A school nurse notices a sudden drop in grades and increased absenteeism in a previously high-achieving student.
When approached, the student avoids eye contact and has flat affect. What is the nurse's next best action?
Refer the student to the school social worker for a mental health evaluation.
Encourage the student to take academic breaks.
Contact the child's teacher to discuss tutoring.
Notify the parent to request a medical workup.
The Correct Answer is A
Choice A rationale
A sudden drop in grades, increased absenteeism, avoidance of eye contact, and flat affect are significant behavioral and emotional changes that suggest a potential underlying mental health issue. Referring the student to a school social worker, who is trained in mental health assessments and interventions, ensures a timely and appropriate professional evaluation. Early identification and intervention are crucial for improving outcomes in adolescent mental health.
Choice B rationale
Encouraging academic breaks without addressing the root cause of the student's distress is unlikely to resolve the underlying issues. While breaks can be beneficial, they do not provide the comprehensive support needed for significant behavioral and emotional changes that suggest potential mental health concerns. This approach may delay necessary professional intervention.
Choice C rationale
Contacting the child's teacher to discuss tutoring focuses solely on the academic decline and overlooks the emotional and behavioral cues. While academic support might be needed, it does not address the possible mental health component indicated by the flat affect and avoidance of eye contact, which are often symptoms of distress.
Choice D rationale
Notifying the parent to request a medical workup is a reasonable step if a physical health issue is suspected. However, the constellation of symptoms (behavioral changes, emotional blunting, social withdrawal) more strongly points towards a mental health concern rather than a purely physical one, making a referral to a mental health professional more immediately relevant.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
At the end of the first trimester, around 12-14 weeks gestation, the uterus is still relatively low in the pelvis. The symphysis pubis serves as a reliable anatomical landmark for locating the fundus of the uterus at this stage. Placing the Doppler just above this bony prominence allows for optimal transmission of sound waves to detect the fetal heart tones.
Choice B rationale
The right upper quadrant contains structures like the liver, gallbladder, and part of the colon. At the end of the first trimester, the uterus is not typically high enough to extend into this region. Therefore, attempting to locate fetal heart tones in this area would be ineffective and unlikely to yield a clear signal, as the fetus is not yet positioned there.
Choice C rationale
Just above the umbilicus is the general location for assessing fetal heart tones later in pregnancy, typically during the second and third trimesters when the uterus has significantly enlarged and risen out of the pelvis. At the end of the first trimester, the uterus is still too small and low for the fetal heart tones to be consistently heard at this location.
Choice D rationale
The left upper quadrant contains the stomach, spleen, and part of the colon. Similar to the right upper quadrant, the uterus is not positioned high enough in the first trimester to extend into this area. Therefore, attempting to locate fetal heart tones in the left upper quadrant would be inappropriate and unlikely to be successful.
Correct Answer is C
Explanation
Choice A rationale
Providing a high-protein diet is beneficial for tissue repair and overall healing, as proteins are essential building blocks for cells and enzymes involved in the inflammatory and reparative processes. However, this intervention is secondary to addressing the underlying infection. Nutritional support optimizes recovery but does not directly eliminate the bacterial pathogen.
Choice B rationale
Encouraging weight-bearing on the affected limb is contraindicated in acute osteomyelitis. This action could exacerbate inflammation, increase pain, and potentially lead to pathological fractures or further dissemination of the infection within the bone, compromising structural integrity and delaying healing. Rest is crucial for minimizing stress on the compromised bone.
Choice C rationale
Administering IV antibiotics as prescribed is the priority intervention because osteomyelitis is a severe bacterial infection of the bone. Intravenous administration ensures high systemic concentrations of antibiotics, reaching the infected bone tissue efficiently to eradicate the pathogen, prevent further bone destruction, and reduce the risk of systemic complications like sepsis.
Choice D rationale
Applying heat packs to the affected area might provide some symptomatic relief from pain by increasing blood flow, but it is not a primary intervention for osteomyelitis. Heat can potentially increase swelling and may not be effective in reaching the deep-seated infection within the bone. Direct antimicrobial therapy is paramount for resolution.
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