Deck 15: Child Maltreatment

Question 1

When taking an initial health history on an adolescent who is presenting to the clinic, the teen reveals she was abused as a child by her stepfather and temporarily placed out of the home in foster care. A history of child maltreatment is often associated with increased health risks in adolescence. These may include:

A) Early onset of sexual activity
B) Depression
C) Higher rates of Type 2 diabetes mellitus
D) a and b
E) All of the above

Answer 1

E

Question 2

Children are at greater risk for child maltreatment living in homes with a variety of risk factors that include all of the following except:

A) Single parenthood
B) Extended family cohesiveness
C) Maternal depression
D) Substance abuse
E) Intimate partner violence

Answer 2

B

Question 3

Child maltreatment often occurs in families that do not have known risk factors.

Answer 3

True

Question 4

A mother presents to the clinic with her 6-year-old daughter and she is concerned that she has been moody and withdrawn from family activities over the past few months. She also noted bruising on her arm a few weeks ago, which concerned her. Social and family history revealed the family moved into a household with another family and an adult relative. Your physical exam reveals bruising on the thigh area and upper arm. What is the best next step with this child and family?

A) Interview the child without the parent present.
B) Report bruises to Child Protective Services.
C) Complete the visit and send the child home with appointment for follow-up.
D) Consult child's father about bruises.

Question 5

A parent presents to the emergency department with a 2-year-old boy with c/o pain in left arm. The history is consistent with possible accidental trauma. In examining the toddler, you note some point tenderness on the arm. You order imaging of the arm, and ask the family to wait for the result. Which of the following radiograph results is often associated with nonaccidental trauma?

A) Hairline fracture of radius
B) Bucket-handle or corner fracture of humerus
C) Subluxation of ulna
D) All of the above

Question 6

Which of the following statements about child maltreatment reporting laws in the United States is most accurate?

A) All 50 states have identical child maltreatment reporting laws.
B) Homelessness is reportable as neglect in all 50 states.
C) Witnessing intimate partner violence is not reportable as child maltreatment in any states.
D) In many states, consensual sexual activity of a minor with another minor or adult is reportable as sexual abuse, depending on ages of both parties.

Question 7

Which of these findings is most suspicious for physical abuse?

A) Bruising on the shins of a 7-year-old
B) Splash burn on the chest of an ambulatory 18-month-old
C) Bruising on the buttocks and thighs of a 5-month-old infant
D) Faded linear scars on the forearms of an adolescent

Question 8

A grandmother suspects that her 8-year-old granddaughter has been sexually abused. Which of these statements about physical findings in prepubertal girls is most accurate?

A) Mild erythema in the vulvar area is a typical and nonsuspicious finding.
B) Vaginal discharge is always indicative of sexual abuse.
C) Prepubertal girls who are asymptomatic should always have cultures taken for sexually transmitted diseases (STDs) if sexual abuse is suspected.
D) Sexual abuse is highly unlikely if the child has a normal physical exam.

Question 9

A 3-month-old boy is brought to the emergency room by his father, who is concerned about his son's increasingly lethargic behavior. He states the child fell off the changing table yesterday. Which statement is most accurate about this situation?

A) An accidental fall inside the home is a common cause of serious head trauma in infants and young children.
B) The recommended work-up for a child with this history should include a dilated retinal exam and a skeletal series.
C) The risk for abusive head trauma is highest in toddlers and preschool-aged children.
D) Symptoms of abusive head trauma are to distinguish from symptoms of a serious infection in young infants.

Question 10

The APN's responsibility to report child maltreatment is best explained by which statement?

A) The APN should report child maltreatment only after an investigation of all other possible causes.
B) The APN must report all cases in which parents say they suspect maltreatment.
C) The APN must report a reasonable suspicion of child maltreatment based on history, behaviors, and physical findings.
D) The APN should report maltreatment only after consulting with a clinic or hospital supervisor.