護理師正在評估一位病人是否存在潛在的老人虐待風險因素。哪些發現應被識別為可能遭受身體虐待的指標？（選所有適合的）
A nurse is assessing a client for risk factors related to potential elder abuse. Which findings should the nurse identify as indicators of possible physical abuse? (Select all that apply.)
- AThe client has multiple bruises in various stages of healing on the trunk.✓ 正解病人軀幹有多處不同癒合階段的瘀青。
- BThe caregiver seems overly concerned and stays close to the client during the exam.✓ 正解照顧者似乎過度關心，並在檢查期間緊貼著病人。
- CThe client has a history of wandering due to advanced dementia.病人有高齡失智症導致的遊走病史。
- DThe client's clothing is soiled and they appear malnourished.病人衣物髒污且看起來營養不良。
- EThe client becomes quiet and avoids eye contact when the caregiver enters the room.✓ 正解當照顧者進入房間時，病人變得安靜並避免眼神接觸。
識別老人虐待需要觀察生理徵象與互動行為。選項 A 的軀幹多處癒合程度不一的瘀青是典型的反覆受傷指標（非跌倒常見部位）。選項 B 的照顧者過度干預、不讓病人單獨說話是常見的控制行為，旨在防止受害者揭露真相。選項 E 則反映了受害者的恐懼反應。值得注意的是，選項 D（污穢、營養不良）雖然是虐待的一種，但通常歸類為「疏忽（Neglect）」而非題目要求的「身體虐待（Physical Abuse）」。選項 C 是失智症狀，而非受虐指標。臨床思路上，護理師必須區分疏忽、心理虐待與身體虐待的具體表徵，並對異常的照顧者互動保持高度警戒。
Identifying elder abuse requires observation of both physical signs and interactional behaviors. Option A's multiple bruises on the trunk in various stages of healing is a classic indicator of repeated injury (not a common site for falls). Option B's overly intrusive caregiver who prevents the client from speaking alone is a common controlling behavior aimed at preventing disclosure. Option E reflects a fear response in the victim. Notably, Option D (soiled clothing and malnutrition), while a form of abuse, is typically classified as 'neglect' rather than the 'physical abuse' specified in the question. Option C is a symptom of dementia, not an indicator of abuse. Clinically, the nurse must distinguish between the specific manifestations of neglect, psychological abuse, and physical abuse, and remain highly vigilant for abnormal caregiver interactions.
在美國，護理師是法律規定的強制通報者（Mandated Reporter），只要「懷疑」有虐待就必須通報，不需證據；台灣亦有類似規定（113 專線），但臨床實務中，對於家庭內部衝突的通報有時會面臨較大的文化阻力。