Chapter 16 Wong

When is isotretinoin (Accutane) indicated for the treatment of acne during adolescence? a. The acne has not responded to other treatments. b. The adolescent is or may become pregnant. c. The adolescent is unable to give up foods causing acne. d. Frequent washing with antibacterial soap has been unsuccessful.

ANS: A Isotretinoin is reserved for severe cystic acne that has not responded to other treatments. Isotretinoin has teratogenic effects and should never be used when there is a possibility of pregnancy. No correlation exists between foods and acne. Antibacterial soaps are ineffective. Frequent washing with antibacterial soap is not a recommended therapy for acne.

The nurse is teaching the parents of a child recently diagnosed with ADHD who has been prescribed methylphenidate (Ritalin). Which should the nurse include in teaching about the side effects of methylphenidate? a. "Your child may experience a sense of nervousness." b. "You may see an increase in your child's appetite." c. "Your child may experience daytime sleepiness." d. "You may see a decrease in your child's blood pressure."

ANS: A Nervousness is one of the common side effects of Ritalin. Decreased appetite with subsequent weight loss, insomnia, and increased blood pressure are other common side effects.

An adolescent girl tells the nurse that she is very suicidal. The nurse asks her whether she has a specific plan. Asking this should be considered: a. an appropriate part of the assessment. b. not a critical part of the assessment. c. suggesting that the adolescent needs a plan. d. encouraging the adolescent to devise a plan.

ANS: A Routine health assessments of adolescents should include questions that assess the presence of suicidal ideation or intent. Questions such as, "Have you ever developed a plan to hurt yourself or kill yourself?" should be part of that assessment. Adolescents who express suicidal feelings and have a specific plan are at particular risk and require further assessment and constant monitoring. The information about having a plan is an essential part of the assessment and greatly affects the treatment plan.

Which is the most significant factor in distinguishing those who commit suicide from those who make suicidal attempts or threats? a. Social isolation b. Level of stress c. Degree of depression d. Desire to punish others

ANS: A Social isolation is a significant factor in distinguishing adolescents who will kill themselves from those who will not. It is also more characteristic of those who complete suicide than of those who make attempts or threats. Level of stress, degree of depression, and desire to punish others are contributing factors in suicide, but they are not the most significant factor in distinguishing those who complete suicide from those who attempt suicide.

A sexually active female adolescent asks the nurse about the contraceptive Depo-Provera. What should the nurse explain regarding the contraceptive? a. Requires injections every 3 months b. Requires daily administration of medication by mouth c. Provides long-term continuous protection, up to 5 years d. Prevents pregnancy if given within 72 hours of unprotected sex

ANS: A The contraceptive Depo-Provera is administered by injection every 3 months. Oral contraceptives, not Depo-Provera, require daily administration of medication by mouth. Norplant, not Depo-Provera, provides long-term continuous protection for up to 5 years. Postcoital contraception, not Depo-Provera, prevents pregnancy if given within 72 hours of unprotected sex.

A 14-year-old boy and his parents are concerned about bilateral breast enlargement. The nurse's discussion of this should be based on which statement? a. This is usually benign and temporary. b. This is usually caused by Klinefelter syndrome. c. Administration of estrogen effectively reduces gynecomastia. d. Administration of testosterone effectively reduces gynecomastia.

ANS: A The male breast responds to hormonal changes. Some degree of bilateral or unilateral breast enlargement occurs frequently in boys during puberty. Although individuals with Klinefelter syndrome can have gynecomastia, it is not a common cause for male breast enlargement. Estrogen is not a therapy for gynecomastia. Administration of testosterone has no benefit for gynecomastia and may aggravate the condition.

A mother calls the school nurse saying that her daughter has developed a school phobia. She has been out of school 3 days. The nurse's recommendations should include which intervention? a. Immediately return the child to school. b. Explain to the child that this is the last day she can stay home. c. Determine the cause of phobia before returning the child to school. d. Seek professional counseling before forcing the child to return to school.

ANS: A The primary goal is to return the child to school. Parents must be convinced gently, but firmly, that immediate return is essential and that it is their responsibility to insist on school attendance. The longer the child is permitted to stay out of school, the more difficult it will be for the child to reenter. Trying to find the cause of phobia will only delay the return to school and inhibit the child's ability to cope. Professional counseling is recommended if the problem persists, but the child's return to school should not wait for the counseling.

A nurse is recommending strategies to a group of school-age children for prevention of obesity. Which should the nurse include? (Select all that apply.) a. Eat breakfast daily. b. Limit fruits and vegetables. c. Have frequent family meals with parents present. d. Eat frequently at restaurants. e. Limit television viewing to 2 hours a day.

ANS: A, C, E The nurse should counsel school-age children to eat breakfast daily, have mealtimes with family, and limit television viewing to 2 hours a day to prevent obesity. Fruits and vegetables should be consumed in the recommended quantities, and eating at restaurants should be limited.

An adolescent has been diagnosed with Chlamydia infection. Which medication should the nurse expect to be prescribed for this condition? a. Ceftriaxone (Rocephin) IM b. Azithromycin (Zithromax) PO c. Acyclovir (Zovirax) PO d. Penicillin G benzathine (Bicillin) IV

ANS: B Azithromycin is used to treat Chlamydia. The patient should be rescreened in 3 to 4 months. Ceftriaxone is used to treat gonorrhea, acyclovir is used to suppress genital herpes simplex virus, and penicillin G benzathine is used to treat syphilis.

