NSG 334 Chapter 29: Growth and Development of the Adolescent

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." The sedentary teen needs to consume approximately 1,600 calories each day. A balanced diet includes plenty of fresh fruit and a small amount of fat. To avoid all fat could place the child's health at risk. Protein intake is important for the development of tissue. The teen will need about 5 ounces of protein daily.

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 The final stage of cognitive development, the stage of formal operational thought, begins at age 12 or 13 years and grows in depth over the adolescent years, though it may not be complete until about age 25. This step involves the ability to think in abstract terms and use the scientific method (deductive reasoning) to arrive at conclusions. With the ability to use scientific reasoning, adolescents can plan their future. They can create a hypothesis (What if I go to college? What if I do not?) and think through the probable consequences (In the long run, I will earn more money; I could begin earning money immediately). This scenario does not pertain to socialization, role identification, or sensorimotor development.

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. When an adolescent is ill or injured, it affects the body and body image. A hospitalized adolescent's primary concerns are pain and the loss of privacy. The adolescent is also anxious about being separated from friends and losing control of one's life. When an adolescent is hospitalized, it is very important the adolescent be given privacy. The adolescent needs individualized attention, confidentiality, and the right to participate in decisions about one's own health care. The adolescent should have contact with friends and be allowed in unit activities. Because the adolescent is under the age of 18, the parents should be involved and informed of the care. The nurse can talk with the adolescent and parents about care decisions and the adolescent's need for support from family.

The mother of a 13-year-old boy confides to the pediatric nurse practitioner that her son has recently had a nocturnal seminal emission. The mother is concerned, and the nurse explains "wet dreams" and the other male traits of puberty to the mother. Which response indicates a need for further discussion?

"My son must be sexually active or having overly sexual thoughts to have a nocturnal emission." Spontaneous erections and nocturnal seminal emissions do not mean that the child is sexually active or having overactive sexual thoughts. Parents need to be instructed that these occurrences are spontaneous and that the child is not doing anything to cause them.

In late adolescence, the client likely has the greatest influence on his or her own decision making. While offering teaching to the parents and healthy cooking classes to the siblings are options, the adolescent will most benefit from being the one to make choices about care. Focusing on more recent concerns rather than the idea of future complications with the adolescent will gain more credibility.

"Your child can become modest and self-conscious and teasing may cause embarrassment." It is never appropriate to discuss what is happening with a client in a way that is demeaning and hurtful. A 14-year-old adolescent is experiencing many bodily changes and is very self conscious. The nurse can share experiences with the client and the family, but it should not be in a way that the adolescent is embarrassed. Parents can share their experiences with the child, but they have to be open to this discussion or it can lead to an awkward experience for the adolescent. Reminding the parent of how the child is feeling and the possible feelings that can come from their interactions will bring the parent's attention to a delicate situation and is most appropriate. Simply stating these are expected findings does not address the joking manner of the parent.

During the assessment of a 15-year-old female, the nurse notes a new body piercing in the navel. Which statements by the nurse would be appropriate in regard to this new piercing? Select all that apply.

-"I notice you have a new piercing. Be sure to clean it twice a day so you don't get an infection." -"Did they tell you when you got your piercing how important cleaning it is? Infections can take up to a year to heal in a naval piercing." Informing the client about infection risks and prevention are appropriate responses by the nurse when noticing a new body piercing. Judgmental responses and personal responses are not appropriate from the nurse.

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 The developmental task of adolescence is to develop a sense of identity, or deciding who and what kind of person one is. Friends and peers are important to facilitating the adolescent in determining one's identity. Permitting the client to make decisions assists in developing autonomy, which is a toddler task. Praising facilitates initiative, which is a preschool task. Independently performing tasks assists in developing industry, which is a school-age task.

The father of a 15-year-old daughter is concerned she is not getting adequate nutrition to play high school basketball. Her games are on Friday nights. Which suggestion should the nurse point out will best suit the needs of this adolescent?

