A 14-year-old girl presents to the school nurse with the fourth vaginal yeast infection she has had during the past 6 months. The nurse should assess the adolescent for which finding(s)? Select all that apply.
Thirst.
Increased appetite.
Heat intolerance.
Tachycardia.
Urinary frequency.
Correct Answer : A,D,E
A. Thirst: Recurrent yeast infections in adolescents may indicate underlying hyperglycemia, as excessive glucose in the urine promotes fungal growth. Thirst is a classic symptom of diabetes mellitus and should be assessed.
B. Increased appetite: While diabetes can sometimes cause polyphagia, it is less specific than other signs such as thirst, urinary frequency, and tachycardia. It may not be present in every case and is not a primary screening indicator.
C. Heat intolerance: Heat intolerance is more commonly associated with hyperthyroidism, not recurrent yeast infections. Assessing for this symptom is not directly relevant to evaluating potential diabetes in this adolescent.
D. Tachycardia: Elevated heart rate can occur with dehydration caused by hyperglycemia and osmotic diuresis. Tachycardia may be an important clinical clue in assessing for undiagnosed diabetes.
E. Urinary frequency: Polyuria is a hallmark symptom of hyperglycemia and diabetes mellitus. Recurrent yeast infections may prompt assessment for urinary frequency as part of the screening for possible diabetes.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Heart rate 130–136 beats/minute, blood pressure 190–200/90–100 mm Hg, Kussmaul respirations: Although hypertensive and tachycardic, Kussmaul respirations are typically associated with metabolic acidosis rather than ICP. These findings are concerning but not classic for increased ICP.
B. Heart rate 55–50 beats/minute, blood pressure 160/70–194/70 mm Hg, irregular respirations: This pattern reflects Cushing’s triad—bradycardia, hypertension with widening pulse pressure, and irregular respirations—which is a hallmark sign of increased ICP and requires immediate reporting.
C. Heart rate 110–100 beats/minute, blood pressure 130/70–110/70 mm Hg, shallow respirations: Vital signs are not indicative of ICP; shallow respirations may be due to other causes, and the blood pressure trend is decreasing rather than showing hypertension with widening pulse pressure.
D. Heart rate 70–100 beats/minute, blood pressure 120/60–90/60 mm Hg, rapid respirations: These findings suggest hypotension and tachypnea, which are more indicative of hypovolemia or other systemic issues rather than increased ICP.
Correct Answer is A
Explanation
A. Monitor an IV infusion rate on an established schedule: This task is appropriate for a UAP because it involves observation and reporting rather than clinical decision-making. The UAP can ensure the IV is running at the prescribed rate and alert the nurse if any deviations occur.
B. Titrate oxygen to the prescribed parameters: Adjusting oxygen requires clinical judgment and assessment of respiratory status, including oxygen saturation and signs of hypoxia. This is a nursing responsibility and cannot be delegated to a UAP.
C. Insert a urinary catheter for an uncomplicated client: Catheter insertion is a sterile procedure that requires nursing knowledge and skill. Delegation to a UAP is not permitted due to the risk of infection and need for proper technique.
D. Procure platelet products from the blood bank: Obtaining blood products involves verification of patient identifiers, blood type, and compatibility, which are nursing responsibilities. This task requires clinical accountability and cannot be delegated to a UAP.
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