may experience post-traumatic stress disorder, depression, anxiety, or other mental health issues as a result of sexual abuse.

Choice A Reason: This statement by the nurse would be inappropriate, as it would be accusatory, confrontational, and threatening to the parents. This may provoke anger or defensiveness from the parents, and worsen the situation for the child. The nurse should report the suspected emotional abuse to the appropriate authorities, but not disclose this to the parents.

Choice B Reason: This statement by the nurse would be appropriate, as it would be empathetic, nonjudgmental, and supportive to the parents. This may help the nurse establish rapport and trust with the parents, and explore their feelings and needs. The nurse may also use this opportunity to provide education and resources to the parents on positive parenting strategies and stress management.

Choice C Reason: This statement by the nurse would be inappropriate, as it would be false, misleading, and enabling to the parents. The nurse should not praise or reinforce the parents' abusive behavior, as this may encourage them to continue or escalate it. The nurse should also not minimize or ignore the child's emotional distress.

Choice D Reason: This statement by the nurse would be inappropriate, as it would be critical, blunt, and confrontational to the parents. This may cause guilt or shame in the parents, and damage the therapeutic relationship with the nurse. The nurse should not lecture or scold the parents, but rather use open-ended questions and reflective listening to help them understand the impact of their behavior on their child.

Choice A Reason: This statement by the nurse would be inaccurate, as hitting or slapping a child for misbehaving is an example of physical abuse, not neglect. Physical abuse is the intentional use of physical force that causes or risks harm to a child.

Choice B Reason: This statement by the nurse would be inaccurate, as leaving a child alone at home while going to work may or may not be an example of neglect, depending on the age and maturity of the child, the duration and frequency of the absence, and the availability of supervision and support. Neglect is the failure to provide for a child's basic physical, emotional, educational, or medical needs.

Choice C Reason: This statement by the nurse would be inaccurate, as forcing a child to participate in sexual activities is an example of sexual abuse, not neglect. Sexual abuse is the involvement of a child in sexual activity that he or she cannot consent to or understand.

Choice D Reason: This statement by the nurse would be accurate, as failing to provide a child with adequate food, clothing, or shelter is an example of neglect. Neglect is the failure to provide for a child's basic physical, emotional, educational, or medical needs.

Choice A Reason: This is the correct answer. A 2-year-old client who has a skull fracture and subdural hematoma has the highest risk of mortality from abuse, as these injuries are indicative of severe head trauma, which can lead to brain damage, coma, or death. Head injuries are one of the most common causes of death among abused children, especially those under 4 years old.

Choice B Reason: A 5-year-old client who has multiple rib fractures and a punctured lung has a high risk of morbidity from abuse, as these injuries are indicative of blunt force trauma to the chest, which can cause respiratory distress, infection, or shock. However, these injuries are less likely to be fatal than head injuries, especially if treated promptly.

Choice C Reason: An 8-year-old client who has second-degree burns on both hands and arms has a moderate risk of morbidity from abuse, as these injuries are indicative of thermal injury from hot liquids or objects, which can cause pain, infection, or scarring. However, these injuries are less likely to be life-threatening than head or chest injuries, unless they cover a large surface area of the body.

Choice D Reason: A 12-year-old client who has a broken femur and internal bleeding has a low risk of morbidity from abuse, as these injuries are indicative of blunt force trauma to the leg, which can cause pain, swelling, or hematoma. However, these injuries are unlikely to be fatal unless complicated by infection, embolism, or hemorrhage.

Choice A Reason: This is the correct answer. Play therapy is a form of psychotherapy that uses play as a medium of communication and expression for children who have difficulty verbalizing their feelings and thoughts. Play therapy allows the client to explore, understand, and resolve his emotional issues in a safe and nonthreatening way, with the guidance of a trained therapist.

Choice B Reason: This is not a correct answer. Play therapy may help the client to develop social skills and interact with other children who have similar experiences, but this is not the primary rationale for using play therapy for this client. Play therapy is more focused on the individual needs and goals of the client, rather than on group dynamics or peer support.

Choice C Reason: This is not a correct answer. Play therapy may teach the client coping skills and strategies to deal with stressful situations and emotions, but this is not the main rationale for using play therapy for this client. Play therapy is more focused on the emotional healing and resolution of the client, rather than on behavioral modification or skill acquisition.

