Prep-u: Chapter 7: Growth and Development of the Adolescent

A 16-year-old girl has arrived for her sports physical with a new piercing in her navel. Which response by the nurse is best?

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

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

"Boys your age will often continue growing for a few more years." Teenage boys can experience growth in height until age 17.5. The nurse should reassure the teen that this may happen for him. Telling the client not to be ashamed, or assuring him it is not as short as his peers fails to provide information or support. Determining the height of the other men in the family may be indicated at a later time but is not the most appropriate initial comment

The nurse is caring for a 13-year-old girl. The child has been identified as overweight with no underlying psychological or secondary causes. The nurse is reviewing the child's weight-loss progress and nutrition at a follow-up visit. What finding indicates a need for further discussion and teaching?

"Her goal is to be a size smaller by our vacation in two weeks." The mother must be reminded that a successful weight loss program emphasizes long-term permanent changes, not rapid weight loss or short-term diets to meet a short-term goal.

The nurse is counseling an overweight, sedentary 15-year-old girl. The nurse is assisting her to make appropriate menu choices. Which statement indicates the adolescent understands how to make appropriate dietary selections?

"I need to have 4 servings of fruit each day." The sedentary teen needs to consume approximately 1,600 calories each day. The recommended number of daily servings of fruit is four. A balanced diet includes a small amount of fat. To avoid all fat could place the child's health at risk. Protein intake is important for the development of tissue. The teen will need about 5 ounces of protein daily.

An adolescent's mother states that she does not know what to do with him: He is taking two or three showers a day when not that long ago she could barely get him to take a bath at all. What should the nurse's reply be to the mother?

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

Evan, a 14-year-old, and his mother are in the office for an annual visit and his mother jokes openly in front of you about the changes in Evan's voice and the hair under his armpits. What is an appropriate response from the nurse when she is talking with the mother?

"Remember that he can become modest and self-conscious and teasing may cause embarrassment."

An adolescent confides in the nurse that he is currently in a homosexual relationship with a classmate. He states, "I am not sure if I am really gay?" What is the best response by the nurse?

"Some teenagers experiment with homosexuality at this age. It may take some time before you determine if you are gay." Adolescents may experiment with homosexual behavior, though homosexual behavior as a teen does not necessarily indicate that the adolescent will maintain a homosexual orientation

A 15-year-old female adolescent tells the nurse she would like to get a tattoo. What response by the nurse is most appropriate?

"Tattoos are invasive and there is the potential for disease with their application."

The mother of an African-American adolescent voices concern to the nurse because her daughter, "has gotten her period before all of her friends." How should the nurse respond?

"That must be difficult, but on average African-American girls start their period earlier than other ethnicities." Menarche, the first menstrual period, usually begins between the ages of 9 and 15 years (average 12.8 years), but on average African-American girls reach menarche earlier than other ethnicities.

In discussing the psychosocial development of the adolescent, it is important to understand that in order for adolescents to be in intimate relationships in which feelings are mutually shared, both persons must have:

A sense of trust and identity In order to be intimate or to share one's deepest feelings with another person, is impossible unless both persons have established a sense of trust and a sense of identity.

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

Activation of androgen hormones. As androgen rises with puberty, sebaceous glands are activated to increase production of sebum, which leads to plugging of ducts (comedones).

A nurse is explaining cognitive development in children to a client, with the help of Piaget's theory of cognitive development. What would be the best explanation by the nurse about the formal operations level of cognitive development?

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

The school nurse is assessing a 16-year-old girl who was removed from class because of disruptive behavior. She arrives in the nurse's office with dilated pupils and is talking rapidly. Which drug might she be using?

Amphetamines Amphetamine use manifests as euphoria with rapid talking and dilated pupils. Signs of opiate use are drowsiness and constricted pupils. Barbiturates typically cause a sense of euphoria followed by depression. Marijuana users are typically relaxed and uninhibited

The school nurse is providing nutritional guidance to a 9th-grade health class. Which foods should the nurse recommend as good sources for calcium?

Cheese, yogurt, and white beans

The nurse is working with a teenage patient. He has relatively straight teeth, but his lower front teeth are slightly crossed over. The nurse suggests to the child's caregiver that an orthodontist see him. What is the reason the nurse might make this suggestion?

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

Marijuana use has no long-term side effects.

False Long-term side effects of marijuana can include pulmonary disorders such as sinusitis, bronchitis, emphysema, and perhaps lung cancer (which can develop after only 1 year of continual use compared with 20 years of cigarette use), as well as lack of sperm formation or subfertility in males

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

Identity vs. role confusion They must develop their own personal identity—a sense of being independent people with unique ideals and goals

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

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

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

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

Based on the most frequent cause of death in adolescents, what preventive measure would the nurse most want to teach an adolescent?

Motor-vehicle safety Motor-vehicle accidents are the number one cause of death in adolescents.

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

Nocturnal emissions This involuntary ejaculation during the night can be disturbing to the adolescent male who has little or no understanding of what is happening in his body.

