A school nurse is talking with a 13-year-old non-binary student at their annual health screening visit. Which statement by the adolescent will the nurse prioritize?

I haven't had a growth spurt yet, and all my friends are taller than me.

My parents treat me like a baby sometimes.

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

There's a big project due by the end of the month, and I'm really stressed about it.

Answer and Explanation

The Correct Answer is C

Choice A reason: Concerns about physical development, such as not having had a growth spurt yet, are common among adolescents. While this statement indicates some distress, it is generally considered a normal part of adolescent development and may not require immediate intervention.

Choice B reason: Feeling infantilized by parents is also a common issue among teenagers. This can be addressed through communication and support, but it is not typically an urgent matter.

Choice C reason: Statements about social isolation and feeling disliked by peers can be indicative of significant emotional distress or even depression. This statement warrants immediate attention to assess the adolescent's mental health and provide necessary support or intervention.

Choice D reason: Stress related to academic pressures, such as a big project, is common among students. While it is important to address stress management, it does not typically indicate an immediate risk to the student's well-being.

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Correct Answer is A

Explanation

Choice A reason: Applying a cold pack to the affected area is the most appropriate intervention for managing hemarthrosis (bleeding into the joint) in a patient with haemophilia A. Cold therapy helps reduce pain, swelling, and inflammation by constricting blood vessels, which can slow down bleeding. This intervention also provides comfort to the patient and helps manage the acute symptoms of hemarthrosis effectively.

Choice B reason: Administering ibuprofen for pain is not recommended for patients with haemophilia A because ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can increase the risk of bleeding by inhibiting platelet function. Instead, acetaminophen (Tylenol) is often preferred for pain management in these patients as it does not have the same blood-thinning effects.

Choice C reason: Performing range-of-motion exercises is not appropriate during the acute phase of hemarthrosis. Movement and exercise can exacerbate bleeding and increase pain. It is essential to allow the joint to rest and stabilize before considering gentle range-of-motion exercises during the recovery phase. Immediate management should focus on controlling bleeding and reducing inflammation.

Choice D reason: Placing the leg in a dependent position (lower than the heart) is not recommended for managing hemarthrosis. Elevating the affected limb is a better approach as it helps reduce swelling and pain by promoting venous return and minimizing blood flow to the affected area. The dependent position can increase blood flow to the joint, potentially worsening the bleeding and swelling.

A. Have the patient sit on the side of the bed. B. Walk alongside the patient to the bathroom. C. Obtain an oral temperature. D. Assess for sensation in the lower extremities. E. Assess bowel sounds and passing flatus.

Correct Answer is ["A","B","D"]

Explanation

Choice A reason: Having the patient sit on the side of the bed before standing is crucial to prevent dizziness or fainting, especially after giving birth. This intervention allows the patient to stabilize and ensures that they do not experience sudden drops in blood pressure, which can lead to falls.

Choice B reason: Walking alongside the patient to the bathroom is important to provide support and ensure their safety. The patient may still be weak or unsteady after giving birth, and having the nurse nearby can help prevent falls and provide assistance if needed.

Choice C reason: Obtaining an oral temperature is not immediately necessary when assisting a patient to the bathroom post-vaginal birth. While monitoring vital signs is important, this intervention does not directly contribute to the immediate need for safe ambulation.

Choice D reason: Assessing for sensation in the lower extremities is essential to ensure that the patient has regained feeling and control in their legs. This assessment helps to determine if there are any residual effects from epidural anaesthesia or other factors that may affect mobility and safety.

Choice E reason: Assessing bowel sounds and passing flatus is important for overall postpartum care but is not directly related to assisting the patient to the bathroom. This intervention is more relevant to monitoring gastrointestinal recovery and function after childbirth.

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A school nurse is talking with a 13-year-old non-binary student at their annual health screening visit. Which statement by the adolescent will the nurse prioritize?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a patient with haemophilia A who is experiencing hemarthrosis of the knee. Which intervention will the nurse perform?

Correct Answer is A

Explanation

The nurse is assisting a patient 2 hours post-vaginal birth out of bed to the bathroom for the first time. Which interventions will the nurse implement? Select all that apply.

Correct Answer is ["A","B","D"]

Explanation

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The nurse is providing education to the parent of an 8-year-old with haemophilia about ways to decrease the risk of a bleeding event. Which statement by the parent demonstrates that teaching was effective?

A school nurse is talking with a 13-year-old non-binary student at their annual health screening visit. Which statement by the adolescent will the nurse prioritize?

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