A nurse is assisting with the care of an adolescent. Which of the following statements should the nurse identify as high-risk behaviors?

I participate in physical activities 3 times per week

I use sunscreen with an SPF of 10.*

I limit playing video games to 3 hours per day."

I have had sexual relations, but did not get the HPV vaccine."

Answer and Explanation

The Correct Answer is D

A) I participate in physical activities 3 times per week: Engaging in physical activity is a positive behavior and is not considered high-risk. Regular physical activity is important for maintaining overall health and preventing obesity, cardiovascular disease, and other health issues.

B) I use sunscreen with an SPF of 10: While using sunscreen is a protective behavior, an SPF of 10 is lower than the recommended SPF of at least 30 for effective protection against harmful UV radiation. This is not the most significant high-risk behavior compared to others, but it still indicates some risk of sun damage.

C) I limit playing video games to 3 hours per day: Limiting screen time to 3 hours per day can be considered a balanced approach to video gaming. While excessive screen time can be problematic, 3 hours per day is not necessarily a high-risk behavior for an adolescent, as long as it doesn't interfere with other important aspects of life, like physical activity, sleep, and socialization.

D) I have had sexual relations, but did not get the HPV vaccine: Engaging in sexual activity without receiving the HPV vaccine is a high-risk behavior. The HPV vaccine helps prevent certain strains of the human papillomavirus, which can cause cervical cancer and other cancers. Lack of vaccination increases the risk of contracting HPV and developing related complications.

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Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"C"}

Explanation

B. A chest X-ray: The client’s symptoms (cough, blood-tinged sputum, night sweats, fever, and weight loss) are concerning for tuberculosis (TB) or another pulmonary infection. A chest X-ray is a key diagnostic tool to assess for lung abnormalities, including TB infiltrates or cavitations.

D. A Mantoux test: The Mantoux tuberculin skin test (TST) is used to screen for Mycobacterium tuberculosis infection. Given the client’s recent travel to South Africa, a high TB prevalence area, and their symptoms, TB testing is crucial.

Incorrect:

A. A pulmonary function test: This evaluates chronic respiratory conditions like asthma or COPD, but is not a first-line test for an acute cough with systemic symptoms.

C. A nasopharyngeal swab: This is used for diagnosing viral infections like influenza or COVID-19, which are less likely given the client’s blood-tinged sputum and prolonged systemic symptoms.

E. Blood cultures: These are used to detect bacteremia or sepsis, but there is no indication of systemic bacterial infection (e.g., hemodynamic instability, severe leukocytosis).

A. "For a client who has Clostridium difficile. I will cleanse my hands with an alcohol based rub. B. ‘’Droplet precautions require that I wear a gown and gloves when providing client care." C. ‘’Following a blood spill, I should use a bleach solution with a ratio of 1 to 20. D. "Soiled dressings should be placed in a biohazard trash receptacle."

Correct Answer is D

Explanation

A) "For a client who has Clostridium difficile, I will cleanse my hands with an alcohol-based rub.":
This statement is incorrect. When caring for a client with Clostridium difficile (C. diff), hand hygiene must be performed using soap and water, not an alcohol-based rub. Alcohol does not effectively kill C. diff spores. Handwashing with soap and water is essential to reduce the spread of this infection, as alcohol-based hand sanitizers are ineffective against C. diff spores.

B) "Droplet precautions require that I wear a gown and gloves when providing client care.":
This statement is incorrect. Droplet precautions require wearing a surgical mask to protect against large respiratory droplets that may be expelled during coughing or sneezing. Gowns and gloves are not routinely necessary unless there is a risk of contact with body fluids or secretions. Contact precautions, not droplet precautions, would require a gown and gloves.

C) "Following a blood spill, I should use a bleach solution with a ratio of 1 to 20.":
This statement is partially correct but not fully optimal. For blood spills, the correct bleach solution ratio for disinfection is typically 1 part bleach to 9 parts water (a 1:10 ratio) rather than 1:20. The bleach solution must be strong enough to effectively kill pathogens and viruses, so a 1:9 dilution is preferred.

D) "Soiled dressings should be placed in a biohazard trash receptacle.":
This statement is correct. Soiled dressings, particularly those that are contaminated with blood, bodily fluids, or pathogens, should always be disposed of in a biohazard trash receptacle. This ensures the safe and appropriate handling of potentially infectious materials and helps prevent the spread of infection.

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A nurse is assisting with the care of an adolescent. Which of the following statements should the nurse identify as high-risk behaviors?

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Naxlex Comprehensive Predictor Exams

Select words from the choices below to fill in each blank in the following sentence. To further evaluate the client, the nurse anticipates the client will need ____ and ____ .

Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"C"}

Explanation

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Correct Answer is D

Explanation

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