Ped's Adolescent

What is the most common cause of ophthalmia neonatorum in infants born to adolescent mothers? 1 Chlamydia 2 Gonorrhea 3 Human papilloma virus 4 Herpes simplex virus

1 Ophthalmia neonatorum is a neonatal infection caused when the infant is born to a mother who has a chlamydia infection.

The clinic nurse is teaching an adolescent about lifestyle modifications to prevent hyperlipidemia. Which statement by the adolescent indicates a need for further teaching? 1 "I'll start eating more red meat." 2 "I'm going to eat a lot of low-fat yogurt." 3 "I'll try to stop eating so much processed food." 4 "I'll start eating whole-grain bread instead of white."

1 Red meats are high in fat. The monounsaturated and polyunsaturated fats can increase high density lipoprotein and decrease low density lipoprotein cholesterol. For this reason, an increase in the consumption of red meat is not advisable. Most whole grains, breads, pastas, and cereals are naturally low in fat. Adolescents should be taught to choose lean meats, beans, and low-fat dairy products and to limit their intake of processed foods such as crackers, cookies, cakes, and higher fat snacks.

What factors may cause an adolescent to develop a smoking addiction? Select all that apply. 1 Peer pressure 2 Academic success 3 Involvement in sports 4 Imitating adult behavior of smoking 5 Imitating lifestyles portrayed in movies and advertisements

145 Factors that influence an adolescent to smoke include peer pressure and imitating adult behavior of smoking and lifestyles portrayed in movies. Succeeding in academics and being involved in sports are not factors that cause an adolescent to begin smoking.

What over-the-counter drugs are used to treat vulvovaginal candidiases? Select all that apply. 1 Tinidazole 2 Miconazole 3 Clotrimazole 4 Azithromycin 5 Metronidazole

23 Miconazole and clotrimazole are standard over-the-counter drugs used to treat candidiasis. Tinidazole is used to treat trichomoniasis. Azithromycin is used to treat chlamydia. Metronidazole is used to treat bacterial vaginosis and trichomoniasis.

Which medication is the first-line treatment for acne in adolescents? 1 Tretinoin 2 Doxycycline 3 Clindamycin 4 Benzoyl peroxide

4 Benzoyl peroxide is an effective first-line medication used to treat acne in adolescents; this medication is effective against inflammatory and noninflammatory acne. Tretinoin, doxycycline, and clindamycin are also used to treat acne, but they are not first-line agents.

Which characteristic change is observed during late adolescence stage? 1 Changes in puberty 2 Changes in dressing 3 Dominant peer orientation 4 Develops adult relationships

4 The characteristic change observed during the late adolescence stage is developing adult relationships. Early adolescence is characterized primarily by the changes of puberty. Middle adolescence is characterized by changes in dressing and dominant peer orientation.

According to current statistics, what percent of adolescents try marijuana by the end of high school? Record your answer using a whole number. ________

Current statistics show that by the end of high school, 49% of adolescents experiment with marijuana.

Arrange the events of an examination of a rape victim for a sexually transmitted infection in correct order. 1. Repetition of serologic tests for syphilis and HIV infection. 2. Serum sample for HIV infection, hepatitis B, and syphilis. 3. Nucleic acid amplified testing for chlamydia and gonorrhea. 4. Wet mount and culture or point-of-care testing of a vaginal swab specimen for trichomoniasis.

First, the sexual assault nurse should conduct nucleic acid amplified testing for chlamydia and gonorrhea. Next, the nurse should check for trichomoniasis via a wet mount and culture or point-of-care testing of a vaginal swab specimen. After this, a serum sample for HIV infection, hepatitis B, and syphilis should be conducts. Finally, serologic tests for syphilis and HIV infection are repeated every 3 to 6 months after the assault.

What is the maximum recommended length for enema tube insertion in an adolescent? Record your answer using a whole number. _____ cm

In adolescents, the maximum length for insertion of an enema tube is 10 cm.

Which herbal therapies would be beneficial to a client with menstrual cramping? Select all that apply. 1 Catnip 2 Fennel 3 Black haw 4 Bugleweed 5 Chamomile

123 Herbal drugs such as catnip, fennel, and black haw are used to treat menstrual cramping and dysmenorrhea. Bugleweed and chamomile are used to treat breast pain.

What would be the drug of choice for a client who is diagnosed with chlamydia? 1 Imiquimod 2 Ceftriaxone 3 Azithromycin 4 Benzathine penicillin

3 Azithromycin is recommended for clients with chlamydia infections. Imiquimod is beneficial for treating genital warts in clients with human papillomavirus infections. Ceftriaxone is the drug of choice for treating gonorrhea. Benzathine penicillin is recommended for treating syphilis.

Which herbal medication would the nurse suggest to a client to reduce premenstrual discomfort? 1 Fennel 2 Bugleweed 3 Chamomile 4 Black cohosh root

4 Black cohosh root is used to reduce premenstrual discomfort and tension associated with menstrual disorders. Fennel is an uterotonic agent that is used to reduce menstrual cramping and dysmenorrhea. Bugleweed is an antigonadotropic agent that decreases prolactin levels and reduces breast pain. Chamomile is an antispasmodic agent that helps to reduce breast pain.

What is the average diastolic pressure recorded in a 16 year old? Record your answer using a whole number. ________________ mm Hg

The average diastolic pressure recorded in a 16 year old is 75 mm Hg.

What is the average normal diastolic pressure in a 13 year old? Record your answer using a whole number. _______ mm Hg

The average normal diastolic pressure in in a 13 year old is 65 mm Hg.

What is the average systolic blood pressure in a 15 year old? Record your answer using a whole number ______________________ mm Hg

The average systolic blood pressure in a 15 year old is 119 mm Hg.

What is the maximum heart rate of a 16 year old? Record your answer using a whole number. ____________________ beats per minute

The maximum heart rate of a 16 year old is 90 beats per minute.

Arrange the stages of the menstrual cycle in sequential order. 1. Ovulation 2. Follicular phase 3. Feedback mechanism 4. Follicular involution

The menstrual cycle begins with the follicular phase. During this phase, one ovarian follicle becomes dominant and produces a large amount of estrogen. After this phase is ovulation; this occurs when the dominant follicle releases an ovum around day 14 of the cycle. After the ovum is released, the follicle involutes with the decreased production of estrogen and thus progesterone in blood. As a feedback response to this decrease, the pituitary gland increases the production of follicle stimulating hormone, which initiates a new menstrual cycle.

What is the minimum respiratory rate in a normal adolescent? Record your answer using a whole number. _____________________ breaths/minute

The minimum respiratory rate in a normal adolescent is 16 breaths/minute.

What is the average systolic blood pressure in a 13-year-old adolescent? Record your answer using a whole number. _____ mm Hg

The normal systolic blood pressure in a 13-year-old adolescent is 110 mm Hg.

What size of induration after a tuberculin test signifies a positive result in a 16-year-old client? Record your answer using a whole number. _________________ mm

The nurse should consider an induration of 15 mm (1.5 cm) a positive sign of tuberculin testing in a 16-year-old client.

What are the pathophysiologic factors of acne? Select all that apply. 1 Comedogenesis 2 Production of excessive sebum 3 Alteration in follicular growth 4 Consumption of dairy products 5 Colonization of Propionibacterium acnes

1235 Pathophysiologic factors of acne include comedogenesis (the formation of comedones), the production of excessive sebum, an alteration in follicular growth, and the proliferation of Propionibacterium acnes. Consuming dairy products may potentiate acne, but it is not a pathophysiologic factor.

At what age, the pubertal growth spurt reaches its peak in males? 1 12 years 2 14 years 3 16 years 4 18 years

2 Pubertal growth spurt reaches peak during 14 years in males marked by general increase in the growth of skeleton, muscles, and internal organs. The pubertal growth spurt reaches peak during 12 years in females. The middle adolescent period occurs at 15 to 17 years shows a slowdown in growth. Physical maturity is attained in late adolescent stage around 18 to 20 years.

Which herbal therapies can be recommended to a client with breast pain? Select all that apply. 1 Dong quai 2 Chamomile 3 Bugleweed 4 Chaste tree fruit 5 Black cohosh root

234 Herbal therapies for breast pain include chamomile, bugleweed, and chaste tree fruit. Dong quai is recommended for menstrual cramping and dysmenorrhea. Black cohosh root eases premenstrual discomfort and tension.

The nurse receives an order to prepare a solution for administering a cleansing enema for a 15-year-old client. What is the volume of solution that the nurse should prepare? 1 150 to 250 mL 2 250 to 350 mL 3 300 to 500 mL 4 500 to 750 mL

4 In adolescents, the volume of solution required is 500 to 750 mL. The nurse should prepare 150 to 250 mL of warmed solution for infants. The nurse should prepare 250 to 350 mL of warmed solution for administering a cleansing enema in a toddler. In school-age children, the volume of warmed solution is 300 to 500 mL.

