Abuse & neglect NCLEX-RN Practice Questions

Abuse & Neglect NCLEX-RN Practice Questions

This topic-wise MCQ blog focuses on Abuse & Neglect within the Psychosocial Integrity domain for the NCLEX-RN exam. The questions are designed to strengthen clinical judgment in detecting abuse across the lifespan, ensuring client safety, performing trauma-informed care, documenting objectively, and complying with mandatory reporting laws. You will encounter realistic scenarios on child maltreatment, elder abuse, intimate partner violence (IPV), sexual assault, human trafficking, neglect, and exploitation. Emphasis is placed on prioritization, ethics, consent, interprofessional collaboration, and culturally sensitive care. These practice questions help learners differentiate between injury patterns, recognize red flags, and take appropriate nursing actions to safeguard clients while adhering to legal and professional standards. This is a Topic Wise Question blog for NCLEX-RN Exams.

Q1. A nurse assesses a 4-year-old with multiple bruises in various stages of healing and a history that does not match the injuries. What is the priority action?

• Report suspected abuse immediately to child protective services as a mandated reporter
• Confront the caregivers directly and demand an explanation
• Document findings and wait to gather more proof before reporting
• Discharge the child with safety resources for the caregivers

Correct Answer: Report suspected abuse immediately to child protective services as a mandated reporter

Q2. An older adult in a long-term care facility presents with dehydration, weight loss, and stage 3 pressure injuries. Which initial nursing action is most appropriate?

• Notify adult protective services immediately without further assessment
• Ensure the client’s immediate safety by stabilizing and addressing injuries, notify the provider/charge nurse, and then follow mandatory reporting procedures
• Confront the primary caregiver about suspected neglect
• Discharge the client to family care for closer oversight

Correct Answer: Ensure the client’s immediate safety by stabilizing and addressing injuries, notify the provider/charge nurse, and then follow mandatory reporting procedures

Q3. A pregnant client experiencing intimate partner violence (IPV) develops a safety plan. Which statement indicates correct understanding?

• “I will prepare a hidden, packed bag and create a code word to alert friends or family.”
• “We should start couples counseling so the abuse will stop.”
• “I will remove the restraining order to keep the family together.”
• “I will confront my partner when they are calm and alone.”

Correct Answer: “I will prepare a hidden, packed bag and create a code word to alert friends or family.”

Q4. Which documentation best reflects appropriate charting of suspected abuse?

• “Client is likely abused by spouse” without further detail
• Objective descriptions of injuries, body map, photographs per policy, and verbatim client statements in quotation marks
• Summarized impressions from unit staff and family input only
• “Client denies abuse” and no other documentation to preserve privacy

Correct Answer: Objective descriptions of injuries, body map, photographs per policy, and verbatim client statements in quotation marks

Q5. Which finding most strongly increases suspicion of physical abuse in a child with a long-bone fracture?

• Immediate presentation to the ED after injury
• Injury consistent with the developmental level and history
• Delay in seeking care with incongruent caregiver explanations
• Presence of a single bruise on a bony prominence

Correct Answer: Delay in seeking care with incongruent caregiver explanations

Q6. A sexual assault survivor arrives at the ED. What is the priority nursing action?

• Ask the client to remove clothing and shower before the exam
• Assess and stabilize airway, breathing, circulation, and acute injuries
• Begin forensic evidence collection without consent to prevent loss of evidence
• Begin detailed questioning about the assault immediately

Correct Answer: Assess and stabilize airway, breathing, circulation, and acute injuries

Q7. In which situation may a nurse disclose client information without consent?

• Explaining the client’s condition to a neighbor who is concerned
• Reporting suspected child abuse to child protective services as required by law
• Updating estranged family members to gain additional history
• Providing details to the media to help with public awareness

Correct Answer: Reporting suspected child abuse to child protective services as required by law

Q8. Which presentation is most consistent with emotional/psychological abuse in a child?

• A preschooler who is overly compliant, withdrawn, and repeatedly states, “I am bad”
• A toddler with scattered bruises on shins after playground activity
• An adolescent with a healed forearm fracture from a documented sports injury
• A school-age child with a common cold and normal affect

Correct Answer: A preschooler who is overly compliant, withdrawn, and repeatedly states, “I am bad”

Q9. Which client is at greatest risk for elder abuse?

