A nurse is evaluating the social profile of a new adolescent client at a community health clinic. Which of the following actions by the client is the priority for the nurse to address?

The client still journals their feelings about their sister's death 7 years ago.

The client took courses online and experienced cyberbullying,

The client reports that they primarily eat fast food while living on a limited budget.

The client reports missing classes due to suffering from seasonal allergies.

Answer and Explanation

The Correct Answer is B

B. Experiencing cyberbullying can have significant negative effects on an adolescent's mental health and well-being. Addressing cyberbullying promptly is crucial to ensuring the client's safety and mental health.

A. Journaling their feelings about their sister's death suggests that they are actively processing their emotions, which can be a healthy coping mechanism.

C. Addressing dietary habits and providing education on healthy eating is important but it may not be as urgent as addressing issues such as cyberbullying or mental health concerns.

D. While supporting the client with managing their allergies is important, it may not be the priority for immediate intervention compared to issues such as cyberbullying or mental health concerns.

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Correct Answer is C

Explanation

C. The nurse should address the client's inappropriate and boundary-crossing behavior first. The client's statement, "Kiss me baby! You know you want to!" is suggestive and inappropriate in a professional healthcare setting. It indicates a lack of understanding or disregard for appropriate social boundaries and may be a manifestation of the client's serious mental illness.

A, B, D- While the client's vital signs (blood pressure, heart rate, respiratory rate, and temperature) and clothing choice (wearing a heavy coat and scarf in warm weather) may be important to assess and address, the immediate priority is to address the client's inappropriate behavior and ensure a safe and therapeutic environment for both the client and the nurse.

A. Decreased blood pressure and nausea B. Constipation and pupil constriction C. Bone and muscle aches D. Increased heart rate and vomiting

Correct Answer is D

Explanation

D. Alcohol withdrawal is characterized by a range of symptoms that can vary in severity. Some common symptoms include increased heart rate (tachycardia), sweating, tremors, anxiety, nausea, vomiting, and agitation.

A. Alcohol withdrawal is more commonly associated with increased blood pressure rather than decreased blood pressure. Nausea can be a symptom of alcohol withdrawal, particularly in the early stages, but it is not necessarily a defining characteristic.

B. Constipation and pupil constriction are not typically associated with alcohol withdrawal. These symptoms are more commonly seen with opioid withdrawal.

C Bone and muscle aches are common symptoms of alcohol withdrawal. They can occur as a result of the body's reaction to the sudden cessation of alcohol intake and the associated changes in neurotransmitter levels.

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A nurse is evaluating the social profile of a new adolescent client at a community health clinic. Which of the following actions by the client is the priority for the nurse to address?

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Correct Answer is C

Explanation

A nurse is caring for a client who was admitted for alcohol detoxification. Which of the following findings should the nurse expect to observe that indicate the client is experiencing alcohol withdrawal?

Correct Answer is D

Explanation

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