Which blood gas result should the nurse expect an adolescent with diabetic ketoacidosis to exhibit? 1 pH 7.30, CO2 40 mm Hg, HCO3- 20 mEq/L (20 mmol/L) 2 pH 7.35, CO2 47 mm Hg, HCO3- 24 mEq/L (24 mmol/L) 3 pH 7.46, CO2 30 mm Hg, HCO3- 24 mEq/L (24 mmol/L) 4 pH 7.50, CO2 50 mm Hg, HCO3- 22 mEq/L (22 mmol/L)

1 A client in diabetic ketoacidosis will have blood gas readings that indicate metabolic acidosis. The pH will be acidic (7.30), and the HCO3- will be low (20 mEq/L [20 mmol/L]). The normal pH is 7.35 to 7.45; CO2 ranges from 35 to 45 mm Hg, and HCO3- ranges from 22 to 26 (22 to 26 mmol/L). A pH of 7.35 and a CO2 of 47 mm Hg indicate respiratory acidosis. pH values of 7.46 and 7.50 represent alkalosis, not acidosis.

A nurse concludes that the teaching about sickle cell anemia has been understood when an adolescent with the disorder makes which statement? 1 "I'll start to have symptoms when I drink less fluid." 2 "I'll start to have symptoms when I have fewer platelets." 3 "I'll start to have symptoms when I decrease the iron in my diet." 4 "I'll start to have symptoms when I have fewer white blood cells."

1 Dehydration precipitates sickling of red blood cells and therefore is a major causative factor for painful episodes associated with sickle cell anemia. An inadequate number of platelets (thrombocytes) is unrelated to painful episodes associated with sickle cell anemia. Iron intake is unrelated to the sickling phenomenon. An inadequate number of white blood cells is unrelated to painful episodes associated with sickle cell anemia.

A nurse is teaching a high school student about scoliosis treatment options. On what should the nurse focus? 1 Effect on body image 2 Least invasive treatment 3 Continuation with schooling 4 Maintenance of contact with peers

1 Establishing an identity, the major developmental task of the adolescent, is related to the affirmation of self-image. To achieve this task there is a need to conform to group norms, one of which is appearance. The type of treatment is not an issue. Although it is important to continue schooling and to maintain contact with peers, the effect on body image is more important.

A female adolescent reports excessive hair growth in the pubic region and under the arms. What may be responsible for these changes? 1 High levels of estrogen 2 Low levels of progesterone 3 High levels of testosterone 4 Low levels of follicle stimulating hormone

1 High estrogen levels in the later stages of puberty generally promote the growth of pubic and axillary hair. Progesterone is generally involved in the implantation of the fertilized egg in the uterus and the maintenance of pregnancy. High testosterone levels increase pubic and axillary hair in males. Low follicle stimulating hormone levels reduce estrogen levels.

After her child's visit to the pediatrician a mother tells the nurse that she is concerned that an antidepressant has been prescribed for her adolescent son. What is the best response by the nurse? 1 "Tell me more about what's bothering you." 2 "You need to speak with the primary healthcare provider about your concern." 3 "Are you sure it's not a medication for attention deficit disorder?" 4 "Didn't the primary healthcare provider tell you why your son needs an antidepressant?"

1 Reflecting the parent's feelings provides an opportunity for further exploration. It is the nurse's responsibility to assess the mother's concerns before planning further interventions. Implying that either the primary healthcare provider or the mother is wrong is a nontherapeutic response. Implying that the mother didn't listen or understand is a judgmental, nontherapeutic response.

How does exercise help relieve menstrual discomfort in adolescents? Select all that apply. 1 By reducing ischemia 2 By decreasing vasodilation 3 By increasing prostaglandins 4 By reducing pelvic discomfort 5 By releasing endogenous opiates

145 Exercise helps to relieve menstrual discomfort through increased vasodilation followed by a subsequent decrease in ischemia. Exercise reduces congestion in the pelvis and minimizes the discomfort in the pelvis. Exercise promotes the release of endogenous opiates and suppresses prostaglandin production.

A 17-year-old mother is to sign the consent for her son's myringotomy. What should the nurse say to the mother about this procedure? 1 "This procedure may not help." 2 "Tell me what you know about this procedure." 3 "Your son will need to have this done again when he's older." 4 "One of your parents must also sign this because you're too young."

2 Informed consent requires that the responsible person understand the procedure. Predicting therapeutic outcomes is not within the role of the nurse. Predicting future surgical interventions is not within the role of the nurse. A 17-year-old mother is an emancipated minor who has the legal authority to sign her child's consent form.

The client reports excessive bleeding during the menstruation. Which herbal therapies are unlikely to be prescribed by the primary healthcare provider? Select all that apply. 1 Raspberry 2 Chamomile 3 Lady's mantle 4 Chaste tree fruit 5 Shepherd's purse

24 Chamomile is an antispasmodic agent that helps to reduce breast pain. Chaste tree fruit is used to reduce breast pain by reducing the prolactin levels. Raspberry, lady's mantle, and shepherd's purse are uterotonic drugs used to treat menorrhea.

A young pregnant adolescent is diagnosed as having bacterial vaginosis. What further complications related to bacterial vaginosis may occur during pregnancy? Select all that apply. 1 Neonatal sepsis 2 Cervical dysplasia 3 Preterm labor and birth 4 Intraamniotic infection 5 Postpartum endometritis

345 Preterm birth and labor may occur because bacteria that enters the cervix irritates the uterus, which cause contractions. Bacterial vaginosis is associated with high risk of intraamniotic infection and postpartum endometritis. Neonatal sepsis occurs because of gonococcal infections. Cervical dysplasia occurs in clients with human immunodeficiency virus infections.

After a teaching session a nurse determines that an adolescent with newly diagnosed type 1 diabetes has sufficient knowledge of the disorder. What is the next nursing action? 1 Setting goals with the client 2 Developing a rapport with the client 3 Teaching the client how to give insulin injections 4 Instructing the client how to monitor blood glucose

1 A negotiation of goals is essential to successful learning; mutual goal-setting provides a focus for learning. A rapport should have developed before teaching of the adolescent about diabetes was started. Teaching the client how to give injections or monitor the blood glucose level is premature. If the client does not identify a specific need or set a goal, motivation may be minimal.

Which is the preferred drug of choice for the treatment of syphilis in a pregnant adolescent? 1 Penicillin G 2 Doxycycline 3 Tetracycline 4 Erythromycin

1 According to the Center for Disease Control and Prevention, penicillin G is the preferred drug of choice for any stage of syphilis in pregnant women. Both doxycycline and tetracycline are contraindicated during pregnancy. Erythromycin may not be able to cure a fetal infection.

According to Erikson's theory, which of these actions can predispose an adolescent to being in a state of confusion? 1 If an adolescent fails to establish a sense of identity 2 If an adolescent has a feeling of isolation and rejection 3 If an adolescent's parents fail to establish a sense of trust in him or her 4 If an adolescent's parents try to control him or her and limit his or her choices

1 Acquiring a sense of identity is essential for making adult decisions. If an adolescent fails to develop a sense of identity, they may end up in a state of confusion. If a young adult is not able to establish a companionship, isolation results due to rejection and disappointment. If the parents fail to establish a sense of trust with an infant, the child may develop feelings of mistrust. Controlling a child and limiting his or her choices may lead to a child developing a sense of shame and doubt.

The parents of a 15-year-old adolescent who is being treated for allergies privately tell a nurse that they suspect that their child is a hypochondriac. What is the most therapeutic response by the nurse? 1 Discussing developmental behaviors of adolescents 2 Explaining potentially serious complications of allergies 3 Discussing some of the underlying causes of hypochondriasis 4 Explaining that the parents may be transferring their fears to their adolescent

1 Adolescents are very aware of their changing bodies and become especially concerned with any alteration resulting from illness or injury. Explaining the complications of allergies does not address concepts related to growth and development of the adolescent and may cause unnecessary concern about the child's physical condition. A discussion about hypochondriasis may reinforce the parents' concern. Indicating that the parents may be engaging in transference is accusatory and is not supported by adequate data; this response may precipitate such feelings as anger and guilt.

An 18-year-old high school student arrives at the local blood drive center to donate blood for the first time. As the site is being prepared for needle insertion, the student becomes agitated, starts to hyperventilate, and complains of dizziness and tingling of the hands. What should the nurse instruct the student to do? 1 Breathe into cupped hands. 2 Pant using rapid, shallow breaths. 3 Use a rapid deep-breathing pattern. 4 Hold the breath for as long as possible.

1 Breathing into cupped hands allows carbon dioxide to reenter the lungs, which will increase the serum bicarbonate level, relieving the respiratory alkalosis that is occurring as a result of hyperventilation. A rapid breathing pattern will exacerbate the respiratory alkalosis because excess carbon dioxide will continue to be expelled with rapid breathing, lowering the serum bicarbonate level. A fast deep-breathing pattern will exacerbate the respiratory alkalosis because excess carbon dioxide will continue to be expelled with rapid breathing, lowering the serum bicarbonate level. A person who is experiencing a panic attack will not be able to hold his or her breath.

