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An adolescent girl calls the nurse at the clinic because she had unprotected sex the night before and does not want to be pregnant. What should the nurse explain?
- A. It is too late to prevent an unwanted pregnancy.
- B. An abortion may be the best option if she is pregnant.
- C. The risk of pregnancy is minimal, so no action is necessary.
- D. Postcoital contraception is available to prevent implantation and therefore pregnancy.
Correct Answer: D
Rationale: Emergency contraception like Plan B, if taken within 72 hours, can prevent pregnancy by inhibiting implantation. It?s not too late, abortion isn?t immediately necessary, and pregnancy risk varies but warrants action.
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A parent calls the clinic nurse because his 7-year-old child was bitten by a black widow spider. What action should the nurse advise the parent to take?
- A. Apply warm compresses.
- B. Carefully scrape off the stinger.
- C. Take the child to the emergency department.
- D. Apply a thin layer of corticosteroid cream.
Correct Answer: C
Rationale: Black widow spider venom is neurotoxic, requiring emergency treatment with antivenin and possibly muscle relaxants. Warm compresses spread the venom, black widows lack stingers, and corticosteroid cream is ineffective against the venom.
The middle school nurse is planning a behavior modification program for overweight children. What is the most important goal for participants of the program?
- A. Learn how to cook low-fat meals.
- B. Improve relationships with peers.
- C. Identify and eliminate inappropriate eating habits.
- D. Achieve normal weight during the program.
Correct Answer: C
Rationale: Identifying and eliminating inappropriate eating habits is the core of behavior modification, addressing root causes of obesity. Cooking skills are secondary, peer relationships are not the focus, and normal weight is a long-term goal.
A school-age child has been bitten on the leg by a large snake that may be poisonous. During transport to an emergency facility, what should the care include?
- A. Apply ice to the snakebite.
- B. Immobilize the leg with a splint.
- C. Place a loose tourniquet distal to the bite.
- D. Apply warm compresses to the snakebite.
Correct Answer: B
Rationale: Immobilizing the leg with a splint minimizes venom spread by reducing movement. Ice reduces blood flow, potentially trapping venom, a tourniquet should be proximal if used, and warm compresses increase circulation, spreading the venom.
What behavior is the nurse most likely to assess in an adolescent with anorexia nervosa (AN)?
- A. Eats in secrecy
- B. Uses food as a coping mechanism
- C. Has a marked preoccupation with food
- D. Lacks awareness of how eating affects weight loss
Correct Answer: C
Rationale: Individuals with AN are preoccupied with food, often preparing it for others or hoarding it while eating minimally. Secret eating and using food as a coping mechanism are typical of bulimia nervosa, and those with AN are aware of calorie intake?s impact.
An adolescent girl is brought to the hospital emergency department by her parents after being raped. The girl is calm and controlled throughout the interview and examination. The nurse should recognize this behavior is what?
- A. A sign that a rape has not actually occurred
- B. One of a variety of behaviors normally seen in rape victims
- C. Indicative of a higher than usual level of maturity in the adolescent
- D. Suggestive that the adolescent had severe emotional problems before the rape occurred
Correct Answer: B
Rationale: Rape victims exhibit varied responses, including calm behavior, which may mask inner turmoil. This is a normal coping mechanism, not indicative of the event?s validity, maturity, or pre-existing emotional issues.