NURS 355 Chapter 17
The school nurse is teaching an adolescent about social networking and texting on phones. What statement by the adolescent indicates a need for further teaching?
"My text messaging during class time in school will not cause any disruption." Internet chatrooms and social networking sites have created a more public arena for trying out identities and developing interpersonal skills with a wider network of people, occasionally with anonymity. This can create opportunities for young people who have a limited access to friends (because of rural location, shyness, or rare chronic conditions) to interact with people like themselves. Both the online and text environment can create opportunities for cyberbullying, in which teens engage in insults, harassment, and publicly humiliating statements online or on cell phones. Text messaging and instant messaging via cell phones has become a common activity and can sometimes be disruptive during school. If the adolescent indicates it will not be disruptive, further teaching is needed.
A 12-year-old girl asks the nurse about an increase in clear white odorless vaginal discharge. What response should the nurse give?
"This is normal before menstruation starts." Early in puberty, there is often an increase in normal vaginal discharge (physiologic leukorrhea) associated with uterine development. Girls or their parents may be concerned that this vaginal discharge is a sign of infection. The nurse can reassure them that the discharge is normal and a sign that the uterus is preparing for menstruation. It is caused by an increase in estrogen, not progesterone.
The nurse is explaining to an adolescent the rationale for administering a Tdap (tetanus, diphtheria, acellular pertussis) vaccine 3 years after the last Td (tetanus) booster. What should the nurse tell the adolescent?
"This vaccine will provide pertussis immunity." When the Tdap is used as a booster dose, it may be administered earlier than the previous 5-year interval to provide adequate pertussis immunity (regardless of interval from the last Td dose). It is not time or past time for a booster because they are required every 5 years. Another booster will be needed in 5 years, so it is not the last dose.
he school nurse recognizes that pubertal delay in girls is considered if breast development has not occurred by which age?
13 years Girls may be considered to have pubertal delay if breast development has not occurred by age 13 years or if menarche has not occurred within 2 to 2 1/2 years of the onset of breast development.
The school nurse recognizes that pubertal delay in boys is considered if no enlargement of the testes or scrotal changes have occurred by what age?
13.5 to 14 years Concerns about pubertal delay should be considered for boys who exhibit no enlargement of the testes or scrotal changes by ages 13 1/2 to 14 years or if genital growth is not complete 4 years after the testicles begin to enlarge.
The school nurse recognizes that adolescents should get how many hours of sleep each night?
9 hours Adolescents should generally get around 9 hours of sleep each night.
The development of sexual orientation during adolescence is what?
A developmental process The development of sexual orientation as a part of sexual identity includes several developmental milestones during late childhood and throughout adolescence. The sequence and time spent in phases are different for each individual. Boys and girls pass through the same developmental milestones.
The school nurse is teaching a class on injury prevention. What should be included when discussing firearms?
Adolescence is the peak age for being a victim or offender in the case of injury involving a firearm. The increase in gun availability in the general population is linked to increased gun deaths among children, especially adolescents. Gun carrying among adolescents is on the rise and not limited to the stereotypic inner-city youth. Adolescents can be taught to safely use guns for hunting, but they must be stored properly and used only with supervision. Nonpowder guns (air rifles, BB guns) cause almost as many injuries as powder guns.
What is an important consideration for the school nurse planning a class on injury prevention for adolescents?
Adolescents need to discharge energy, often at the expense of logical thinking. The physical, sensory, and psychomotor development of adolescents provides a sense of strength and confidence. There is also an increase in energy coupled with risk taking that puts them at risk. Adolescents are risk takers because their feelings of indestructibility interfere with understanding of consequences. Sports can be a useful way for adolescents to discharge energy. Care must be taken to avoid overuse injuries.
What are characteristics of middle adolescence (15-17 years) with regard to relationships with peers? (Select all that apply.)
Behavorial standards set by peer group Acceptance of peers extremely important Exploration of ability to attract opposite sex Characteristics of middle adolescence relationships with peers include behavioral standards set by the peer group, acceptance of peers is extremely important, and exploration of the ability to attract opposite sex. Seeking peer affiliations to counter instability is a characteristic of early adolescence relationships with peers. Peer groups receding in importance in favor of individual friendships is characteristic of late adolescence relationships with peers.
What is most descriptive of the spiritual development of older adolescents?
Beliefs become more abstract Because of their abstract thinking abilities, adolescents are able to interpret analogies and symbols. Rituals, practices, and strict observance of religious customs become less important as adolescents question values and ideals of families. Adolescents question external manifestations when not supported by adherence to supportive behaviors.
In girls, what is the initial indication of puberty?
Breast development In most girls, the initial indication of puberty is the appearance of breast buds, an event known as thelarche. The usual sequence of secondary sexual characteristic development in girls is breast changes, a rapid increase in height and weight, growth of pubic hair, appearance of axillary hair, menstruation (menarche), and abrupt deceleration of linear growth.
The nurse is assessing the Tanner stage in an adolescent female. The nurse recognizes that the stages are based on which?