• An independent older adult living with supportive family
• An older adult with advanced dementia dependent on an overwhelmed caregiver
• An older adult living in an assisted living facility with adequate staffing
• An older adult active in community groups and clubs

Correct Answer: An older adult with advanced dementia dependent on an overwhelmed caregiver

Q10. A competent adult experiencing IPV refuses to report the abuse. Which nursing action is most appropriate?

• Report the abuse to police without the client’s consent
• Respect the client’s decision, provide resources and safety planning, and document findings objectively
• Call the partner to discuss the situation
• Discharge the client without further discussion

Correct Answer: Respect the client’s decision, provide resources and safety planning, and document findings objectively

Q11. Which scenario best illustrates child neglect?

• Leaving a toddler home alone for several hours
• Spanking that does not leave marks
• Sibling rivalry resulting in a minor scratch
• Child refusing to eat a single meal

Correct Answer: Leaving a toddler home alone for several hours

Q12. During assessment, which finding is most concerning for physical abuse regardless of cultural discipline practices?

• Single bruise on the knee from a fall
• Patterned injuries (e.g., belt marks) and bruises in various stages of healing
• Minor abrasion from outdoor play
• Calluses on the hands from sports

Correct Answer: Patterned injuries (e.g., belt marks) and bruises in various stages of healing

Q13. In the ED, a young adult is accompanied by a controlling companion who refuses to leave and answers all questions. What is the most appropriate nursing action?

• Proceed with the interview in the presence of the companion for efficiency
• Provide discharge instructions to the companion only
• Separate the client from the companion for a private assessment and screening for trafficking and abuse
• Ask the companion to complete the intake form for the client

Correct Answer: Separate the client from the companion for a private assessment and screening for trafficking and abuse

Q14. Which finding suggests possible financial exploitation of an older adult?

• Consistent grocery receipts and paid utilities
• Sudden unpaid bills and new “friend” controlling access to bank accounts
• Regularly scheduled medical appointments kept
• Stable living arrangement with long-term caregiver

Correct Answer: Sudden unpaid bills and new “friend” controlling access to bank accounts

Q15. A novice nurse says, “I’ll report child abuse only when I have proof.” What is the best response by the preceptor?

• “Wait for proof; reporting too soon can cause problems.”
• “You must report any reasonable suspicion of abuse according to law and policy.”
• “Ask the parents to admit the abuse before reporting.”
• “Only report if the child asks you to.”

Correct Answer: “You must report any reasonable suspicion of abuse according to law and policy.”

Q16. Which bruise pattern is most suspicious for inflicted injury?

• Small abrasions on elbows after a soccer game
• Symmetric hand-shaped bruises on the posterior thighs
• Single bruise on the shin after tripping
• Scrape on the palm after a fall

Correct Answer: Symmetric hand-shaped bruises on the posterior thighs

Q17. A school-age child presents with poor hygiene, persistent hunger, and untreated dental caries. Teachers report frequent absences. What does this most likely indicate?

• Normal variation in child development
• Child neglect requiring further assessment and reporting
• Oppositional defiant disorder
• Somatic symptom disorder

Correct Answer: Child neglect requiring further assessment and reporting

Q18. Which safety plan element should the nurse advise against for a client experiencing IPV?

• Turning off phone location services and removing location sharing
• Keeping copies of important documents in a safe place
• Creating a code word to alert trusted contacts
• Posting safety plans and shelter addresses on public social media

Correct Answer: Posting safety plans and shelter addresses on public social media

Q19. During a suspected child sexual abuse evaluation, which approach is best?

• Use open-ended, developmentally appropriate questions and avoid repeated interviews
• Ask leading questions to speed up disclosure
• Interview the child in front of caregivers only
• Promise confidentiality regardless of safety concerns

Correct Answer: Use open-ended, developmentally appropriate questions and avoid repeated interviews

Q20. Regarding forensic evidence collection after sexual assault, which nursing action is most appropriate?

