The practical nurse (PN) is assisting with screening examinations at a community clinic where a toddler is brought by a parent for scheduled vaccines. The toddler clings to the caregiver and cowers when approached. Which assessment warrants immediate intervention by the PN?

A. Small bruises on the lower extremities: Minor bruising can be common in toddlers due to normal activity and play. While it should be documented and monitored, it does not require immediate intervention unless there are patterns suggestive of abuse. B. Refusal to answer simple questions: Hesitation or reluctance to speak can be normal behavior in a fearful or shy toddler. It warrants gentle assessment and observation but is not immediately life-threatening. C. One-inch laceration across center of forehead: A laceration may require first aid, but a single superficial injury is typically managed without urgent intervention, unless it threatens airway, bleeding control, or infection risk. D. Several dime-sized circular burns on the back: Multiple patterned burns, particularly on the back, are highly suspicious for intentional injury. These findings indicate possible physical abuse and warrant immediate intervention to ensure the child’s safety and initiate protective measures.