ch.29
A teacher refers a student to the school nurse because the student is frequently falling asleep during class. After talking with the student, the nurse is most concerned by which statement by the student?
"I get 7 hours of sleep every night so I don't know why I am so tired." (p.1051)
The nurse is providing education on adolescent safety to a group of caregivers. Which statement by a caregiver indicates additional teaching is needed?
"Taking a course on driving safety is sufficient to teach safe driving skills." (p.1047)
The parent of a black adolescent voices concern to the nurse because the daughter, "has gotten her period before all of her friends." How should the nurse respond?
"That must be difficult, but on average black girls start their period earlier than other ethnicities." (p.1034-1035)
The nurse is assessing a 14-year-old male client when the client's parent jokes about the changes in the client's voice and the hair under his armpits. Which response by the nurse to the client's parent is most appropriate?
"Your child can become modest and self-conscious and teasing may cause embarrassment." (p.1034)
The nurse is preparing to talk with an adolescent about contraception. During the interaction, which communication techniques will be beneficial?
- Face the teen during the interaction. - Use open-ended questions. - Let the teen know that you may not know all the answers for their questions. - Ask that the teen be open and patient when you are providing information. (p.1039)
To help prevent obesity, which intervention would the nurse include in an adolescent's plan of care?
Describe a normal serving size. (p.1049-1050)
The nurse is talking with parents of a depressed 16-year-old boy. Which question is of the mostimportance?
Is there a gun in your home? (p.1047-1048)
A female client tells the nurse about noticing an increase in weight and fat deposits during the past year. The nurse reviews the client's chart and recognizes that the client is most likely going through puberty. Which nursing action is most appropriate at this time?
Provide reassurance that these are normal changes. (p.1035)
What activity would best foster the developmental task of an adolescent who uses a wheelchair to ambulate?
Talking to another adolescent who has a similar situation (p.1036)
A teenage boy tells the nurse that his parents embarrass him in front of his friends when they kiss him goodbye. The nurse is aware that this teenager is revisiting which stage of development identified by Erikson?
autonomy (p.1036)
A nurse is reading a journal article about adolescents and major causes of injuries in this age group. The nurse demonstrates understanding of this information by identifying which situation as the major cause of adolescent injuries?
motor vehicle crashes (p.1046)
The nurse is caring for a 13-year-old girl. The child has been identified as overweight with no underlying psychological or secondary causes. The nurse is reviewing the child's weight-loss progress and nutrition at a follow-up visit. What finding indicates a need for further discussion and teaching?
"Her goal is to be a size smaller by our vacation in two weeks." (p.1043)
The nurse is counseling an overweight, sedentary 15-year-old girl. The nurse is assisting her to make appropriate menu choices. Which statement indicates the adolescent understands how to make appropriate dietary selections?
"I need to have 4 servings of fruit each day." (p.1050)
The mother of a 9-year-old female voices concern to the nurse about her daughter developing breasts "at such a young age." How should the nurse respond?
"I understand your concern, but girls typically enter puberty around the age of 9 or 10." (p.1036)
An adolescent who is depressed states, "Nothing ever seems to be right in my life." Which would be the most appropriate response by the nurse?
"You are feeling sad right now. It's a hard time." (p.1043)
A 17-year-old female is meeting with the nurse for an annual well-visit and is asking the nurse questions about how to know when one is in love. The nurse should point out which factor to help decide if both individuals have reached a mutual agreement and are ready for an intimate relationship?
A sense of trust and identity (p.1029-1040)
A nurse is explaining cognitive development in children to a client, with the help of Piaget's theory of cognitive development. What would be the best explanation by the nurse about the formal operations level of cognitive development?
After age 12 children can think in the abstract, including complex problem solving. (p.1037-1038)
A chronically ill adolescent is readmitted to the hospital with an infected wound requiring long-term dressing changes. What is the best way the nurse can encourage independence for this client?
Allow the adolescent to choose the time for the dressing change. (p.1042-1043)
The nurse is meeting with a group of caregivers of adolescents and discussing sex and sexuality, including how to discuss these issues with their children. Which comment should the nurse prioritize with this group of caregivers?
Being honest and straightforward with teenagers will encourage them to ask about subjects like sexuality. (p.1040)
For reasons of anticipatory guidance, nurses should be aware that menarche appears earlier in some ethnic groups than others. In which ethnic group is menarche likely to appear first?
Black (p.1035)
The parents of a 16-year-old male are worried about recent changes in his behavior, ignoring his schoolwork and sports, and spending almost all of his free time interacting with his girlfriend. Which suggestion should the nurse point out would best address this situation?
He has developed his own identity by now; being able to establish close relationships with girls is important preparation for all of his adult relationships. They should honor his need to be with, or talk to, his girlfriend as long as he has completed his schoolwork for the day. (p.1040-1042)
The school nurse is developing a school wellness program to promote healthy eating habits and regular physical activity. What is the most important element to emphasize to maximize compliance, healthy habits, and long-term change?
Include both parents and children in the wellness program. (p.1059-1060)
The nurse is meeting with a group of caregivers of adolescents. Which example should the nurse point out is most effective for the caregiver to support the adolescent?
Let them choose their hairstyle, even though it may not look the best for them. (p.1045-1046)
A 15-year-old girl is in the hospital for surgery and is confined to bed. The nurse can tell that the client is nervous about being in the hospital. She tells the nurse that she feels "gross" and "on display" in her hospital gown. What should the nurse do to encourage a sense of autonomy and dignity related to the girl's body image?
