Building trust and creating a comfortable and confidential environment is critical in caring for adolescents. Which of the following are ways an advanced practice registered nurse (APRN) can create a relaxed and informative environment for adolescent patients? Select All That Apply.

Trichomonal vaginitis is a sexually transmitted infection caused by Trichomonas vaginalis, a protozoan parasite affecting the lower genital tract. It commonly presents with profuse, foul-smelling, yellow-green vaginal discharge accompanied by vulvar irritation, itching, dysuria, and vaginal erythema. The vaginal mucosa may appear diffusely inflamed, and the cervix can sometimes show a “strawberry” appearance due to punctate hemorrhages. Recognizing the characteristic discharge and associated irritation helps distinguish it from other causes of vaginitis.

Rationale:
A. Atrophic vaginitis is usually seen in postmenopausal women due to decreased estrogen levels causing thinning and dryness of the vaginal mucosa. Symptoms commonly include vaginal dryness, dyspareunia, and irritation rather than profuse yellow-green discharge. It would be very unlikely in an 18-year-old patient with this presentation.

B. Trichomonal vaginitis is characterized by frothy, profuse, foul-smelling yellow-green discharge with associated itching, burning, dysuria, and diffuse vaginal erythema. The infection causes inflammation of the vaginal mucosa and vulva, leading to irritation and discomfort. This presentation matches the symptoms described, making it the most likely diagnosis.

C. Candidal vaginitis typically presents with thick, white, “cottage cheese-like” discharge rather than yellow-green discharge. Intense itching and vulvar irritation are common, but the odor is usually minimal or absent. The profuse malodorous discharge is more consistent with trichomoniasis than candidiasis.

D. Bacterial vaginosis usually causes a thin, grayish-white vaginal discharge with a strong fishy odor, especially after intercourse. It does not cause significant vulvar itching, dysuria, or marked vaginal erythema because inflammation is minimal. The presence of yellow-green discharge and diffuse erythema makes trichomonal vaginitis more likely.

Delirium and dementia are both cognitive disorders seen in older adults, but they differ significantly in onset, course, and level of consciousness. Delirium is an acute, reversible condition often triggered by medical illness, medications, or hospitalization. It is characterized by sudden onset, fluctuating symptoms, inattention, and altered awareness. Dementia, in contrast, is a chronic, progressive decline in cognitive function without changes in consciousness.

Rationale:
A. Gradual decline in memory over several years is more consistent with dementia rather than delirium. Dementia develops slowly and progressively, affecting memory, reasoning, and executive function over time. Delirium, however, has an acute onset and fluctuating course, making this option less supportive of delirium.

B. Depressed mood may be seen in both delirium and dementia, as well as in primary psychiatric conditions such as depression. While mood changes can accompany delirium, they are not a distinguishing feature. This finding does not strongly differentiate delirium from dementia.

C. Impaired recent memory is commonly seen in both delirium and dementia, making it a nonspecific finding. In delirium, memory impairment occurs due to inattention and fluctuating cognition, while in dementia it results from progressive neurodegeneration. Because it is shared by both conditions, it does not clearly distinguish between them.

D. Fluctuating level of consciousness is the hallmark feature that most strongly supports delirium. Patients may shift between hyperalert, lethargic, and disoriented states over short periods of time, often worsening at night (sundowning). This variability in awareness and attention is not seen in dementia, where consciousness remains clear until late stages.