Three daily meals that include choices from each of the food groups; Friday's lunch eaten around 2 p.m. with a small amount of fat and a somewhat larger than usual portion of complex carbohydrates. A meal that is low in fat and high in complex carbohydrates, eaten 3 to 4 hours before an event, is appropriate for the teen athlete. Carbohydrate-loading, which some practice during the week before an athletic event, increases the muscle glycogen level to 2 to 3 times normal and may hinder heart function. The other suggested menus would not provide the additional muscle glycogen needed for optimal functioning.

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. Rapidly growing bones, muscles, joints, and tendons are more vulnerable to unusual strains and fractures. While some people may seem to be accident-prone, this adolescent's injuries are most likely the result of the stage of physical growth. There is no evidence the adolescent has any underlying medical conditions.

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." Voicing empathy regarding the mother's concern conveys support, and letting her know that this is normal growth and development helps ease her concerns. The other responses don't address her concerns or show genuine empathy.

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 average number of hours of sleep that teens require per night is 8.5 to 9.5 due to rapid growth that occurs during these years. Following a curfew and limiting distractions at bedtime can help provide the student with adequate hours of sleep each night.

An adolescent's parent states not knowing what to do with the adolescent. The parent reports the teenager is taking two or three showers a day when not that long ago the parent could barely get the teen to take a shower at all. What should the nurse's reply be to the parent?

"Reinforce the family rules but also allow the adolescent to develop one's own routine." Adolescents find that frequent baths and deodorants are important due to the apocrine sweat gland secretion activity. The increases in sex hormones and steroids cause the skin to be oily. This leads to more showers or baths daily. This is a time when the adolescent is defining what type of personal hygiene products are preferred. Hygiene and personal care can become a source of family arguments as the young person develops a style of personal care. Parents need to be mindful of the adolescent yet maintain family rules and boundaries regarding aspects of personal care. It is important for teenagers to feel that they have some ability to develop their own personal care standards and daily patterns.

The nurse is caring for an adolescent who braggingly states smoking cigarettes. Though not always effective, the nurse correctly instructs the adolescent on which topics? Select all that apply.

-Smoking damages the respiratory system. -Smokeless tobacco damages gums and teeth. -Teens who smoke are more likely to use alcohol and drugs. -Smoking is associated with fighting and unprotected sex. -Tobacco use is addicting (nicotine). The nurse correctly discusses the effects of tobacco on the respiratory system, gums and teeth. Teens who smoke are more likely to engage in risky behavior including alcohol, drugs and unprotected sex. Tobacco is addicting as the individual may crave the nicotine. There are many negatives to tobacco use but it does not increase the potency of alcohol.

Nurses should provide anticipatory guidance to males to prepare them for what particular pubertal change in middle-to-late adolescence?

nocturnal emissions Involuntary ejaculation during the night can be disturbing to the adolescent male who has little or no understanding of what is happening in the body. Lengthening of the penis begins to occur in early adolescence as does reddening of the scrotum and emergence of pubic hair.

The nurse is providing a class for a group of girls. When discussing the changes surrounding puberty, what information should be included? Select all that apply.

-Most girls begin menstruation between ages 12 and 13. -Thelarche occurs as early as age 9 years. -Black girls experience menarche earlier than white girls. Girls reach physical maturity before boys, and menarche, the first menstrual period, usually begins between the ages of 9 and 15 years (average 12.8 years). Breast budding (thelarche) occurs at approximately age 9 to 11 years and is followed by the growth of pubic hair. Black girls on average reach menarche slightly earlier than white girls.

The nurse is preparing to participate in a community discussion on the needs of the adolescents in the local school. The nurse should point out which goal is the primary concern for these young individuals as the committee makes plans?