An adolescent tells the school nurse that she is pregnant. Her last menstrual period was 4 months ago. She has not received any medical care. She smokes but denies any other substance use. What is the priority nursing action? a. Notify her parents b. Refer for prenatal care c. Explain the importance of not smoking d. Discuss dietary needs for adequate fetal growth

ANS: B Teenage girls and their unborn children are at greater risk for complications during pregnancy and delivery. With improved therapies, the mortality for teenage pregnancy is decreasing, but the morbidity is high. A pregnant teenager needs careful assessment by the nurse to determine the level of social support available to her and possibly her partner. Guidance from the adults in her life would be invaluable, but confidentiality should be maintained. Although it is important to explain the importance of not smoking and to discuss dietary needs for adequate fetal growth, because of her potential for having a high-risk pregnancy, she will need a comprehensive prenatal program to minimize maternal-fetal complications.

Which is an important consideration when the nurse is discussing enuresis with the parents of a young child? a. Enuresis is more common in girls than in boys. b. Enuresis is neither inherited nor has a familial tendency. c. Organic causes that may be related to enuresis should be considered first. d. Psychogenic factors that cause enuresis persist into adulthood.

ANS: C Organic causes that may be related to enuresis should be ruled out before psychogenic factors are considered. Enuresis is more common in boys than in girls and has a strong familial tendency. Psychogenic factors may influence enuresis, but it is doubtful that they are causative.

A nurse is conducting a class for adolescent girls about pelvic inflammatory disease (PID). Why should the nurse emphasize the importance of preventing pelvic inflammatory disease (PID)? a. PID can be sexually transmitted. b. PID cannot be treated. c. PID can have devastating effects on the reproductive tract. d. PID can cause serious defects in future children of affected adolescents.

ANS: C PID is a major concern because of its devastating effects on the reproductive tract. Short-term complications include abscess formation in the fallopian tubes, whereas long-term complications include ectopic pregnancy, infertility, and dyspareunia. PID is an infection of the upper female genital tract, most commonly caused by sexually transmitted infections but it is not sexually transmitted to another person. PID can be treated by treating the underlying cause. There is a possibility of ectopic pregnancy but not birth defects in children.

Parents have a concern that their child is depressed. The nurse relates that which characteristic best describes children with depression? a. Increased range of affective response b. Preoccupation with need to perform well in school c. Change in appetite, resulting in weight loss or gain d. Tendency to prefer play instead of schoolwork

ANS: C Physiologic characteristics of children with depression include change in appetite resulting in weight loss or gain, nonspecific complaints of not feeling well, alterations in sleeping pattern, insomnia or hypersomnia, and constipation. Children who are depressed have sad facial expressions with absence or diminished range of affective response. These children withdraw from previously enjoyed activities and engage in solitary play or work with a lack of interest in play. A lack of interest is seen in doing homework or achieving in school, resulting in lower grades in children who are depressed.

The nurse is assisting the family of a child with a history of encopresis. Which should be included in the nurse's discussion with this family? a. Instruct the parents to sit the child on the toilet at twice-daily routine intervals. b. Instruct the parents that the child will probably need to have daily enemas. c. Suggest the use of stimulant cathartics weekly. d. Reassure the family that most problems are resolved successfully, with some relapses during periods of stress.

ANS: D Children may be unaware of a prior sensation and unable to control the urge once it begins. They may be so accustomed to bowel accidents that they are unable to smell or feel it. Family counseling is directed toward reassurance that most problems resolve successfully, although relapses during periods of stress are possible. Sitting the child on the toilet is not recommended because it may intensify the parent-child conflict. Enemas may be needed for impactions, but long-term use prevents the child from assuming responsibility for defecation. Stimulant cathartics may cause cramping that can frighten the child.

An adolescent girl asks the school nurse for advice because she has dysmenorrhea. She says that a friend recommended she try an over-the-counter nonsteroidal anti-inflammatory drug (NSAID). The nurse's response should be based on which statement? a. Aspirin is the drug of choice for the treatment of dysmenorrhea. b. Over-the-counter NSAIDs are rarely strong enough to provide adequate pain relief. c. NSAIDs are effective because of their analgesic effect. d. NSAIDs are effective because they inhibit prostaglandins, leading to reduction in uterine activity.

ANS: D First-line therapy for adolescents with dysmenorrhea is NSAIDs. This group of drugs blocks the formation of prostaglandins. NSAIDs, not aspirin, are the drugs of choice in dysmenorrhea. NSAIDs are potent anti-inflammatory agents that inhibit prostaglandin. Although NSAIDs have analgesic effects, the mechanism of action in dysmenorrhea is most likely the antiprostaglandin effect.

Which symptoms should the nurse expect to observe during the physical assessment of an adolescent girl with severe weight loss and disrupted metabolism associated with anorexia nervosa? a. Dysmenorrhea and oliguria b. Tachycardia and tachypnea c. Heat intolerance and increased blood pressure d. Lowered body temperature and brittle nails

ANS: D Symptoms of anorexia nervosa include lower body temperature, severe weight loss, decreased blood pressure, dry skin, brittle nails, altered metabolic activity, and presence of lanugo hair. Amenorrhea, rather than dysmenorrhea, and cold intolerance are manifestations of anorexia nervosa. Bradycardia, rather than tachycardia, may be present.

An adolescent asks the nurse what causes primary dysmenorrhea. The nurse's response should be based on which statement? a. It is an inherited problem. b. Excessive estrogen production causes uterine pain. c. There is no physiologic cause; it is a psychological reaction. d. There is a relation between prostaglandins and uterine contractility.

ANS: D The exact etiology of primary dysmenorrhea is debated. Overproduction of uterine prostaglandins has been implicated, as has overproduction of vasopressin. Dysmenorrhea is not known to be inherited. Excessive estrogen has not been implicated in the etiology. It has a physiologic cause. Women with dysmenorrhea have higher prostaglandin levels.