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It occurs from a streptococcal viral infection is incorrect because infectious mononucleosis is caused by the Epstein–Barr virus (EBV), which is a viral infection spread through saliva. Streptococcus refers to a bacterial organism, most commonly associated with strep throat, and is not the cause of mononucleosis. Understanding the viral origin is important because it explains why antibiotics are not effective.

You need to take the full course of antibiotics is incorrect because antibiotics do not treat viral infections. Mononucleosis is managed with supportive care, including rest, hydration, antipyretics, and pain relief. Additionally, administration of antibiotics such as amoxicillin or ampicillin in patients with mono can cause a diffuse maculopapular rash, which is an important teaching point for patients and families.

If contracted you need to stay home from school is incorrect because routine exclusion from school is not required. Mononucleosis is not spread by casual contact, and students may attend school as tolerated based on fatigue level. However, adolescents should be instructed to avoid contact sports or strenuous activity for several weeks due to the risk of splenic enlargement and potential splenic rupture, which is a critical safety concern.

I’ll make sure they push the PCA button every 6 minutes is incorrect because PCA is not scheduled dosing. The patient should push the button only when pain is present, not automatically at fixed intervals.

I’ll press the PCA button every 6 minutes so they get enough pain medication while they are sleeping is incorrect because family members must never press the PCA button. This is unsafe and can lead to oversedation and respiratory depression, especially while the patient is asleep.

I’ll have to wake them up every 2 hours overnight so they can push the PCA button is incorrect because patients should not be awakened to receive PCA medication. If the patient is asleep, it indicates that pain is adequately controlled.

Femur fracture is incorrect because creatine kinase (CK) is an enzyme found primarily in skeletal muscle, cardiac muscle, and brain tissue, not bone. Although a traumatic fracture can cause some surrounding muscle injury, isolated bone fractures do not typically result in significantly or persistently elevated CK levels. CK elevation reflects muscle cell damage, not bone injury.

Osteoporosis is incorrect because osteoporosis involves loss of bone mineral density, increasing fracture risk, but it does not involve muscle cell destruction. Therefore, CK levels are typically normal in patients with osteoporosis unless another muscle-related condition is present.

Scoliosis is incorrect because scoliosis is a spinal curvature disorder affecting the alignment of the vertebrae. While it may be associated with muscle imbalance or discomfort, it does not cause muscle fiber breakdown or elevated CK levels.

A bland diet high in protein is incorrect because children with acute poststreptococcal glomerulonephritis (APSGN) often require dietary sodium and sometimes fluid restriction, especially if edema or hypertension is present. Protein intake is not increased and may actually be moderated if kidney function is impaired, to reduce the workload on the kidneys.

Bed rest lasting at least 4 weeks is incorrect because strict, prolonged bed rest is not required. Activity may be limited during the acute phase if the child has significant hypertension, edema, or fatigue, but as symptoms improve, gradual return to normal activity is encouraged.

A daily intramuscular dose of penicillin is incorrect because antibiotics are used to eradicate the original streptococcal infection, not to treat the kidney inflammation itself. If antibiotics are prescribed, they are typically given for a standard course, not as long-term daily intramuscular therapy.

Administering the most painful vaccination first does not reduce pain or anxiety. Evidence-based practice recommends giving the most painful injection last so the child does not associate the entire experience with immediate severe pain. This option may actually increase fear and distress.

Administering acetaminophen after vaccination is not an effective strategy for reducing procedural pain or anxiety at the time of injection. Additionally, routine prophylactic use of acetaminophen around vaccination is not recommended because it may reduce the immune response to some vaccines.

Aspirating prior to vaccine administration is not recommended for routine childhood immunizations and does not decrease pain or anxiety. It may actually increase discomfort and prolong the procedure.

Enlargement of mamillary tissue is not a typical secondary sex characteristic in adolescent males. Although some adolescent males may experience temporary breast tissue enlargement (gynecomastia) due to hormonal fluctuations during puberty, this finding is usually transient and not considered a normal or defining secondary sex characteristic of male sexual development.

Completion of skeletal growth occurs at the end of adolescence or early adulthood, after epiphyseal plates close. Puberty is marked by rapid skeletal growth rather than the completion of growth, so this finding does not reflect a secondary sex characteristic.

Enlargement of the testes represents a primary sex characteristic. Primary sex characteristics involve direct development and maturation of the reproductive organs necessary for reproduction, which occur earlier in puberty and are distinct from secondary characteristics such as body size, voice changes, and hair distribution.

Inform the client to apply medication prior to bed is incorrect because isotretinoin is taken orally, not applied topically. While some acne medications are topical and may be applied at night, isotretinoin is systemic and requires monitoring of lab values and adherence to dosage instructions.

Inform the client to take a multivitamin daily is incorrect. In fact, patients on isotretinoin should avoid excessive vitamin A supplementation, as isotretinoin is a vitamin A derivative and excess can increase toxicity risk.

Inform the client to scrub vigorously prior to application is incorrect because isotretinoin is not applied topically, and vigorous scrubbing of the skin can worsen acne and cause irritation. Gentle cleansing is always recommended for acne-prone skin.

Providing counseling to adolescents during rehabilitation is important for addressing emotional, psychological, or behavioral issues, but it does not address the broader systemic barriers that often disproportionately affect minority adolescents.

Identifying individuals at risk for substance abuse is a valuable preventive measure, yet it focuses on a specific risk factor rather than addressing overall health disparities that impact minority adolescents.

Guiding minority adolescents to prevent injuries and accidental deaths is beneficial, especially for safety education, but it is limited in scope and does not tackle the underlying inequities in access to healthcare.