A client tells the nurse that she has noticed an increase in her weight and fat deposits during the last year. The nurse reviews the client's chart and recognizes that the client is most likely going through puberty. Which nursing action is most appropriate at this time?

Provide reassurance that these are normal changes. Increased fat deposits and weight and height changes are normal as girls begin hormonal changes of puberty. During adolescence, girls are very sensitive about their appearance and constant need for reassurance. Puberty is a period when children are very self-conscious about their overall appearance. Reassurance needs to be provided that increased fat deposits and weight and height changes are normal

The activity that would best foster the developmental task of an adolescent who is physically challenged would be:

Talking to another adolescent who has a similar disorder. A sense of identity is developed by "trying on" roles and discussing values and goals with others.

Jamie, an 18-year-old, comes to the clinic. In the health history she reveals that she has a nipple ring and is looking to get a tattoo in the next few months. What is the most important thing that the nurse can teach her at this time?

Tattooing carries risks such as infection, disease, and nerve damage. The nurse needs to emphasize that tattoos and body piercing can be painful, and carry risks of complications such as infection, blood-borne diseases, keloids and granulomas, allergic reactions, excessive bleeding, nerve damage, or damage to the piercing site. Complications are more likely if they tattoo themselves or have the tattoos done by a friend. The nurse needs to encourage the adolescent to seek the expertise of a trained technician, doctor, or nurse to have the piercing, tattooing, or branding done

The nurse is assessing the psychosocial development of an an adolescent. The nurse determines that the client is in the middle post-conventional phase with which observation?

The adolescent tells the nurse, "I'm starting to think that some of my friends care a lot more about what other people think of them than what I do." According to Kohlberg, the middle post-conventional phase is characterized by the adolescent developing their own set of morals by evaluating individual morals in relation to peer, family, and societal morals. This is demonstrated when the adolescent stated. The early post-conventional phase is characterized by asking broad, usually unanswerable questions about life such as the question about God. During the late post-conventional phase the adolescent internalizes their own morals and values, and continue to compare own morals and values to those of society. During this phase the adolescent also evaluates morals of others.

What best describes Erikson's psychosocial development task for the adolescent child?

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

The nurse is admitting a 15-year-old to the pediatric unit. What does the nurse recognize as a priority for this child?

The child's need for privacy should be respected. Adolescents must be given privacy, individualized attention, confidentiality, and the right to participate in decisions about their health care.

Suicide is so common in adolescents it ranks third as a cause of death in the 10- to 24-year-old age group.

True

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

• "I notice you have a new piercing. Be sure to clean it twice a day so you don't get an infection." • "Did they tell you when you got your piercing how important cleaning it is? Infections can take up to a year to heal in a naval piercing."

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

• Face the teen during the interaction. • Use open-ended questions. • Let the teen know that you may not know all the answers for their questions. • Ask that the teen be open and patient when you are providing information.

The mother of a 9-year-old female voices concern to the nurse about her daughter developing breasts "at such a young age." How should the nurse respond?

"I understand your concern, but girls typically enter puberty around the age of 9 or 10." Voicing empathy regarding the mother's concern conveys support, and letting her know that this is normal growth and development helps ease her concerns. The other responses don't address her concerns or show genuine empathy.

The nurse is collecting data from a teen being seen for a well-child check-up. During the interview, the teen reports he sleeps about 6 hours per night during the week but is able to sleep 8 to 9 hours per night on the weekend. What response by the nurse is most appropriate?

"Let's talk about ways to increase the amount of rest you get during the week." It is recommended that teens get 8 to 9.5 hours of sleep per night. Teens who do not get adequate rest during the week often sleep more hours on the weekend. The best practice would be to determine ways to improve daily rest patterns.

Parents comment that their son seemed more coordinated on the basketball floor at 12 years than he does now at 14. The nurse can include what information in the response?

Rapid and uneven growth of early adolescence (11 to 14 years) can interfere with coordination. Uneven growth of soft tissues and bones during growth spurts can cause decreased coordination for boys. The age of 14 years is usually the time of peak height velocity (PHV).

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

Teens can be exposed to inappropriate materials, harassment, threats, and potential for molestation.

The nurse is discussing the topics of sex and sexuality and how to discuss these issues with a group of caregivers of adolescents. Which statement made by the nurse is most appropriate to tell this group of caregivers?

"Being honest and straightforward with teenagers will encourage them to ask their parents about subjects like sexuality

Jenny is a 15-year-old who is being seen today in the clinic, and her mom comments on the fact that Jenny seems to always choose the opposite of what everyone else wants and that her mood swings are a common occurrence. What statement below shows the nurse that Jenny's mom understands these changes?

"This is common for this age group and it will get better with time." During the middle adolescence the teenager spends more time ignoring adult authority and becomes more reliant on peer relationships. Adolescents might choose a stance directly opposite that of their parents and use peer support to back their ideas. Mood swings are a common occurrence during the adolescent period and they tend to smooth out and the teen will become more introspective. By late adolescence emotions become more consistent

The nurse is caring for an 11-year-old girl. The girl's mother reports that the girl does not want to play team sports like soccer or volleyball anymore. Her daughter insists she does not enjoy them. The mother is concerned that her daughter will not get enough physical activity and asks the nurse for guidance. How should the nurse respond?

