A nurse has been working with a family at the community health office and is alert to signs of family violence. Which of the following would the nurse be most concerned about, in this regard?
1. The baby always seems to have a cold.
2. One of the children never speaks and seems on guard when in the presence of a parent.
3. The family's clothes are relatively clean, but the children usually have some kind of dirt stain on their shirt or pants.
4. The family does not have a regular physician.
2. One of the children never speaks and seems on guard when in the presence of a parent.
Rationale:
Family violence includes abuse between intimate partners, child abuse, and elder abuse, and may include physical, mental, and verbal abuse as well as neglect. A child who does not speak and is watchful when parents are near would be a significant indicator of a possible abuse situation. The nurse, however, must be careful in assessing for this and would possibly want to speak to the child on a one-to-one basis for further assessment information. The baby may have an untreated condition, but chronic cold symptoms are not evidence of abuse. Dirty clothes or clothes not meeting the nurse's standards are not signs of abuse—maybe for this family, appearance is not a high priority. Not having a regular physician would be a concern for health promotion and maintenance, but not for abuse.
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