The nurse finds that an adolescent has episodes of binge eating followed by self-induced vomiting and strenuous exercise. Which condition is the adolescent likely to have? 1 Bulimia 2 Anorexia 3 Orthorexia 4 Binge behavior

1 Bulimia is a disorder characterized by repeated episodes of binge eating followed by inappropriate compensatory behavior, such as self-induced vomiting and/or strenuous exercise. Anorexia is an eating disorder characterized by low body weight. Orthorexia is a disorder in which the individual avoids certain foods, believing them to be harmful. Binge behavior is consumption of large amounts of foods in a brief time but without the subsequent compensatory behavior.

Pulse oximetry is prescribed for an adolescent. What should the nurse do to ensure accuracy of the pulse oximeter reading? 1 Attach the probe to a finger or earlobe. 2 Wait 30 minutes before obtaining a reading. 3 Calibrate the oximeter at least every 8 hours. 4 Place the probe on the abdomen or upper leg.

1 Capillary beds are closest to the surface in a finger or earlobe; this proximity permits more accurate measurement of arterial oxygen saturation. An almost instantaneous, accurate readout may be obtained with the use of a pulse oximeter. The pulse oximeter does not require routine calibration. Placing the probe on the abdomen or upper leg is contraindicated because the capillary beds are not close to the surface on the abdomen or upper thigh.

A nurse is teaching a 15-year-old adolescent with newly diagnosed type 1 diabetes about self-care. What is the primary long-term goal this nurse and client should agree on? 1 Maintaining normoglycemia 2 Complying with the diabetic diet 3 Adhering to an exercise program 4 Developing a nonstressful lifestyle

1 Maintaining normoglycemia is a realistic goal because it decreases the risk of complications such as neuropathy, retinopathy, and atherosclerosis. A regimen of insulin, exercise, and diet will help the adolescent achieve this goal. Compliance with a diabetic diet is an objective because it will help the adolescent achieve the long-term goal; diet alone is insufficient to achieve normoglycemia. Adherence to an exercise program is an objective because it will help the adolescent achieve the long-term goal; exercise alone is insufficient to achieve normoglycemia. Development of a nonstressful lifestyle is a worthwhile goal, but it is not realistic.

An adolescent girl is concerned about her body image after amputation of a leg for bone cancer. After the nurse has obtained the girl's consent, what nursing action is most therapeutic? 1 Encouraging her peers to visit 2 Keeping her lower body covered 3 Placing her in a room by herself 4 Limiting her visitors to the family 00:00:06 Question Answer Confidence ButtonsJust a guessPretty sureNailed it

1 Peer acceptance is crucial during this period; friends must have the opportunity to accept the client with one leg. Concealment does not help the adolescent or others accept the loss. Isolating the adolescent will increase feelings of alienation and being different. An adolescent needs to relate to and be accepted by peers as well as family.

Prolonged labor is an incident very common in pregnant adolescents. Which age group of adolescents has the highest risk of prolonged labor? 1 12 to 13 years 2 14 to 15 years 3 16 to 18 years 4 19 to 21 years

1 The adolescents of age group 12 to 13 years are at the higher risk of prolonged labor because of cephalopelvic disproportion and underdevelopment. The age group of 14 to 15 will have moderate chances of prolonged labor as the transition between cephalopelvic disproportion and pelvic adequacy starts. For age group 16 to 21 the labor time shortens as the body completes transition.

A 16-year-old single mother of a 1-year-old infant and the infant's grandmother bring the baby to the emergency department and report that the infant accidentally fell down the stairs. The nurse knows that a consent form for treatment should be signed. Who has the responsibility for signing the consent? 1 The mother, despite her age 2 No one, because this is an emergency 3 The grandmother, because she is a relative 4 Family court, because the mother is a minor

1 The client is an emancipated minor, meaning that she has adult status. In most states the age of majority is 18 years; however, parents younger than 18 years are considered emancipated minors and may sign consents for themselves and their children. Consent always is needed when a parent is present and capable of providing it. The grandmother does not have the legal right to give consent. Family court is unnecessary.

Which gland secretes gonadotropin-releasing hormone (GnRH) to help control the events of puberty? 1 Hypothalamus 2 Thyroid 3 Anterior pituitary 4 Posterior pituitary

1 The hypothalamus releases gonadotropin-releasing hormone (GnRH), which stimulates the anterior pituitary gland. This gland exerts hormonal influence on the events of puberty. GnRH travels through a network of capillaries to the anterior pituitary gland, where it stimulates the production and secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), but the anterior pituitary itself does not secrete GnRH. The posterior pituitary and thyroid glands have no involvement in the neuroendocrine events of puberty.

Which statement about varicocele is true? 1 Varicocele occurs most often on the left side. 2 The left testicle is larger when associated varicocele is present. 3 Testicular size increases with increasing duration of a varicocele. 4 Dihydrotestosterone level increases with the duration of a varicocele

1 Varicocele occurs most often on the left side. The left testicle is smaller when associated varicocele is present. Testicular size decreases with increasing duration of varicocele. Dihydrotestosterone levels decrease with increasing duration of a varicocele.

What are the common characteristics of a relationship between a middle adolescent and his or her parents? Select all that apply. 1 Great push for emancipation 2 Low point in the parent-child relationship 3 Desire to remain dependent on parents 4 Major conflicts over independence and control 5 Emotional and physical separation from parents

124 A child in middle adolescence will have a great push for emancipation, a low point in the parent-child relationship, and major conflicts over independence and control. A younger child will have a desire to remain dependent on his or her parents. A child in late adolescence will have an emotional and physical separation from his or her parents.

What are the manifestations of hypoestrogenism? Select all that apply. 1 Hot flashes 2 Amenorrhea 3 Gynecomastia 4 Hypermenorrhea 5 Reduced bone density

125 Low levels of estrogen may cause hot flashes, amenorrhea, and reduced bone density. Gynecomastia and hypermenorrhea are manifestations of excess estrogen production.

Which behavior patterns may be exhibited by teenagers in their late adolescence? Select all that apply. 1 Concealed temper 2 Introspective nature 3 Consistent emotions 4 Feeling of inadequacy 5 Intense daydreaming

13 Psychologically, teenagers in their late adolescence exhibit a consistency of emotions and are more likely to conceal their feelings and anger. An introspective nature and feelings of inadequacy are expressed by teenagers in their middle adolescence. Intense daydreaming is associated with teenagers in their early adolescence.

What sexually transmitted diseases are caused by bacteria? Select all that apply. 1 Syphilis 2 Hepatitis 3 Gonorrhea 4 Herpes simplex 5 Trichomoniasis

13 Syphilis is caused by Treponema pallidum, a motile spirochete bacterium. Gonorrhea is caused by a bacteria called Neisseria gonorrhoeae. Hepatitis A and herpes simplex are caused by viruses. Trichomoniasis is caused by a protozoan.

A school nurse is planning a class on injury prevention for a group of high school students. What guidelines should the nurse include? Select all that apply. 1 Swim with a buddy. 2 Drink beer instead of wine. 3 Use well-traveled walkways. 4 Smoke only in designated areas. 5 Refuse to play "chicken" with others.

135 Developmentally, adolescents have a drive for independence, an inclination for risk-taking, and a feeling of indestructibility. These traits increase the risk for injury. If one develops problems in the water, the buddy can secure help. Using well-traveled walkways reduces the risk for being alone and overcome by an individual who wishes to do harm. Refusing to play "chicken" helps the student prevent dangerous situations from which the student cannot retreat. Beer is alcohol, and its intake, and that of all types of alcohol, should be discouraged; when one is under the influence of alcohol, reaction time and judgment decrease and the risk for injury increases. Smoking should be discouraged to decrease the risk for respiratory disease.

What are the medical concerns in adolescent pregnancies? Select all that apply. 1 Anemia 2 Fetal obesity 3 Poor maternal weight gain 4 Pregnancy-induced diabetes 5 Pregnancy-induced hypertension

135 Medical concerns in adolescent pregnancies include maternal anemia, poor weight gain, and pregnancy-induced hypertension. Adolescents often receive delayed or inadequate prenatal care, increasing the risk of a low-birthweight infant, not an obese one. Pregnancy-induced diabetes is a risk factor associated with pregnancies involving maternal obesity and maternal age greater than 25 years.

A nurse is educating a group of adolescent girls about the risk of pregnancy. Which statements does the nurse include to help ensure adequate teaching? Select all that apply. 1 Infants born to adolescent mothers have low birth weights. 2 Pregnant adolescents are more likely to seek out prenatal care. 3 Infants born to adolescent mothers are more likely to be premature. 4 Pregnant adolescent girls should avoid participating in prenatal classes. 5 Infants born to adolescent girls have an increased risk of alcohol and drug exposure.

135 The nurse should explain to the adolescent girls that pregnancy at this age results in low birth weight infants. Infants born to adolescent mothers are at increased risk of prematurity and increased risk of exposure to alcohol and drugs. Pregnant adolescents are less likely to seek out prenatal care. Adolescents who participate in prenatal classes have improved nutrition and healthier babies.

