When-obtaining an adolescent's health history, which intervention is most important of the nurse to implement?

Assess for the use of illicit drugs.

Obtain a smoking history first.

Evaluate vital signs and laboratory findings.

Ask the parents to leave the room.

Answer and Explanation

The Correct Answer is D

A. Assess for the use of illicit drugs. While assessing illicit drug use is important, it may not be the most crucial intervention during the initial health history-taking process.

B. Obtain a smoking history first. While obtaining a smoking history is important, it may not take precedence over other aspects of the health history, especially if there are more pressing concerns.

C. Evaluate vital signs and laboratory findings. While vital signs and laboratory findings are important components of the assessment, they are typically obtained after the health history has been completed.

D. Ask the parents to leave the room. Ensuring privacy and confidentiality is crucial during adolescent health assessments to encourage open communication and address sensitive issues. Asking the parents to leave the room allows the adolescent to speak freely about their health concerns without fear of judgment or disclosure to their parents.

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Correct Answer is D

Explanation

A Description of head pain: While head pain can be a concern after an MVC, it doesn't necessarily require immediate intervention based on the information provided.

B. Concentrated urine output: Concentrated urine can suggest dehydration, but it's not the most urgent finding in this scenario.

C. Bruising on both arms: Bruising is a common consequence of an MVC and doesn't require immediate intervention.

D. Blood glucose is 160 mg/dL (8.88 mmol/L): This blood sugar level is above the normal reference range and could indicate hyperglycaemia (high blood sugar). In an older adult, especially after a stressful event like an MVC, it's crucial to address this as it can worsen confusion and other symptoms.

A. The gallbladder is normal. B. Deeper palpation technique is needed. C. The client is too obese. D. Palpating in the wrong abdominal quadrant.

Correct Answer is A

No explanation

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When-obtaining an adolescent's health history, which intervention is most important of the nurse to implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

While assessing a client who is obese, the nurse is unable to locate the gallbladder when palpating below the liver margin at the lateral border of the rectus abdominal muscle. Which is the most likely explanation for failure to locate the gallbladder by palpation?

Correct Answer is A

While assessing the legs of an adult client, the nurse observes leathery-looking skin. The client reports aching, tired legs that swell if standing for long periods of time. To screen for venous insufficiency, the nurse should ask the client if they have experienced which subjective finding?

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