Choice D Reason: This is not a correct answer. Play therapy may enhance the client's cognitive development and problem-solving abilities, but this is not the primary rationale for using play therapy for this client. Play therapy is more focused on the affective and expressive aspects of the client, rather than on the cognitive or intellectual aspects.

Choice A Reason: This is the correct answer. Post-traumatic stress disorder (PTSD) is a mental health disorder that occurs after exposure to a traumatic event that involves actual or threatened death, serious injury, or sexual violence. PTSD is characterized by intrusive symptoms (such as nightmares, flashbacks, or distressing memories), avoidance symptoms (such as avoiding reminders of the trauma or detaching from others), negative alterations in cognition and mood (such as guilt, shame, or distrust), and alterations in arousal and reactivity (such as hypervigilance, irritability, or insomnia).

Choice B Reason: This is not a correct answer. Major depressive disorder (MDD) is a mental health disorder that involves persistent and pervasive feelings of sadness, hopelessness, or worthlessness that interfere with daily functioning. MDD may be triggered by traumatic events such as sexual abuse, but it does not necessarily involve symptoms of intrusion, avoidance, or hyperarousal that are specific to PTSD.

Choice C Reason: This is not a correct answer. Generalized anxiety disorder (GAD) is a mental health disorder that involves excessive and uncontrollable worry about various aspects of life that causes significant distress or impairment. GAD may be exacerbated by traumatic events such as sexual abuse, but it does not necessarily involve symptoms of intrusion, avoidance, or negative mood that are specific to PTSD.

Choice D Reason: This is not a correct answer. Dissociative identity disorder (DID) is a mental health disorder that involves disruption of identity characterized by two or more distinct personality states that recurrently take control of behavior. DID may be associated with traumatic events such as sexual abuse, but it does not necessarily involve symptoms of intrusion, avoidance, or arousal that are specific to PTSD.

Choice A Reason: This is a correct answer. Headache is a sign of increased intracranial pressure (ICP), as the pressure on the brain causes pain and discomfort. Headache may be more difficult to assess in a 3-year-old client, but the nurse should instruct the parents to look for cues such as holding or rubbing the head, crying, or refusing to eat or play.

Choice B Reason: This is a correct answer. Vomiting is a sign of increased intracranial pressure (ICP), as the pressure on the brainstem causes stimulation of the vomiting center and nausea. Vomiting may be more frequent and projectile in a 3-year-old client with increased ICP, and may not be related to food intake or illness.

Choice C Reason: This is a correct answer. Bradycardia is a sign of increased intracranial pressure (ICP), as the pressure on the brainstem causes disruption of the autonomic nervous system and decreased heart rate. Bradycardia may be accompanied by hypertension and irregular respirations, which are known as Cushing's triad, a late and ominous sign of increased ICP.

Choice D Reason: This is not a correct answer. Dilated pupils are not a sign of increased intracranial pressure (ICP), but rather a sign of brain herniation, which is a life-threatening complication of increased ICP. Brain herniation occurs when the brain tissue shifts from its normal position and compresses vital structures such as the cranial nerves and the brainstem. Dilated pupils may indicate compression of the oculomotor nerve (cranial nerve III), which controls pupil constriction.

Choice E Reason: This is a correct answer. Irritability is a sign of increased intracranial pressure (ICP), as the pressure on the brain causes changes in behavior and personality. Irritability may manifest as agitation, restlessness, crying, or aggression in a 3-year-old client with increased ICP, and may not be responsive to soothing or distraction.

Choice A Reason: This is incorrect because confronting the parents with the suspicion of abuse may put the child at further risk of harm or retaliation. The nurse should not disclose the suspicion to anyone who is not authorized or involved in the investigation.
Choice B Reason: This is correct because the nurse has a legal obligation to report any Reasonable suspicion of child abuse and neglect to the appropriate authorities and agencies, such as child protective services, law enforcement, or health department, depending on the state laws and regulations. The nurse should follow the reporting procedures and protocols of the facility and state.
Choice C Reason: This is incorrect because reporting the suspicion to the nurse manager and documenting the findings in the child's chart are not sufficient actions to fulfill the legal obligation of the nurse. The nurse manager may not have the authority or responsibility to report or investigate the case, and documenting the findings does not ensure that the child will receive protection or intervention.
Choice D Reason: This is incorrect because reporting the suspicion to the social worker and asking for a referral to a child protection service are not immediate or direct actions to fulfill the legal obligation of the nurse. The social worker may not be available or qualified to handle the case, and asking for a referral does not guarantee that the report will be made or followed up.