"Give her some options; it's important to find something she enjoys."

The nurse is performing a health surveillance visit with a 12-year-old boy. Which characteristic suggests the boy has entered adolescence?

Experiences frequent mood changes If the boy has just entered adolescence, he is likely to exhibit frequent mood changes. A growing interest in attracting girls' attention and understanding that actions have consequences are typical of the middle stage of adolescence. Feeling secure with his body image does not occur until late adolescence

When discussing the growth and development of an adolescent, the nurse refers to various theories and phases of development. A nurse is discussing Erikson's theory of psychological development with an adolescent client. Based on Erikson's theory of psychosocial development, which should the nurse identify as the major challenge faced by adolescents?

Achieving their own identity According to Erikson's theory of psychosocial development, the major challenge of adolescence is the achievement of identity. Achieving independence from parental domination is another task of adolescence, but not the ultimate one.

A 16-year-old's caregivers are worried about changes in his behavior. He has always been industrious in his schoolwork and very focused on sports. Now he has a girlfriend and seems to spend almost all of his time with or on the phone with her and little or no time on his schoolwork. What information might the nurse offer these caregivers about this behavior?

He has developed his own identity by now; being able to establish close relationships with girls is important preparation for all of his adult relationships. They should honor his need to be with or talk to his girlfriend as long as he has completed his schoolwork for the day. When identity has been established, generally between the ages of 16 and 18 years, adolescents seek intimate relationships, usually with members of the opposite sex. Intimacy, which is mutual sharing of one's deepest feelings with another person, is impossible unless both persons have established a sense of trust and a sense of identity. Intimate relationships are a preparation for long-term relationships, and people who fail to achieve intimacy may develop feelings of isolation and experience chronic difficulty in communicating with others.

The parents of a 16-year-old are fearful that their child may be using illegal drugs. They report to the nurse that they have noticed recently that their child seems much more focused when doing homework or chores, is losing weight, displays a high level of energy, and becomes agitated easily. The nurse is aware that the teen is displaying symptoms of which type of drug use?

Methamphetamine Euphoria, increased energy and alertness, agitation, weight loss, insomnia, tachycardia, and hypertension are symptoms of methamphetamine use.

A 16-year-old client has been hospitalized 100 miles from home for a week. She is recovering from surgery to repair a broken kneecap, an injury incurred while skateboarding. She was cheerful and chatty when she first arrived, but the nurse notes in recent days she has become increasingly quiet and seems lonely. Which nursing intervention would be most appropriate for this client?

Show her where the teen lounge in the hospital is so she can meet other teens, use a phone, and check her e-mail. Adolescents need access to their peers so they can keep up social contacts. Access to a phone, computer, and e-mail will help the teen stay connected. Recreation areas are important. In settings specifically designed for adolescents, recreation rooms can provide an area where teens can gather to do schoolwork, play games and cards, and socialize.

The nursing student is discussing the effects on hormone production for an 11-year-old boy who has been admitted with a brain injury. Which statements by the nursing student are accurate?

• "Gonadotropin-releasing hormone (GnRH) is produced by the hypothalamus. Since this child has a brain injury, this could be a concern for normal production of other hormones." • "The production and secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) could be effected by his brain injury." • "Sperm production could be impacted because follicle-stimulating hormone (FSH) and luteinizing hormone (LH) stimulate its production." • "Maturation of the testicles is directly impacted by luteinizing hormome (LH). Having a brain injury at this age could cause problems with this stage of puberty." Gonadotropin-releasing hormone (GnRH), produced by the hypothalamus, travels to the anterior pituitary gland to stimulate the production and secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The increased levels of FSH and LH stimulate the gonadal response. LH stimulates acts on testicular Leydig cells in boys, prompting maturation of the testicles and testosterone production. FSH with LH stimulates sperm production. Since production of these hormones are stimulated by the hypothalamus and the pituitary glands, a brain injury at this age could the onset or continuation of changes seen with puberty.

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

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

A 16-year-old adolescent is talking with the nurse at a local health clinic about skin care. Which comments by the teen does the nurse determine require additional conversation?

• "My favorite time of day to be outside is the middle of the day, around noon." • "I only tan before going on spring break to get a base tan so I won't burn." • "The more exposure and burns I get now will toughen my skin so I won't get skin cancer when I'm older." The nurse should further discuss comments that demonstrate incorrect information about sun exposure. Any exposure to tanning beds should be avoided to prevent skin cancer risks. Other risks for skin cancer include being in the sun between the times of 10:00 am and 4:00 pm, and sun exposure and burns during childhood and adolescence. A minimum SPF of 15 should be used, so SPF 30 is good practice, as is wearing sun-protective clothing when outside during the day.