Which physical or behavioral signs of substance abuse should a nurse look for in an adolescent? Select all that apply. 1 Worrying about being addicted 2 Showing a high performance in social activities 3 Experiencing an overdose or withdrawal symptoms 4 Worrying about a friend or family member who is addicted 5 Manifesting bizarre behavior or confusion

135 Worrying of being addicted, experiencing overdose or withdrawal symptoms, and manifesting bizarre behavior may be earliest signs of substance abuse. Showing high performance in social activities and worry about a friend or family member's substance abuse are not with a manifestation of substance abuse.

How does group identity aid psychosocial development in adolescents? Select all that apply. 1 It helps them evaluate their own health. 2 It helps them feel a sense of admiration and approval. 3 It helps them develop decision-making and budgeting skills. 4 It provides them the opportunity to learn acceptable behavior. 5 It helps them lessen the feeling that they are different from their peers.

14 Group identity helps the adolescent feel a sense of admiration and approval. Peer groups provide the adolescent with a sense of belonging, approval, and the opportunity to learn acceptable behavior. Health identity helps the adolescent evaluate his or her own health. Family identity helps adolescents develop decision-making and budgeting skills. Sexual identity helps adolescents assuage the fear that they are different from peers.

Which statements are true regarding primary dysmenorrhea? Select all that apply. 1 During the luteal phase, F2-alpha is secreted 2 Anovulatory bleeding that occurs after menarche is painful 3 Primary dysmenorrhea usually appears 2 to 5 months after menarche 4 Pain usually begins at the onset of menstruation and lasts for 8 to 48 hours 5 Excessive release of prostaglandin F2-alpha decreases the frequency of uterine contractions

14 Primary dysmenorrhea is a condition associated with the ovulatory cycle. During the luteal phase and subsequent menstrual flow, F2-alpha is secreted. The pain usually begins at the onset of menstruation and lasts for 8 to 48 hours. Anovulatory bleeding, which is common in the few months or years after menarche, is painless. Primary dysmenorrhea usually appears 6 to 12 months after menarche when ovulation is established. Excessive release of prostaglandin F2-alpha increases the amplitude and frequency of uterine contractions.

A young pregnant adolescent reports bleeding and abdominal pain and is diagnosed with an ectopic pregnancy. Which risk factors should the nurse look for in the client? Select all that apply. 1 Habit of smoking 2 Irregular menses 3 Use of contraceptive pills 4 Damage to the fallopian tubes 5 History of pelvic inflammatory disease

145 Adolescents who smoke experience a higher risk for ectopic pregnancy. Inflammation of the fallopian tubes and ovaries and a history of pelvic inflammatory disease are risk factors. The use of contraceptive pills and a history of irregular menses are not associated with ectopic pregnancy.

How do adolescents establish health identity during psychosocial development? Select all that apply. 1 By evaluating their own health with a feeling of well-being 2 By fostering their independence within a balanced family structure 3 By building close peer relationships to achieve acceptance in the society 4 By achieving marked physical changes with masculine and feminine behaviors 5 By having the ability to function normally in the absence of any disease or infirmity

15 Adolescents establish health identity by evaluating their own health with a feeling of well-being. They also establish health identity by being able to function normally in the absence of any disease or infirmity. An individual establishes family identity by fostering their independence within balanced family structure. By building close peer relationships, an adolescent establishes a group identity. The sound and healthy growth of adolescents, characterized by marked physical changes, helps to build sexual identity.

Which test is used to diagnose trichomoniasis? 1 Whiff test 2 Saline wet smear test 3 Normal saline smear test 4 Potassium hydroxide test

2 A saline wet smear test is used to diagnose trichomoniasis. A whiff test is used to diagnose bacterial vaginosis. A normal saline smear test is also used to diagnose bacterial vaginosis. A potassium hydroxide test is used to diagnose candidiasis.

Which of these stages is followed by the "society-maintaining orientation," according to the Kohlberg's theory? 1 "Social contract orientation" 2 "Good boy-nice girl orientation" 3 "Instrumental relativist orientation" 4 "Punishment and obedience orientation"

2 According to Kohlberg's theory, "good boy-nice girl orientation" (stage 3) is followed by "society-maintaining orientation" (stage 4). "Social contract orientation" is stage 5. "Instrumental relativist orientation" is stage 2. "Punishment and obedience orientation" is stage 1.

An adolescent displaying low self-esteem complains of inflamed, red, and painful lesions on his forehead. What condition does he have? 1 Varicoceles 2 Acne vulgaris 3 Open comedones 4 Closed comedones

2 Acne vulgaris is a common skin problem that adolescents experience. It is an inflammatory manifestation to the proliferation of Propionibacterium acnes. A varicocele is a collection of elongated and twisted superficial veins near the spermatic cord, superior to the testicle. Comedones are noninflammatory lesions.

What should a nurse emphasize when teaching lifelong management of type 1 diabetes to an adolescent? 1 Soaking the feet in hot water each day 2 Inspecting both feet frequently for signs of trauma 3 Drying the feet thoroughly after a bath by rubbing with a towel 4 Treating minor cuts on the feet with an antiseptic such as iodine

2 Adequate inspection of the feet should become a habit; it is the quickest and easiest means of identifying pressure sites and preventing infection. Hot water should never be used, because it may cause burn injury of the skin. The feet should be patted dry, not rubbed; rubbing may cause abrasions and injure the skin. Strong antiseptics are too harsh and should not be used because they may cause injury to the skin.

A teenager is being discharged with a cast. What should the nurse recommend if the client experiences pruritus around the cast edges? 1 "Scratch the itchy area gently." 2 "Put an ice pack on the affected area." 3 "Sprinkle a layer of powder around the itchy spots." 4 "Ask your doctor for a prescription for an antihistamine."

2 An ice pack numbs the area and may temporarily diminish the discomfort. Scratching stimulates the release of histamine, which worsens the pruritus; also, scratching may break the skin and open an avenue for infection. Powder may become caked and slip under the cast, causing additional discomfort. Also, powder should be avoided because it is toxic if inhaled. Antihistamines are not prescribed unless all other measures have failed.

A 13-year-old is found to have idiopathic scoliosis. She is upset about the treatment regimen and is worried about being different from her friends. What should the nurse do to help the child maintain a positive self-image during treatment? 1 Remind her how crooked her back will be if she refuses treatment. 2 Help her investigate appropriate clothing to enhance her appearance. 3 Disregard her negative characteristics and focus on her positive attributes. 4 Refer her for psychological counseling until the treatment program is completed.

2 Clothes can be selected to minimize the appearance of a brace, especially if an effort is made to wear current styles. Reminding the child how she will look without treatment has a negative connotation that emphasizes the problem. Focusing only on positive attributes may be misinterpreted as unqualified praise; adults should give honest appraisals of both positive and negative attributes. There are no data to indicate that the child will not adjust to the treatment regimen.

Which stage of Kohlberg's theory explains the influence of moral values on an individual's thought? 1 Good boy-nice girl orientation 2 Society-maintaining orientation 3 Instrumental relativist orientation 4 Universal ethical principle orientation

2 During the society-maintaining orientation stage, an individual expands focus from a relationship with others to societal concerns. These individuals may be influenced by moral values. During the good boy-nice girl orientation stage, an individual wants to win the approval of and maintain the expectations of one's immediate group. When a child wants to be on time for dinner, this action explains the instrumental relativist orientation stage. The universal ethical principle orientation stage defines "right" in accordance with self-chosen ethical principles.

An adolescent visits the allergy clinic because of seasonal environmental allergies, and blood is drawn for testing. Which laboratory finding indicates to the nurse that an allergic response is in progress? 1 Decreased platelet count 2 Increased eosinophil level 3 Increased lymphocyte count 4 Decreased immunoglobulin level

2 Eosinophils increase to inhibit the inflammatory response to histamine, which is released in allergic reactions. Platelets and lymphocytes are unrelated to allergic reactions. Immunoglobulins increase, not decrease, in response to an allergic reaction.

An adolescent reports scrotal pain, redness, dysuria, and fever. Which condition does this adolescent have? 1 Varicocele 2 Epididymitis 3 Testicular torsion 4 Testicular cancer

2 Epididymitis is a condition associated with scrotal pain, dysuria, redness, and fever. Varicocele can be palpated as a worm-like mass situated above the testicles. Manifestations of testicular torsion include nausea, vomiting, and abdominal pain. The presence of a heavy, hard mass that is palpable accompanied by back pain and shortness of breath is associated with testicular cancer.

A 15-year-old with cystic fibrosis (CF) is admitted with a respiratory infection. The nurse determines that the adolescent is cyanotic, has a barrel-shaped chest, and is in the 10th percentile for both height and weight. What is the priority nursing intervention? 1 Increasing physical activities 2 Performing postural drainage 3 Maintaining dietary restrictions 4 Administering prescribed pancreatic enzymes

2 Postural drainage, including percussion and vibration, aids removal of respiratory secretions that provide a medium for further bacterial growth. Children with CF must cope with impaired gas exchange that results in intolerance to activity. Increasing activity at this time may be too taxing. There must be a balance between activity and rest within the child's limitations. There are no dietary restrictions. Children with CF should have a balanced nutritional intake that is high in calories. Although important, administration of prescribed pancreatic enzymes is not the priority.

