The nurse is assessing a child with a suspected fracture.
Which finding is indicative of a complete fracture?

Choice A rationale

Referring the child to a gastrointestinal specialist might be considered later, but it is not the priority action. Since the child shows no evidence of physical illness, the most likely cause of chronic soiling is functional or psychological. Addressing the potential underlying psychosocial factors takes precedence over pursuing further physical diagnostics immediately.

Choice B rationale

Reprimanding the child gently is an inappropriate and potentially harmful action. Encopresis is often involuntary and can be a source of significant shame and distress for the child. Reprimanding can exacerbate these feelings, leading to further withdrawal and potentially hindering therapeutic progress rather than encouraging control or behavioral change.

Choice C rationale

Reporting suspected encopresis and beginning a psychosocial evaluation is the priority nursing action. Encopresis, in the absence of physical illness, strongly suggests a psychological or behavioral component. A psychosocial evaluation is critical to identify underlying stressors, emotional issues, or developmental factors contributing to the soiling behavior, facilitating appropriate intervention.

Choice D rationale

Instructing the child to eat more fiber is an intervention for constipation, which can be a contributing factor to encopresis. However, it's not the priority action when there's no evidence of physical illness and chronic soiling is present. Without addressing potential psychological factors, dietary changes alone are unlikely to resolve the complex issue of non-organic encopresis.

Choice A rationale

According to Erik Erikson's theory of psychosocial development, adolescence (roughly ages 12-18) is characterized by the central crisis of identity versus role confusion. During this stage, adolescents explore various roles, beliefs, and values to form a cohesive sense of self and define their place in society, integrating past experiences with future aspirations.

Choice B rationale

Autonomy versus shame and doubt is the psychosocial crisis associated with early childhood, typically ages 1-3 years. During this stage, children develop a sense of personal control over physical skills and a sense of independence. Successful resolution leads to autonomy, while failure can result in feelings of shame and self-doubt.

Choice C rationale

Trust versus mistrust is the psychosocial crisis of infancy, typically ages 0-1 year. In this stage, infants develop a sense of trust in caregivers and the world based on the consistency and reliability of care received. Successful resolution fosters hope and security, while neglect can lead to mistrust and anxiety.

Choice D rationale

Industry versus inferiority is the psychosocial crisis characteristic of school age, typically ages 6-12 years. Children at this stage are focused on developing competence and mastering academic and social skills. Success in these endeavors leads to a sense of industry, while difficulties can result in feelings of inferiority and low self-esteem.