The nurse is caring for a child who has been hospitalized for maltreatment.
When reviewing the child's records, which of the following may place the child at an increased risk of abuse?
The child's mother has a history of depression.
Both parents work outside the home.
The child's father is the primary caretaker.
The family lives in an apartment.
The Correct Answer is A
Choice A rationale
Parental mental health issues, such as a history of depression in the mother, significantly increase the risk for child maltreatment. Psychological distress can impair a parent's ability to cope with stress, manage anger, provide consistent, nurturing care, and meet the child's emotional and physical needs, thereby increasing the likelihood of abuse or neglect occurring within the family unit.
Choice B rationale
Both parents working outside the home is common in many families and is not considered an independent risk factor for child abuse. Economic stability, often associated with parental employment, may actually decrease stress compared to families experiencing financial hardship, making this a neutral or protective factor rather than a risk factor.
Choice C rationale
A child's father being the primary caretaker does not inherently increase the risk of abuse. The risk factors for child abuse are related to specific parental characteristics (e.g., substance abuse, history of abuse, mental illness) or situational stressors, not the gender identity of the parent who assumes the primary caregiving role.
Choice D rationale
Living in an apartment or in high-density housing is a socioeconomic factor often correlated with, but not a direct cause of, child abuse. While poverty and housing stress are known risk factors, the type of dwelling itself is less significant than specific stressors like unemployment, social isolation, and parental psychological instability.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Administering acetaminophen (Tylenol) is a standard intervention for fever (101 degrees F) in a child to improve comfort and decrease metabolic demand. Fever reduction is important, especially in a child with a "toxic appearance," which suggests a serious underlying illness. This is a supportive measure, and the dosage would be based on the child's weight and provider's order.
Choice B rationale
A "toxic appearance" in a child with fever is a medical emergency that indicates potential sepsis or another severe illness, requiring immediate and aggressive management. Obtaining intravenous (IV) access is essential for rapid administration of IV fluids and antibiotics, and for drawing blood cultures and other diagnostic labs necessary to guide treatment and stabilize the critically ill child.
Choice C rationale
In a febrile child presenting with a toxic appearance, broad-spectrum antibiotics are typically administered empirically (before culture results are available) after obtaining blood cultures. This prompt intervention is crucial to combat potential bacterial sepsis, which is a leading cause of morbidity and mortality in this presentation. The administration is generally done via the established IV access.
Choice D rationale
While fluid replacement is necessary for a febrile child who may be dehydrated, attempting to replace fluid deficits orally in a child with a toxic appearance is contraindicated and unsafe. These children are at high risk for aspiration, have poor gut perfusion, and require rapid, controlled fluid resuscitation, which must be accomplished via the intravenous (IV) route. Oral rehydration is too slow and unreliable in this critical condition.
Correct Answer is A
Explanation
Step 1 is: Calculate the minimum safe dose for 24 hours. 5 mcg/kg/24 hr × 16.1 kg = 80.5 mcg/24 hr.
Step 2 is: Calculate the maximum safe dose for 24 hours. 6 mcg/kg/24 hr × 16.1 kg = 96.6 mcg/24 hr.
Step 3 is: Compare the ordered dose to the safe range. The ordered dose is 150 mcg. The safe dose range is 80.5 mcg to 96.6 mcg. The ordered dose (150 mcg) is higher than the maximum safe dose (96.6 mcg). The ordered dose is NOT safe, so the initial answer is B. However, the question choices are A. Yes, B. No, C. The dose is too low for the client's weight, D. The safe dose range is too narrow to determine. Since the ordered dose is too high, the most accurate choice indicating it is NOT safe is "No".
Choice A rationale
The statement "Yes" is incorrect because the ordered dose of 150 mcg is significantly above the calculated safe range maximum of 96.6 mcg/24 hr. Administering an overdose of levothyroxine can lead to hyperthyroidism symptoms like tachycardia, heat intolerance, and anxiety, which is not a safe practice.
Choice B rationale
The statement "No" is correct because the ordered dose of 150 mcg is not within the therapeutic and safe range of 80.5 mcg to 96.6 mcg for a 16.1 kg child. Dosing levothyroxine accurately is crucial as it has a narrow therapeutic index, and excess dosage carries risks of serious cardiac side effects.
Choice C rationale
The statement "The dose is too low for the client's weight" is incorrect. The maximum safe dose is 96.6 mcg, and the ordered dose is 150 mcg, which makes the ordered dose too high, not too low. Giving an excessively high dose can cause adverse effects due to drug toxicity or an induced hypermetabolic state in the body systems.
Choice D rationale
The statement "The safe dose range is too narrow to determine" is incorrect. The safe dose range is clearly defined by the provided parameters as 80.5 mcg to 96.6 mcg/24 hr. The calculation provides a precise and sufficient range to determine that the ordered dose of 150 mcg is clearly unsafe and should be questioned by the nurse.
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