An unconscious 16-year-old adolescent with type 1 diabetes is brought to the emergency department. The blood glucose level is 742 mg/dL (41.2 mmol/L). What finding does the nurse expect during the initial assessment? 1 Pyrexia 2 Hyperpnea 3 Bradycardia 4 Hypertension

2 Rapid breathing is an attempt by the respiratory system to eliminate excess carbon dioxide; it is a characteristic compensatory mechanism for correcting metabolic acidosis. An increase in temperature will occur if an infection is present; it is not a response to hyperglycemia. Tachycardia, not bradycardia, results from the hypovolemia of dehydration. Hypotension, not hypertension, may result from the decreased vascular volume associated with hyperglycemia.

The nurse is helping an adolescent with iron-deficiency anemia make breakfast meal choices. Which foods should the nurse suggest? 1 Apple fruit cup 2 Bowl of raisin bran 3 Cup of blueberry yogurt 4 Slice of wheat bread toast with butter

2 The iron content in the options is as follows: ¾ cup raisin bran, 13.5 mg; one slice of wheat bread, 0.9 mg; 1 cup of blueberry fruit yogurt, 0.2 mg; and apple fruit cup, 0.2 mg. The best choice is the bowl of raisin bran cereal, which has the highest iron content of all the choices.

The mother of an adolescent asks the nurse, "What's the best way to remove a tick from the skin?" What is the best response by the nurse? 1 "Touch the tick with a lit cigarette." 2 "Remove the tick carefully with tweezers." 3 "Pour ammonia over the tick, and it will shrivel up." 4 "Spray the tick with insect repellent, and it will fall off."

2 The tick must be carefully removed with tweezers or forceps so the body and head are both removed; this technique prevents further inoculation of the individual. Using a lit cigarette, ammonia, or insect repellent is unsafe; the tick may further inoculate the child, and the method may hurt the child.

A 15-year-old plans to go to a nightclub without informing his or her parents but is afraid of being caught. Which behavior does this indicate? 1 Seriation 2 Invulnerability 3 Personal fable 4 Imaginary audience

2 When an adolescent goes to a club but fears getting caught by his or her parents, this action shows a sense of invulnerability. Feelings of invulnerability frequently lead to risk-taking behaviors. Seriation is the ability to mentally classify objects according to their quantitative dimensions. Personal fable is when adolescents think that their thoughts and feelings are unique. Adolescents have a belief that an imaginary audience constantly scrutinizes their actions.

Which stages are a part of conventional reasoning, according to the Kohlberg's theory of moral development? Select all that apply. 1 Social contract orientation 2 Good boy-nice girl orientation 3 Society-maintaining orientation 4 Instrument relativist orientation 5 Universal ethical principle orientation

23 According to Kohlberg's theory, good boy-nice girl orientation and society-maintaining orientation are parts of conventional reasoning. Social contract orientation is stage 5 under postconventional reasoning. Instrument relativist orientation is stage 2 of preconventional reasoning. Universal ethical principle orientation is stage 6 under postconventional reasoning of Kohlberg's theory.

Which statement describes stage 4 of Kohlberg's theory? Select all that apply. 1 Child recognizes that there is more than one right view. 2 Child shows respect for authority and maintains the social order. 3 Adolescents choose to avoid a party where they know beer will be served. 4 Individual wants to win approval and maintain the expectations of one's immediate group. 5 Child's response to a moral dilemma is in terms of absolute obedience to authority and rules.

23 According to stage 4 of Kohlberg's theory, adolescents show respect for authority and maintain the social order. They choose not to attend a party where beer will be served because they know this is wrong. During stage 2, the child recognizes that there is more than one right view. Stage 3 states that an individual wants to win approval and maintain the expectations of one's immediate group. During stage 1, the child's response to a moral dilemma is in terms of absolute obedience to authority and rules.

Which of these statements are true about an adolescent according to Lawrence Kohlberg's theory of moral development? Select all that apply. 1 "An individual recognizes that there is more than one correct view." 2 "An individual's thoughts are influenced by moral decisions and behaviors." 3 "An individual expands his or her focus from a relationship with others to societal concerns." 4 "An individual wants to win the approval of and maintain the expectations of one's immediate group." 5 "An individual's response to a moral dilemma is in terms of absolute obedience to authority and rules."

23 During the conventional reasoning level, an adolescent's thought is influenced by moral decisions and right behaviors. Also, adolescents expand their focus from a relationship with others to societal concerns. During the postconventional reasoning level, an individual follows societal laws but recognize the possibility of changing the law to improve society. During the preconventional reasoning stage, a child's response to a moral dilemma is in terms of absolute obedience to authority and rules. During the preconventional reasoning stage, an individual recognizes that there is more than one correct view, and wants to win the approval of and maintain the expectations of one's immediate group.

Which of these statements about pregnancy in the adolescent population are true? Select all that apply. 1 Infants of teen mothers are at risk of delivering babies late. 2 Pregnant adolescents often seek out less prenatal care. 3 Adolescent mothers need competent day care for their infants. 4 Infants of adolescent mothers are at increased risk for prematurity. 5 Fetuses of adolescent mothers are at higher risk for chromosomal defects.

234 Pregnant adolescents are less likely to seek out prenatal care. Adolescent mothers need competent day care for their infants. Infants born to adolescent mothers are more likely to be premature than are infants born to adult mothers. Infants born to teen mothers are at risk of being born prematurely. Pregnancies in older mothers are at greater risk for chromosomal defects.

An adolescent wants to have bariatric surgery. What are the criteria for this surgery? Select all that apply. 1 Regular exercise 2 Adherence to nutritional guidelines after surgery 3 BMI of at least 40 with severe obesity 4 Avoidance of pregnancy for 3 months after surgery 5 Ability to give informed consent to surgery

235 Bariatric surgery is performed on clients with morbid obesity. Adolescent after surgery should strictly adhere to the nutritional guidelines. A body mass index of at least 40 with severe obesity and other health problems is a criterion to have bariatric surgery. The adolescent should agree to avoid pregnancy for 1 year postoperatively. The adolescent should give informed consent to the surgery. Regular exercise is needed to stay healthy but is not a criteria.

Which genetically inherited syndromes are mostly recognized in adolescence? Select all that apply. 1 Down syndrome 2 Turner syndrome 3 Edwards syndrome 4 Angelman syndrome 5 Klinefelter syndrome

25 Turner syndrome and Klinefelter syndrome are the genetic disorders most commonly recognized in adolescence. Although these syndromes are associated with genetic abnormalities, they may not be detected until adolescence because abnormalities may not become apparent until the client reaches this growth stage. Down syndrome, Edwards syndrome, and Angelman syndrome are recognized in the prenatal to newborn periods.

"But you don't understand" is a common statement associated with adolescents. What is the nurse's best response when hearing this? 1 "I don't understand what you mean." 2 "I do understand; I was a teenager once too." 3 "It would be helpful to understand; let's talk." 4 "It's you who should try to understand others."

3 "It would be helpful to understand; let's talk" attempts to open the communication process. Reflecting the words, not the feelings, serves to entrench the communicant's position and does little to open the flow of communication. Saying "I was a teenager once too" shifts the focus away from the client. Telling the client to try to understand others is authoritative and closes the flow of communication.

At which stage does an adolescent develop abstract thinking? 1 Genital stage 2 Conventional reasoning 3 Formal operations period 4 Identity vs. role confusion

3 According to Piaget's moral development theory depicts, an adolescent develops abstract thinking during the formal operations period. According to Freud's genital stage, sexual urges reawaken and are directed to an individual outside the family circle. During the conventional reasoning stage, a person establishes his or her morals based on his or her own personal internalization of societal expectations. According to the identity versus role confusion stage, there is a marked preoccupation with appearance and body image.

Which period of Piaget's theory marks the end of cognitive development? 1 Sensorimotor 2 Preoperational 3 Formal operations 4 Concrete operations

3 According to Piaget's theory, the formal operations period marks the end of cognitive development. During this period, adolescents have the capacity to reason with respect to possibilities. The sensorimotor period is the first period when a newborn develops a schema or pattern for dealing with the environment. The second period is the preoperational period when a child develops egocentrism and animism. During the concrete operations period, children are able to perform mental operations.

Which of these behaviors does an adolescent exhibit? 1 Temper tantrums 2 Attempts to control situations 3 Synchronization of moral skills 4 Eagerness for formal education

3 Adolescents refine and synchronize physical, psychosocial, cognitive, and moral skills to become an accepted member of society. Toddlers tend to have temper tantrums. Toddlers also learn about how to control situations. Preschoolers refine the mastery of their bodies and eagerly await the beginning of formal education.

When teaching an adolescent with type 1 diabetes about dietary management, what instruction should the nurse include? 1 Meals should be eaten at home. 2 Foods should be weighed on a gram scale. 3 A ready source of glucose should be available. 4 Specific foods should be cooked for the adolescent.

3 An adolescent with type 1 diabetes must carry a source of simple sugar (e.g., glucose tablets, Insta-Glucose, sugar-containing candy such as LifeSavers) to rapidly counteract the effects of hypoglycemia. This should be followed by a complex carbohydrate and a protein. Stating that meals should be eaten at home is an unrealistic and unnatural instruction for an adolescent. Stating that foods should be weighed on a gram scale is an unnecessary and time-consuming procedure. The adolescent should be made to feel a part of the family; the recommended diet is nutritious and no different from that of the rest of the family.