Offer to assist the girl in washing her hair and let her pick the shampoo. (p.1052)
A 16-year-old client has been hospitalized 100 miles from home for 1 week to repair a fractured patella suffered in a skateboarding accident. She was cheerful and chatty when she first arrived, but the nurse notes in recent days she has become increasingly quiet and seems lonely. Which nursing intervention should the nurse prioritize for this client?
Take her to the teen lounge so she can meet other teens, use a phone, and check her email. (p.1046-1048)
An 18-year-old adolescent reveals the presence of nipple ring and is looking to get a tattoo in the next few months. What is the most important thing that the nurse can teach the adolescent at this time?
Tattooing carries risks such as infection, disease, and nerve damage. (p.1053)
The physician has made a notation in the medical record of a 17-year-old that the teen is not demonstrating successful completion of Erikson's stages of development. What behavior would be consistent with this assessment?
The teen is uncertain and frequently unable to make decisions. (p.1036)
Nurses should provide anticipatory guidance to males to prepare them for what particular pubertal change in middle-to-late adolescence?
nocturnal emissions (p.1035)
The nurse is caring for an 11-year-old girl. The girl's mother reports that the girl does not want to play team sports like soccer or volleyball anymore. Her daughter insists she does not enjoy them. The mother is concerned that her daughter will not get enough physical activity and asks the nurse for guidance. How should the nurse respond?
"Give her some options; it's important to find something she enjoys." (p.1045)
A teenage boy and his mother have come to the office for a routine visit. In the hallway, his mother confides that she is concerned because her son is playing games that the girls play, and she has noticed that when he plays any role-playing games his character is very feminine. She tells you that she is worried about his sexual orientation. What is the best response to her concerns?
"This behavior may be exploratory or reflect peer pressure, so do not make assumptions regarding sexual orientation." (p.1040)
The adolescent comes to the clinic seeking information about sexuality concerns. The clinic nurse assures the adolescent that confidentiality and privacy will be maintained unless a life-threatening situation occurs. Maintaining confidentiality demonstrates which nursing goal?
- development of a trusting relationship - compliance with existing laws - an environment where adolescents can be truthful (p.1040-1041)
A 17-year-old adolescent chats excitedly with the nurse about plans for college and a career. The adolescent states having checked out every college in the region and determined which one is the best fit and would give the adolescent the best career options. The nurse recognizes which developmental aspect in this client?
Formal operational thought (p.1037-1038)
The nurse is admitting a 15-year-old adolescent to the hospital pediatric unit. What does the nurse recognize as a priority for this adolescent?
The adolescent's need for privacy should be respected. (p.1042)
The nurse is caring for an adolescent athlete who is being seen for a fractured arm. The parent reports that this is the third sports injury in the past 2 years. The parent asks the nurse why the adolescent—who is healthy overall— continues to have injuries. How should the nurse respond?
The bones, joints, and tendons of adolescents are vulnerable to injury due to their rapid state of growth. (p.1045)
A 16-year-old girl has arrived for her sports physical with a new piercing in her navel. Which response by the nurse is best?
"Be sure to clean the navel several times a day." (p.1052)
Which nursing action will best assist a 15-year-old client accomplish the developmental task according to Erikson?
Allow the client's friends to visit while the client is hospitalized (p.1036)
The nurse is collecting data from an adolescent being seen for a well-child check. During the interview, the teen reports he sleeps about 6 hours per night during the week but is able to sleep 8 to 9 hours on the weekend. What response by the nurse is most appropriate?
"Let's talk about ways to increase the amount of rest you get during the week." (p.1051)
The nurse is providing anticipatory guidance to the parents of a 15-year-old who voice concerns with their teenager's sleep habits. They state, "Left to her own devices, I'm sure she'd stay up until 3:00 in the morning on the weekends and sleep until after lunchtime." Which should the nurse explain to the parents?
"That must be hard for you to manage. Perhaps we can explore some strategies with her to establish more predictable sleep patterns." (p.1051)
The nurse is instructing a 12½-year-old boy who says, "I am too short! Girls are taller than I am. Guess I won't be playing basketball." What instructions are best included in the plan of care?
- "Girls begin to grow rapidly at a younger age than boys do. Boys start later and grow longer." - "There are a lot of size differences in your age group now because everyone enters puberty and grows at slightly different times than others." - "You could add as much as 12 inches to your height before you stop growing." (p.1035)
The nurse is educating a 17-year-old adolescent after a new diagnosis of diabetes. What does the nurse understand about teaching an adolescent?
The adolescent will likely have the greatest influence on one's own decisions. (p.1037)
A high school athlete comes to the emergency department with hypertension, aggressiveness, and psychosis. What question would be important for the nurse to ask the client?
"Do you take anabolic steroids?" (p.1059)
The parents of a 16-year-old are fearful that their child may be using illegal drugs. They report to the nurse that they have noticed recently that their child seems much more focused when doing homework or chores, is losing weight, displays a high level of energy, and becomes agitated easily. The nurse is aware that the teen is displaying symptoms of which type of drug use?
methamphetamine (p.1057-1058)
A 16-year-old adolescent is talking with the nurse at a local health clinic about skin care. Which comments by the teen does the nurse determine require additional conversation?
- "I only tan before going on spring break to get a base tan so I won't burn." - "My favorite time of day to be outside is the middle of the day, around noon." - "The more exposure and burns I get now will toughen my skin so I won't get skin cancer when I'm older." (p.1053)
According to Erikson, the adolescent develops his or her own sense of being an independent person with individual thoughts and goals. This stage is referred to as:
identity vs. role confusion. (p.1037)
