An infant presents to the emergency department (ED) with physical ...

[schs14]

An infant presents to the emergency department (ED) with physical injuries. The nurse is taking the child's history. Which parental statement would cause the nurse to be suspicious of abuse?
 
  1. I was walking up the steps and slipped on the ice and fell while carrying my baby.
  2. The baby's 18-month-old brother was trying to pull the baby out of the crib and dropped the baby on the floor.
  3. I placed the baby in the infant swing. His 6-year-old brother was running through the house and tripped over the swing, causing it to fall.
  4. I did not realize that my baby was able to roll over yet, and I was just gone a minute to check on dinner when the baby rolled off of the couch and onto our tile floor.

Question 2

Which is the priority nursing action when working with a parent who is suspected of Munchausen syndrome by proxy?
 
  1. Try to keep the parent separated from the child as much as possible.
  2. Explain to the child that the parent is causing the illness and that the healthcare team will prevent the child from being harmed.
  3. Carefully document parentchild interactions.
  4. Confront the parent with concerns of possible abuse.

[nguyenhoanhat]

Answer to Question 1

2
Explanation:
1. This statement is plausible from a developmental perspective; therefore, the nurse would not be suspicious of abuse.
2. Developmentally, it would be very difficult for an 18-month-old child to pull an infant out of a crib.
3. This statement is plausible from a developmental prospective; therefore, the nurse would not be suspicious of abuse.
4. This statement is plausible from a developmental prospective; therefore, the nurse would not be suspicious of abuse.

Answer to Question 2

3
Explanation:
1. Separating the parent from the child might alienate the parent and cause her to leave with the child.
2. Talking to the child about the healthcare team's suspicions could be confusing and frightening for the child.
3. Munchausen syndrome by proxy is very difficult to prove, and evidence provided by the careful documentation of the nursing staff can be very influential. Care must be taken not to make the parent suspicious and to keep the child in the hospital until enough evidence is collected.
4. Confronting the parent might alienate the parent and cause her to leave with the child.