What is female athlete triad? 1 Amenorrhea in athlete females 2 Hypogonadotropic amenorrhea 3 Amenorrhea, an eating disorder, and osteoporosis 4 Amenorrhea and osteoporosis

3 Athletes with amenorrhea, irregular eating habits and reduced nutritional intake, and osteoporosis are said to have female athlete triad. Simple amenorrhea is not considered female athlete triad. Hypogonadotropic amenorrhea results from a problem in the central hypothalamic-pituitary axis, where there is a hypothalamic suppression resulting in amenorrhea.

How do adolescents establish group identity during psychosocial development? 1 By evaluating their own health with a feeling of well-being 2 By fostering their independence with balanced family structure 3 By building close peer relationships in order to achieve acceptance in the society 4 By achieving marked physical changes with masculine and feminine behaviors

3 By building close peer relationships, adolescents develop a sense of belonging, approval, and the opportunity to learn acceptable behavior. This action establishes group identity. An adolescent establishes health identity by evaluating his or her own health with a feeling of well-being. An individual establishes family identity by fostering his or her independence within a balanced family structure. The sound and healthy growth of an adolescent, with marked physical changes, helps the adolescent build sexual identity.

Which nutrient deficiency in the pregnant adolescent may result in decreased birth weight as a consequence of low bone mineral density in the fetus? 1 Zinc 2 Iron 3 Calcium 4 Folic acid

3 Calcium and vitamin deficiency may result in decreased birth weight as a consequence of low bone mineral density. Zinc deficiency may not lead to a decrease in bone mineral density. Iron deficiency may lead to anemia. Folic acid deficiency may result in neural tube defects.

What transformations occur during the mid-puberty stage of a normally developing adolescent female? 1 Scanty and irregular menstrual periods 2 Appearance of pubic hair and an increase in normal vaginal discharge 3 Breast enlargement and the growth of pubic hair 4 Changes in the nipple and areola and the development of a small bud of breast tissue

3 During mid-puberty, the breast enlarges from a small bud of breast tissue, while pubic hair develops and covering the mons pubis and labia majora. Scanty and irregular menstrual periods are a characteristic feature of late-puberty. The first appearance of pubic hair, an increase in normal vaginal discharge, changes in the nipple and areola, and the development of a small bud of breast tissue occur during early-puberty.

The nurse is teaching a class about nutrition to a group of adolescents. Taking into consideration the prevalence of overweight teenagers, what is the best recommendation the nurse can make? 1 "Join a gym." 2 "Drink fewer diet sodas." 3 "Decrease fast food intake." 4 "Take a multivitamin daily."

3 Eating a variety of healthful foods instead of a fast-food diet that is high in fat and carbohydrates helps decrease excess weight and increase energy with which to engage in physical activities. Joining a gym is expensive and unnecessary. Physical activity can be achieved in the schoolyard or at home. A multivitamin will not promote weight loss. Vitamins and minerals are best obtained in a balanced diet. Diet soft drinks do not contribute to obesity.

An 18-year-old adolescent male complains of painful urination and yellow-green mucosal discharge from urethra not associated with abdominal pain. What condition is the client likely to have? 1 Varicocele 2 Testicular torsion 3 Epididymitis 4 Gynecomastia

3 Epididymitis is a condition characterized by dysuria, pyuria, scrotal pain, redness, and swelling. Epididymitis is not associated with gastrointestinal symptoms as in testicular torsion. Varicocele is a condition characterized by elongation, dilation, and tortuosity of the veins of the spermatic cord superior to the testicle which is not associated with urethral discharge. Gynecomastia has no symptoms of abnormal urethral discharge.

An adolescent who has just been found to have type 1 diabetes asks a nurse about exercise. What is the best response by the nurse? 1 "Exercise should be restricted." 2 "Exercise will increase blood glucose." 3 "Extra snacks are needed before exercise." 4 "Extra insulin is required during exercise."

3 Exercise lowers the blood glucose level; an extra snack can prevent hypoglycemia. Exercise is encouraged, not restricted. Exercise lowers, not increases, blood glucose. Extra insulin is contraindicated because exercise decreases the blood glucose level; extra insulin may precipitate hypoglycemia.

Which event is considered as the hallmark of late puberty in young girls? 1 Breast enlargement 2 Adult type sexual hair 3 First menstrual period 4 Physiologic leukorrhea

3 First menstrual period is considered the hallmark of late puberty in young girls. Breast enlargement along with change in pubic hair to adult type sexual hair covering the mons pubis and labia majora occurs during mid-puberty stage. Physiologic leukorrhea (increased normal vaginal discharge) marks the uterine development early in puberty.

In which period of Piaget's theory does the adolescent feel a sense of invulnerability? 1 Sensorimotor 2 Preoperational 3 Formal operations 4 Concrete operations

3 In the formal operation period, the fourth period of Piaget's theory, the adolescent feels a sense of invulnerability. This leads to risk-taking behaviors. In the sensorimotor period, the first period of Piaget's theory, the infant develops a schema or action pattern for dealing with the environment. Period II is the preoperational period. During this time, a child learns to think with the use of symbols and mental images. The period of concrete operations is the third period of Piaget's theory. At this time, the child is able to coordinate two concrete perspectives in social and scientific thinking.

Which statement about levonorgestrel requires correction? 1 Levonorgestrel is an over the counter drug. 2 Levonorgestrel is an emergency contraceptive. 3 Levonorgestrel is taken in combination with methotrexate. 4 Levonorgestrel should be taken within 120 hours of intercourse.

3 Methotrexate is a drug prescribed for inducing abortion; this drug is used in combination with misoprostol. Levonorgestrel is an over-the-counter medication that is given without a prescription. It is an emergency contraceptive that should be taken within 120 hours of intercourse.

An adolescent who has had a leg amputated because of bone cancer begins to experience phantom limb sensations. How should the nurse respond when the client complains of pain and requests medication? 1 By withholding the medication to help prevent addiction 2 By stating that the limb has been removed and that the pain is psychological 3 By acknowledging that the pain is real and administering medication to relieve it 4 By explaining that the phantom limb sensation will subside within a few more days

3 Pain medication is required, along with intensive supportive nursing care. To the client the pain is real, requiring pain medication; addiction is not a concern at this time. Explaining that the pain is psychological in origin does not help relieve the pain; medication and emotional support are required. The pain may not recede within a few days; pain medication should be administered.

An adolescent with terminal cancer tells the home care nurse, "I'd really like to get my general education development (GED) certificate. Do you think that's possible?" What is the best approach for the nurse to take in response to the adolescent's question? 1 Refocusing the conversation on things the adolescent has already accomplished in life 2 Trying to help the adolescent understand that this goal is too taxing and slightly unrealistic 3 Arranging a conference with the school and encouraging the adolescent to prepare for the test 4 Suggesting to the adolescent that this energy should be directed toward expressing feelings about the illness

3 Passing the high school equivalency test is the client's desire, and the nurse should do everything possible to help the client fulfill the goal. Refocusing the conversation on things that the adolescent has already accomplished in life is not therapeutic; the client has an unmet need, and the nurse should not try to refocus the client away from the stated objective. The client should be encouraged, not discouraged; mental activity is not too taxing and is not unrealistic if the client wishes to engage in it. There are no data supporting the conclusion that the client needs to work through feelings about the illness.

A professor asks a student nurse to explain the stage when an adolescent has prevalence of egocentric thought. Which period of the Piaget's theory will the nurse explain? 1 Sensorimotor 2 Preoperational 3 Formal operations 4 Concrete operations

3 Piaget's theory divides child development into four periods. During the period of formal operations, there is a prevalence of egocentric thought in adolescents. During the sensorimotor period, infants develop a schema or action pattern for dealing with the environment. During the preoperational period, a toddler has egocentric thoughts. During the concrete operations period, the child thinks about an action before it was performed physically.

A nurse is caring for a 13-year-old child who has an external fixation device on the leg. What is the nurse's priority goal when providing pin care? 1 Easing pain 2 Minimizing scarring 3 Preventing infection 4 Preventing skin breakdown

3 Pin sites provide a direct avenue for organisms into the bone. Pin care will not ease pain. Some scarring will occur at the pin insertion site regardless of pin site care. Skin has a tendency to grow around the pin, rather than break down, as long as infection is prevented.

An obese adolescent who has short stature and is hyperphagic is diagnosed with hypogonadism. Which congenital disorder may be present in this adolescent? 1 Alström syndrome 2 Laurence-Moon-Biedl syndrome 3 Prader-Willi syndrome 4 Pseudohypoparathyroidism

3 Prader-Willi syndrome is a congenital disorder characterized by hypogonadism. The client may have short stature and be hyperphagic. Alström syndrome, Laurence-Moon-Biedl syndrome, and pseudohypoparathyroidism are congenital disorders characterized by obesity but not hypogonadism.

