A nurse is caring for a 9-year-old child in a pediatric clinic. The client’s parent shares that they left an abusive partner a year ago and is in a safe place. Which of the following should the nurse identify as a sign the impact violence may have had on the child?

Choice A reason: Doing well in school is generally a positive indicator of resilience and adjustment. Children who are performing academically may not show overt signs of trauma in this domain. While abuse can affect school performance, success in academics is not typically considered a sign of negative impact. Instead, it suggests the child may be coping effectively in this area. Choice B reason: Talking about best friends at school reflects healthy social development and peer relationships. Positive friendships are protective factors against the effects of trauma and abuse. This statement does not indicate a negative impact of violence but rather shows that the child is engaging socially and building supportive connections. Choice C reason: Reporting abdominal pain at night when going to bed is a psychosomatic symptom often associated with stress, anxiety, or unresolved trauma. Children exposed to violence may develop physical complaints without a clear medical cause, reflecting emotional distress manifesting in the body. Nighttime symptoms are particularly significant because they may be linked to fear, insecurity, or intrusive memories when the child is alone and vulnerable. This is a clear sign of the lingering impact of violence. Choice D reason: Participation in school activities is a positive behavior that demonstrates engagement, socialization, and resilience. Involvement in extracurricular activities often supports emotional healing and provides structure. This does not indicate a negative impact of violence but rather shows adaptive functioning.