Teens are busy developing their own personal identity. According to Erikson, the central task of adolescence is to develop unique personality and identity. The developmental task for the school-age child is to develop a sense of industry, and completing activities builds that feeling of confidence. Erikson's psychosocial developmental task for toddlers is to achieve autonomy (independence) and do things on their own. Learning to speak and to understand and respond to discipline are not developmental tasks, according to Erikson.

Computer use at home and at school has increased adolescents' comfort in gaining access to and using the Internet. This has expanded their exposure to risks. What potential risks are there for an adolescent to be exposed to?

Teens can be exposed to inappropriate materials, harassment, threats, and potential for molestation. Teens are exposed to a great deal of inappropriate materials, harassments from other online users, and potential threats of molestation or solicitation of sexual favors. Teens are at risk for identity theft, but it is not as big of a concern for them because they do not use their Social Security information or credit card information. Computer use can contribute to obesity, but the risks of inappropriate materials, threats, and sexual exploitation are a greater threat. It is possible for teens to become addicted but the other risks are of more concern to parents.

The health care provider has prescribed oral tetracycline for an adolescent girl to help clear acne. What statement about the medication made by the girl would require additional teaching from the nurse?

"I need to take the medication with food every day." Acne improvement is generally not seen for 2 to 4 weeks after beginning antibiotic therapy. Adolescents need to be supported and urged to continue to take the medication as prescribed during the waiting period. Without noticeable improvement, adolescents have a tendency to continue taking the higher initial dose or even increase the dose hoping to initiate a faster effect. Food impairs the absorption of oral tetracycline, so the drug should be taken on an empty stomach (2 hours before or after eating). Adolescents must be certain of the date of expiration of the drug. Outdated tetracycline breaks down into an extremely toxic composition. Antibiotics have no effect on menses.

The nurse is discussing an adolescent's development with the client's parents. Which statement by the parents indicate an understanding of the nurse's teaching?

"Our adolescent is working toward achieving a sense of personal identity." According to Erikson's theory of psychosocial development, the major challenge of adolescence is the achievement of identity. Achieving independence from parental domination is another task of adolescence, but not the ultimate one. Helping other adolescents achieve higher goals is not a part of Erikson's theory of psychosocial development. Developing trust occurs in infancy.

The nurse is assessing a 12=year-old boy. Which assessment finding(s) are consistent with the child's age? Select all that apply.

-pubic hair spreading to the sides -enlargement of the testes -longer extremities relative to trunk During early adolescence, 10 to 13 years old, the male has pubic hair that is beginning to curl and spreads laterally. Growth and enlargement of the testes in the scrotum and continued lengthening of the penis occurs. The child has a leggy look due to extremities growing faster than the trunk. During middle adolescence, 14 to 16 years of age, pubic hair of the male becomes coarser in texture and voice changes are noted. The voice becomes more masculine due to the rapid enlargement of the larynx and pharynx as well as lung changes.

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. When caring for hospitalized adolescents, providing time for self-care, such as shampooing hair, is important to include in an adolescent's nursing care plan. Offering to assist the client in washing her hair and letting her pick the shampoo both encourages a sense of autonomy to the client and offers her dignity related to her body image. Brushing the girl's hair for her and assisting her with using the bed pan for urination do not encourage a sense of autonomy. If it is the hospital's policy to require clients to be dressed in a hospital gown while admitted, the nurse should not allow the girl to wear her own clothes.

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. Preadolescent boys grow generally at a slower, steadier rate than do girls. Girls grow more rapidly during preadolescence and then their growth rate slows dramatically after menarche.

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 Black girls on average reach menarche slightly earlier than White, Hispanic, and South Asian girls.

An adolescent who is depressed states, "Nothing ever seems to be right in my life." How should the nurse respond?

"You are feeling sad right now. It is a hard time." Some degree of depression is present in most adolescents because they are not only losing their parents while they grow apart from them but also their carefree childhood. When using therapeutic communication, it is important for the nurse to accept the adolescent's verbalization as real. Support should be real. Telling the adolescent that things will be better in college provides false reassurance. Telling the adolescent to "look at the bright side of things" or that "being a teenager is hard work" offer platitudes and interrupt the adolescent's interactions.

