A nurse is caring for an adolescent client who has pelvic inflammatory disease as a consequence of a sexually transmitted infection and will need intravenous antibiotic therapy. The client tells the nurse, "My parents think I am a virgin. I don't think I can tell them I have this kind of an infection." Which of the following responses should the nurse make?
"You seem scared to talk to your parents."
"If you want me to, I can tell your parents for you."
"Your parents will have to be told why you are being admitted."
"Give your parents a chance; they'll understand."
The Correct Answer is A
Choice A: "You seem scared to talk to your parents." This response is appropriate because it reflects the client's feelings and shows empathy and respect. It also opens the door for further communication and support from the nurse.
Choice B: "If you want me to, I can tell your parents for you." This response is not appropriate because it does not respect the client's autonomy and confidentiality. It also may make the client feel more anxious or helpless and may damage the trust between the client and the nurse.
Choice C: "Your parents will have to be told why you are being admitted." This response is not appropriate because it does not address the client's feelings or concerns. It also may sound harsh or threatening to the client, who may fear the consequences of telling her parents.
Choice D: "Give your parents a chance; they'll understand." This response is not appropriate because it does not acknowledge the client's feelings or concerns. It also may sound unrealistic or insensitive to the client, who may have valid reasons to doubt her parents' reaction or acceptance.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A: Ask the client's English-speaking family member to translate. This action is not appropriate because it may compromise the accuracy and confidentiality of the information. The family member may not have sufficient medical knowledge or vocabulary to translate correctly or may omit or alter some details due to personal bias or embarrassment.
Choice B: Use a translation dictionary to reinforce the teaching. This action is not appropriate because it may be time-consuming and ineffective. The translation dictionary may not have all the relevant terms or phrases or may provide inaccurate or ambiguous translations. The nurse may also lose the client's attention or interest by relying on the dictionary.
Choice C: Seek assistance from a facility-approved interpreter. This action is appropriate because it ensures the quality and clarity of the communication. The facility-approved interpreter is a professional who has the skills and training to provide accurate and unbiased translation of the information. The interpreter can also facilitate the interaction and feedback between the nurse and the client.
Choice D: Ask an assistive personnel (AP) who speaks the client's language to serve as an interpreter. This action is not appropriate because it may violate the scope of practice and ethical standards of the AP. The AP may not have the qualifications or authority to provide interpretation services or may have a conflict of interest or role confusion with the client. The AP may also have other duties or responsibilities that may interfere with the interpretation process.

Correct Answer is B
Explanation
Choice A: Protrusion of the posterior bladder wall downward through the anterior vaginal wall is not the correct answer because it describes a different condition called cystocele. A cystocele occurs when the bladder pushes into the vagina due to weakened pelvic support structures.
Choice B: Bulging of the small intestine through the posterior vaginal wall is the correct answer because it describes an enterocele. Enterocele occurs when the small intestine slides into a pouch between the rectum and vagina due to weakened pelvic support structures.
Choice C: Descent of the uterus through the pelvic floor into the vagina is not the correct answer because it describes a different condition called uterine prolapse. Uterine prolapse occurs when the uterus drops down into or out of the vagina due to weakened pelvic support structures.
Choice D: Sagging of the rectum with the pressure exerted against the posterior vaginal wall is not the correct answer because it describes a different condition called rectocele. Rectocele occurs when the rectum bulges into or out of the vagina due to weakened pelvic support structures.
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