Which drug used to treat syphilis is contraindicated in pregnancy? 1 Miconazole 2 Clotrimazole 3 Tetracycline 4 Metronidazole

3 Tetracycline can be administered to clients with syphilis who are allergic to penicillin G. This drug is contraindicated in pregnant women, as it can cause birth defects or staining/discoloration to the fetus' developing teeth if given during the second trimester. Miconazole and clotrimazole are used to treat candidiasis. Metronidazole is used to treat bacterial vaginosis.

The nurse is teaching crutch-walking to a 12-year-old adolescent. What does the child do that indicates the need for more teaching? 1 Takes short steps of equal length 2 Looks forward to maintain balance 3 Looks down when placing the crutches 4 Assumes an erect posture when walking

3 The child should maintain an erect walking posture, without looking down, to ensure equilibrium and prevent loss of balance. Taking short steps is the correct technique for safe ambulation while crutch-walking. Looking forward is the correct technique for safe ambulation while crutch-walking; it keeps the body's center of gravity over the hips. Maintaining an erect posture is the correct technique for safe ambulation during crutch-walking; it keeps the body's center of gravity over the hips.

Which statement regarding the teenage diet is true? 1 Adolescents are fond of healthy food 2 Adolescents need vitamin supplements 3 Adolescents need high amounts of calories 4 Adolescents require low amounts of protein

3 The energy needs of teenagers increase to meet the greater metabolic demands of growth. Adolescents are fond of eating fast food at restaurants. Vitamin supplements are not required for teenagers. The daily requirement of protein increases in teenagers.

A 13-year-old adolescent is found to have idiopathic scoliosis. Because exercise and avoidance of fatigue are essential components of care, which sport should the nurse suggest as the most therapeutic for this preadolescent? 1 Golf 2 Bowling 3 Swimming 4 Badminton

3 The hyperextension required in swimming helps strengthen back muscles and necessitates deeper respirations, both of which are necessary before surgery and before wearing a brace or cast. The other options involve twisting the back muscles, which is not therapeutic for a child with this condition.

A 16-year-old girl with sickle cell anemia is experiencing a painful episode (vaso-occlusive crisis) and has a patient-controlled analgesia (PCA) pump. She complains of pain (5 on a scale of 1 to 10) in her right elbow. The nurse observes that the pump is "locked out" for another 10 minutes. What action should the nurse implement? 1 Turning on the television for diversion 2 Calling the primary healthcare provider for another analgesic prescription 3 Placing the prescribed as-needed warm, wet compress on the elbow 4 Informing her gently that she must wait until the pump reactivates to get more medication

3 Vasodilation should help reduce pain from cellular clumping; applying a warm, wet compress will address the pain until the pump can be activated. Television may be an adequate distractor for mild pain, not moderate or severe pain. Nursing measures should be attempted first to relieve the pain before the primary healthcare provider is called. Telling the adolescent to wait provides no comfort.

What are the treatment goals in anorexia nervosa? Select all that apply. 1 The development of a calorie-restricted diet plan 2 The development of a regular exercise schedule 3 The repairing of family interactions 4 The reinstitution of normal nutrition to counteract a state of malnutrition 5 The correction of deficits and distortions in psychological functioning via psychotherapy

345 Clients with anorexia nervosa have a strong fear of becoming overweight. This is characterized by reduced nutritional food intake causing progressive weight loss and malnutrition. These clients usually have impaired family interactions due to low self-esteem. Therefore, the treatment goals should consist of repairing family interactions, reinstituting normal nutritional meals, and correcting deficits and distortions in psychological functioning.

What are the physiologic changes noticed in an adolescent during puberty? Select all that apply. 1 Increase in the respiratory rate 2 Increase in the number of neurons 3 Increase in number of neural connections 4 Decrease in the basal body temperature gradually 5 Increase in serum iron, hemoglobin, and hematocrit

345 During puberty, as a part of normal physiologic growth, there is proliferation of support cells that nourish the neurons along with increase in number of neural connections in the brain. The basal body temperature decreases gradually and reaches adult value by 12 years of age. The size and strength of heart, blood volume, systolic blood pressure, serum iron levels, hemoglobin, and hematocrit values increase whereas heart rate decreases and reaches adult value. The diameter and length of the lungs increase, but respiratory rate decreases gradually to reach the adult value by adolescence. The growth of neurons does not increase but slows to a more gradual rate by adolescence.

What drugs are used to induce abortion in an adolescent? Select all that apply. 1 Leuprolide 2 Zidovudine 3 Misoprostol 4 Mifepristone 5 Methotrexate

345 Misoprostol is a prostaglandin analog that acts directly on the cervix, stimulating contractions. Mifepristone acts by binding to progesterone receptors and blocking the action of progesterone, which is necessary for maintaining a pregnancy. Methotrexate is a cytotoxic drug that can cause early abortion by blocking folic acid in fetal cells. Leuprolide is a gonadotropin-releasing hormone (GnRH) agonist used to treat endometriosis. Zidovudine is an antiviral drug used in a pregnant woman in the prenatal and the perinatal periods to prevent the transmission of human immunodeficiency virus to the fetus.

What is gynecomastia? Select all that apply. 1 Inflammation of epididymis of testis 2 Suspended testis from its vascular structures 3 Bilateral or unilateral enlargement of breast in adolescent boys 4 Elongation and dilation of the veins of the spermatic cord superior to the testicle 5 An unusual physical change during the growth and development of sexual organs

35 Gynecomastia is a bilateral or unilateral enlargement of breast seen in adolescent boys. It is an unusual change during growth and development and subsides on its own. Gynecomastia is caused by a hormone imbalance of testosterone and estrogen. Epididymitis is inflammation of epididymis of testis. Intravaginal torsion of the testicle is a condition in which the tunica vaginalis, which normally encases the testicle, fails to do so and the testis hangs free from its vascular structures. A varicocele is characterized by elongation, dilation, and tortuosity of the veins of the spermatic cord superior to the testicle.

Which gonadotropin-releasing hormone agonists are used to treat endometriosis? Select all that apply. 1 Trazodone 2 Diclofenac 3 Leuprolide 4 Isotretinoin 5 Nafarelin acetate

35 Leuprolide and nafarelin acetate are gonadotropin-releasing hormone (GnRH) agonists used to treat endometriosis. Trazodone is used in cases of erectile dysfunction. Diclofenac is a nonsteroidal antiinflammatory drug used to relieve pain in endometriosis. Isotretinoin is an oral agent that is effective against severe cystic acne.

Which of these statements regarding adolescents are true? Select all that apply. 1 Homicide is infrequent among adolescents. 2 Suicide is the leading cause of death in adolescents. 3 The United States has the highest rate of teenage pregnancy. 4 Half of all adolescents have use alcohol by the end of the high school. 5 Anorexia nervosa and bulimia are two eating disorders found in adolescence.

35 The United States has the highest annual rates of teenage pregnancy and childbearing among the industrialized nations. Anorexia nervosa and bulimia are two eating disorders found in adolescents. Homicide is not infrequent; it is the second leading cause of death among adolescents. Motor vehicle accidents, not suicide, are the leading cause of death among adolescents. Eighty-five percent of adolescents, not 50%, have used alcohol by the end of high school.

A 14-year-old teenager with type 1 diabetes wants to go out to eat with friends after a volleyball game. The teenager asks the school nurse whether this is permissible on the insulin/diet/exercise regimen that has prescribed. How should the nurse respond? 1 "Fast foods are unhealthy, especially for teenagers with diabetes." 2 "It would be best if you ate at home, where you can control your diet." 3 "Go with your friends but make an effort to eat something other than pizza." 4 "I'll teach you how to determine the amount of carbohydrates in different fast foods."

4 A fast food exchange list allows the diabetic teenager to participate in postgame activities without feeling different from peers; this is important to the adolescent. The nutritional benefits of fast foods are not the issue. The adolescent needs to learn how to select appropriate foods when away from the home environment; this will promote social interaction with peers. Eating a different food when all of the friends are eating pizza will make the adolescent feel different from the peers; the temptation not to adhere to the diet may be too great to resist.

Which information is correct about the cognitive changes of a teenager? 1 A teenager deals with actual problems. 2 A teenager thinks in terms of the present. 3 A teenager cannot consider the possibilities of a situation occurring. 4 A teenager considers an infinite variety of causes and solutions.

4 A teenager considers an infinite variety of causes and solutions when encountered with a problem. A teenager is able to deal with hypothetical problems and takes the future into consideration. A teenager is able to imagine multiple outcomes of a situation.

At which stage of Kohlberg's theory does an individual show societal concerns? 1 Stage I 2 Stage II 3 Stage III 4 Stage IV

4 According to Kohlberg's theory of moral development, at stage IV the individual expands focus from a relationship with others towards societal concerns. At stage I, the child is afraid of punishment. A child in this stage reasons, "I must follow the rules; otherwise I will be punished." At stage II, the child recognizes that there is more than one right view. At stage III, the child wants to win approval and maintains the expectations of one's immediate group.

