A nurse is talking with a 13-year-old female client who is having her annual health-screening visit. Which of the following comments by the client should concern the nurse?
"My parents treat me like a baby sometimes."
"There's a pimple on my face, and I worry that everyone will notice it."
"I start taking ibuprofen a few days before my period starts."
"None of the kids at my school like me, and I don't like them either."
The Correct Answer is D
A. "My parents treat me like a baby sometimes." This statement reflects a common adolescent feeling of striving for independence and experiencing frustration when treated as a child. It is a normal part of adolescent development and not a cause for immediate concern.
B. "There's a pimple on my face, and I worry that everyone will notice it." Concern about appearance is typical for adolescents due to the increased focus on body image and peer perception. This statement is a normal expression of adolescent self-consciousness.
C. ``I start taking ibuprofen a few days before my period starts." Using ibuprofen preemptively for menstrual cramps is a reasonable self-care practice for adolescents experiencing menstrual discomfort. This statement does not indicate any immediate health concern.
D. "None of the kids at my school like me, and I don't like them either." This statement indicates social isolation and potential issues with peer relationships, which can be a red flag for emotional distress or depression. It may suggest that the adolescent is experiencing significant difficulties in their social life that could lead to more serious mental health concerns.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. A school-age child who cries when the nurse is giving him an injection: Crying during an injection is a normal reaction for a child and does not indicate abuse.
B. A toddler who has multiple bruises on the shins of both legs and his parents report that he is clumsy: Bruises on the shins are common in toddlers due to normal play and falls. Without other concerning signs, this does not strongly indicate abuse.
C. A preschooler who has a BMI indicating obesity: While childhood obesity can be a sign of neglect in some cases, it is not a specific or immediate indicator of abuse without other signs.
D. An adolescent who asks to stay in the hospital because he likes the room: This is concerning because it might indicate that the adolescent is not feeling safe or comfortable at home, which could be a sign of abuse or neglect.
Correct Answer is C
Explanation
A. Remove the window and view the incision. Inspecting the incision through the cast window is important for monitoring for signs of infection or complications, but it is not the first priority. Ensuring the extremity has adequate circulation and function is critical initially.
B. Medicate the client for pain. Pain management is essential, especially postoperatively, but assessing the integrity and function of the affected extremity takes precedence to ensure there are no immediate complications like compromised circulation or nerve damage.
C. Perform neurovascular checks of the affected extremity. Performing neurovascular checks is the highest priority to ensure that circulation, sensation, and movement are intact. This helps identify any immediate issues with the cast or complications from surgery that could jeopardize the limb’s health.
D. Turn the client so the cast will dry on all sides. Ensuring the cast dries properly is important to maintain its integrity and effectiveness, but this action is secondary to assessing neurovascular status to prevent serious complications.
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