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 should explain that there are four levels of cognitive development in Piaget's theory. The sensorimotor level is up to age 2 where children learn by touching, tasting, and feeling. They learn to control body movement. Preoperational level takes place in children ages 2 to 7 years who investigate and explore the environment and look at things from their own point of view. At the concrete operations level, from ages 7 to 11 years, children internalize actions and can perform them in the mind. At the formal operations, after age 12, children can think in the abstract. Complex problem solving is included in this category.

A 15-year-old adolescent shows a pattern of gaining weight, not a large amount but a little more each visit. The adolescent is not active in any sports and eats out frequently with parents. What is the best way for the nurse to assess the adolescent's eating pattern?

Have the adolescent keep a food diary for 1 week. Having the adolescent keep a food diary over 1 week allows the nurse as well as the client to examine what the client eats and when the client is eating it. Keeping a food journal allows a discussion of the choices made and the substitutes that the client could possibly make. The times that the client eats may also lead to weight gain. Asking for recall of 3 days' intake would be difficult, and most information would be inaccurate due to forgetting some item of food intake or when the food was eaten. Most people have no idea how many calories are in a food item unless they are specifically counting calories for dieting or health reasons. An adolescent would have a difficult time demonstrating a healthy portion size unless it has been demonstrated first.

The clinic nurse is assessing a 14-year-old client. The client states "I am worried I have a brain tumor. I am so clumsy when I play sports now that it is totally embarrassing." Which response by the nurse is appropriate?

"You are experiencing rapid and uneven growth now which can interfere with coordination." Uneven growth of soft tissues and bones during growth spurts can cause decreased coordination for boys. The age of 14 years is usually the time of peak height velocity (PHV). The nurse would let the client know this is expected to alleviate the client's fears. There is no need to request an MRI. The nurse would not ask yes/no questions as these do not provide insightful information. Stating the nurse understands why the client is worried indicates the client has reason to fear a brain tumor.

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?" Anabolic steroids are used by adolescents who play sports. They are used to enhance the adolescent's athletic ability. They produce euphoria and lessened fatigue. Unfortunately, steroid use can also lead to early closure of the epiphyseal plate, acne, elevated triglyceride levels, hypertension, aggressiveness, and possibly psychosis. Human growth hormone is also used to enhance athletic performance. The side effects of it are joint pain and swelling and the development of diabetes. Amphetamines provide a sense of well-being, alertness, and self-esteem. They can produce paranoia and extreme restlessness. Cocaine produces increased pulse and respirations, increased temperature, and blood pressure and decreased appetite.

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? Select all that apply.

-"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." The nurse should further discuss comments that demonstrate incorrect information about sun exposure. Any exposure to tanning beds should be avoided to prevent skin cancer risks. Other risks for skin cancer include being in the sun between the times of 10:00 am and 4:00 pm, and sun exposure and burns during childhood and adolescence. A minimum SPF of 15 should be used, so SPF 30 is good practice, as is wearing sun-protective clothing when outside during the day.

A 15-year-old is hospitalized for acute appendicitis. Which activities would the nurse include in the client's plan of care? Select all that apply.

-Allow friends to visit during visiting hours. -Include the parents when educating the client. -Arrange care to provide for extra rest and sleep. Because protein synthesis occurs most readily during sleep, and adolescents are building so many new cells, this age group may need proportionately more sleep than any other age group. When adolescents are admitted to the hospital they may sleep as if exhausted. Adolescents are capable of total self-care and because of their body awareness, may even be overly conscientious about personal hygiene and appearance. When caring for hospitalized provide time for self-care, such as shampooing the hair. Confidentiality is of utmost important as adolescents do not like to feel different than their peers and do not want their information shared unless they share it. At the beginning of care, the adolescent and the parents need to decide how much involvement the parents will have in care (e.g., will they stay in the room, will the adolescent be able to have a role in decision making).