Choice A Reason: This is correct because seeking professional help, such as counseling, therapy, or support groups, can help parents cope with stress, anger, frustration, or other emotions that may trigger abusive or neglectful behaviors toward their children. Parents should also learn healthy coping skills and stress management techniques to prevent maltreatment.
Choice B Reason: This is incorrect because using physical punishment, such as hitting, spanking, slapping, or shaking, can cause physical and emotional harm to children, and may escalate into abuse. Physical punishment is not an effective way of disciplining children, as it teaches them that violence is acceptable and does not address the underlying causes of their misbehavior. Parents should use positive reinforcement, natural consequences, time-outs, or other nonviolent methods of discipline instead.
Choice C Reason: This is correct because monitoring children's online activities and limiting their exposure to violent media can help prevent them from being exposed to inappropriate or harmful content, such as pornography, cyberbullying, sexting, or grooming by predators. Violent media can also desensitize children to aggression and violence, and influence their attitudes and behaviors. Parents should set rules and boundaries for their children's internet use, and educate them about online safety and etiquette.
Choice D Reason: This is incorrect because respecting children's privacy does not mean avoiding asking them personal questions. Parents should maintain open and honest communication with their children, and show interest and concern for their well-being. Parents should ask their children about their feelings, thoughts, experiences, friends, activities, schoolwork, etc., and listen attentively and empathetically. Parents should also be aware of any signs or changes that may indicate that their children are experiencing problems or difficulties.
Choice E Reason: This is correct because educating children about their rights and how to seek help if they feel unsafe can empower them to protect themselves from abuse and neglect. Children should know that they have a right to be treated with respect, dignity, care, and protection, and that they have a right to say no to anything that makes them uncomfortable or hurts them. Children should also know how to identify trusted adults who can help them in case of maltreatment, such as teachers, counselors, nurses, doctors, police officers, etc., and how to contact them.

Choice A Reason: This is incorrect because telling the child that they don't have to be afraid of the nurse may not be effective in reducing their fear or anxiety. The child may not trust the nurse or feel comfortable with them, especially if they have been threatened or manipulated by the abuser. The nurse should instead try to establish rapport and trust with the child, by using a calm and gentle tone of voice, maintaining eye contact, using open-ended questions, and validating the child's feelings.
Choice B Reason: This is incorrect because telling the child that they did the right thing by telling someone what happened to them may not be appropriate at this stage of the interview. The child may not have disclosed the abuse yet, or may have been coerced or pressured to do so by someone else. The nurse should instead encourage the child to share their story at their own pace, and reassure them that they are safe and supported.
Choice C Reason: This is correct because telling the child that they are not to blame for what happened to them and that it's not their fault can help them cope with the feelings of guilt, shame, and self-blame that are common among victims of sexual abuse. The nurse should emphasize that the responsibility and accountability lie with the abuser, who violated the child's rights and boundaries, and that the child did nothing wrong or deserved what happened to them.
Choice D Reason: This is incorrect because telling the child that they have to tell everything that happened to them and that it's very important may put pressure on the child and make them feel overwhelmed or defensive. The child may not be ready or willing to disclose the details of the abuse, or may fear the consequences of doing so, such as retaliation from the abuser, disbelief from others, or legal involvement. The nurse should instead respect the child's autonomy and privacy, and avoid forcing or rushing them to talk.

