A nurse is caring for four clients at an urgent care center. Which of the following clients should the nurse suspect has been physically abused?

Choice A reason: A fracture of the tibia and fibula in a 7-year-old child can occur accidentally during activities such as riding a bicycle. While fractures should always be evaluated carefully, the mechanism of injury described is consistent with the child’s developmental abilities and does not immediately suggest abuse. Choice B reason: Scalding burns over the face and chest in a toddler are concerning, but the explanation provided—that the child pulled on a tablecloth and spilled hot tea—is a plausible accidental mechanism. Toddlers are curious and often pull on objects within reach. Although burns should always be assessed carefully, this scenario is consistent with accidental injury. Choice C reason: Bruises on bony prominences such as the lower legs and elbows are common in toddlers who are learning to walk. These bruises are typically accidental and expected in children at this developmental stage. The location of the bruises is consistent with normal activity and does not strongly suggest abuse. Choice D reason: A 6-month-old infant sustaining near drowning after reportedly climbing into a tub and turning on the water is highly suspicious for abuse or neglect. At this age, infants lack the developmental ability to climb into a tub or turn on water. The explanation provided is inconsistent with the child’s developmental stage, making this scenario strongly indicative of abuse or neglect. This is the client the nurse should suspect has been physically abused.