The nurse is caring for a 16-year-old client. The client confides in the nurse that they use of marijuana daily. Which action by the nurse is appropriate?

Discuss adverse side effects with the client. The nurse will first discuss adverse side effects of marijuana use with the client. The nurse is not legally bound to notify law enforcement and this would be a breach of client confidentiality. Currently, persons living where recreational marijuana use is legal must be at least 18 years of age to legally consume. The nurse would not need to ask about where the client obtains the marijuana as the nurse is focused on the client and not other persons. The client has stated marijuana use. How long the client has used marijuana is not important at this time.

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. Achieving a sense of identity may be difficult for adolescents who have a chronic illness. Some of the nursing actions which encourage identity in the chronically ill adolescent include the following: respecting food preferences; allowing the adolescent to choose the time for the dressing changes; teaching the name, actions, and possible side effects of medication; and respecting modesty. The school can provide homework so the adolescent does not get further behind in school work, and the teen can go to the teen room each day. These provide a good emotional outlet, but they do not promote independence. Teaching the parents to do the dressing changes makes the adolescent dependent on the parents. If the dressings are at a location the adolescent can reach and dexterity is not limited, then the adolescent should be allowed self-care.

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. When identity has been established, generally between the ages of 16 and 18 years, adolescents seek intimate relationships, usually with members of the opposite sex. Intimacy, which is mutual sharing of one's deepest feelings with another person, is impossible unless both persons have established a sense of trust and a sense of identity. Intimate relationships are a preparation for long-term relationships, and people who fail to achieve intimacy may develop feelings of isolation and experience chronic difficulty in communicating with others.

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. Which nursing goal(s) is the nurse highlighting in this process? Select all that apply.

-development of a trusting relationship -compliance with existing laws -an environment where adolescents can be truthful Adolescents may seek a health care appointment for an unrelated health concern as a reason to discuss a sexual health question with a health care professional. Reassurance should be given to the adolescent that all questions and concerns will be addressed and will be kept confidential. This is the basis for the nurse-client relationship. All questions and concerns do not involve treatment and, therefore, do not involve parental consent. Parents may voice concerns because they are responsible for the insurance and billing. The nurse should act as a client advocate and work with the parents to develop a mutual understanding of the situation.

The nurse is assessing an 11-year-old girl. Which assessment finding(s) should the nurse expect? Select all that apply.

-presence of pubic hair -enlarged breast buds -enlarged areolas -increased genitalia pigmentation Early adolescence is between ages 10 to 13 years. In female adolescents, pubic hair begins to curl and spread over the mons pubis, genitalia pigmentation increases, breast buds and areolas continue to enlarge, no separation of breasts, and the first menstrual period (average 12 years, normal range 9 to 16 years) may occur. In middle adolescence (age 14 to 16 years), pubic hair becomes coarse in texture and the amount of hair increases. in addition, the areola and nipples separate from the breast to form a secondary mound.

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.

-"Since you are so active, your carbohydrate intake should comprise 45% to 65% of your daily diet." -"Can you tell me the reason you feel the need to cut your carbohydrates when your activity level is high?" Teenage boys who are moderately active require between 2,200 and 2,800 calories per day and 45% to 65% should come from carbohydrates. Carbohydrates should not be cut, especially during an athletic season when energy use is increased. Asking the student why he or she is cutting carbohydrates is appropriate in order to help the nurse address the issue effectively.

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 A sense of identity is developed by "trying on" roles and discussing values and goals with others. A sense of trust develops when an adolescent is able to find out whom (and what ideas) to have faith in. The adolescent period is also a time where past stages of development are revisited. The sense of autonomy is where the adolescent seeks ways to express individuality. The stage of initiative is where the adolescent develops vision of what he or she might become. Talking with another adolescent who also uses a wheelchair to ambulate will help the adolescent see possibilities and reassurances. Making decisions or having assistance from someone else does not allow the adolescent to "try out" roles.

