A nurse is providing teaching to an older adult client who has a seizure disorder and a new prescription for phenytoin. Which of the following instructions should the nurse include?

The correct answer is choice C: “Do you have thoughts of harming yourself?”.

This is the priority question for the nurse to ask the client because it assesses the client’s risk for suicide, which is a serious and potentially life-threatening complication of conduct disorder. The nurse should use a direct and nonjudgmental approach when asking about suicidal ideation and plan.

Choice A: “How do you get along with your peers at school?” is wrong because it is not the most urgent question to ask the client.

While it is important to assess the client’s social relationships and possible peer rejection, this can be done after addressing the client’s safety and mental status.

Choice B: “Do you have a criminal record?” is wrong because it is not relevant to the client’s current condition and might make the client feel defensive or stigmatized.

The nurse should avoid asking questions that imply blame or judgment and focus on the client’s strengths and coping skills.

Choice D: “How do you manage your behavior?” is wrong because it is not appropriate for the nurse to ask the client in an emergency department setting.

This question might imply that the client is responsible for their conduct disorder, which is a complex and multifactorial mental health condition. The nurse should collaborate with the client and their family to develop a behavior management plan that involves positive reinforcement, limit setting, and consistent consequences.

Normal ranges: According to the DSM-5, conduct disorder is characterized by a persistent pattern of behavior that violates the rights of others or societal norms.

The symptoms of conduct disorder include aggression, deceitfulness, destruction of property, serious rule violations, and lack of remorse.

Conduct disorder can cause significant impairment in social, academic, or occupational functioning. The prevalence of conduct disorder is estimated to be 4% among children and adolescents.

The risk factors for conduct disorder include genetic factors, neurobiological factors, environmental factors, and psychological factors.

Banana slices are soft, easy to chew, and can be picked up by the toddler’s fingers, which promotes independence in eating. According to the CDC, foods that toddlers should avoid include:

• Added sugars and no-calorie sweeteners, such as sugar-sweetened and diet drinks
• High-salt foods, such as canned foods, processed meats, frozen dinners, fast food, and junk food
• Unpasteurized juice, milk, yogurt, or cheese
• Foods that may cause choking, such as hard or crunchy foods, sticky foods, stringy cheese, and foods that are not cut up into small pieces

Choice A is wrong because popcorn is a choking hazard for toddlers.

It is hard, crunchy, and can get stuck in the airway. The NHS advises not to give whole nuts and peanuts to children under 5 years old.

Choice B is wrong because grapes are also a choking hazard for toddlers.

They are round, slippery, and can block the airway. The NHS recommends cutting grapes into quarters before giving them to young children.

Choice D is wrong because hot dogs are high in salt and can cause choking if not cut up into small pieces. The Extension warns against giving hot dogs to young toddlers.