03-04-2007, 09:36 AM
13. A 14-year-old white girl is brought to the health center by her mother. The mother is in tears and states, "My daughter has been suspended from school for cursing at a teacher in class. Last night she came home 2 hours after her curfew. When I confronted her she yelled at me and pushed me into the wall. I don't know what is wrong with her." The girl states, "There is nothing wrong with me. I just want to be with my friends and do what I want. I don't feel I need a curfew. I didn't do anything wrong at school. The teacher mouthed off at me. She should have been suspended instead of me." The girl has been your patient since age 10 years when the family moved from another state. She has a history of allergies to mold and dust for which she uses loratadine as needed. She takes no other medications. Her menses began at age 12 years. Vital signs now are: temperature 37.0°C (98.6°F), pulse 90/min, respirations 12/min and blood pressure 106/60 mm Hg. Physical examination is normal. Which of the following is the most appropriate opening question to the patient when you are speaking alone with her? A) "Are you using drugs or alcohol?" B) "How do you want your parents to react to your violating their rules?" C) "What seems to be bothering you the most?" D) "Why aren't you showing your parents any respect?" E) "Why did you push your mother?"