A school nurse is implementing health screening. Which of the following assessment findings should the nurse recognize as the highest priority?
A child who has a BMI of 18
An adolescent who has scoliosis
An adolescent who has psoriasis
A child who has nits
The Correct Answer is D
Choice A reason: A child who has a BMI of 18 is not the highest priority, as it is within the normal range for children. BMI, or body mass index, is a measure of weight relative to height. A BMI of 18 is considered healthy for children aged 2 to 20 years, according to the Centers for Disease Control and Prevention (CDC). The nurse should monitor the child's growth and development and provide nutrition education as needed.
Choice B reason: An adolescent who has scoliosis is not the highest priority, as it is a common and usually mild condition. Scoliosis is a sideways curvature of the spine that affects about 3% of adolescents. Most cases of scoliosis are mild and do not require treatment, although some may need braces or surgery. The nurse should refer the adolescent to a specialist for further evaluation and management.
Choice C reason: An adolescent who has psoriasis is not the highest priority, as it is a chronic and non-contagious condition. Psoriasis is a skin disorder that causes red, scaly patches on the skin that may itch or burn. Psoriasis is not curable, but it can be controlled with medications, creams, or light therapy. The nurse should provide education and support to the adolescent and encourage them to seek medical care as needed.
Choice D reason: A child who has nits is the highest priority, as it indicates a parasitic infestation that can spread to others. Nits are the eggs of head lice, which are tiny insects that live on the scalp and feed on blood. Head lice can cause itching, irritation, and infection of the scalp. The nurse should isolate the child and notify the parents and the school staff. The nurse should also provide instructions on how to treat the infestation and prevent reinfestation.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Presenter's teaching strategies are not the factor that will have the greatest effect on the success of the class. Although the presenter should use effective and appropriate teaching methods that suit the learning objectives and outcomes, the teaching strategies alone cannot guarantee the success of the class if the client is not motivated to quit smoking.
Choice B reason: Presenter's credibility is not the factor that will have the greatest effect on the success of the class. Although the presenter should have the knowledge, skills, and experience to deliver the smoking cessation education, the presenter's credibility alone cannot ensure the success of the class if the client is not motivated to quit smoking.
Choice C reason: Client's motivation is the factor that will have the greatest effect on the success of the class. Motivation is the driving force that influences the client's behavior and actions. The client's motivation to quit smoking can be influenced by various factors, such as personal, social, environmental, or health-related reasons. The presenter should assess the client's motivation level, and use strategies to enhance and sustain it throughout the class.
Choice D reason: Client's education level is not the factor that will have the greatest effect on the success of the class. Although the presenter should consider the client's education level when designing and delivering the smoking cessation education, the client's education level alone cannot determine the success of the class if the client is not motivated to quit smoking.
Correct Answer is B
Explanation
Choice A reason: Arranging for Meals on Wheels assistance is not the priority action, as it does not address the underlying issue of the client's partner's refusal to help with feeding. Meals on Wheels may also not be suitable for the client's dietary needs and preferences.
Choice B reason: Determining the client's ability to self-feed is the priority action, as it will help the nurse assess the client's nutritional status and needs, as well as the level of support required from the partner or other caregivers. The nurse can also educate the partner on the importance of adequate nutrition and hydration for the client, and provide strategies to facilitate feeding.
Choice C reason: Directing the home health aide to assist with meals is not the priority action, as it may not be feasible or acceptable to the client or the partner. The home health aide may also not have the skills or training to assist with feeding a client with Alzheimer's disease.
Choice D reason: Referring the client's partner to an Alzheimer's support group is not the priority action, as it does not address the immediate problem of the client's lack of eating. However, it may be a helpful intervention in the long term, as it can provide the partner with emotional support, education, and resources to cope with the challenges of caring for a client with Alzheimer's disease.
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