The nurse is providing teaching to a mother of a 4-year-old child about prevention of communicable disease. Which of the following is important to include in her teaching.

Child abuse assessment requires careful evaluation of injury patterns, developmental consistency, and mechanism plausibility. Non-accidental trauma often presents with patterned, clustered, or location-specific bruising inconsistent with accidental mechanisms such as falls, especially in protected body regions.

Rationale:

A. A caregiver being anxious for medical attention is not a specific indicator of abuse. Parental anxiety may reflect concern, guilt, or situational stress but is not diagnostically associated with non-accidental trauma without corroborating physical findings.

B. Frequent emergency visits labeled as “accident prone” may reflect normal childhood activity patterns or poor supervision, but it is nonspecific and can be seen in both abusive and non-abusive environments. It alone does not strongly suggest intentional injury.

C. Bruises on the head, arms, and legs can occur in a true fall down stairs, as these are exposed bony areas commonly injured in accidental trauma. The distribution described is consistent with a plausible mechanism and is not highly specific for abuse.

D. Clustered bruising on the torso, back, or buttocks is highly suspicious for non-accidental injury because these are protected areas unlikely to be injured in accidental falls. Patterned bruises in these regions strongly suggest inflicted trauma and warrant further investigation.

Pediatric medication administration demands absolute precision, as even minor calculation errors can lead to severe adverse outcomes. Nurses must systematically verify every prescription by converting the child's weight to kilograms, establishing the safe dosage range (SDR) based on clinical drug references, and ensuring the ordered dose falls within those parameters before calculating the fluid volume for administration.

Rationale:
• 2–4 mg per dose: The child weighs 44 lb, which converts to 20 kg (44 ÷ 2.2 = 20 kg). The safe dosage range is 100–200 mcg/kg/dose.
Minimum dose: 100 mcg × 20 kg = 2,000 mcg = 2 mg
Maximum dose: 200 mcg × 20 kg = 4,000 mcg = 4 mg
Therefore, the safe dosage range is 2–4 mg per dose.

• Yes: The prescribed dose is 3 mg orally every 4 hours as needed. Since 3 mg falls within the safe dosage range of 2–4 mg per dose, the order is considered safe for administration.

• 1.5 mL: The medication concentration is 2 mg per 1 mL. Using dimensional analysis:
3 mg ordered × (1 mL ÷ 2 mg) = 1.5 mL. The nurse should administer 1.5 mL of liquid morphine.