Chapter 19 - Care of the Adolescent

The family reports to the nurse that their adolescent always wants to argue, will not participate in family functions, and has poor school grades. What recommendation should the nurse make for an adolescent client who presents with these symptoms?

Make an appointment with the health care provider.

The nurse is providing anticipatory guidance for violence prevention to a group of parents with adolescents. Which parental action should the nurse include as the most effective in preventing suicide?

Checking for signs of depression or lack of friends.

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.

A young adult female is suspected of having gonorrhea. The nurse would anticipate additional testing for which sexually transmitted infection?

chlamydia

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?"

A 15-year-old male client diagnosed with gonorrhea states, "I can't tell my partner about this." What is the best response by the nurse?

"What concerns you about telling your partner?"

When obtaining information from a teen concerning the reason for seeking health care, which question would be most important?

"What health concerns are you having?"

When 12-year-old Chelsie comes in for her annual check-up, the nurse must take a health history and do a physical exam. What is the most appropriate manner for the nurse to obtain a health history?

Ask Chelsie if she minds if her mother is in the room with her.

The nurse is discussing ways to promote discipline with parents who are becoming increasingly frustrated with their adolescent. What would the nurse suggest to the parents?

Develop consistent expectations and use consistent responses each time.

Infectious mononucleosis ("mono") is caused by which of the following?

Epstein-Barr virus

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.

The nurse is performing a physical assessment on an 11-year-old girl during a health surveillance visit. Which of the following findings would suggest the child has reached adolescence?

The child has higher blood pressure.

A 15-year-old girl has been experiencing dysmenorrhea for the past year. Over the past 6 months, she has been taking ibuprofen and oral contraceptives, with no improvement. What underlying condition should be assessed for in this client at this point?

endometriosis

A 17-year-old client is found unconscious and brought to the emergency department following ingestion of an unknown quantity of aspirin. A suicide note was found with the client. Once the client is conscious, the nurse completes a psychosocial assessment. Which factor does the nurse identify as placing the client at risk of attempting suicide again?

The client's parents were recently divorced and one parent moved away.

The nurse is talking to a 13-year-old boy about choosing friends. Which function do peer groups provide that can have a negative result?

following role models

What is one of the most commonly reported communicable diseases in the United States?

gonorrhea

A high school football player comes to the clinic with malaise, fever, headache, and anorexia that have been present for the last few days. Upon physical examination, the nurse notes that the cervical lymph nodes are firm and tender. Tonsils are red and enlarged and appear to have a white covering. What should the nurse suspect the diagnosis to be for this client?

mononucleosis

A client diagnosed with dysmenorrhea has several medications prescribed. Which medication should the nurse question?

oxycodone

The nurse knows that barriers to the adolescent's health and successful achievement of the tasks of adolescence exist. What is the major barrier to health for this population?

socioeconomic

The nurse is teaching a nutritional class to a group of adolescents who are lactose-intolerant. Which food should the nurse point out will help these adolescents consume the calcium they need for proper nutrition?

soybean curd

The nurse is planning an education session for adolescent males on health promotion activities. Which topic should the nurse include as being the most applicable for this population?

testicular self-examination

An adolescent is concerned that although he has pubic hair, he has no facial hair yet. He wishes facial hair would grow to cover acne lesions. The nurse would advise him that facial hair:

usually follows pubic hair growth.

The nurse is promoting nutrition to a teen who is going through a growth spurt. Which food should the nurse recommended for its high iron content?

whole grain bread

When questioning a 15-year-old about his health history, what would be an appropriate way for the nurse to ask about the child's drug history?

"Have you heard that some teens like to smoke? Have you tried this?"

Billy's mother is with him at a visit for a sore throat. During the interview she states that she does not know what to do with him. "He's taking two or three showers a day and it was not that long ago that I could barely get him to take a bath at all." Which response by the nurse would be most appropriate?

"Reinforce the family rules but also allow him to develop his own routine."

An adolescent confides in the nurse about a current sexual relationship with a same-sex classmate. The adolescent states, "I am not sure if I am really gay?" What is the best response by the nurse?

"Some adolescents experiment with same-sex relationships at this age. It may take some time before you determine if you are gay."

The nurse is taking the health history of a 15-year-old client. What would be an appropriate way for the nurse to ask about the client's drug use history?

"Some teens like to smoke. Have you tried this?"

The school nurse is assessing a 15-year-old female client. The client states, "I just want to be pretty and to look like everyone else." Which response by the nurse is appropriate?

"You seem concerned. Let's talk about your feelings."

The nurse is assessing a 16-year-old girl at an annual well-clinic visit and notes the girl started menses at 13 years of age and grew 1 inch (2.5 cm) over the past year. When questioned by the young lady if this is normal, which answer should the nurse prioritize?

"You're following expected patterns of growth."

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.

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

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.

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?

The nurse is performing an assessment of the reproductive system of a 17-year-old girl. What would alert the nurse to a developmental delay in this girl?

Lack of occurrence of first menstrual period

The parents are concerned their 14-year-old child is always eating. The child weighs 54 kg and is 65 inches (165 cm) tall. What is the best explanation the nurse can give the parents?

The calories help his body increase muscle mass."

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.

An 18-year-old client is planning to attend college in the fall. The health care nurse informs the adolescent that a visit with the primary care physician (PCP) will need to be scheduled before the start of college. What primary purpose does this PCP visit serve?

to update immunizations

What is the best explanation of Erikson's theory of psychosocial development during adolescence?

The adolescent faces many different decisions during the teen years concerning the future and the adult world.

The nurse is working with a 15-year-old hospitalized with a chronic illness. Which action by the nurse might help the chronically ill teen thrive while hospitalized?

Encourage the teen to talk to friends on the phone and connect with friends on the computer by email.

An adolescent female with anemia has been prescribed a diet high in iron. Selection of which meal indicates to the nurse that the client understands the prescribed diet?

baked chicken, steamed cauliflower, garden salad

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."

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 eat plenty of fruit each day."

Which nurse response to the parent indicates that the nurse recognizes the importance of the child's increasing responsibility for his or her personal heath choices?

"I recommend you talk with your adolescent child and discuss their preference for which dentist to visit."

A 17-year-old male adolescent on the high school swim team tells the nurse that during swim season he cuts the carbohydrates in his diet to 30% to help his swim times. What responses by the nurse are appropriate? Select all that apply.

- "Can you tell me the reason you feel the need to cut your carbohydrates when your activity level is high?" - "Since you are so active, your carbohydrate intake should comprise 45% to 65% of your daily diet."

The nurse assesses the spirituality of an adolescent. What traits are uncharacteristic during this time frame? Select all that apply.

- Adolescents will base their actions on the avoidance of punishment and the attainment of pleasure. - Adolescents can understand the concepts of right and wrong and are developing a conscience. - Adolescents are able to understand and incorporate into their behavior the concept of the "golden rule."

The nurse is preparing to talk with an adolescent about contraception. During the interaction, which communication techniques will be beneficial? Select all that apply.

- 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.

The mother of a 15-year-old boy expresses sadness to the nurse that her son is "much more connected to his friends than his family." What understanding would benefit this parent? Select all that apply.

- Peers are needed for emotional security while stepping away from family. - Peers provide opportunity to learn and practice social roles. - Peers can be positive or negative influences. - Adolescents need parental support and guidance as they move toward greater peer involvement.

The school nurse is teaching parents risk factors for suicide in adolescents. What would the nurse discuss? Select all that apply.

- Substance use disorder - History of previous suicide attempt - Mental health changes - Family disorganization

A public health nurse is instructing on the short-term and long-term effects of sexually transmitted infections. Which effects would be included? Select all that apply.

- implications for fertility - relationships with future partners - emotional stress

The nurse is interviewing an adolescent. What should the nurse recognize as an important aspect of interviewing the adolescent?

Adolescents will share more about themselves in a private conversation.

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.

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.

The nurse is preparing a presentation for a local health fair depicting the differences in maturity between preadolescents. Which differing factor should the nurse prioritize in the presentation?

Boys grow at a slower, steadier rate than do girls

Jordan is coming back to the office for a follow-up visit. He is 15 years old and he keeps gaining weight at each visit. Although the amount is not large, it is a little more at each visit. Jordan says that he is not active in any sports and that he and his father eat out a lot. Which of the following would be most appropriate for the nurse to do to asses Jordan's eating pattern?

Have Jordan keep a food diary for one week.

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.

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 and interact with other teens

An adolescent female is experiencing dysmenorrhea. What should the nurse teach the client to help with this disorder?

Take over-the-counter ibuprofen.

The nursing instructor is leading a class discussion on the various aspects of adolescents. The instructor determines the class is successful after the students correctly choose which milestone as the beginning of adolescence?

The beginning of puberty

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.

The father of a child with mononucleosis is concerned with his child's fever and cough. The father asks when antibiotic therapy will begin. What is the best response by the nurse?

"Mononucleosis is a viral infection so an antibiotic isn't used. We address the symptoms with appropriate therapy.

A 14-year-old boy has come to his primary care physician's office for a routine well-child visit with his parent. Which statement by the parent should the nurse prioritize for further investigation after noting the father has a history of alcohol use disorder?

"Our next door neighbor is older than my son, and he drinks when they hang out together."

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."

A nurse is attending to a group of boys at a school. The nurse is required to document the sexual development in boys on a regular basis. The nurse would anticipate which clients having the highest incidence of nocturnal emissions?

Clients who are showing pubertal changes

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.

What anticipatory guidance can the nurse provide the girl who has noted the development of breast buds?

Menarche should follow in about 2 years.

The parent of an adolescent has called to talk to the pediatric nurse over concern that her daughter is not getting proper nutrition now that she has started following a vegetarian diet. Which response should the nurse prioritize for this parent?

Vegetarian diets can be healthy; ensure she includes whole-grain products, legumes, nuts, seeds, and soy dairy substitutes.

A nurse is caring for a teenager who is in the end stage of cancer. Which of the following nursing interventions provides self-esteem and self-worth to the teen?

allowing the teenager to completely participate in decisions