A nurse in a pediatric clinic is caring for a school-age child who has a perforated eardrum. The nurse suspects abuse. Which of the following actions should the nurse take?

Choice A reason: Serum creatinine levels are commonly used to assess kidney function. While kidney function is important, it does not specifically evaluate nutritional status. Chronic alcohol use can impact multiple organs, but thiamine deficiency is a more direct concern related to nutritional status in these patients.

Choice B reason: Thiamine (vitamin B1) deficiency is a well-known complication of chronic alcohol use disorder. Alcohol interferes with the absorption and utilization of thiamine, leading to deficiencies that can cause severe neurological problems, such as Wernicke's encephalopathy and Korsakoff's syndrome. Monitoring thiamine levels is crucial in assessing and managing the nutritional status of clients with chronic alcohol use disorder.

Choice C reason: Urinalysis is a basic test that can provide information about kidney function and the presence of infections, among other things. However, it is not specifically useful in evaluating the nutritional status of a client with chronic alcohol use disorder. Nutritional deficiencies would not be directly assessed through a routine urinalysis.

Choice D reason: Erythrocyte sedimentation rate (ESR) is a non-specific marker of inflammation and is used to detect inflammatory conditions. While it can provide information on inflammatory processes, it does not directly assess nutritional status. The nutritional impact of chronic alcohol use disorder is more accurately evaluated by specific nutrient levels, such as thiamine.

Choice A reason: If a nurse suspects child abuse, they are legally required to report it to the appropriate authorities. Informing the parents that the findings must be reported is necessary to comply with mandatory reporting laws. This step ensures that the child receives the necessary protection and that the situation is investigated further by child protective services or law enforcement.

Choice B reason: Completing an incident report for risk management is an internal process used by healthcare facilities to document incidents that occur within the facility. While it is important to document the findings, this action alone does not fulfill the nurse's legal obligation to report suspected abuse to the authorities.

Choice C reason: Interviewing the child about the suspected abuse with a parent present may not be appropriate, especially if there is a possibility that the parent is the abuser. The presence of the parent could influence the child's responses and prevent them from speaking freely about the abuse. It is crucial to conduct the interview in a safe and supportive environment, often with a child protection professional or a social worker.

Choice D reason: Avoiding asking the child what caused the injury is not recommended in cases of suspected abuse. It is important for the nurse to gather as much information as possible about the cause of the injury. However, the nurse should approach the questioning in a sensitive and non-leading manner to avoid further traumatizing the child.