An adolescent tries dangerous stunts on a bike without fearing that this activity could result in life-threatening injury. Which characteristic does this signify? 1 Animism 2 Personal fable 3 Imaginary audience 4 Sense of invulnerability

4 Adolescents have the belief that they are invulnerable. Feelings of invulnerability often lead to risk-taking behaviors, especially in early adolescence. A toddler experiences animism, in which he or she personifies objects and believes that they have feelings. The personal fable is seen in adolescents; the adolescent thinks of him- or herself as the center of attention and believes that he or she is unique. Adolescents also feel that they have an imaginary audience, enthusiastically listening to or watching him or her.

An adolescent with Duchenne muscular dystrophy has received care at the pediatric clinic since early childhood. Of which body system should the nurse perform a focused assessment to identify life-threatening complications as the child ages? 1 Neurologic 2 Gastrointestinal 3 Musculoskeletal 4 Cardiopulmonary

4 As muscular degeneration advances in the adolescent, the diaphragm, auxiliary muscles of respiration, and heart are affected, resulting in life-threatening respiratory infections and heart failure. Central nervous system functioning is not affected by Duchenne muscular dystrophy. Nutritional problems are less of a priority than cardiopulmonary problems. Although the musculoskeletal system will exhibit marked degeneration, it is second in priority to the cardiopulmonary changes.

An adolescent girl with a seizure disorder refuses to wear a medical alert bracelet. What should the nurse tell the girl that may help her wear the bracelet consistently? 1 Hide the bracelet under long-sleeved clothes. 2 Wear the bracelet when engaging in contact sports. 3 Ask her friends to wear bracelets that look like hers. 4 Select a bracelet similar to bracelets worn by her peers.

4 Because adolescents have a developmental need to conform to their peers, the teenager should be able to select a bracelet of a design similar to that of those worn by her peers. Hiding the bracelet under long-sleeved clothes might be acceptable in cool weather, but not when it is warm and friends are wearing T-shirts. The bracelet should be worn at all times when the girl is not with responsible family members. Asking friends to wear a similar bracelet may be difficult, especially if the girl does not wish to tell her friends why she needs the bracelet.

What is the most major cause of acne in adolescent women? 1 Stress 2 Dietary intake 3 Family history 4 Hormonal imbalance

4 Hormonal imbalances cause premenstrual flares of acne in nearly 70% of women. A clear association between stress and acne has not been demonstrated. A research study showed that 45% of adolescent men have a family history of acne. Studies show some evidence of an association between the intake of dairy products and high glycemic-index foods and acne.

An 18-year-old adolescent who was diagnosed with new-onset type 1 diabetes mellitus has stress and reports not having a menstrual cycle for a long time. Which condition is the adolescent experiencing? 1 Amenorrhea 2 Primary amenorrhea 3 Female athlete triad 4 Hypogonadotropic amenorrhea

4 Hypogonadotropic amenorrhea may occur in type 1 diabetic adolescents experiencing stress. This condition can also result from sudden and severe weight loss, eating disorders, strenuous exercise, and mental illness.

Which period of Piaget's theory explains self-consciousness in an adolescent? 1 Period I 2 Period II 3 Period III 4 Period IV

4 In period IV of Piaget's theory, an adolescent demonstrates feelings and behaviors characterized by self-consciousness. During period I, an infant develops a schema or action pattern for dealing with the environment. During period II, the child demonstrates animism, in which he or she personifies objects. While going through period III, the child thinks about an action that earlier was performed physically.

A nurse teaches a teenager who is undergoing chemotherapy about the need for special mouth care because of the potential for lesions. What statement by the teenager leads the nurse to conclude that the instructions have been understood? 1 "I'll brush my teeth with baking soda." 2 "I'll use mouthwash to rinse my mouth." 3 "I'll swish my mouth out with hydrogen peroxide." 4 "I'll use a soft-bristled toothbrush to clean my teeth."

4 Soft bristles are less irritating to the oral mucosa and less likely to cause trauma than irritating substances are. Baking soda, mouthwash, and hydrogen peroxide are all caustic substances that may irritate the mucosa.

A nurse is caring for a 15-year-old client who is undergoing chemotherapy for leukemia. What does the nurse recognize that adolescents with health problems are most concerned about? 1 Missing time at school 2 Limiting social activities 3 Being dependent while enjoying the sick role 4 Feeling different regarding changes in body image

4 The 15-year-old is preoccupied with appearance. The side effects of the antineoplastics and prednisone may result in the adolescent feeling different, which affects body image. Although missing school may be a concern, it is typically not the primary concern. Although limitation of social activities is a concern, it is not the primary concern. Socialization can be facilitated. A 15-year-old enjoys and strives for independence and does not enjoy the sick role.

A nurse is reviewing the laboratory report of a 13-year-old adolescent with type 1 diabetes. What test is considered the most accurate in the evaluation of the effectiveness of diet and insulin therapy over time? 1 Blood pH 2 Serum protein level 3 Serum glucose level 4 Glycosylated hemoglobin

4 The glycosylated hemoglobin (GHb) test provides an accurate long-term index of the child's average blood glucose level for the 10- to 12-day period before the test; the more glucose the red blood cells were exposed to, the greater the GHb percentage. A high blood pH may indicate developing ketoacidosis, but it reflects short-term variations. Serum protein readings do not reflect the effectiveness of glucose management. Serum glucose readings reflect short-term (hours) variations.

Which method of contraception may provide adolescents with the longest duration of protection? 1 NuvaRing 2 Levonorgestrel implant 3 Spermicidal suppositories 4 Levonorgestrel intrauterine system

4 The levonorgestrel intrauterine system is a T-shaped intrauterine system which releases levonorgestrel. It must be placed within seven days of menses and provides protection up to five years. The NuvaRing, a flexible, soft, and transparent ring placed in the vagina, must be replaced every three weeks. The levonorgestrel implant is a small rod that provides protection for up to three years. Spermicidal suppositories are inserted into the vagina to kill sperm and provide protection for only a short duration.

What is the average optimal blood pressure of an adolescent? 1 85/54 mm Hg 2 95/65 mm Hg 3 105/65 mm Hg 4 110/65 mm Hg

4 The optimal blood pressure of an adolescent is 110/65 mm Hg. The average optimal blood pressure in an infant is 85/54 mm Hg. The average optimal pressure in a toddler is 95/65 mm Hg. The average optimal blood pressure seen in children between the ages of 6 and 13 is 105/65 mm Hg.

According to the Erikson's theory, which stage describes the will of an adolescent to achieve a goal? 1 Initiative versus guilt 2 Integrity versus despair 3 Intimacy versus isolation 4 Identity versus role confusion

4 The stage of identity versus role confusion is the fifth stage of development as per Erikson's theory. During this stage, identity development begins with the goal of achieving some perspective or direction. The initiative versus guilt stage is the third stage of Erikson's theory. During this stage, children like to pretend and try out new roles. The integrity versus despair stage is the eighth stage of Erikson's theory. At this stage, many older adults view their lives with a sense of satisfaction. The development of sense of care in a young adult occurs at the stage of intimacy versus isolation. This is the sixth stage of development according to Erikson's theory.

Which statement is true regarding varicoceles? 1 Varicoceles are commonly seen in prepubertal children. 2 Varicoceles result in a partial or complete venous occlusion. 3 Varicoceles result in a red, warm, and edematous scrotum. 4 Varicoceles cause an elongation of the veins of the spermatic cord.

4 Varicocele is characterized by a dilation and elongation of the veins of the spermatic cord that is presently superior to a testicle. This condition is rarely seen in prepubertal children. Testicular torsion results in partial or complete venous occlusion. In cases of severe torsion, the scrotum becomes red, warm, and edematous.

What are the greatest risks for injury for an adolescent? Select all that apply. 1 Poisoning 2 Abduction 3 Home accidents 4 Substance abuse 5 Automobile accidents

45 Substance abuse and automobile accidents pose the greatest risks of injury among adolescents. Poisoning and child abduction are more common among toddlers and preschoolers. Home accidents are common among toddlers as well.

According to current studies, what percentage of adolescents has used alcohol by the end of high school? Record your answer using a whole number. _____%

Current statistics show that by the end of their high school years, 85% of adolescents have used alcohol.

Arrange the pathophysiologic events of acne in the correct sequence. 1. Immune response and inflammation 2. Excessive sebum production 3. Alterations in follicular growth and differentiation 4. Colonization of Propionibacterium acnes

Excessive sebum production occurs with the maturation of adrenocortical glands. This action is followed by alterations in follicular growth and differentiation. Propionibacterium acnes proliferate and increase in number. This proliferation leads to an accumulation of neutrophils, which causes the formation of papules, pustules, nodules, and cysts and subsequent inflammation.

Arrange in order the steps involved in the changes that occur during puberty. 1. Stimulation of the gonadal response 2. Triggering of GnRH by the hypothalamus 3. Movement of GnRH through a network of capillaries to the anterior pituitary gland 4. Stimulation of production and secretion of FSH and LH

Some events trigger the production of gonadotropin-releasing hormone (GnRH) by the hypothalamus. GnRH travels through a network of capillaries to the anterior pituitary gland and stimulates the production and secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). When the levels of these hormones increase, they in turn stimulate the gonadal response.