A school nurse is talking with a 13-year-old female at her annual health-screening visit. Which of the following comments made by the adolescent should be the nurse's priority to address?

I haven't gotten my period yet, and all my friends have theirs."

There's a big pimple on my face, and I worry that everyone will notice it

"None of the kids at this school like me, and I don't like them either."

"My parents treat me like a baby sometimes."

Answer and Explanation

The Correct Answer is C

A) "I haven't gotten my period yet, and all my friends have theirs."

While the concern about not having gotten her period yet is a valid one, it's a common experience during adolescence. Variability in the timing of puberty is normal, and addressing this concern might involve providing reassurance and education about the natural range of development.

B) "There's a big pimple on my face, and I worry that everyone will notice it."

While concerns about physical appearance are common during adolescence, they are less urgent in terms of emotional and psychological well-being. Addressing body image issues is important, but the statement about lack of social acceptance and reciprocal liking indicates potentially deeper emotional challenges.

C) "None of the kids at this school like me, and I don't like them either."

Explanation:

Adolescence is a time of significant emotional and social development. The statement about not being liked by other students and not liking them in return indicates potential social isolation and difficulties in forming positive relationships. Adolescents often seek social acceptance and peer relationships are crucial for their well-being and development.

D) "My parents treat me like a baby sometimes."

This statement suggests a common parent-adolescent dynamic where there might be conflicts about independence and autonomy. While these feelings are valid, they don't necessarily reflect a higher priority concern related to social isolation and peer relationships.

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Correct Answer is A

Explanation

Remaining with the client provides support and ensures their safety. The client's behavior indicates distress, and having a nurse nearby can help the client feel more comfortable and secure.

B. Give the client a PRN sleeping medication:

Explanation: Administering a sleeping medication should not be the first response, especially if the client is agitated. It's important to address the underlying cause of the agitation and consider other interventions before resorting to medication.

C. Encourage the client to go back to bed:

Explanation: Encouraging the client to go back to bed might not be effective if they are experiencing significant distress or anxiety. It's better to address their emotional state first before suggesting any changes in activity.

D. Explore alternatives to pacing the floor with the client:

Explanation: This is a reasonable course of action. Exploring alternatives to the client's current behavior can help address their distress and find ways to manage their emotions more effectively.

A. Bleeding B. Cataracts C. Dysrhythmias D. Pancreatitis

Correct Answer is C

Explanation

A. Bleeding:

Explanation: Bleeding is not a common adverse effect of haloperidol, which is an antipsychotic medication used to treat conditions like schizophrenia. Haloperidol primarily works on the central nervous system and is not known to directly cause bleeding issues.

B. Cataracts:

Explanation: Cataracts are not a common adverse effect of haloperidol either. While long-term use of some antipsychotic medications can lead to metabolic and endocrine disturbances, which might indirectly impact eye health, cataracts are not a direct and immediate concern with haloperidol use.

C. Dysrhythmias:

Explanation: Correct Answer. Haloperidol has the potential to cause cardiac-related adverse effects, including dysrhythmias (irregular heart rhythms). This is a particular concern in individuals who are predisposed to heart conditions or have other risk factors. The medication can prolong the QT interval, which is a measure of the time it takes for the heart's electrical system to recharge between beats. Prolonged QT interval can lead to serious and potentially life-threatening arrhythmias.

D. Pancreatitis:

Explanation: Pancreatitis is not a common adverse effect of haloperidol. Pancreatitis typically involves inflammation of the pancreas and can be caused by various factors such as gallstones, alcohol consumption, and certain medications. Haloperidol is not known to directly cause inflammation of the pancreas.

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A school nurse is talking with a 13-year-old female at her annual health-screening visit. Which of the following comments made by the adolescent should be the nurse's priority to address?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is having difficulty sleeping and is pacing the floor. The client's head down, and he is wringing his hands. Which of the following actions should the nurse take?

Correct Answer is A

Explanation

A nurse is caring for a client who has severe manifestations of schizophrenia and is medicated PRN for agitation with haloperidol. The nurse should assess the client for which of the following adverse effects?

Correct Answer is C

Explanation

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