When assessing a female adolescent for scoliosis, what should the nurse ask the client to do?

Correct Answer: A

Rationale: When assessing a female adolescent for scoliosis, the nurse should ask the client to bend forward at the waist with arms hanging freely. This Adams forward bend test allows the nurse to evaluate the spine for any asymmetry, curvature, or rib hump that may indicate scoliosis. By observing the alignment of the spine while the client is in a forward bent position, the nurse can gather important information to determine if further evaluation or referral to a healthcare provider is necessary.

Correct Answer: D

Rationale: The protrusion of the frontal fontanelle in a child can be a concerning sign and can be seen in various conditions such as meningitis, hydrocephalus, and subdural hematoma. In meningitis, the inflammation of the meninges can lead to increased intracranial pressure, which may cause the fontanelle to bulge. Hydrocephalus, which is the buildup of fluid in the brain, can also result in the fontanelle being more pronounced. Additionally, a subdural hematoma, which is a collection of blood between the brain and its outermost covering, can lead to pressure on the brain and consequent fontanelle protrusion. Therefore, all the provided choices (A, B, C) are correct as they can lead to the protrusion of the frontal fontanelle in a child.

Correct Answer: C

Rationale: Rectal temperatures are not recommended in newborns because they can potentially cause perforation of the rectal mucosa. Newborns have fragile, delicate tissues in the rectal area, and the insertion of a rectal thermometer may lead to injury or damage to the mucosal lining. It is important to exercise caution and use alternative methods for taking temperatures in newborns to avoid any harm or discomfort.

Correct Answer: B

Rationale: The current recommendations for hepatitis B (HBV) vaccine state that the first dose should be administered between ages 12 and 15 months. The vaccine series typically consists of three doses, with the second dose administered 1-2 months after the first dose, and the third dose given at least 8 weeks after the second dose. This schedule is recommended by the Centers for Disease Control and Prevention (CDC) to provide optimal protection against the hepatitis B virus. Starting the vaccine series at 12-15 months ensures that the child's immune system is mature enough to respond effectively to the vaccine and generate lasting immunity.

Correct Answer: D

Rationale: Cellulitis is a common skin infection that is often caused by bacteria, primarily Streptococcus or Staphylococcus organisms. These bacteria typically enter the skin through a crack or break, such as a cut, insect bite, or scratch. Once inside the skin, they can cause inflammation and infection, leading to symptoms such as redness, warmth, swelling, and tenderness in the affected area. Prompt treatment with antibiotics is essential to clear the infection and prevent complications.