Substance Abuse and Abuse Q 39
Joseph, a 12-year-old child, complains to the school nurse about nausea and dizziness. While assessing the child, the nurse notices a black eye that looks like an injury. This is the third time in 1 month that the child has visited the nurse. Each time, the child provides vague explanations for various injuries. Which of the following is the school nurse’s priority intervention?
A. Contact the child's parents and ask about the child's injury.
B. Encourage the child to be truthful with her.
C. Question the teacher about the parent's behavior.
D. Report suspicion of abuse to the proper authorities.
Correct Answer: D. Report suspicion of abuse to the proper authorities.
The nurse is obligated to report suspicion of child abuse to the appropriate protective services. Failure to do so can risk further endangerment of the child, and failure to report is a misdemeanor violation on the part of the nurse. Maintain factual and objective documentation of all observations, including child’s physical condition, child’s behavioral response to parents, health care workers, other visitors, parent’s response to child, and interviews with family members.
Option A: The parents will be contacted and an investigation will proceed under the legal authority of the child protective service agency. Assess behavior of parents toward the child, including responses to the child’s behavior, ability to comfort the child, feelings, and perceptions toward the child, expectations for the child,over-protective or concern for the child.
Option B: Although the nurse would expect to establish rapport with the child, encouraging the child to be truthful would send the message that the nurse believes the child is lying; therefore, this intervention would be inappropriate. Encourage expression of concerns and fears of the child regarding environment and management; Grant questions and provide honest explanations and communication at the level of the child’s age. Provides an opportunity to release feelings that can decrease anxiety.
Option C: Questioning the teacher may or may not provide validation of the nurse’s suspicions; regardless, this intervention does not ensure the child’s safety, which is the priority. Communicate information and needs of the child to those on the abuse team (or to new caretakers if the child is being placed with a foster parent or someone other than parents); provide written instruction for care and child’s needs.