A nurse is assisting in the care of a newly admitted client.

Which of the following findings should the nurse report immediately to the provider? Select all that apply

A) "The adolescent interrupts the nurse to ask a question": Interrupting is common in adolescents with ADHD, as impulsivity is a characteristic of the disorder. While this behavior can be disruptive, it does not necessarily present a barrier to communication. The adolescent may be seeking clarification, and the nurse can guide them to ask questions at appropriate times.

B) "The adolescent occasionally turns away from the nurse and stares at the wall": This behavior may indicate that the adolescent is distracted or disengaged, but it does not necessarily block communication. It's important for the nurse to assess the adolescent’s attention and attempt to re-engage them if needed.

C) "The adolescent taps on the arm of the chair throughout the conversation": Tapping or other repetitive movements are often seen in individuals with ADHD and can be a significant barrier to effective communication. This behavior can be distracting for both the adolescent and the nurse, making it difficult to maintain focus on the conversation and absorb information. The nurse should address this by encouraging a calmer, more focused posture during discussions.

D) "The adolescent rocks in their chair while speaking with the nurse": Rocking can be a self-soothing behavior or a way to help manage restlessness, common in ADHD. While it can be distracting, it is less likely to be a major barrier to communication than tapping, which may be more intrusive. The nurse should assess if the behavior affects the adolescent’s ability to focus or engage.

A) Dampened clothes are used for dusting the area: Using dampened clothes for dusting can help minimize the spread of dust and particulate matter in the environment. As long as the cloth is clean and properly disinfected, this action is not typically a source of infection. This is generally a safer approach for cleaning and does not pose an immediate infection risk.

B) Waste containers are lined with: While the phrasing is incomplete, if waste containers are lined properly with appropriate liners and are disposed of regularly, they should not serve as a significant source of infection. Waste disposal is important, but a properly lined container reduces the risk of contamination.

C) Soiled linens are placed on the floor: Placing soiled linens on the floor is a significant source of potential infection for immunocompromised clients. Floors can harbor bacteria, viruses, and other pathogens, and placing soiled linens there increases the likelihood of cross-contamination. The linens should be handled in a way that prevents contact with unclean surfaces to avoid spreading infection.

D) Uncapped sharps are put in a puncture-resistant container: A puncture-resistant container is designed to safely contain sharps such as needles, scalpels, or other sharp objects, minimizing the risk of injury. If sharps are uncapped, however, they could present a risk of needle-stick injury or contamination. However, the main risk comes from improper disposal, not the container itself. Proper disposal in an appropriately designed container is essential to minimizing infection risks.