A nurse is reinforcing teaching with a client who has chronic stress.
Which of the following instructions should the nurse provide?

Choice A rationale

Interviewing the child about suspected abuse with a parent present could compromise the investigation and potentially endanger the child further. The parent, if the abuser, might intimidate or coach the child, preventing the disclosure of crucial information. A private, safe environment is necessary for the child to speak freely.

Choice B rationale

Completing an incident report for risk management is an important internal administrative step for the healthcare facility. However, it does not fulfill the legal and ethical obligation to report suspected child abuse to the appropriate external authorities who can initiate an investigation and ensure the child's safety.

Choice C rationale

Informing the parents that the findings must be reported to authorities might alert a potential abuser and could lead to further harm or the destruction of evidence. The priority is the child's safety, and direct reporting to the appropriate agency is the necessary first step.

Choice D rationale

Reporting suspected child abuse to the appropriate child protective services agency is the mandated legal and ethical responsibility of healthcare professionals. A perforated eardrum in a school-age child, especially if the explanation is inconsistent with the injury, raises suspicion of non-accidental trauma and requires immediate reporting to ensure the child's safety and well-being.

The statements that indicate the client is progressing as expected include:

• Client has identified several coping mechanisms when they feel tempted to use substances.
• Client has written a plan for what to do if relapse should occur.
• Client states that they are willing to participate in outpatient therapy following discharge.
• Client states that they have a plan to receive their methadone daily following discharge.

These statements demonstrate the client’s ability to recognize and implement strategies for managing cravings, their proactive approach to relapse prevention, and their willingness to continue treatment after discharge—all signs of expected progress in recovery. However, uncertainty about post-discharge living arrangements and eagerness to reconnect with old friends could present challenges, as returning to previous environments may increase relapse risk. Continued support and planning are essential for a successful transition.