Which physical assessment finding by the nurse is most indicative of tracheoesophageal fistula in a newborn?

Choice A reason: A splash-pattern scald burn in a 2-year-old may indicate non-accidental trauma, as it suggests hot liquid thrown or poured, inconsistent with accidental spills. Such patterns, per tools like TEN-4-FACESp, raise suspicion of abuse, requiring further investigation to ensure the child’s safety.

Choice B reason: An injury explanation matching the child’s developmental abilities (e.g., a toddler falling while running) is less likely to indicate abuse. Consistent histories align with accidental injuries, not raising suspicion under abuse screening tools, making this an incorrect choice for findings suggestive of child abuse.

Choice C reason: Bruising on the torso of a 9-month-old, per the TEN-4-FACESp tool, is highly suspicious for abuse, as non-mobile infants rarely sustain accidental torso bruises. Such findings suggest external force inconsistent with developmental capabilities, warranting investigation for non-accidental trauma to protect the child.

Choice D reason: Sock-like burns on bilateral feet from immersion indicate non-accidental trauma, as they suggest forced submersion in hot liquid, creating uniform burn patterns. This is a classic abuse finding, distinct from accidental burns, requiring immediate reporting to child protective services for the child’s safety.

Choice A reason: Bubble baths can irritate the urethra and introduce bacteria, increasing the risk of urinary tract infections in children with vesicoureteral reflux, where urine flows backward from the bladder to the ureters. This practice is contraindicated, making it an incorrect inclusion in the teaching plan for parents.

Choice B reason: Holding urine for 6 to 8 hours promotes urinary stasis, increasing the risk of bacterial growth and infections in vesicoureteral reflux. Frequent voiding is recommended to flush the urinary tract, making this instruction harmful and incorrect for managing the condition effectively in children.

Choice C reason: Prophylactic antibiotics are often prescribed in vesicoureteral reflux to prevent recurrent urinary tract infections, which can lead to kidney damage. By reducing bacterial colonization in the urinary tract, antibiotics protect renal function, making this a critical component of the teaching plan for parents to ensure compliance.

Choice D reason: Fluid restrictions are not indicated for vesicoureteral reflux. Increased fluid intake promotes frequent urination, flushing bacteria from the urinary tract and reducing infection risk. Restricting fluids could exacerbate the condition, making this an incorrect and harmful suggestion for the teaching plan.