Choice A Reason: This is incorrect because an abusive partner is not someone who loves their partner too much or wants to protect them from others. This is a common misconception that romanticizes abuse and excuses it as a sign of passion or devotion. An abusive partner does not love their partner, but rather uses them as an object of their own gratification or domination. An abusive partner does not protect their partner from others, but rather isolates them from their family, friends, or other sources of support or help.
Choice B Reason: This is incorrect because an abusive partner is not someone who respects their partner's opinions and decisions, even if they disagree with them. This is a characteristic of a healthy and respectful relationship, where both partners value each other's individuality and autonomy, and communicate openly and honestly about their differences. An abusive partner does not respect their partner's opinions and decisions, but rather criticizes, belittles, or ignores them, and tries to impose their own views or preferences on them.
Choice C Reason: This is correct because an abusive partner is someone who tries to control their partner's behavior, feelings, thoughts, or choices. This is a characteristic of an unhealthy and abusive relationship, where one partner exerts power and influence over the other partner through various tactics, such as threats, coercion, manipulation, intimidation, isolation, jealousy, blame, guilt, etc. An abusive partner does not care about their partner's well-being or happiness, but rather about their own needs or desires.
Choice D Reason: This is incorrect because an abusive partner is not someone who supports their partner's goals and interests, even if they are different from theirs. This is a characteristic of a healthy and supportive relationship, where both partners encourage and celebrate each other's achievements and aspirations. An abusive partner does not support their partner's goals and interests, but rather discourages, sabotages, or interferes with them, and tries to make their partner dependent on them.

Choice A Reason: This is an example of secondary prevention, not primary prevention.
Choice B Reason: This is an example of tertiary prevention, not primary prevention.
Choice C Reason: This is the correct answer. This is an example of primary prevention, which aims to prevent child abuse and neglect from occurring in the first place.
Choice D Reason: This is a legal obligation for nurses and other mandated reporters, but it is not a prevention strategy.The correct answer is C. Educating parents and caregivers about child development and positive parenting skills is an example of primary prevention, which aims to prevent child abuse and neglect from occurring in the first place by addressing the risk factors and enhancing the protective factors at individual, family, community, and societal levels. Choice A is an example of secondary prevention, which aims to identify and intervene with children and families who are at risk of or have experienced maltreatment by providing early detection, screening, assessment, referral, treatment, and follow-up services. Choice B is an example of tertiary prevention, which aims to reduce the negative consequences of maltreatment and prevent its recurrence by providing specialized treatment and support services for children and families who have been affected by abuse or neglect. Choice D is a legal obligation for nurses and other mandated reporters, but it is not a prevention strategy.

Choice A Reason: This is an example of secondary prevention, not primary prevention.
Choice B Reason: This is an example of tertiary prevention, not primary prevention.
Choice C Reason: This is the correct answer. This is an example of primary prevention, which aims to prevent child abuse and neglect from occurring in the first place.
Choice D Reason: This is a legal obligation for nurses and other mandated reporters, but it is not a prevention strategy.

The correct answers are A, B, C, and E. These are examples of secondary prevention, which aims to identify and intervene with children and families who are at risk of or have experienced maltreatment by providing early detection, screening, assessment, referral, treatment, and follow-up services. Choice D is an example of primary prevention, which aims to prevent child abuse and neglect from occurring in the first place by addressing the risk factors and enhancing the protective factors at individual, family, community, and societal levels.

Choice A Reason: This is a correct answer. This is an example of secondary prevention, which aims to identify children who are at risk of or have experienced maltreatment by using validated tools.
Choice B Reason: This is a correct answer. This is an example of secondary prevention, which aims to intervene with children and families who need further evaluation or intervention by providing referral services.
Choice C Reason: This is a correct answer. This is an example of secondary prevention, which aims to identify children who are at risk of or have experienced maltreatment by providing education and training for teachers and staff on how to recognize and respond to child abuse and neglect.
Choice D Reason: This is an incorrect answer. This is an example of primary prevention, not secondary prevention.
Choice E Reason: This is a correct answer. This is an example of secondary prevention, which aims to intervene with children who have been affected by abuse or neglect by providing support groups and peer mentoring.

The correct answer is B. Asking the mother how she thinks her child feels when she blames them for their father's actions is an empathic response that can help her reflect on the impact of her behavior on her child's emotional well-being. Choice A is a confrontational response that may make the mother defensive or angry. Choice C is a judgmental response that may make the mother feel guilty or ashamed. Choice D is a closed-ended question that may not elicit much information or insight from the mother.

Choice A Reason: This is an incorrect answer. This is a confrontational response that may make the mother defensive or angry.

Choice B Reason: This is the correct answer. This is an empathic response that can help the mother reflect on the impact of her behavior on her child's emotional well-being.

Choice C Reason: This is an incorrect answer. This is a judgmental response that may make the mother feel guilty or ashamed.

Choice D Reason: This is an incorrect answer. This is a closed-ended question that may not elicit much information or insight from the mother.