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." The best response is to describe the proper care using frequent cleansing with antibacterial soap. It is too late for warnings about the dangers of piercing such as skin- or blood-borne infections, or disease from unclean needles.

The nurse is collecting data from a 15-year-old boy who is being seen at the ambulatory care clinic for immunizations. During the initial assessment, he voices concerns about being shorter than his peers. What response by the nurse is indicated?

"Boys your age will often continue growing for a few more years." Teenage boys can experience growth in height until age 18 or even later. The nurse should reassure the teen that this may happen for him. Telling the client not to be ashamed or assuring him that he's not as short as his peers fails to provide information or support. Determining the height of the other men in the family may be indicated at a later time but is not the most appropriate initial comment.

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?

"On average Black girls start their period earlier than other ethnicities." Menarche, the first menstrual period, usually begins between the ages of 9 and 15 years (average 12.8 years), but on average Black adolescents reach menarche earlier than adolescents of other ethnicitic backgrounds. This response addresses the parent's concern. The other responses do not address the parent's concern or may lead the parent to think this is an abnormal occurrence.

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." It is common for adolescents to adopt habits of going to bed late and awakening late, especially on weekends. Despite the fact that this is common, it is not ideal; the nurse should explore strategies for changing the adolescent's behavior in a collaborative and inclusive manner. Simply communicating that it is unacceptable is unlikely to bring about change.

A 15-year-old client's parent comments on the fact that the adolescent seems to always choose the opposite of what everyone else wants and that mood swings are a common occurrence. What statement shows the nurse that the client's parent understands these changes?

"This is common for this age group and it will get better with time." During middle adolescence, the adolescent spends more time ignoring adult authority and becomes more reliant on peer relationships. Adolescents might choose a stance directly opposite that of their parents and use peer support to back their ideas. Mood swings are a common occurrence during the adolescent period. They tend to smooth out and the adolescent will become more introspective. By late adolescence emotions become more consistent. Making statements such as "my adolescent will never find anyone to live with" or "we will have to learn to live with [my adolescent's temperament]" does not demonstrate the parent has a good idea of what is happening during the adolescent period.

The nurse is assisting a 15-year-old who has been diagnosed with anemia in making menu selections. Which selections for the upcoming day's meals indicate an understanding of what foods are high in iron? Select all that apply.

-peanut butter sandwich -liver -kale Foods high in iron include liver and other meat products such as beef, chicken, and fish. Peanut butter, nuts, seeds, and leafy green vegetables are also sources of iron.

The school nurse is monitoring a student athlete who experienced a concussion 2 weeks ago during a soccer game. The student reports having difficulty in a course in which the child previously performed well. Which action should the nurse take first?

Ask the student to describe the issues he is having in the class. Talking with the teacher and performing a neurological assessment are actions that may be necessary, but the nurse must first determine if the student is following the recommended level of cognitive activity; this can be accomplished by asking the child to describe the issues he is having in class. Contacting the parents immediately would not be warranted until sufficient information is collected.

An adolescent with a new piercing comes to the health center at the school. The client reports feeling hot. Which action will the nurse complete first?

Assess the client for signs of infection. The nurse will first assess the client for signs of infection. The client reports feeling hot, which could indicate a fever. The nurse would assess the client's temperature and for other signs and symptoms of infection, such as redness, swelling, warmness, drainage, discomfort. The nurse would ask when the client started feeling hot and about the technique used for the piercing to gain additional history and insight. However, these questions are not priority over assessing the client. Determining if the client has any additional piercings is not necessary, as this will not provide information about the client's current situation.

A client has confided in a nurse that her 13-year-old daughter has recently changed dramatically in her social interactions with others. What is a social behavior most likely to be exhibited by a girl at this age?

Banding together with other girls and dressing like them In early adolescence, girls tend to band together with girls. They dress identically with other members of their group: jeans and sweatshirts, special jackets, or whatever the fashion may be. On the surface, this makes adolescents appear to be losing their identities rather than finding them.