Breast size and the shape and distribution of pubic hair In females, the Tanner stages describe pubertal development based on breast size and the shape and distribution of pubic hair. The stages of vaginal changes, progression of menstrual cycles to regularity, and the development of fat deposits occur during puberty but are not used for the Tanner stages.
Parents of an adolescent ask the school nurse, "It is OK for our adolescent to get a job?" The nurse should answer telling the parents the effects of adolescents who work more than 20 hours a week are what? (Select all that apply.)
Can lead to fatigue Can lead to poorer grades Can reduce extracurricular involvement Detrimental effects are likely for adolescents who work more than 20 hours a week. Greater involvement in work can lead to fatigue, decreased interest in school, reduced extracurricular involvement, and poorer grades. Involvement in work may take time away from other activities that could contribute to identity development. Adolescent work as it exists today may negatively affect development.
What aspects of cognition develop during adolescence?
Capability of using a future time perspective Adolescents are no longer restricted to the real and actual. They also are concerned with the possible; they think beyond the present. During concrete operations (between ages 7 and 11 years), children exhibit thought processes that enable them to see things from the point of view of another, place things in a sensible and logical order, and progress from making judgments based on what they see to making judgments based on what they reason.
What is true concerning the development of autonomy during adolescence?
Conformity to both parents and peers gradually declines toward the end of adolescence. During middle and late adolescence, the conformity to parents and peers declines. Subjective feelings of self-reliance increase steadily over the adolescent years. Adolescents have genuine behavioral autonomy. Rebellion is not typically part of adolescence. It can occur in response to excessively controlling circumstances or to growing up in the absence of clear standards. Parent and peer relationships can play complementary roles in the development of a healthy degree of individual independence.
What guidelines should the nurse use when interviewing adolescents? (Select all that apply.)
Ensure privacy Use open-ended questions Begin with less sensitive issues and proceed to more sensitive ones Guidelines for interviewing adolescents include ensuring privacy, using open-ended questions, and beginning with less sensitive issues and proceeding to more sensitive ones. The nurse should not share thoughts but maintain objectivity and should avoid assumptions, judgments, and lectures. It may not be possible for all interactions to be confidential. Limits of confidentiality include a legal duty to report physical or sexual abuse and to get others involved if an adolescent is suicidal.
What are characteristics of dating relationships in early adolescence? (Select all that apply.)
Follow ritualized "scripts" Involve playing stereotypic roles Participating in mixed-gender group activities Early dating relationships typically follow highly ritualized "scripts" in which adolescents are more likely to play stereotypic roles than to really be themselves. Participating in mixed-gender group activities, such as going to parties or other events, may have a positive impact on young teenagers' well-being. One-on-one dating during early adolescence, however, with a lot of time spent alone, may lead to sexual intimacy before a teen is ready. Although teenagers may begin dating during early adolescence, these early dating relationships are not usually psychosocially intimate.
According to Piaget, adolescents tend to be in what stage of cognitive development?
Formal operational thought Cognitive thinking culminates in the capacity for abstract thinking. This stage, the period of formal operations, is Piaget's fourth and last stage. Concrete operations usually occur between ages 7 and 11 years. Conventional and postconventional thought refers to Kohlberg's stages of moral development.
Girls experience an increase in weight and fat deposition during puberty. What do nursing considerations related to this include?
Give reassurance that these changes are normal. A certain amount of fat is increased along with lean body mass to fill the characteristic contours of the adolescent's gender. A healthy balance must be achieved between expected healthy weight gain and obesity. Suggesting dietary measures or increased exercise to control weight gain would not be recommended unless weight gain was excessive because eating disorders can develop in this group. Some fat deposition is essential for normal hormonal regulation. Menarche is delayed in girls with body fat contents that are too low.
An adolescent asks the nurse about the "safety of getting a tattoo." The nurse explains to the adolescent that it is important to find a qualified operator using proper sterile technique because an unsterilized needle or contaminated tattoo ink can cause what? (Select all that apply.)
Hepatitis C virus Hepatitis B virus HIV Mycobacterium chelonae skin infections Using the same unsterilized needle to tattoo body parts of multiple teenagers presents the same risk for human immunodeficiency virus (HIV), hepatitis C virus, and hepatitis B virus transmission as occurs with other needle-sharing activities. Contaminated tattoo ink can cause nontuberculous M. chelonae skin infections. The hepatitis E virus is transmitted via the fecal-oral route, principally via contaminated water, not by contaminated needles.
According to Erikson, the psychosocial task of adolescence is developing what?
Identity Traditional psychosocial theory holds that the developmental crises of adolescence lead to the formation of a sense of identity. Intimacy is the developmental stage for early adulthood. Independence is not one of Erikson's developmental stages.
How does the onset of the pubertal growth spurt compare in girls and boys?
In girls, it occurs about 1 year before it appears in boys. The average age of onset is 9 1/2 years for girls and 10 1/2 years for boys. Although pubertal growth spurts may occur in girls 3 years before it appears in boys on an individual basis, the average difference is 1 year. Usually girls begin their pubertal growth spurt earlier than boys.
What are characteristics of late adolescence (18-20 years) with regard to sexuality? (Select all that apply.)
