The nurse is taking a health history on an adolescent. Which best describes how the chief complaint should be determined?
Use what the adolescent says to determine, in correct medical terminology, what the problem is.
Ask the adolescent, "Why did you come here today?".
Ask for a detailed listing of symptoms.
Interview the parent away from the adolescent to determine the chief complaint.
The Correct Answer is B
The correct answer is choice B. Ask the adolescent, "Why did you come here today?".
Choice A rationale:
Using the adolescent's own words in correct medical terminology to determine the problem is essential for accurate documentation, but it might not be the initial step in determining the chief complaint. The approach in choice B provides an opportunity for the adolescent to express their primary concern in their own terms.
Choice B rationale:
Asking the adolescent, "Why did you come here today?" allows them to voice their main reason for the visit in their own words. This approach respects their autonomy and encourages open communication. It also helps to identify the primary issue from the adolescent's perspective.
Choice C rationale:
While asking for a detailed listing of symptoms is important for a comprehensive health history, it might not be the best way to initially determine the chief complaint. This approach could potentially overwhelm the patient and miss the opportunity for them to express their primary concern.
Choice D rationale:
Interviewing the parent away from the adolescent might be necessary in certain situations, but it is not the best method for determining the adolescent's chief complaint. The adolescent's input is crucial for understanding their own health concerns and developing a patient-centered approach.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The correct answer is choice C. Activity intolerance related to generalized weakness.
Choice A rationale:
Risk for injury related to depressed sensorium. This choice is not the most appropriate nursing diagnosis for a child with moderate anemia. While anemia can lead to fatigue and weakness, the main concern is the child's ability to tolerate physical activities, not the risk of injury due to a depressed sensorium.
Choice B rationale:
Decreased cardiac output related to abnormal hemoglobin. This choice is not the most suitable nursing diagnosis for a child with moderate anemia. While abnormal hemoglobin levels can affect cardiac output, moderate anemia typically doesn't lead to such a significant decrease in cardiac output that it becomes the primary nursing diagnosis. Activity intolerance is a more relevant concern.
Choice C rationale:
Activity intolerance related to generalized weakness. This is the most appropriate nursing diagnosis for a child diagnosed with moderate anemia. Moderate anemia results in a decrease in oxygen-carrying capacity, leading to generalized weakness and reduced ability to perform physical activities without becoming fatigued. The child's hemoglobin levels are likely low enough to cause noticeable activity intolerance.
Choice D rationale:
Risk for Injury related to dehydration and abnormal hemoglobin. This choice is not the best nursing diagnosis for a child with moderate anemia. Dehydration may exacerbate the effects of anemia, but the primary issue here is the anemia itself causing weakness and activity intolerance, which are better addressed with the choice C diagnosis.
Correct Answer is A
Explanation
The correct answer is choice A: Rotavirus.
Choice A rationale:
Rotavirus is a viral pathogen that frequently causes acute diarrhea in young children. It is highly contagious and is responsible for a significant portion of severe diarrhea cases worldwide. Rotavirus infections are most common in infants and young children, and they can lead to dehydration, especially in developing countries where access to clean water and proper sanitation might be limited.
Choice B rationale:
Salmonella organisms can cause food poisoning and gastrointestinal infections that lead to diarrhea. However, they are more commonly associated with bacterial infections rather than viral-induced acute diarrhea.
Choice C rationale:
Shigella organisms are also bacterial pathogens that cause diarrhea, specifically bacillary dysentery. While they can cause severe diarrhea, they are not the viral pathogen typically responsible for acute diarrhea in young children.
Choice D rationale:
Giardia organisms are parasites that can cause gastrointestinal infections leading to diarrhea. However, they are not viruses, and they are less commonly associated with acute diarrhea in children compared to rotavirus.
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