A nurse in a community clinic is caring for a 20-month-old toddler who has spiral fractures of the right ulna and radius. Which of the following findings should the nurse recognize as a potential indication of abuse?

A. Crying when the arm is examined is an expected response in a toddler with a painful fracture and does not by itself indicate abuse. B. A single injury alone is not necessarily suspicious for abuse; accidental injuries can cause one fracture. C. Being brought in promptly (30 minutes after injury) suggests appropriate parental concern and is not a red flag. D. Spiral fractures typically result from a twisting motion and are uncommon from a simple fall off a couch. When the history provided by the parents does not match the type of injury, this inconsistency is a strong indication of possible abuse.