The psychiatric nurse practitioner is evaluating a 6-year-old girl who acts inappropriately with her peers, asking to see their "bathing suit parts." She reports playing a "secret game" with her mom's boyfriend in which he touched her under her panties. Which of the following is the most appropriate immediate action?
Call the grandmother to come get the child.
Tell the mother to cease contact with the boyfriend.
Call the local child protection agency.
Call the child's school and have them call child protective services.
The Correct Answer is C
Choice A reason: While involving a trusted family member may be helpful later, it does not fulfill the legal and ethical obligation to report suspected abuse. It delays appropriate intervention.
Choice B reason: Telling the mother to cease contact with the boyfriend may be necessary, but it is not the PMHNP’s role to enforce protective measures without proper reporting. This action alone does not initiate an investigation or ensure the child’s safety.
Choice C reason: Mandatory reporting laws require healthcare professionals to report suspected child abuse immediately to the appropriate child protection agency. This ensures that trained professionals can investigate and intervene to protect the child.
Choice D reason: Delegating the responsibility to the school is inappropriate. The PMHNP is the mandated reporter and must act directly to notify child protective services.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Administering another 3 mg of flumazenil immediately after a failed response to the initial dose is not recommended due to the risk of precipitating seizures, especially in patients with chronic benzodiazepine use or co-ingestion of pro-convulsant substances. Flumazenil has a narrow therapeutic window and should be titrated cautiously.
Choice B reason: Although smaller incremental doses of flumazenil (e.g., 0.2–1 mg) may be used in some protocols, repeated dosing after a cumulative 3 mg without response is generally discouraged. The risk of adverse effects, particularly seizures, increases with higher cumulative doses.
Choice C reason: Waiting 20 minutes and administering another 3 mg would exceed the recommended maximum cumulative dose of flumazenil, which is typically 3–5 mg. This approach increases the risk of serious complications and is not supported by clinical guidelines.
Choice D reason: If a patient does not respond to a total of 3 mg of flumazenil, further administration is not advised. The lack of response suggests that the cause of altered mental status may not be due to benzodiazepines alone or that the patient has developed tolerance. Supportive care and airway management should be prioritized.
Correct Answer is C
Explanation
Choice A reason: Traumatic brain injury typically requires a history of head trauma, which is not mentioned in this case. While it can cause unresponsiveness, there is no evidence of injury or fall, making this diagnosis less likely.
Choice B reason: Seizures can cause sudden loss of consciousness, but they are usually followed by postictal confusion or convulsions, which are not described here. Additionally, there is no history of epilepsy or seizure-like activity.
Choice C reason: Alcohol intoxication is the most likely diagnosis given the context of fraternity involvement and sudden unresponsiveness. College initiation events often involve binge drinking, and even if the patient rarely drinks, peer pressure or hazing could lead to acute alcohol poisoning. This fits the clinical picture and social context.
Choice D reason: Cardiopulmonary arrest is a critical condition, but it is a consequence rather than a diagnosis. It could result from alcohol poisoning, but without evidence of cardiac or respiratory disease, it is not the primary diagnosis.
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