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Why is honest information important in building a trusting relationship with adolescent patients?
- A. Encourage the adolescent to seek help outside of the school clinic.
- B. Keep disclosures from the adolescent confidential.
- C. Honest information ensures establishing a trusting relationship.
- D. Discourage minor adolescents from disclosing private concerns.
Correct Answer: C
Rationale: Honesty is fundamental in building trust with adolescent patients as it helps create an environment where they feel safe to share their concerns openly. By being honest and maintaining confidentiality, healthcare providers can establish a strong and trusting relationship with adolescents, ultimately leading to better healthcare outcomes.
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A 16-year-old male client who has been treated in the past for a seizure disorder is admitted to the hospital. Immediately after admission, he begins to have a grand mal seizure. Which action should the nurse take?
- A. Obtain assistance in holding him to prevent injury.
- B. Observe him carefully.
- C. Call a CODE.
- D. Place a padded tongue blade between the teeth.
Correct Answer: B
Rationale: During a grand mal seizure, the priority action for the nurse is to ensure the safety of the client. Observing the client carefully allows the nurse to monitor the seizure activity, the client's breathing, and any signs of distress without interfering with the seizure process. Restraining the client or placing objects in the mouth can lead to injury and should be avoided. Calling a CODE is not appropriate for a seizure as it is a normal response to the client's condition.
The healthcare provider is providing postoperative care to a 4-year-old child who underwent tonsillectomy. The provider notices that the child is frequently swallowing. What should the provider do first?
- A. Check the child's throat for signs of bleeding
- B. Offer the child ice chips to soothe the throat
- C. Elevate the head of the child's bed
- D. Administer prescribed pain medication
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
The caregiver is caring for a 2-month-old infant with a diagnosis of bronchiolitis. Which assessment finding would be most concerning to the caregiver?
- A. Nasal flaring and grunting
- B. Coughing and wheezing
- C. Poor feeding and irritability
- D. Increased respiratory rate
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A mother brings her 3-week-old infant to the clinic because the baby vomits after eating and always seems hungry. Further assessment indicates that the infant's vomiting is projectile, and the child seems listless. Which additional assessment finding indicates the possibility of a life-threatening complication?
- A. Irregular palpable pulse
- B. Hyperactive bowel sounds
- C. Underweight for age
- D. Crying without tears
Correct Answer: D
Rationale: Crying without tears is a sign of severe dehydration, which is a potentially life-threatening complication in infants with projectile vomiting. Dehydration can rapidly progress in infants, leading to serious consequences if not promptly addressed. The combination of projectile vomiting, listlessness, and absence of tears when crying should raise concerns about severe dehydration and the need for urgent intervention to prevent further complications.
What suggestion should the nurse provide to prevent diaper rash in a 4-month-old infant as requested by the mother?
- A. Generously powder the baby's diaper area with talcum powder at each diaper change to promote dryness.
- B. Wash the diaper area every 2 hours with soap and water to help prevent skin breakdown.
- C. Use a barrier cream, such as zinc oxide, which does not have to be completely removed with each diaper change.
- D. Place a cloth diaper inside the disposable diaper for overnight periods when increased wearing time is likely.
Correct Answer: C
Rationale: Using a barrier cream like zinc oxide forms a protective layer on the skin, creating a barrier against irritants and moisture, thus helping to prevent diaper rash. Unlike other options, barrier creams do not need to be completely removed at each diaper change, allowing the skin to remain protected between changes.