To help prevent obesity, which intervention would the nurse include in an adolescent's plan of care?

Describe a normal serving size. Some adolescents may be unaware that their food intake is excessive because they have been told they need excess nutrients for healthy adolescent growth and everyone in their family eats large portions. Health teaching with these adolescents may need to begin with a discussion of "normal" weight and standard food portions. If adolescents eat a diet too low in protein for any length of time, they can develop a negative nitrogen balance, which can lead to impaired growth. Therefore, a diet of fewer than 1,400 to 1,600 calories a day can rarely be tolerated by adolescents. Teenage girls who are moderately active require about 2,000 calories per day and teenage boys who are moderately active require between 2,200 and 2,800 calories per day. Eating in excess can lead to obesity and should be avoided.

The nurse is assessing a teenage client and notes his lower front teeth are slightly crossed over. The nurse points out to his caregiver that he should see an orthodontist about this to prevent which potential situation?

Even slight malocclusions make chewing and jaw function less efficient. Dental malocclusion (improper alignment of the teeth) is a common condition that affects the way the teeth and jaws function. Correction of the malocclusion with dental braces improves chewing ability and appearance. Crooked teeth do not lead to more cavities, nor do they lead to infection and tooth loss. While appearance and acceptance in society is important to the adolescent, that is not the most important reason for orthodontic care for the adolescent.

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. Every campaign to support good nutrition and daily physical activity must include parents and their children as active members of the learning community. Although the other actions can accomplish in-school enhancements to health, long-term change tends to be more likely when the programs implemented involve the family. Programs implemented without a family-centered approach often fail when the child's home life and school life are disconnected.

The nurse is talking with parents of a depressed 16-year-old boy. Which question is of the most importance?

Is there a gun in your home? He may be at risk for suicide. Firearm-related suicides have been responsible for a large number of the suicide deaths in 15- to 19-year-olds nationwide. All the other questions assess for depression and do not protect against suicide.

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. The adolescent whose family caregivers make it difficult to conform are adding another stress to an already emotion-laden period. By allowing the adolescent to follow trends and fads in clothing choices, hairstyles, and music, the caregiver decreases the stress for the child. Information about drugs and alcohol is important to share, but these topics would be better discussed with the child. It is important the adolescent spend time with peers.

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

Menarche should follow in about 2 years. Menarche usually follows within 2 years of the first signs of breast development. Peak height velocity (PVH) in girls occurs 6 to 12 months following menarche. It does not follow immediately. Breast development progresses through several stages and will not be complete until late puberty. Adult height is not reached at the time of menarche but about 6 to 12 months following menarche.

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. Increased fat deposits and weight and height changes are normal as girls begin hormonal changes of puberty. During adolescence, girls are very sensitive about their appearance and experience a constant need for reassurance. Puberty is a period when children are very self-conscious about their overall appearance. Reassurance needs to be provided that increased fat deposits and weight and height changes are normal. Dietary management is indicated if a true weight problem is present, but healthy eating should be encouraged rather than dieting. Adolescents should be encouraged to participate in appropriate exercise programs. Dieting issues such as anorexia and bulimia can threaten the health of adolescents.

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. Adolescents need access to their peers so they can keep up social contacts. Meeting other teens in the facility is one way to accomplish that. The client most likely also has an electronic device which will enable her to stay in contact with family and friends back home but meeting others can also help meet social needs. Recreation areas are important. In settings specifically designed for adolescents, recreation rooms can provide an area where teens can gather to do schoolwork, play games and cards, and socialize. Because she is 100 miles from home, a visit from friends might be difficult.

