Answer to Question 1
4
Middle adulthood is a time of change in marriage, family and parenting.
Answer to Question 2
A
Based on available information, it appears the patient is unable to care for herself and is therefore a vulnerable adult, one of the criteria in most locales for mandatory reporting of suspected abuse. The requirement for legal adjudication of incompetence varies from locale to locale, but it appears that the patient would at least meet the criteria for such adjudication, so the case could be reported IF the nurse suspected the injuries were due to abuse. However, in this case, the injuries are consistent with the daughter's report of the patient's fall, which could cause bruises in the locations noted. There is no data suggestive of abuse or neglect, such as bruises of various ages or in locations unexplained by falls, or signs of malnutrition or impaired hygiene. Therefore, there is no suspicion of abuse or neglect and thus no obligation to report. Also, reporting the case when there are no valid data supporting a diagnosis of abuse would result in an investigation that would likely increase family distress and impair the working relationship with the clinic, making it harder to monitor for signs of abuse or neglect in the future.