The correct answer is D. Assessing the child for other signs and symptoms of abuse, such as behavioral changes, fear of adults, or poor school performance, is a Reasonable and appropriate action that the community health worker could have taken to determine if the child was being abused. Choice A is a harsh and blaming response that may discourage the participant from sharing their experiences or learning from their mistakes. Choice B is a passive and complacent response that may reinforce the participant's inaction or denial of abuse. Choice C is a risky and potentially harmful response that may put the child or the community health worker in danger if the parents are abusive and become angry or violent.

Choice A Reason: This is an incorrect answer. This is a harsh and blaming response that may discourage the participant from sharing their experiences or learning from their mistakes.

Choice B Reason: This is an incorrect answer. This is a passive and complacent response that may reinforce the participant's inaction or denial of abuse.

Choice C Reason: This is an incorrect answer. This is a risky and potentially harmful response that may put the child or the community health worker in danger if the parents are abusive and become angry or violent.

Choice D Reason: This is the correct answer. This is a Reasonable and appropriate action that the community health worker could have taken to determine if the child was being abused.

The correct answer is D. The number of children and families who did not experience any recurrence of maltreatment after completing the program is an outcome that directly reflects the goal of tertiary prevention, which is to reduce the negative consequences of maltreatment and prevent its recurrence by providing specialized treatment and support services for children and families who have been affected by abuse or neglect. Choice A is an output indicator that measures how many people were reached by the program, but not how effective it was. Choice B is a process indicator that measures how satisfied people were with the program, but not how beneficial it was. Choice C is an outcome indicator that measures how much people improved in their well-being after completing the program, but not how much they reduced their risk of maltreatment.

Choice A Reason: This is an incorrect answer. This is an output indicator that measures how many people were reached by the program, but not how effective it was.

Choice B Reason: This is an incorrect answer. This is a process indicator that measures how satisfied people were with the program, but not how beneficial it was.

Choice C Reason: This is an incorrect answer. This is an outcome indicator that measures how much people improved in their well-being after completing the program, but not how much they reduced their risk of maltreatment.

Choice D Reason: This is the correct answer. This is an outcome indicator that directly reflects the goal of tertiary prevention, which is to reduce the negative consequences of maltreatment and prevent its recurrence by providing specialized treatment and support services for children and families who have been affected by abuse or neglect.

The correct answer is D. Ensuring the safety and comfort of the child in a private room is the priority action that the nurse should take first when caring for a child who is suspected to be a victim of physical abuse. This action can help protect the child from further harm, reduce their anxiety and fear, and establish trust and rapport with the nurse. Choice A is an important action that the nurse should take to document the evidence of abuse, but it is not the first action. Choice B is a legal and ethical action that the nurse should take to report the suspected abuse and collaborate with other professionals, but it is not the first action. Choice C is an assessment action that the nurse should take to gather more information about the situation, but it is not the first action.

Choice A Reason: This is an incorrect answer. This is an important action that the nurse should take to document the evidence of abuse, but it is not the first action.

Choice B Reason: This is an incorrect answer. This is a legal and ethical action that the nurse should take to report the suspected abuse and collaborate with other professionals, but it is not the first action.

Choice C Reason: This is an incorrect answer. This is an assessment action that the nurse should take to gather more information about the situation, but it is not the first action.

Choice D Reason: This is the correct answer. This is the priority action that the nurse should take first when caring for a child who is suspected to be a victim of physical abuse.

The correct answer is C. Using alcohol or drugs to cope with stress and relax is an unhealthy and harmful behavior that can increase the risk of child abuse and neglect by impairing parental judgment, self-control, and coping skills. The nurse should provide further teaching to this parent and explain the negative effects of substance abuse on parenting and child development. Choice A is a correct statement that indicates an understanding of seeking professional help if needed. Choice B is a correct statement that indicates an understanding of joining a support group for parents where they can share their feelings and experiences. Choice D is a correct statement that indicates an understanding of practicing relaxation techniques such as deep breathing or meditation.

Choice A Reason: This is a correct statement that indicates an understanding of seeking professional help if needed.

Choice B Reason: This is a correct statement that indicates an understanding of joining a support group for parents where they can share their feelings and experiences.

