A client at 17-weeks gestation expels the products of conception in her bed. Which intervention is most important for the nurse to implement?

Choice A rationale

While obtaining a smoking history is a crucial component of an adolescent's health assessment, it is not the most important initial intervention. Building rapport and creating a confidential environment are foundational for encouraging open communication. By prioritizing sensitive questions like smoking history first, the nurse may risk alienating the adolescent and hindering the overall health history process.

Choice B rationale

Adolescents often feel more comfortable and are more likely to disclose sensitive information, such as substance use, sexual activity, or mental health concerns, when their parents are not present. This provides a confidential and private setting that respects their autonomy and encourages them to speak openly and honestly, which is essential for a comprehensive and accurate health history.

Choice C rationale

Assessing for the use of illicit drugs is a critical part of a comprehensive health history for an adolescent. However, it is a specific component of the interview that should occur after a foundation of trust and confidentiality has been established. This question, if asked prematurely, may cause the adolescent to become defensive or reluctant to share other important health information.

Choice D rationale

Evaluating vital signs and lab findings is an important part of any health assessment. However, it is a physical or objective data collection step, not an intervention for obtaining a health history. The most important initial intervention when conducting a health history with an adolescent is to establish an environment of trust and confidentiality, which is a prerequisite for gathering subjective data.

Choice A rationale

Each pregnancy is an independent event with its own set of probabilities. The risk of inheriting an autosomal dominant disorder does not decrease or increase with subsequent children. The probability is determined by the parental genotype, and it remains a constant fifty percent chance for each child born to an affected parent.

Choice B rationale

The question explicitly states that the disorder is autosomal dominant, meaning it is not sex-linked. Therefore, the inheritance pattern is not dependent on the sex of the child. It affects both male and female offspring with equal probability, and it is crucial to provide accurate genetic counseling based on the specific inheritance pattern.

Choice C rationale

The inheritance of an autosomal dominant disorder is probabilistic, not deterministic. Each child has a separate and independent 50% chance of inheriting the mutated gene. The outcome for a previous child does not influence the genetic outcome for a future child, as each pregnancy is a separate genetic event.

Choice D rationale

An autosomal dominant disorder means that a single copy of the mutated gene is sufficient to cause the disorder. Since one parent is affected, they have a fifty percent chance of passing on the mutated allele to each of their children. The other parent, who is unaffected, can only pass on the normal allele, resulting in a fifty percent chance for the disorder.