Intimacy involves commitment Growing capacity for mutuality and reciprocity May publicly identify as gay, lesbian, or bisexual Characteristics of late adolescence sexuality include intimacy involving commitment; growing capacity for mutuality and reciprocity; and publicly identifying as gay, lesbian, or bisexual. Exploration of "self-appeal" is a characteristic of middle adolescence sexuality. Limited dating, usually group, is a characteristic of early adolescence sexuality.
A 16-year-old adolescent boy tells the school nurse that he is gay. The nurse's response should be based on what?
It is important to provide a nonthreatening environment in which he can discuss this. The nurse needs to be open and nonjudgmental in interactions with adolescents. This will provide a safe environment in which to provide appropriate health care. Adolescence is when sexual identity develops. The nurse's own beliefs should not bias the interaction with this student. Homosexual adolescents face very different challenges as they grow up because of society's response to homosexuality.
What is true concerning masturbation during adolescence?
Many girls do not begin masturbation until after they have intercourse. The age of first masturbation for girls is variable. Some begin masturbating in early adolescence; many do not begin until after they have had intercourse. Boys typically begin masturbation in early adolescence. Masturbation provides an opportunity for self-exploration. Both heterosexual and homosexual youth use masturbation. It does not affect the development of intimacy.
The nurse is caring for children on an adolescent-only unit. What growth and development milestones should the nurse expect from 11- and 14-year-old adolescents? (Select all that apply.)
No major conflicts wit parents Highly value conformity to group norms Secondary sexual characteristics appear Growth and development milestones in the 11- to 14-year-old age group include minimal conflicts with parents (compared with the 15- to 17-year-old age group), a high value placed on conformity to the norm, and the appearance of secondary sexual characteristics. Self-centeredness and narcissism are seen in the 15- to 17-year-old age group along with a rich and idealistic fantasy life. Abstract thought processes are not well established until the 18- to 20-year-old age group.
The school nurse teaches adolescents that the detrimental long-term effects of tanning are what? (Select all that apply.)
Premature aging of the skin Increased risk for skin cancer Possible phototoxic reactions Adolescents should be educated regarding the detrimental effects of sunlight on the skin. Long-term effects include premature aging of the skin; increased risk for skin cancer; and, in susceptible individuals, phototoxic reactions. Exposure to levels of sunlight cause an increase in vitamin D production. Tanning can often reduce outbreaks of acne.
The nurse is preparing a pamphlet for parents of adolescents about guidance during the adolescent years. What suggestion should the nurse include in the pamphlet?
Provide clear, reasonable limits and define consequences when rules are broken. An anticipatory guideline to include when teaching parents of adolescents is to provide clear, reasonable limits and have clear consequences when rules are broken. Parents should avoid criticism when mistakes are made and should allow opportunities for the teen to voice different views and opinions. Parents should try to avoid comparing the teen with a sibling or extended family member. Parents should try to be more engaged in the teen's school functions to show support and unconditional love.
The nurse is assessing the Tanner stage in an adolescent male. The nurse recognizes that the stages are based on what?
Size and shape of the penis and scrotum and distribution of pubic hair In males, the Tanner stages describe pubertal development based on the size and shape of the penis and scrotum and the shape and distribution of pubic hair. During puberty, hair begins to grow on the face and chest; the voice becomes deeper; and muscles grow in the arms, legs, and shoulders, but these are not used for the Tanner stages.
The school nurse recognizes that students who are targeted for repeated harassment and bullying may exhibit what? (Select all that apply.)
Skip school Attempt suicide Bring weapons to school Report symptoms of depression Students targeted for repeated teasing and harassment are more likely to skip school, to report symptoms of depression, and to attempt suicide. Equally troubling, teens who are regularly harassed or bullied are also more likely to bring weapons to school to feel safe. Students who are bullied do not want to attend extracurricular activities.
In boys, what is the initial indication of puberty?
Testicular enlargement Testicular enlargement is the first change that signals puberty in boys; it usually occurs between the ages of 9 1/2 and 14 years during Tanner stage 2. Voice change occurs between Tanner stages 3 and 4. Fine pubic hair may occur at the base of the penis; darker hair occurs during Tanner stage 3. The penis enlarges during Tanner stage 3.
Adolescents often do not use reasoned decision making when issues such as substance abuse and sexual behavior are involved. What is this because of?
They are dealing with issues that are stressful and emotionally laden. In the face of time pressures, personal stress, or overwhelming peer pressure, young people are more likely to abandon rational thought processes. Many of the health-related decisions adolescents confront are emotionally laden or new. Under such conditions, many people do not use their capacity for formal decision making. The majority of adolescents have cognitive skills and are capable of reasoned decision making. Stress affects their ability to process information. Reasoned decision making should be used in issues that are crucial such as substance abuse and sexual behavior.
What are characteristics of early adolescence (11-14 years) with regard to identity? (Select all that apply.)
Trying out of various roles Conformity to group norms Preoccupied with rapid body changes Characteristics of early adolescence identity include trying out of various roles, conformity to group norms, and preoccupation with rapid body changes. Mature sexual identity and increase in self-esteem are characteristics of late adolescent identity.