Choice C Reason: This is an incorrect statement that indicates a need for further teaching. Using alcohol or drugs to cope with stress and relax is an unhealthy and harmful behavior that can increase the risk of child abuse and neglect.

Choice D Reason: This is a correct statement that indicates an understanding of practicing relaxation techniques such as deep breathing or meditation.

The correct answers are A, B, D, and E. These are indicators that show that the family has made progress in their physical, mental, and social well-being after completing the tertiary prevention program for child abuse and neglect. Choice C is an incorrect answer that shows that the family has not made progress in their social well-being and may still be at risk of maltreatment. The nurse should provide further support and guidance to this family and encourage them to seek help from other sources of social support, such as friends, relatives, neighbors, or community organizations.

Choice A Reason: This is a correct answer that shows that the family has made progress in their communication and conflict resolution skills, which are important for maintaining healthy and respectful relationships.

Choice B Reason: This is a correct answer that shows that the family has made progress in their expectations and goals, which are important for enhancing their motivation and self-regulation.

Choice C Reason: This is an incorrect answer that shows that the family has not made progress in their social well-being and may still be at risk of maltreatment. The nurse should provide further support and guidance to this family and encourage them to seek help from other sources of social support.

Choice D Reason: This is a correct answer that shows that the family has made progress in their self-esteem and self-efficacy, which are important for improving their confidence and competence as parents and caregivers.

Choice E Reason: This is a correct answer that shows that the family has made progress in their parenting practices, which are important for ensuring the safety and well-being of their children.

The correct answer is B. Emotional abuse is the deliberate attempt to harm a child's self-worth or emotional well-being. It can include verbal insults, threats, rejection, isolation, or humiliation. Emotional abuse can affect a child's self-esteem, confidence, and social skills. Physical abuse often co-occurs with emotional abuse, as the abuser may use physical violence to intimidate, control, or degrade the child.

Choice A Reason: Sexual abuse is the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent. Sexual abuse can include contact and non-contact acts, such as touching, fondling, oral sex, penetration, exposure, or pornography. Sexual abuse can also cause emotional and psychological harm to the child, but it is not the same as emotional abuse.

Choice C Reason: Psychological abuse is similar to emotional abuse, but it also involves the manipulation of a child's thoughts, feelings, or behaviors. Psychological abuse can include brainwashing, gaslighting, indoctrination, or coercion. Psychological abuse can cause confusion, anxiety, depression, or dissociation in the child.

Choice D Reason: Neglect is the failure to provide for a child's basic physical, emotional, educational, or medical needs. Neglect can include inadequate food, clothing, shelter, hygiene, supervision, affection, education, or health care. Neglect can also cause physical and emotional harm to the child, but it is not the same as emotional abuse.

Choice A Reason: Seeking professional help if one has a history of trauma or mental illness can help reduce the risk of abusing or neglecting one's own children. Trauma and mental illness can impair one's ability to cope with stress, regulate emotions, and form healthy attachments with others. Professional help can provide counseling, medication, therapy, or other interventions to address these issues and improve one's mental health and well-being.

Choice B Reason: Learning about one's child's development and setting realistic expectations can help prevent frustration, anger, or disappointment that may lead to abusive or neglectful behavior. Children have different needs, abilities, and personalities at different stages of their growth and development. Parents should understand these differences and adjust their expectations and responses accordingly. Parents should also praise their children for their efforts and achievements and provide positive reinforcement for desired behaviors.

Choice C Reason: Using physical punishment as a last resort to discipline one's child is not a recommended strategy to prevent child abuse and neglect. Physical punishment can cause physical injuries, pain, fear, anger, resentment, or aggression in the child. Physical punishment can also damage the trust and bond between the parent and the child and teach the child that violence is an acceptable way to solve problems or express emotions.

Choice D Reason: Joining a support group or networking with other parents who have similar challenges can help prevent isolation, stress, or burnout that may contribute to abusive or neglectful behavior. Support groups or networks can provide emotional, social, or practical support, advice, or resources for parents who are struggling with parenting issues, such as managing stress, balancing work and family, dealing with behavioral problems, or coping with special needs. Support groups or networks can also help parents feel less alone, more understood, and more empowered.

