Final answer:
Discomfort while walking is a potential indication of child sexual abuse that a nurse should consider. Other signs listed may indicate different forms of abuse, but not specifically sexual abuse. Health care providers must be observant and considerate of various potential signs when assessing a child.
Step-by-step explanation:
Among the listed options, a nurse in the emergency department should identify discomfort while walking as a potential indication of child sexual abuse. Discomfort or pain in walking can be associated with trauma to the genital area. Sexual abuse in children can lead to a variety of physical findings, some of which may be noticeable in the child's gait or comfort level with certain movements. It is crucial for health care professionals to be observant and consider the possibility of abuse when a child presents with non-specific symptoms that do not have a clear explanation.
Though a stained shirt could be a sign of general neglect or poor hygiene, it is not specifically indicative of sexual abuse. Bruises on the upper back might suggest physical abuse, and thin extremities could be a sign of neglect or malnutrition. In assessing potential cases of child abuse, it is important for health care providers to consider the context and conjunction of various signs while understanding the broad impact of abuse on a child's wellbeing, including the increased risk for psychiatric disorders and behavioral issues.