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. The nurse needs to emphasize that tattoos and body piercing can be painful, and carry risks of complications such as infection, blood-borne diseases, keloids and granulomas, allergic reactions, excessive bleeding, nerve damage, or damage to the piercing site. Complications are more likely if a person tattoos oneself or has the tattoo done by a friend. The nurse needs to encourage the adolescent to seek the expertise of a trained technician, doctor, or nurse to have the piercing, tattooing, or branding done. There are developed safety rules for those who do piercing and tattoos.

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. In late adolescence, the client likely has the greatest influence on his or her own decision making. While offering teaching to the parents and healthy cooking classes to the siblings are options, the adolescent will most benefit from being the one to make choices about care. Focusing on more recent concerns rather than the idea of future complications with the adolescent will gain more credibility.

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. According to Erikson's stages of development, the teen develops a sense of identity. Failure to successfully complete this stage will result in a lack of self confidence and an inability to see one's self as in independent being. The establishment of the ability to trust is completed in an earlier stage of psychosocial development. A desire to move away from the parental home is not uncommon and is not a sign of impaired navigation of this level of psychosocial development.

A 15-year-old adolescent is seen at a health care facility for facial acne. When counseling the teen, the nurse would teach that the basic cause of acne is:

activation of androgen hormones. Acne occurs in adolescence as the result of hormone influence. With increased androgen production the sebaceous glands become more active. With increased testosterone production (in both boys and girls) increased sebum is produced. These increased hormone productions lead to the development of acne. Showering will certainly lead to cleaner skin and the removal of oils but the lack of showering does not cause acne. Diet and thyroid hormones do not play a role in the development of acne.

The nurse is educating an adolescent female who needs to increase dietary iron but has expressed concern about weight gain. What dietary choices would the nurse recommend?

chicken, whole-wheat bread, watermelon Chicken, whole-wheat bread, and watermelon are all foods high in iron. The calorie content will not promote weight gain. All the other options do not include good sources of iron but are nutritious foods. The calorie content is also acceptable.

The nurse is working with a 12-year-old who has recently experienced family instability and family violence. When assessing this client in the context of Erikson's developmental theory, the nurse should recognize that the adolescent has a risk of which negative outcome?

confusion about role in the world Erikson identifies the primary developmental task of early adolescence as identity versus role confusion. That is, unsuccessful development results in confusion about role and identity. This does not necessarily result in aggression or antisocial behavior. Dissociative identity disorder is a specific psychiatric disorder.

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 Peers serve as role models for social behaviors, so their impact on an adolescent can be negative if the group is using drugs, or the group leader is in trouble. Sharing problems with peers helps the adolescent work through conflicts with parents. The desire to be part of the group teaches the child to negotiate differences and develop loyalties and stability.

According to Erikson, the adolescent develops their own sense of being an independent person with individual thoughts and goals. This stage is referred to as:

identity vs. role confusion. Adolescents must develop their own personal identity—a sense of being independent people with unique ideals and goals. This is the period Erikson calls identity versus role confusion. Erikson believes during this time the adolescent goes back through all previous developmental periods to achieve this identity. The stage of autonomy versus shame and doubt occurs between 18 months and 3 years. Industry versus inferiority occurs between 5 to 12 years. Intimacy versus isolation occurs in adulthood between the ages of 19 to 40 years.

A teen is suspected of having anovulatory menstrual cycles. This would be the result of which hormone?

luteinizing hormone Luteinizing hormone is responsible for ovulation. Estrogen and progesterone impact the menstrual cycle but do not control ovulation. Prolactin is responsible for preparing the breasts for nursing.

The school nurse is preparing health promotion presentations regarding unintentional injuries for a high school health fair. On which topic should the nurse place as the priority when preparing the presentation?

motor vehicle safety All options should be included in the presentation, but motor vehicle safety has the highest priority because motor vehicle accidents are the leading cause of injury and death, followed by poisoning (which includes prescription drug overdose).

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 Whole grain bread contains high amounts of iron and is a type of food the child would not have an aversion to. Milk is a good source of vitamin D. Carrots are high in vitamin A. Orange juice is a good source for vitamin C.