When-obtaining an adolescent's health history, which intervention is most important of the nurse to implement?
Assess for the use of illicit drugs.
Obtain a smoking history first.
Evaluate vital signs and laboratory findings.
Ask the parents to leave the room.
The Correct Answer is D
A. Assess for the use of illicit drugs. While assessing illicit drug use is important, it may not be the most crucial intervention during the initial health history-taking process.
B. Obtain a smoking history first. While obtaining a smoking history is important, it may not take precedence over other aspects of the health history, especially if there are more pressing concerns.
C. Evaluate vital signs and laboratory findings. While vital signs and laboratory findings are important components of the assessment, they are typically obtained after the health history has been completed.
D. Ask the parents to leave the room. Ensuring privacy and confidentiality is crucial during adolescent health assessments to encourage open communication and address sensitive issues. Asking the parents to leave the room allows the adolescent to speak freely about their health concerns without fear of judgment or disclosure to their parents.
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Correct Answer is B
Explanation
A: Ask when the adolescent was last seen in the clinic. This option might help confirm the identity and recent activity of the patient, but it does not address the primary issue of confidentiality and privacy regarding the adolescent's medical information. Simply asking when the adolescent was last seen does not change the legal requirement to obtain consent from the patient who is now an adult.
B: Explain that the information cannot be released without the 18-year-old's permission. This is the most appropriate response. Once an individual turn 18, they are legally an adult and their health information is protected under the Health Insurance Portability and Accountability Act (HIPAA) in the United States, or similar privacy laws in other countries. Without explicit permission from the 18-year-old patient, the nurse cannot legally release medical information to anyone else, including parents.
C: Tell the mother to have the teenager call the clinic. While this response encourages the teenager to take responsibility for their own healthcare, it does not address the immediate concern of the mother inquiring about the results. It shifts the responsibility to the adolescent but doesn't explain why the mother cannot be given the information. It's a partial solution but lacks clarity on the confidentiality issue.
D: Since the serum samples were drawn last week, provide the mother with the findings. This option is inappropriate and violates HIPAA regulations. Regardless of when the serum samples were drawn, the patient is now legally an adult and the information cannot be shared without their explicit consent. Providing the mother with the findings would be a breach of the adolescent's privacy and legal rights.
Correct Answer is D
Explanation
A. Mother's use of alcohol, drugs, or cigarettes during pregnancy: While this information might be relevant to the child's medical history, it's not directly related to planning care for the umbilical hernia repair surgery itself.
B. List of achievement timeline for developmental milestones: This information might be helpful for a general paediatric assessment, but it's not crucial for planning care specific to an umbilical hernia repair.
C. A history of rubella, rubeola, or chicken pox: Unless there are complications related to these illnesses, they are not directly relevant to the surgery.
D. Reactions to any previous hospitalizations: This information is vital. Knowing how the child reacted to previous hospitalizations (anaesthesia, medications, separation anxiety) can help the nurse anticipate potential challenges and develop strategies to create a positive experience for the child.
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