Free CPN Legal Ethical Practice Questions with Answers

The nurse's primary legal obligation is to report any reasonable suspicion of abuse or neglect to the appropriate authorities (CPS or law enforcement) immediately. Under mandatory reporting laws, nurses are NOT required to prove abuse occurred; suspicion alone is the threshold. Exam Tip: PNCB emphasizes that reporting is a legal mandate that supersedes employer policy or social status. Mandatory reporters are generally granted immunity from civil or criminal liability if the report was made in good faith. Delaying a report to investigate or gather more evidence is a common distractor and is legally inappropriate for the nurse's role.

The TEN-4-FACESp rule identifies bruising on the Torso, Ears, Neck, Frenulum, Angle of jaw, Cheek, Eyelid, or Subconjunctival hemorrhage in a child <4 years old, or ANY bruise on an infant <4 months (TEN-4). Rationale: Accidental bruises typically occur over bony prominences (knees, shins, forehead). Bruises in fleshy or protected areas (ears, neck, buttocks, or the frenulum from forced feeding) are statistically significant indicators of abuse. PNCB Exam Strategy: Distinguish between accidental patterns (shins/forehead) and suspicious patterns (ears/neck/torso). If a question mentions bruising in these specific areas, the answer almost always involves a social work consult or CPS report.

Abusive Head Trauma (AHT), formerly known as Shaken Baby Syndrome. The classic triad includes subdural hematoma, retinal hemorrhages, and encephalopathy (though the triad is not always present). Key Findings: Retinal hemorrhages (especially multilayered) are highly specific for AHT. Findings of varying ages (old and new blood) suggest chronic or repetitive abuse. Nursing Priority: Immediate stabilization of the airway and ICP management, followed by a mandatory report and a multidisciplinary team evaluation (Child Protection Team).

The nurse must consider cultural practices, specifically cupping or coining (Cao Gio). These are traditional healing practices used to treat ailments like respiratory illness or fever. Clinical Pearl: While these practices produce marks that can mimic abuse, they are not intended to harm and are culturally significant. Exam Strategy: The CPN exam tests cultural competence. If the marks are in traditional patterns (symmetrical lines from coining or circles from cupping) and the child is otherwise well-cared for, the nurse should first discuss the findings with the family to understand the context. However, if the practice causes significant injury or if other signs of abuse exist, a report may still be necessary.

A complete Skeletal Survey (not a babygram or a total body X-ray). Rationale: A skeletal survey consists of approximately 20+ specific views of the entire skeleton. It is required for all children <2 years with suspected abuse and should be considered for children aged 2–5. High-Yield Findings: Classical Metaphyseal Lesions (CMLs), also known as bucket-handle or corner fractures, and posterior rib fractures are highly specific for non-accidental trauma due to the shearing forces required to cause them. Exam Tip: A babygram (one shot of the whole body) is insufficient and is a common distractor on exams because it lacks the detail to see subtle metaphyseal fractures.