An adolescent female arrives at the wellness clinic reporting fears that she will hurt herself. The nurse observes scars on both wrists of the client. Which priority action should the nurse implement?

Choice A reason: Feeling guilty about drinking (CAGE’s “G”) suggests awareness of problematic use, indicating psychological dependence. However, guilt is less specific than morning drinking, as it may occur in binge or social drinking without physical addiction. Morning drinking reflects physiological dependence, a stronger marker of chronic alcoholism.

Choice B reason: Needing a morning drink (CAGE’s “E” for eye-opener) indicates physical dependence, a hallmark of alcoholism. This reflects tolerance and withdrawal, where alcohol stabilizes GABA/glutamate imbalances to prevent symptoms like tremors. It’s the most specific indicator, showing the body’s reliance on alcohol, central to alcoholism’s pathophysiology.

Choice C reason: Annoyance at drinking criticism (CAGE’s “A”) suggests defensiveness, possibly indicating psychological dependence. It’s less specific than morning drinking, reflecting social dynamics rather than physical addiction. Alcoholism involves physiological changes, and morning drinking directly demonstrates the body’s need for alcohol to manage withdrawal, making this less indicative.

Choice D reason: Feeling the need to cut down (CAGE’s “C”) shows recognition of excessive drinking but is less specific than morning drinking, which signifies physical dependence from chronic alcohol-induced neurotransmitter changes. This question captures awareness but not the physiological addiction that morning drinking indicates, central to diagnosing alcoholism.

Choice A reason: Difficulty swallowing secretions in croup signals severe airway narrowing from subglottic edema, often parainfluenza-induced. This risks stridor and obstruction, leading to respiratory distress or hypoxia. It requires urgent evaluation for corticosteroids or epinephrine, prioritizing airway patency over less critical symptoms, preventing life-threatening complications.

Choice B reason: Fever of 101.0°F (38.3°C) is common in croup, indicating viral infection, but less urgent than swallowing difficulty, which suggests critical airway compromise. Fever is managed with antipyretics, but severe edema risking obstruction necessitates immediate intervention, making this a lower priority concern.

Choice C reason: Crying when nursing may reflect croup’s sore throat or breathing difficulty but is less specific than swallowing difficulty, indicating severe airway narrowing. Crying does not directly signal life-threatening obstruction, making it less urgent than symptoms of significant subglottic inflammation requiring medical attention.

Choice D reason: Barking cough, worse at night, is typical in croup from subglottic inflammation but managed with supportive care or steroids. Difficulty swallowing secretions indicates severe airway compromise, risking obstruction, requiring urgent intervention over a cough, which is an expected, less critical symptom.