A mother tells the nurse during an admission interview that her 2-year-old, who has numerous bruises, has fallen down stairs frequently. The mother is able to provide few vague details. The nurse evaluates this as:

Possible child abuse

Knowledge deficit pertaining to home safety.

A child with delayed milestones

Normal behavior for a 2 year old

Answer and Explanation

The Correct Answer is A

A. Possible child abuse is the most likely assessment. The presence of numerous bruises and the mother's vague, inconsistent details about the falls are concerning and may indicate that the child is being abused. Children at this age may sustain some bumps or bruises due to falls, but repeated and unexplained injuries, especially if the mother provides few details, should raise suspicion. The nurse should report this concern to appropriate authorities for further investigation.
B. Knowledge deficit pertaining to home safety could be a possibility if the mother is unaware of safety precautions in the home, but the vague and inconsistent explanation of the injuries makes this less likely. A knowledge deficit would typically present with more specific concerns and less concern for frequent injury.
C. A child with delayed milestones does not explain the frequent bruises or the vague details provided by the mother. While developmental delays can occur in some children, they are unlikely to account for such a pattern of injuries.
D. Normal behavior for a 2-year-old typically involves some bumps and bruises, but frequent falls resulting in numerous bruises are not considered normal. Most 2-year-olds are still learning motor skills, but they should not be falling down stairs repeatedly.

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Correct Answer is C

Explanation

A. Delirium is an acute, often sudden onset of confusion and altered mental status, usually caused by an underlying medical condition or medication. It tends to fluctuate and is typically reversible — not consistent with the progressive and long-term decline described.
B. Amnesia refers specifically to memory loss, which can be caused by trauma, disease, or psychological factors, but it does not encompass the broader cognitive decline (such as impaired judgment, language, and executive function) seen in dementia.
C. Dementia is characterized by a gradual and progressive decline in memory, thinking, and reasoning skills over time. The two-year progression described in the question is typical of dementia, especially in older adults.
D. Parkinson’s disease is a neurodegenerative disorder primarily affecting movement.While it can be associated with dementia in later stages, the primary symptoms early on are related to motor function (e.g., tremors, rigidity), not memory and cognition.

A. Visual hallucinations B. Tremors C. Paroxysmal sweating D. Pupil dilation

Correct Answer is D

Explanation

A. Visual hallucinations can occur during alcohol withdrawal, especially in more severe cases such as delirium tremens (DTs). Hallucinations are part of the neuropsychiatric symptoms seen in alcohol withdrawal.
B. Tremors are one of the most common symptoms of alcohol withdrawal. Hand tremors are typically observed and can range from mild to severe.
C. Paroxysmal sweating (or excessive sweating) is also a common symptom of alcohol withdrawal. It occurs due to autonomic instability in the body during withdrawal, and can be quite pronounced.
D. Pupil dilation is not typically a symptom of alcohol withdrawal. In fact, alcohol withdrawal more commonly causes pupil constriction in mild to moderate withdrawal, and pupillary changes are generally less pronounced than other symptoms like tremors, sweating, or anxiety.

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A mother tells the nurse during an admission interview that her 2-year-old, who has numerous bruises, has fallen down stairs frequently. The mother is able to provide few vague details. The nurse evaluates this as:

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A mother tells the nurse during an admission interview that her 2-year-old, who has numerous bruises, has fallen down stairs frequently. The mother is able to provide few vague details. The nurse evaluates this as: