Chapter 20: The Adolescent

22. The nurse is documenting the pediatrician's assessment of a female patient. When assessing Tanner's stages of breast development there is elevation of papilla only. What stage of development will the nurse document? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4

ANS: A According to Tanner's Stages of Sexual Maturity, Stage 1 (Preadolescent) is elevation of papilla only.

2. A 13-year-old boy states, "The girls in my class tower over me." What would be the nurse's most informative response? a. "It may seem that way because girls have a growth spurt 2 years earlier than boys." b. "Perhaps your parents are not exceptionally tall." c. "Boys usually experience a growth spurt 1 year earlier than girls." d. "You may feel short, but you are actually average height for your age."

ANS: A Although the age for growth spurts during puberty varies, growth spurts occur 2 years earlier for girls than for boys.

8. The school nurse is planning a program for girls about the physical changes of puberty. Toward what age girl should this program be directed? a. 10 years b. 12 years c. 14 years d. 16 years

ANS: A Because puberty can occur in girls as early as age 10 years, instruction must be given by that age.

14. A girl tells the nurse that she and her best friend belong to the popular clique. She states, "I love Katy Perry, and I want to be a singer." The nurse recognizes the girl's statement as characteristic of what time period? a. Early adolescence b. Middle adolescence c. Late adolescence d. The entire adolescent period

ANS: A Cliques of unisex friends, having a best friend, and hero worship are characteristics of the early adolescent.

9. What statement made by a parent indicates an understanding about helping a 13-year-old manage his allowance? a. "I set amounts he can earn for particular chores." b. "I give him a certain amount of money for each day." c. "I put money into his bank account each month." d. "I told him to ask me when he needs money."

ANS: A If money is simply handed out as requested, it is difficult to develop responsibility for finances and money management. The older adolescent is able to get a job. The younger adolescent can earn money by doing particular chores.

20. The nurse suggests the use of "I" messages to communicate a parent's feeling to an adolescent. What is the most appropriate example of an "I" message? a. "I feel frightened when you stay out past your curfew." b. "I am your mother, and I insist that you observe your curfew." c. "I am sick and tired of your staying out late." d. "I expect you to show me proper respect."

ANS: A This is the only statement that associates the parent's feelings about the adolescent behavior that is not aggressive or accusatory.

24. To what is the restlessness seen in the adolescent considered to be attributed? (Select all that apply.) a. Drive to be accepted by society as an individual b. Urge for independence c. Establishment of a personal identity d. Intense libido e. Slowing of body changes

ANS: A, B, C, D All the options listed are sources of stress to the adolescent and are stimulants to restlessness except option E: body changes are rapid.

27. A mother confides in the school nurse that she witnessed her son kissing another boy. Which concepts should guide the nurse to base a reply? (Select all that apply.) a. Homosexual behavior in adolescents is not uncommon. b. Homosexuality is a mental disorder. c. Adolescents often desire to explore alternative lifestyles. d. Homosexual tendencies should be addressed with counseling. e. Parents should seek a support group for parents of gays.

ANS: A, C Adolescents may experiment with an alternate sexual expression as part of their self-discovery. Homosexual activities are not uncommon in adolescence.

28. The school nurse is discussing challenges of the adolescent years with a group of high school students in health class. What challenges toward adolescent development will the nurse include? a. Developing intimacy b. Maintaining dependence on parents c. Searching for identity d. Adjusting to body changes e. Establishing future goals

ANS: A, C, D, E Adolescents face the challenges of developing intimacy, searching for identity, adjusting to body changes and establishing goals for the future. Adolescents are striving for independence from parents.

26. The nurse considers what "rites of passage" valued by the adolescent in American society? (Select all that apply.) a. Attaining legal drinking age b. Selection of a career c. Religious affiliation d. Obtaining a driver's license e. High school graduation

ANS: A, D, E Rites of passage are socially recognized milestones that signify adulthood. Legal drinking age, driver's license, and matriculation through high school are such signals. Religious affiliation and selection of a career path do not necessarily signal adulthood.

19. What does adolescent acne result from? a. Ineffective sweat glands b. Oily skin c. Inadequate hygiene d. A poor diet

ANS: B Adolescent acne is the result of overactive sweat glands and oily skin.

23. The school nurse is educating high school students about guidelines to be followed when participating in sports. Which statement by a student alerts the nurse of the need for further information? a. "I will eat carbohydrates before practice." b. "I drink large amounts of fluid when working out." c. "I wear protective gear every time I play sports." d. "I avoid caffeine when participating in sports."

ANS: B Fluids lost by sweat must be replaced by drinking small amounts of fluid during a workout. Thirst is one guide for intake. Caffeine and alcohol deplete body water and are to be avoided. Carbohydrates that provide both energy and other nutrients are best for athletes. Protective gear should be worn by all team players in any contact sport.

17. At what stage is the adolescent considered to be,according to Freud's theory? a. Conceptual b. Genital c. Glandular d. Pubertal

ANS: B Freud describes the adolescent period as genital.

11. An adolescent's parent comments, "My son seems so preoccupied with his appearance these days. Is this normal?" What is the nurse's best response?

ANS: B Preoccupation with self-image is normal and accounts for the constant primping of adolescents.

4. The nurse is planning a safety program for high school students. To what will the nurse relay that most accidental deaths in adolescence are related? a. Firearms b. Automobiles c. Drowning d. Diving injuries

ANS: B The chief safety hazard for the adolescent is automobiles.

