# The clinic nurse reviews the visit note. Which findings require immediate follow-up? Highlight the findings that raise concern for abuse, neglect, or exploitation.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=494054&lang=en  
> language: en  
> subject: Mental Health Concepts  
> category: PSI

## Question

The clinic nurse reviews the visit note. Which findings require immediate follow-up? Highlight the findings that raise concern for abuse, neglect, or exploitation.

Nurses' Notes
1115:
An older client arrives with an adult son for a diabetes follow-up visit. The client walks with a cane and accepts the son's help with transportation to appointments. While helping the client change, the nurse observes two loop-shaped bruises on the upper arms and fresh red marks around one wrist. The son says the bruises occurred when the client "bumped into a door" but cannot say when. When the nurse requests time alone, the son refuses to leave and repeatedly answers questions before the client can speak. The client has an old healed abdominal surgical scar without pain or drainage. The client eats soft foods because the dentures are being repaired this week. During a brief moment when the son steps into the hallway, the client whispers that the son grabbed both wrists and threatened to move the client away from friends. The client says the son has managed transportation and finances for the past six months. Pharmacy records show blood-pressure and diabetes prescriptions have not been filled for two months although the son keeps the client's bank card. The client denies falling during the past month and reports no recent dizziness. Weight is unchanged from the previous visit; the client is clean, well groomed, and says the clothing was chosen independently that morning. The son returns and asks to end the visit because he has another appointment. The nurse arranges a private safety assessment and follows facility policy for suspected abuse.

## Explanation

Patterned injuries, blocked private communication, a direct disclosure of force and threats, and withheld medication access are converging abuse or neglect cues. Safety assessment and mandated procedures take priority.

## In-depth explanation

Quick answer
Follow up on the patterned bruises, the caregiver blocking a private interview, the client's quiet disclosure of grabbing and threats, and the unfilled prescriptions while the caregiver controls the bank card. Together they suggest possible abuse, neglect, and exploitation.

Why this is correct
Older-person abuse may be physical, emotional, neglectful, or financial and commonly involves a caregiver or trusted person.[1] No single subtle cue proves abuse, but the injury pattern, controlling behavior, direct statement, and loss of needed medication create a concerning cluster that requires a private safety assessment.

Easy analogy or mental picture
Think of separate puzzle pieces locking together: injury, control, disclosure, and unmet care. One piece can have another explanation, but the completed picture demands action. The analogy does not replace objective documentation or local reporting procedures.

Memory hook
When injury, control, threats, and missing care cluster, assess safety in private.

NCLEX decision rule
When an older client has unexplained injury plus caregiver control or unmet basic needs, think possible abuse; interview privately, assess immediate safety, document objectively, and follow reporting law and policy.

Why the other choices are wrong
Using a cane, needing help with transportation, preferring soft foods, and having an old surgical scar are not abuse evidence by themselves. They become relevant only if linked with harm, coercion, or failure to meet needs.References

- [1]CDC: About Abuse of Older PersonsCenters for Disease Control and Prevention

- [2]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing

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