Choice E Reason: Reporting any signs of maltreatment in one's family or community to the authorities can help prevent further harm and ensure appropriate intervention and support for the victims and perpetrators of child abuse and neglect. Reporting is a legal and ethical obligation for nurses and other professionals who work with children, but it is also a moral responsibility for anyone who witnesses or suspects maltreatment. Reporting can help protect the child from further harm, stop the cycle of violence, and provide the opportunity for healing and recovery.

The correct answer is A. Dissociation is a psychological defense mechanism that involves a detachment from one's thoughts, feelings, memories, or sense of identity. Dissociation can occur as a result of trauma, such as sexual abuse, to cope with the overwhelming stress and pain. Dissociation can manifest as numbness, detachment, depersonalization, derealization, or dissociative identity disorder.

Choice B Reason: Denial is a psychological defense mechanism that involves refusing to accept or acknowledge the reality or severity of a situation. Denial can occur as a result of trauma, such as sexual abuse, to avoid the negative emotions and consequences associated with it. Denial can manifest as disbelief, rationalization, minimization, or avoidance.

Choice C Reason: Regression is a psychological defense mechanism that involves reverting to an earlier stage of development or behavior that is more comfortable or familiar. Regression can occur as a result of trauma, such as sexual abuse, to escape from the current distress and anxiety. Regression can manifest as thumb-sucking, bed-wetting, clinging, tantrums, or baby talk.

Choice D Reason: Repression is a psychological defense mechanism that involves unconsciously blocking out or forgetting unpleasant or traumatic memories or feelings. Repression can occur as a result of trauma, such as sexual abuse, to protect oneself from the emotional pain and conflict associated with it. Repression can manifest as memory loss, confusion, or lack of insight.

The correct answer is D. This statement reflects the child's internalization of the blame and guilt for the abuse. Emotional abuse can cause the child to feel worthless, unloved, or responsible for the abuser's behavior. The child may apologize or try to please the abuser to avoid further criticism or rejection.

Choice A Reason: This statement reflects the child's anger and resentment towards the abuser. Anger is a normal and healthy emotion that can help the child cope with the abuse and assert his or her rights and boundaries. However, anger can also be harmful if it is expressed inappropriately or excessively.

Choice B Reason: This statement reflects the child's denial or idealization of the abuser. Denial or idealization is a psychological defense mechanism that involves refusing to acknowledge or exaggerating the positive aspects of the abuser or the relationship. Denial or idealization can occur as a result of trauma bonding, Stockholm syndrome, or cognitive dissonance.

Choice C Reason: This statement reflects the child's dissociation or numbness towards the abuser. Dissociation or numbness is a psychological defense mechanism that involves detaching from one's thoughts, feelings, memories, or sense of identity. Dissociation or numbness can occur as a result of trauma, such as emotional abuse, to cope with the overwhelming stress and pain.

The correct answer is C. Tertiary prevention is the level of intervention that aims to reduce the impact and complications of an existing problem or condition on an individual or group. Tertiary prevention can include treatment, rehabilitation, or support services for those who are affected by maltreatment. Tertiary prevention can help restore the health, well-being, and functioning of the victims and perpetrators of child abuse and neglect.

Choice A Reason: Primary prevention is the level of intervention that aims to prevent a problem or condition from occurring in the first place. Primary prevention can include education, awareness, or advocacy campaigns for the general public or specific populations at risk. Primary prevention can help reduce the incidence and prevalence of child abuse and neglect in society.

Choice B Reason: Secondary prevention is the level of intervention that aims to detect and intervene in a problem or condition at an early stage before it becomes more serious or chronic. Secondary prevention can include screening, assessment, or reporting tools and methods for professionals or individuals who work with or encounter children and families. Secondary prevention can help identify and protect the victims and perpetrators of child abuse and neglect and provide appropriate intervention and support.

Choice D Reason: Quaternary prevention is the level of intervention that aims to avoid or reduce the harm or waste of unnecessary or excessive interventions for a problem or condition. Quaternary prevention can include monitoring, evaluation, or feedback mechanisms for professionals or organizations who provide services or interventions for children and families.
Quaternary prevention can help ensure the quality, effectiveness, and efficiency of the interventions and services for child abuse and neglect.

The correct answer is C. Providing pain relief and comfort measures is the nurse's priority action when caring for a child who has been physically abused. The nurse should assess the child's pain level and administer analgesics as prescribed. The nurse should also provide emotional support and reassurance to the child and create a safe and trusting environment.

