A school nurse is talking with a 13-year-old female at her annual health-screening visit. Which of the following comments made by the adolescent should be the nurse's priority to address?
I haven't gotten my period yet, and all my friends have theirs."
There's a big pimple on my face, and I worry that everyone will notice it
"None of the kids at this school like me, and I don't like them either."
"My parents treat me like a baby sometimes."
The Correct Answer is C
A) "I haven't gotten my period yet, and all my friends have theirs."
While the concern about not having gotten her period yet is a valid one, it's a common experience during adolescence. Variability in the timing of puberty is normal, and addressing this concern might involve providing reassurance and education about the natural range of development.
B) "There's a big pimple on my face, and I worry that everyone will notice it."
While concerns about physical appearance are common during adolescence, they are less urgent in terms of emotional and psychological well-being. Addressing body image issues is important, but the statement about lack of social acceptance and reciprocal liking indicates potentially deeper emotional challenges.
C) "None of the kids at this school like me, and I don't like them either."
Explanation:
Adolescence is a time of significant emotional and social development. The statement about not being liked by other students and not liking them in return indicates potential social isolation and difficulties in forming positive relationships. Adolescents often seek social acceptance and peer relationships are crucial for their well-being and development.
D) "My parents treat me like a baby sometimes."
This statement suggests a common parent-adolescent dynamic where there might be conflicts about independence and autonomy. While these feelings are valid, they don't necessarily reflect a higher priority concern related to social isolation and peer relationships.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Dental erosion can occur due to conditions like gastroesophageal reflux disease (GERD) or frequent vomiting, but it is not a characteristic feature of anorexia nervosa.
B. Hyperactive bowel sounds are not specific to anorexia nervosa and may be seen in various gastrointestinal disorders.
C. Hypertension is not a common finding in individuals with anorexia nervosa. In fact, hypotension (low blood pressure) is more commonly observed due to decreased cardiac output related to malnutrition and electrolyte imbalances.
D. bradycardia in a client with a new diagnosis of anorexia nervosa. Bradycardia (abnormally slow heart rate) is a common cardiovascular manifestation in individuals with anorexia nervosa. It is often a result of the body's adaptive response to conserve energy due to severe malnutrition and reduced caloric intake.
Correct Answer is B
Explanation
A. Praise the client for looking at herself in a mirror.
While body image concerns are common in anorexia nervosa, praising the client for looking at herself in a mirror may inadvertently reinforce the focus on appearance and body image, which can be counterproductive.
B. Ask the client to agree to talk to a nurse whenever she feels the urge to exercise.
Explanation: For a client with anorexia nervosa, overexercising can be part of the unhealthy behaviors associated with the disorder. Collaborative communication is important in addressing and managing these behaviors. Asking the client to agree to talk to a nurse whenever the urge to exercise arises is a supportive approach. It allows the nurse to provide emotional support, explore the client's motivations and triggers for overexercising, and work together on finding healthier coping strategies.
C. Reprimand the client about the potential damage that has occurred due to overexercising her body.
Reprimanding the client may lead to feelings of guilt and shame, which are counterproductive in supporting recovery. A more empathetic and supportive approach is needed.
D. Restrict the client from being weighed.
Restricting the client from being weighed might exacerbate anxiety around weight gain and contribute to the client's preoccupation with weight. However, monitoring weight under the supervision of healthcare professionals is important in managing anorexia nervosa.
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