• Collect all samples without consent to preserve evidence
• Obtain informed consent for each part of the exam and evidence collection
• Ask the client to shower to improve comfort before the exam
• Discard clothing worn during the assault to prevent contamination

Correct Answer: Obtain informed consent for each part of the exam and evidence collection

Q21. Which practice constitutes potential abuse through restraints in long-term care?

• Using the least restrictive alternatives before considering restraints
• Applying chemical restraints for staff convenience rather than medical necessity
• Frequent reassessment and timely removal of restraints
• Obtaining a time-limited order and monitoring per policy

Correct Answer: Applying chemical restraints for staff convenience rather than medical necessity

Q22. Which burn pattern most strongly suggests abuse in a toddler?

• Small splash burns on forearms from reaching hot soup
• Symmetric “stocking-glove” distribution burns on both legs
• Single superficial sunburn on shoulders
• Minor contact burn on fingertip from a candle

Correct Answer: Symmetric “stocking-glove” distribution burns on both legs

Q23. A child with frequent unexplained hospitalizations shows symptom improvement when separated from the caregiver. What is the priority nursing action?

• Discharge the child to the caregiver with education
• Document findings and take no further action
• Report suspected factitious disorder imposed on another (medical child abuse) and ensure the child’s safety
• Confront the caregiver directly and close the case if they deny

Correct Answer: Report suspected factitious disorder imposed on another (medical child abuse) and ensure the child’s safety

Q24. An older adult presents with bruises and states, “I fell.” The partner refuses to leave the room. What is the most appropriate next action?

• Accept the explanation and proceed with routine care
• Send both home with fall prevention instructions
• Privately screen the client for abuse and assess safety, ensuring the partner leaves during the interview
• Ask the partner to answer all questions for the client

Correct Answer: Privately screen the client for abuse and assess safety, ensuring the partner leaves during the interview

Q25. A nurse suspects elder abuse in the community. Which interprofessional action is most appropriate?

• Manage the case independently to protect confidentiality
• Initiate referral to social services while following mandatory reporting laws and agency protocols
• Delay referral until the next scheduled visit
• Call neighbors to verify the situation

Correct Answer: Initiate referral to social services while following mandatory reporting laws and agency protocols

Q26. The facility receives a court order for records in an abuse case. What should the nurse do?

• Ignore the order to protect the client’s privacy
• Release only the minimum necessary information per court order and facility policy
• Post the records to a secure social media group for legal review
• Give complete access to any requesting party

Correct Answer: Release only the minimum necessary information per court order and facility policy

Q27. A male client reports fear of his partner and shows injuries. Which response by the nurse is most appropriate?

• “Men are rarely victims; are you exaggerating?”
• “Abuse resources are only for women.”
• “Your experience is valid. Let’s discuss options, resources, and safety planning.”
• “You should confront your partner immediately.”

Correct Answer: “Your experience is valid. Let’s discuss options, resources, and safety planning.”

Q28. A client discloses, “My partner hurts me and I’m scared to leave.” Which therapeutic response is best?

• “Why didn’t you leave earlier?”
• “I’m glad you told me. You are not alone; help and resources are available.”
• “You must report this right now.”
• “Let’s call your partner to talk.”

Correct Answer: “I’m glad you told me. You are not alone; help and resources are available.”

Q29. The nurse reviews orders for a pediatric sexual assault survivor. Which order should the nurse question?

• Emergency contraception per protocol with consent
• Empiric STI prophylaxis per protocol with consent
• Forensic evidence collection with informed consent
• Vaginal douching prior to exam to improve comfort

Correct Answer: Vaginal douching prior to exam to improve comfort

Q30. During a home visit, the nurse finds a toddler in a cluttered home with accessible medications and a loaded firearm on a low shelf. What is the priority action?

• Teach general home safety and schedule a follow-up in one month
• Ensure immediate child safety and initiate mandatory reporting due to imminent danger
• Document and leave without intervention to avoid conflict
• Ask the caregiver to sign a safety waiver

Correct Answer: Ensure immediate child safety and initiate mandatory reporting due to imminent danger

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