護理師正在評估病人是否有受虐跡象。下列哪些發現應被記錄為潛在受虐指標？（選所有適合的）
A nurse is assessing a client for signs of physical abuse. Which findings should the nurse document as potential indicators of abuse? (Select all that apply.)
- ABruises in various stages of healing✓ 正解不同癒合階段的瘀青
- BCigarette burns on the back✓ 正解背部的菸頭燒傷
- CInconsistent explanations for injuries✓ 正解對受傷原因的解释不一致
- DAbrasions on the knees from a fall因跌倒導致的膝蓋擦傷
- EStartled response to touch✓ 正解對觸碰產生驚嚇反應
身體虐待的徵象包括：不同癒合階段的瘀傷（代表反覆受傷）、特殊形狀的傷痕（如菸疤、皮帶痕）、病人或照顧者對傷勢的解釋與傷情不符，以及心理上的警覺反應（如對觸摸感到驚恐）。膝蓋擦傷在跌倒中很常見且符合常理，除非其位置或性質極度異常，否則通常不直接視為虐待指標。護理師必須保持警覺並進行法定通報。
Signs of physical abuse include bruises in various stages of healing (representing repeated injuries), patterned injuries (such as cigarette burns or belt marks), explanations from the patient or caregiver that are inconsistent with the injuries observed, and psychological hypervigilance (such as being startled by touch). Knee abrasions are common in falls and are consistent with everyday accidents; unless their location or nature is highly atypical, they are usually not classified as indicators of abuse. The nurse must remain vigilant and fulfill mandatory reporting requirements.
在美國，護理師是 Mandatory Reporter（法定通報人），未通報需負法律責任；台灣同樣有《家庭暴力防治法》，護理師必須在 24 小時內通報。