A nurse is talking privately with an adolescent who has disclosed that their facial fractures are the result of their punishment for coming home 1 hr after their curfew. Which of the following responses should the nurse make?
"I won't tell anyone else about this unless you say it's okay."
"Your parent was wrong to hit you for coming home late."
"I'm guessing your other parent did not do anything to stop this from happening."
"It is not your fault that this happened to you."
The Correct Answer is D
A. While it is important to maintain confidentiality, the nurse must follow mandatory reporting laws for suspected abuse, which may require informing appropriate authorities.
B. While it may be important to acknowledge the harm done, directly labeling the parent's behavior as "wrong" could potentially escalate the situation and may not be helpful in building rapport with the adolescent.
C. Making assumptions about the behavior of another parent can be seen as judgmental and may not be helpful in addressing the adolescent’s concerns or in facilitating a safe environment for disclosure.
D. This response provides reassurance to the adolescent that they are not responsible for the abuse and helps to create a nonjudgmental, supportive environment, allowing the adolescent to feel safe and heard.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Growth and changes in height and weight accelerate during adolescence, particularly in the early years, as part of the growth spurt.
B. While it is important to involve parents, adolescent clients should be encouraged to participate in decision-making about their health, as they are developing autonomy. Health decisions should include both the adolescent and the parents when possible.
C. Adolescents are often highly interested in discussing health promotion, particularly topics that are relevant to their peer group, such as body image, sexual health, and mental health.
D. The timing of puberty can significantly impact an adolescent’s self-esteem. Early or late onset of puberty may lead to feelings of self-consciousness or social challenges. Understanding this developmental change is essential in supporting the adolescent’s emotional and psychological well-being.
Correct Answer is B
Explanation
A. The MMR vaccine contains live attenuated viruses, which can pose a risk to severely immunocompromised children. This vaccine should not be administered to immunocompromised children unless otherwise advised by a specialist.
B. The DTaP vaccine is an inactivated vaccine and is safe to administer to immunocompromised children. It does not contain live viruses and is recommended for children in this age group.
C. The varicella vaccine is a live attenuated vaccine, which can be risky for immunocompromised children. The nurse should avoid administering this vaccine unless explicitly directed by the healthcare provider.
D. The LAIV is a live attenuated vaccine, which is not recommended for children who are severely immunocompromised. Alternative inactivated flu vaccines should be used.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.