1. The nurse is assessing a 13-year-old boy. With what do physical changes in the pubertal male begin? a. Development of axillary and facial hair b. Enlargement of penis c. Enlargement of testicles d. Pigmentation of the scrotum

ANS: C In boys, pubertal changes begin with enlargement of the testicles and internal structures.

15. The nurse is leading a discussion group with parents of adolescents. One parent comments, "My son can't do anything without checking with his friends first. My opinion doesn't count anymore." What knowledge in regard to this behavior would the nurse formulate as a response? a. It is unusual for adolescent boys. b. It is often more apparent in boys than girls. c. It is a normal phenomenon during adolescence. d. It is suggestive of feelings of low self-worth.

ANS: C Parents may need help understanding that the adolescent's exaggerated conformity is necessary for moving away from dependence and obtaining approval from persons outside the nuclear family.

6. The nurse is planning care of an adolescent. What psychosocial task does the nurse understand is important for the adolescent to develop? a. A sense of initiative b. A sense of industry c. A sense of identity d. A sense of involvement

ANS: C Psychosocial milestones that must be accomplished during adolescence include the five Is—image of self, identity, independence, interpersonal relationships, and intellectual maturity.

21. A 13-year-old girl tells the nurse she is concerned because she has not had her first menstrual period. What is the best initial response from the nurse? a. "Your hormone levels may be irregular." b. "Could you be pregnant?" c. "Age of first menstrual cycle varies." d. "Do not worry about it."

ANS: C Puberty is easily recognized in girls by the onset of menstruation. The first menstrual period is called the menarche. It commonly occurs about age 12 or 13 years, but this varies. It may occur as early as age 10 years or as late as age 15 years.

7. A 13-year-old girl tells the school nurse that she is getting fat, especially in her hips and legs. What understanding by the nurse would best guide the response? a. Many adolescents are unaware of proper nutrition. b. Adolescents of this age become less active and should eat fewer calories. c. Puberty is often preceded by fat deposits in these areas. d. As soon as menarche occurs, she will lose this excess weight.

ANS: C Secondary sexual characteristics become apparent before menarche. Fat is deposited in the hips, thighs, and breasts, causing them to enlarge.

10. What can the nurse suggests as a good dietary source of zinc for an adolescent who is a vegetarian? a. Green, leafy vegetables b. Citrus fruits c. Nuts d. Enriched breads

ANS: C Zinc is essential for growth and sexual maturation in adolescence. Good vegetable sources include nuts, legumes, and wheat germ.

12. What foods would be a healthy choice for an adolescent who just finished playing in a strenuous sports game? a. A cheeseburger and soda b. A hot fudge sundae c. Two sausage and egg breakfast sandwiches and orange juice d. A bagel and skim milk

ANS: D A bagel provides a rapid supply of carbohydrates to the muscles, and skim milk provides a slow release of carbohydrates to the muscles.

13. When planning to answer a 16-year-old girl's questions about menstruation, the nurse must consider cognitive development. What is developed during adolescence according to Piaget? a. The ability to view a situation from multiple perspectives b. The ability to focus more on the past than present situations c. The ability to exercise concrete reasoning d. The ability to consider hypothetical situations

ANS: D According to Piaget, in the formal operations stage adolescents have the ability to think abstractly.

5. A 16-year-old excitedly tells his parents that he was offered a part-time job. Which response represents an effective problem-solving approach for his parents? a. "Your studies are too important for you to have a part-time job." b. "When we went to high school, academics were the adolescent's priority." c. "We want you to put your earnings in a savings account." d. "How do you think you will manage your school work and a job?"

ANS: D An effective approach to help adolescents learn to solve problems is for parents to guide them in exploring alternatives.

16. What does an adolescent's peer group serve as related to development? a. Social outlet b. Association to blur personal identity c. Platform for "group think" d. Initial separation from family

ANS: D Being a member of a peer group and communicating with and seeking approval from this group are hallmarks of the first separation from the family.

3. A parent comments that her adolescent daughter seems to be daydreaming a lot. What does the nurse understand this behavior to indicate regarding their daughter? a. She is bored. b. She is not getting enough rest. c. She is trying to block out stress and anxiety. d. She is mentally preparing for real situations.

ANS: D Daydreaming allows adolescents to act out in their imaginations what will be said or done in certain situations. This helps them to prepare for and cope with interactions with others.

18. The nurse using the PACE interview guide for persons at risk for substance abuse arrives at a score of 2 for an adolescent patient. How would the nurse interpret this score? a. Nonindicative of potential substance abuse b. Normal experimentation of the adolescent c. Need to schedule another PACE interview in 3 months d. Indication for referral for counseling

ANS: D The PACE guide recommends that a score of 2 or higher would suggest the need for a referral for counseling about substance abuse.

25. What are the best breakfast choices for the nurse to point out prior to a big exam, to provide high levels of alertness and increased memory? (Select all that apply.) a. Pancakes and syrup b. Coffee and chocolate-covered donuts c. Bacon and fried eggs d. Whole grain cereal and yogurt e. Oatmeal and sliced apples

ANS: D, E Meals high in protein will break down into norepinephrine and increase alertness. Meals with a high sugar content result in a soothing sleepy response. Meals high in fats digest slowly and draw blood from the brain during the lengthy digestive process.