A 15-year-old adolescent is brought to the clinic by a parent who is concerned about recent changes in behavior. The parent reports that the teen has become withdrawn, irritable, has declining grades, and has started hanging out with a new group of friends. The nurse suspects possible substance use. What is the priority nursing intervention?

Rationale:

A. "Let your child know that (s)he should inform you when (s)he needs to have something done": While communication is important, this response does not acknowledge the child’s developmental need for increasing independence, which is key at this age.

B. "Children of this age need to learn to solve problems and assume more responsibility for themselves": This response recognizes the developmental stage of a 10-year-old, who is beginning to seek autonomy and develop problem-solving skills, promoting healthy growth and self-confidence.

C. "Just let your child know you are the parent, and that what you are doing is the right thing": This authoritarian approach may undermine the child’s emerging independence and could damage the parent-child relationship.

D. "Continue to do what you have been doing for your child. Ten is too young for children to make any decisions for themselves": This dismisses the child’s developmental needs and may hinder their progress toward independence and self-management skills.

Rationale:

A. Development of rheumatic fever: Rheumatic fever is a serious delayed autoimmune complication that can follow untreated or inadequately treated streptococcal pharyngitis. It affects the heart, joints, and nervous system, making its assessment essential at follow-up.

B. Infection that may cause a tooth abscess: A tooth abscess is not related to streptococcal pharyngitis. Dental infections stem from poor oral hygiene or dental trauma, rather than streptococcal throat infections.

C. Nephrosis of the kidney: Post-streptococcal glomerulonephritis, not nephrosis, is a potential renal complication of streptococcal infection, characterized by inflammation of the kidney’s filtering units rather than nephrotic syndrome.

D. Swollen lymph nodes that obstruct the airway: While lymphadenopathy can occur with throat infections, obstruction of the airway by swollen nodes is rare. Airway obstruction would more likely result from severe tonsillar swelling or abscess formation rather than lymph node enlargement alone.