During the assessment, the nurse notices that an African American baby has a darker, slightly bluish-hued patch about 5 cm 7 cm on the buttocks and lower back. What is the nurse's next action?
1. Call the Department of Social Services (DSS) to report this sign of abuse.
2. Confer with the physician about the possibility of a bleeding tendency.
3. Ask the mother about the cause of the bruise.
4. Chart the presence of a Mongolian spot.
4
Rationale 1: The nurse who calls the DSS to report the patch as a sign of abuse will reveal ignorance of biologic differences and possibly provoke the family to file charges of harassment.
Rationale 2: The nurse who confers with the physician about the patch will reveal ignorance of biologic differences in culturally competent assessments.
Rationale 3: Asking the mother about the cause of the bruise reveals the nurse's ignorance of biologic differences and cultural insensitivity.
Rationale 4: The nurse will chart the presence of a Mongolian spot, which is observed in races with dark skin tones.
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