Choice A Reason: Notifying the child protection services is an important action that the nurse should take when caring for a child who has been physically abused, but it is not the priority action. The nurse should report any suspected or confirmed cases of child abuse and neglect to protect the child from further harm and to ensure appropriate intervention and support for the child and family. However, the nurse should first address the child's immediate needs, such as pain relief and comfort measures, before reporting.

Choice B Reason: Documenting the findings in the medical record is an essential action that the nurse should take when caring for a child who has been physically abused, but it is not the priority action. The nurse should document any signs and symptoms of maltreatment, such as bruises, fractures, burns, or wounds, in an objective, accurate, and detailed manner. The nurse should also use body maps or diagrams to illustrate the location, size, shape, color, and pattern of the injuries. The nurse should also document any statements made by the child or the parents that are relevant to the abuse. However, the nurse should first address the child's immediate needs, such as pain relief and comfort measures, before documenting.

Choice D Reason: Interviewing the child and the parents separately is a necessary action that the nurse should take when caring for a child who has been physically abused, but it is not the priority action. The nurse should interview the child and the parents separately to obtain a history of the abuse and to assess their relationship and dynamics. The nurse should use open-ended questions, avoid leading or suggestive questions, and use developmentally appropriate language and techniques. The nurse should also observe their behaviors, expressions, and interactions for any clues or discrepancies. However, the nurse should first address the child's immediate needs, such as pain relief and comfort measures, before interviewing.

The correct answer is C. This statement indicates a need for further teaching because it is incorrect. The parent should be worried if their child shows excessive or inappropriate curiosity about sexual topics or behaviors, such as masturbation, pornography, or sexual acts with other children or adults. This could indicate that their child has been exposed to or involved in sexual activity that they do not fully comprehend or consent to.

Choice A Reason: This statement is correct because it indicates that the parent understands one of the signs of sexual abuse in children. The parent should be concerned if their child suddenly becomes afraid of being alone with certain people, such as relatives, friends, teachers, or caregivers. This could indicate that their child has been sexually abused by someone they know and trust.

Choice B Reason: This statement is correct because it indicates that the parent understands one of the signs of sexual abuse in children. The parent should be alert if their child starts to have nightmares, bedwetting, or sleep problems. These could indicate that their child is experiencing fear, anxiety, or trauma as a result of sexual abuse.

Choice D Reason: This statement is correct because it indicates that the parent understands one of the signs of sexual abuse in children. The parent should pay attention if their child develops genital infections, injuries, or bleeding. These could indicate that their child has been physically harmed by sexual abuse.

Choice A Reason: The family will learn about the nature and treatment of bipolar disorder as one of the outcomes of family therapy. Family therapy can help the family understand the causes, symptoms, and management of bipolar disorder and how it affects their father's behavior and mood. Family therapy can also help the family support their father in adhering to his treatment plan and monitoring his condition.

Choice B Reason: The family will develop coping skills and strategies to deal with the abuse as one of the outcomes of family therapy. Family therapy can help the family identify and address the effects of psychological abuse on their mental and emotional health, such as low self-esteem, depression, anxiety, or guilt. Family therapy can also help the family learn and practice healthy ways to cope with stress, emotions, and conflicts, such as relaxation, assertiveness, or positive thinking.

Choice C Reason: The family will improve their communication and problem-solving skills as one of the outcomes of family therapy. Family therapy can help the family enhance their communication and problem-solving skills by teaching them how to listen, express, negotiate, compromise, or collaborate with each other. Family therapy can also help the family resolve any issues or disagreements that may arise from the abuse or the bipolar disorder.

Choice D Reason: The family will restore their trust and bond with each other as one of the outcomes of family therapy. Family therapy can help the family rebuild their trust and bond with each other by facilitating empathy, respect, acceptance, and forgiveness among the family members. Family therapy can also help the family strengthen their sense of belonging, support, and unity as a family.

Choice E Reason: The family will seek legal action against the abuser is not an expected outcome of family therapy for a family who has been affected by psychological abuse by their father who has bipolar disorder. Family therapy is not intended to punish or blame the abuser, but rather to help him or her understand and change his or her abusive behavior and to help the family heal from the abuse. Seeking legal action against the abuser may be an option for some families who have experienced severe or chronic abuse, but it is not a goal or outcome of family therapy.

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.