A school nurse is examining a child who has a toothache and bruises on both knees.
Which of the following observations should the nurse report as a potential sign of maltreatment at home?

The child is receiving free lunches at school.

The child has recently started experiencing urinary incontinence.

The child has a history of frequent absences from school.

The child appears to be underweight for their age.

Answer and Explanation

The Correct Answer is C

Choice A rationale

While receiving free lunches at school may indicate a low-income status, it does not necessarily suggest maltreatment at home. Many schools offer free or reduced-price lunches to students from low-income families to ensure they receive proper nutrition.

Choice B rationale

Urinary incontinence in a child could be due to various reasons, including medical conditions or stress. While it could potentially be a sign of maltreatment, it is not a definitive indicator and would need to be evaluated in the context of other signs and symptoms.

Choice C rationale

Frequent absences from school can be a potential sign of maltreatment at home. Children who are being maltreated may be kept home to hide physical signs of abuse, or they may be truant due to a lack of parental supervision or a chaotic home environment.

Choice D rationale

Being underweight for their age could be a sign of neglect, one form of maltreatment. However, it could also be due to a variety of other factors, including medical conditions or poor nutrition, and should be evaluated in the context of other signs and symptoms.

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Correct Answer is D

Explanation

Choice A rationale

While it is true that many patients who choose hospice care have declined additional life- prolonging treatments, this is not a requirement for eligibility. Some patients may still pursue certain treatments while receiving hospice care.

Choice B rationale

The need for inpatient care due to lack of a caregiver does not determine eligibility for hospice care. Hospice care can be provided in various settings, including the patient’s home, a hospice facility, or a long-term care facility.

Choice C rationale

While insurance coverage can influence access to hospice care, it is not a condition for medical eligibility. The decision for hospice care is based on the patient’s health status and not on their insurance coverage.

Choice D rationale

This is the correct answer. To be eligible for hospice care, a patient must have a prognosis of six months or less to live if the illness runs its normal course.

A. “Could you describe how you are feeling today?” B. “Are you having any thoughts about hurting yourself?” C. “Is there anything that makes you feel less depressed?” D. “Who is available to help you?”

Correct Answer is B

Explanation

Choice A rationale

Asking the client to describe how they are feeling today is an important part of the assessment. However, when dealing with a client who is managing depression, the nurse’s first priority should be to ensure the safety of the client.

Choice B rationale

Asking if the client is having any thoughts about hurting themselves is the first question the nurse should ask. This is because safety is always the top priority, and clients dealing with depression may be at risk for self-harm or suicide.

Choice C rationale

While it’s important to understand what makes the client feel less depressed, this question is not as immediately critical as assessing for potential self-harm or suicide risk.

Choice D rationale

Understanding the client’s support system is an important part of the assessment, but it is not the first priority. The nurse’s initial focus should be on assessing the client’s immediate safety and mental health status.

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A school nurse is examining a child who has a toothache and bruises on both knees.Which of the following observations should the nurse report as a potential sign of maltreatment at home?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is employed at a hospice organization.Which of the following conditions must a patient meet to be eligible for hospice care?

Correct Answer is D

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Correct Answer is B

Explanation

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A school nurse is examining a child who has a toothache and bruises on both knees.
Which of the following observations should the nurse report as a potential sign of maltreatment at home?