A teenager is in the family practice clinic for a school physical. When the parent leaves the room, the teen admits to "cutting myself" after a relative "touched me in my private area." What action by the nurse is most appropriate?

Question

A.
Document the statements and alert the provider.
B.
Explain that this information must be shared.
C.
Have the secretary call the police department.
D.
Reassure the teen of confidentiality rules.

Answer 1

ANS: B
Older children (teens and preteens) often prefer to be interviewed in private where concerns of a personal nature can be shared in a safe area. Information about sexuality is often discussed at this time. The nurse is responsible for maintaining privacy except in situations of abuse or where a life-threatening situation exists. The nurse should first explain to the teen that this information needs to be shared with the parent before doing anything else. The information does need to be documented and the provider alerted, but not as the priority. Each facility will have policies in place to report possible abuse, which may or may not involve calling the police, Child Protective Services, or a social worker. However, reporting will wait until the nurse explains to the teen that the information needs to be shared.