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 C
Explanation
Choice A rationale
Emphasizing compliance without addressing the underlying emotional distress of an adolescent regarding body image can be counterproductive. Adherence to medical regimens, especially those affecting appearance, is significantly influenced by psychosocial factors and perceived stigma. A confrontational approach often increases resistance, hindering long-term treatment success.
Choice B rationale
Dismissing an adolescent's concern about peer perception trivializes their developmental stage, where social acceptance and body image are paramount. Telling them peers will not notice is often untrue and undermines trust, as adolescents are highly attuned to social cues and peer judgment, which can lead to further noncompliance.
Choice C rationale
Involving the adolescent in brace customization promotes autonomy and ownership over their treatment, significantly increasing compliance. This approach addresses the emotional impact of body image concerns by allowing for personalization, which can mitigate feelings of embarrassment and enhance self-esteem during a critical developmental period.
Choice D rationale
While explaining risks is important for informed consent, focusing solely on negative consequences without offering solutions or addressing emotional barriers can instill fear without promoting adherence. This approach can also lead to resentment or a feeling of being lectured, further alienating the adolescent from treatment.
Correct Answer is A
Explanation
Choice A rationale
Variable decelerations are characterized by an abrupt decrease in the fetal heart rate, often V, W, or U-shaped, and are primarily caused by umbilical cord compression. This compression reduces blood flow and oxygen transfer to the fetus, leading to a transient hypoxic event and subsequent FHR deceleration.
Choice B rationale
Maternal fever typically causes fetal tachycardia, an elevated baseline fetal heart rate (above 160 beats per minute), due to increased fetal metabolic demands and a direct effect of elevated maternal temperature on fetal physiology. It does not directly cause variable decelerations.
Choice C rationale
Fetal head compression typically causes early decelerations, which are symmetrical, gradual decreases in FHR that mirror uterine contractions. This occurs due to increased intracranial pressure stimulating the vagus nerve, leading to a transient slowing of the heart rate.
Choice D rationale
Polyhydramnios, an excessive amount of amniotic fluid, is generally associated with conditions like maternal diabetes or fetal anomalies. While it can alter uterine distension, it is not a direct or primary cause of variable decelerations, which are specifically linked to cord compression.
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