which of the following injuries is most indicative of child abuse
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ATI Pediatrics Proctored Test

1. Which of the following injuries is MOST indicative of child abuse?

Correct answer: D

Rationale: Bruising to the upper back is more suspicious for child abuse compared to the other listed injuries. In young children, injuries like bruises to the upper back are less likely to be accidental and may raise concerns about physical abuse. The upper back is an area less prone to accidental injuries during play or falls. Multiple bruises to the shins are common in active children. A burned hand with splash marks may suggest accidental burns. A small laceration to the chin is also a common injury from falls in children. Therefore, the bruising on the upper back is more concerning for possible child abuse.

2. During your assessment of a woman in labor, you see the baby's arm protruding from the vagina. The mother tells you that she needs to push. You should:

Correct answer: D

Rationale: When encountering a protruding limb during delivery, it is crucial to recognize this as an emergency situation. The correct action is to cover the limb with a sterile towel to prevent injury and transport the mother immediately to a medical facility. Attempting to push the limb back into the vagina or trying to manipulate the baby's position can be harmful and delay necessary medical intervention. Encouraging the mother to push and providing high-flow oxygen is not appropriate in this scenario as immediate transport is essential to ensure the safety of both the mother and the baby.

3. What is a priority discharge instruction for a parent of a child experiencing the first episode of asthma?

Correct answer: A

Rationale: Educating parents about avoiding triggers is a crucial part of managing asthma in children to prevent future asthma attacks. By identifying and minimizing exposure to triggers, parents can help reduce the risk of asthma exacerbations and improve the child's overall quality of life.

4. A 4-year-old boy ingested an unknown quantity of drain cleaner. He is alert, has a patent airway, and has adequate breathing. You should:

Correct answer: C

Rationale: When a child ingests a harmful substance like drain cleaner and remains alert with a patent airway and adequate breathing, the initial steps involve contacting poison control to guide further management. In this scenario, providing oxygen to support respiratory function is essential until definitive care is established. Activated charcoal and ipecac are not recommended in the management of ingested caustic substances like drain cleaner. Performing a head-to-toe exam can wait until the child's immediate respiratory needs are addressed and the poison control center has provided guidance on further management.

5. A mother of a 6-year-old actively playing child, diagnosed with type 1 diabetes mellitus a year ago, calls a clinic nurse and reports that the child has been sick. She checked the child's urine, which was positive for ketones. What should the nurse instruct the mother to do?

Correct answer: C

Rationale: Encouraging the child to drink liquids is essential in managing ketones in urine. Increased fluid intake can help prevent dehydration and aid in flushing out ketones, which is crucial in managing diabetic ketoacidosis, a serious complication of uncontrolled diabetes.

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