# Situation: A 6-year-old is admitted to the pediatric ward with a fractured femur. The account given by his stepfather does not match the injury, and the physician suspects physical abuse. The child's mother is not a suspect. The nurse applies the Special Protection of Children Against Abuse, Exploitation and Discrimination Act (RA 7610). The team holds an interdisciplinary care conference. The medical social worker's home assessment is not yet complete, and the mother wants to take the child home, where the stepfather also lives. Which action by the nurse is BEST?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629658  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A 6-year-old is admitted to the pediatric ward with a fractured femur. The account given by his stepfather does not match the injury, and the physician suspects physical abuse. The child's mother is not a suspect. The nurse applies the Special Protection of Children Against Abuse, Exploitation and Discrimination Act (RA 7610).

The team holds an interdisciplinary care conference. The medical social worker's home assessment is not yet complete, and the mother wants to take the child home, where the stepfather also lives. Which action by the nurse is BEST?

## 보기

1. Support discharge to the mother with instructions to return for follow-up
2. Stop all visits by both parents until the investigation is finished
3. Advise the mother to keep the child away from the stepfather at home
4. Recommend that discharge wait until the home assessment is complete **✔ 정답**

**정답: 4**

## 해설

The nurse is the child's advocate, and the Code of Ethics places the client's welfare and safety first. Until the medical social worker has assessed the home, the team cannot know whether discharge is safe, so the nurse recommends that it wait. The non-suspected mother remains involved in care, in line with family-centered care.

## 심화 해설

Clinical context

A femur fracture in a 6-year-old is a high-energy injury that does not usually occur from minor falls or ordinary play. When the history given by a caregiver does not match the physical findings, the team must consider non-accidental trauma. The nurse’s first duty is to protect the child from further harm while preserving the therapeutic relationship with the non-offending parent.

Why discharge cannot proceed yet

The home environment has not been evaluated. The medical social worker’s assessment is the key piece of information that tells the team whether the stepfather has unsupervised access to the child, whether the home has safety hazards, and whether the mother can realistically protect the child. Without that assessment, the team cannot determine whether discharge is safe. Recommending discharge to the mother with follow-up instructions would place the child back into the same environment where the suspected abuse may have occurred. Advising the mother to keep the child away from the stepfather at home is not enforceable and does not address the underlying safety concern. Stopping all visits by both parents is unnecessarily punitive to the mother, who is not a suspect, and contradicts family-centered care.

Pathway-based approach to suspected abuse

The pilot study by Scallon et al. examined an evidence-based clinical pathway for suspected non-accidental trauma in pediatric patients. The pathway emphasizes standardized screening and a structured evaluation process before disposition decisions are made. A clinical pathway for suspected abuse requires completing the evaluation—including social work assessment—before the child is cleared for discharge. In this case, the incomplete home assessment means the pathway has not been completed. The nurse’s recommendation to wait is consistent with pathway compliance: the team should not bypass a required step simply because a parent requests early discharge.

Nursing priority and ethical reasoning

The nurse acts as the child’s advocate. The Code of Ethics places the client’s welfare and safety above other considerations, including parental convenience or the desire to avoid conflict. The mother remains involved in the child’s care, which supports the child’s emotional stability and respects the mother’s role as the non-suspected caregiver. Key point! Discharge planning for suspected child abuse is a team decision, not a unilateral parental request. Watch out! Do not confuse “supporting the mother” with “discharging to an unassessed home.” The nurse can support the mother while still recommending that discharge wait.

| Option | Why it is not the best action |
| --- | --- |
| 1. Support discharge to the mother with follow-up | Returns the child to the suspected unsafe environment before the home assessment is complete; violates the safety-first principle. |
| 2. Stop all visits by both parents | Punishes the non-suspected mother and disrupts family-centered care; not indicated because the mother is not a suspect. |
| 3. Advise the mother to keep the child away from the stepfather | Relies on verbal instruction without verifying the home situation; not enforceable and does not ensure safety. |
| 4. Recommend that discharge wait until the home assessment is complete | Correct. Completes the suspected-abuse pathway and ensures the team has the information needed to make a safe disposition decision. |

Clinical application for licensure exams

Questions about suspected child abuse test whether the examinee can identify the priority action when safety information is incomplete. The correct answer is almost always the option that delays a potentially unsafe discharge until the evaluation is finished. The nurse does not need to prove abuse; the nurse only needs reasonable suspicion to activate protective measures. In this scenario, the reasonable suspicion is the mismatch between the stepfather’s account and the femur fracture, which triggers the need for a complete social work assessment before the child leaves the hospital [1].References (research sources)

- [1]Identifying Child Abuse in Patients With Femur Fractures Through Pathway Compliance: A Pilot Study.Research articleScallon K, Wiggins S, Samson KK, Shah A. (2024) · DOI: 10.7759/cureus.72044

## 임상 시나리오

Discharge Safety in Suspected Child AbuseHold discharge until home evaluation is complete
A femur fracture in a 6-year-old is a high-energy injury. When the caregiver's story does not match the injury, suspect non-accidental trauma and prioritize the child's safety.

The medical social worker's home assessment is the key safety data. Without it, the team cannot know if the stepfather has unsupervised access or if the mother can protect the child.

Keep the non-suspected mother involved in care. Do not restrict her visits; this supports family-centered care while the investigation continues.

CautionDo not discharge with only verbal instructions to keep the child away from the suspected abuser. This is not enforceable and places the child back into an unevaluated, potentially unsafe environment.

## 핵심 개념

- **Non-accidental trauma** — Injury pattern inconsistent with the reported history, raising concern for physical abuse.
- **RA 7610** — Philippine law protecting children from abuse, exploitation, and discrimination, mandating reporting and protective action.
- **Family-centered care** — Approach that involves non-offending family members in the child's care while ensuring safety.
- **Home assessment** — Evaluation by a medical social worker to determine environmental safety and caregiver capacity before discharge.
- **Nurse as child advocate** — Ethical duty to prioritize the child's welfare and safety above other considerations.

## 같은 주제 문제

- [Situation: A nurse works in the newborn nursery and the neonatal intensive care unit (NICU…](https://mymerci.kr/pages/nclex_q.php?qn_id=629456)
- [Situation: A nurse works in the newborn nursery and the neonatal intensive care unit (NICU…](https://mymerci.kr/pages/nclex_q.php?qn_id=629457)
- [Situation: A nurse works in the newborn nursery and the neonatal intensive care unit (NICU…](https://mymerci.kr/pages/nclex_q.php?qn_id=629458)
- [Situation: A nurse works in the newborn nursery and the neonatal intensive care unit (NICU…](https://mymerci.kr/pages/nclex_q.php?qn_id=629459)
- [Situation: A nurse works on the pediatric ward of a tertiary hospital, where children weig…](https://mymerci.kr/pages/nclex_q.php?qn_id=629460)
- [Situation: A nurse works on the pediatric ward of a tertiary hospital, where children weig…](https://mymerci.kr/pages/nclex_q.php?qn_id=629461)
- [Situation: A nurse works on the pediatric ward of a tertiary hospital, where children weig…](https://mymerci.kr/pages/nclex_q.php?qn_id=629462)
- [Situation: A nurse works in the clinic of a public integrated school that has both element…](https://mymerci.kr/pages/nclex_q.php?qn_id=629463)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._