Ch. 29: Growth and Development of the Adolescent

The nurse is counseling an overweight, sedentary 15-year-old girl. The nurse is assisting her to make appropriate menu choices. Which statement indicates the adolescent understands how to make appropriate dietary selections? "I avoid all fat intake." "To lose weight my protein intake should be limited to 2 to 4 servings per day." "I need to eat plenty of fruit each day." "Because of my age, my dairy intake is unlimited."

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

A 17-year-old adolescent chats excitedly with the nurse about plans for college and a career. The adolescent states having checked out every college in the region and determined which one is the best fit and would give the adolescent the best career options. The nurse recognizes which developmental aspect in this client? Sensorimotor Formal operational thought Socialization Identification of identity

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

The nurse is caring for an adolescent female who is scheduled for an emergent laparoscopic surgical procedure. What question by the nurse would be appropriate? "Do you want to talk with an adult who has had the surgery previously?" "Do you want to read a story about the surgery?" "What concerns do you have about scarring from the surgery?" "What immunizations have you received in the last 12 months?"

"What concerns do you have about scarring from the surgery?" RATIONALE: Body image is important to the adolescent and scarring following the procedure would be a priority for the client. Offering to have the client read a story about the surgery would be appropriate for an older school-aged child. Immunizations are assessed with each admission, although those specifically within the last 12 months would not be a concern for this surgery. Talking with a peer, and not an adult, would be appropriate for an adolescent.

The nurse is providing anticipatory guidance to the parents of a 15-year-old who voice concerns with their teenager's sleep habits. They state, "Left to her own devices, I'm sure she'd stay up until 3:00 in the morning on the weekends and sleep until after lunchtime." Which should the nurse explain to the parents? "This is expected at this stage of development. Are there any ways that you could adjust your family routines to accommodate this?" "I can hear that this is exasperating for you, but know that children do grow out of this in time, with no ill effects." "It's very important that you communicate to your daughter that this is unacceptable because it can have a negative effect on her health." "That must be hard for you to manage. Perhaps we can explore some strategies with her to establish more predictable sleep patterns."

"That must be hard for you to manage. Perhaps we can explore some strategies with her to establish more predictable sleep patterns." RATIONALE: It is common for adolescents to adopt habits of going to bed late and awakening late, especially on weekends. Despite the fact that this is common, it is not ideal; the nurse should explore strategies for changing the adolescent's behavior in a collaborative and inclusive manner. Simply communicating that it is unacceptable is unlikely to bring about change.

A 15-year-old is hospitalized for acute appendicitis. Which activities would the nurse include in the client's plan of care? Select all that apply. Arrange care to provide for extra rest and sleep. Keep the client in hospital gowns for sanitary reasons. Have the nurse control the patient's care as much as possible. Allow friends to visit during visiting hours. Include the parents when educating the client.

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

A nurse is admitting a 16-year-old male to the floor for an appendectomy. How can the nurse prepare this client for hospitalization? Select all that apply. Interview the adolescent separately from the parent to allow expression of information that he may not be comfortable sharing in front of the parent. Encourage him to keep his cell phone nearby to communicate with his friends. Provide privacy when client is changing into the hospital gown or going to the bathroom. Remind him that there are strict rules regarding meal times and when lights are turned out on the floor. Encourage parents to do as much as possible for the client, including ADLs and meal selection.

Interview the adolescent separately from the parent to allow expression of information that he may not be comfortable sharing in front of the parent. Encourage him to keep his cell phone nearby to communicate with his friends. Provide privacy when client is changing into the hospital gown or going to the bathroom. RATIONALE: In order for an adolescent to adapt well to hospitalization, the nurse needs to provide him privacy and allow him control over his surroundings and care when possible. Keeping in contact with peers is very important to an adolescent, as is being discreet in regard to sharing personal information that typically is elicited in an admission interview.

While caring for a 16-year-old client expected to be hospitalized for several months, the nurse will perform which action to assist the client in meeting the current stage of psychosocial development? Permit peers to visit during open visitation hours. Explain medical concepts by providing handouts and brochures. Allow the client to touch equipment before procedures. Provide video games for the client to play.

Permit peers to visit during open visitation hours. RATIONALE: In each stage of development, a significant person or group exerts a lasting influence on the ongoing development of the child. An adolescent striving for self-identity and increased independence spends more time with peers than with family. It is important for the hospitalized adolescent to still be able to visit with peers. Video games may be enjoyed by the adolescent and limit boredom; however, this action would not facilitate psychosocial development. Allowing the client to touch equipment and to explain medical concepts/procedures are methods used to teach toddlers and preschoolers. Providing handouts and brochures are not effective methods to explain medical concepts; the nurse would verbally explain using models, pictures, and diagrams. Handouts and brochures can be used as supplements to teaching.

An 18-year-old adolescent reveals the presence of nipple ring and is looking to get a tattoo in the next few months. What is the most important thing that the nurse can teach the adolescent at this time? Review the safety rules for those who do the tattooing. Tattooing carries risks such as infection, disease, and nerve damage. Complications are more likely when you tattoo yourself. It is not recommended to get the tattoo from your friend in his garage.

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

The nurse is assessing a 14-year-old male client when the client's parent jokes about the changes in the client's voice and the hair under his armpits. Which response by the nurse to the client's parent is most appropriate? "Your child can become modest and self-conscious and teasing may cause embarrassment." "I remember that time in my life, it was so awkward and uncomfortable." "Based on your child's age, changes in hair distribution and voice pitch are expected." "It would be helpful to discuss with your child your trials with puberty and the changes you experienced."

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

A female client tells the nurse about noticing an increase in weight and fat deposits during the past year. The nurse reviews the client's chart and recognizes that the client is most likely going through puberty. Which nursing action is most appropriate at this time? Encourage increased exercise to control weight gain. Review dietary measures to assist in controlling weight gain. Provide reassurance that these are normal changes. Share what foods can be eaten on a low-fat diet to prevent fat deposits.

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

The nurse is assessing the psychosocial development of an adolescent. The nurse determines that the client is in the middle post-conventional phase with which observation? The nurse hears the adolescent asking the parents, "How does God decide that some people get sick and some people don't?" The adolescent states, "I am glad my parents instilled such a good work ethic in me." 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." The nurse hears the adolescent talking with a friend and states, "I don't understand how some of the rich in our society don't help the poor."

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." RATIONALE: According to Kohlberg, the middle post-conventional phase is characterized by the adolescent developing his or her own set of morals by evaluating individual morals in relation to peer, family, and societal morals. This is demonstrated when the adolescent stated. "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." 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 his or her own morals and values, and continues to compare morals and values to those of society. During this phase, the adolescent also evaluates the morals of others. The statements regarding the rich in society and work ethic demonstrate this late phase.

The nurse is educating a 17-year-old adolescent after a new diagnosis of diabetes. What does the nurse understand about teaching an adolescent? The adolescent will likely have the greatest influence on one's own decisions. The adolescent will respond best to teaching about how to avoid future complications. The siblings of the adolescent will need to be taught healthy cooking classes related to diabetes. The parents will need to be instructed separately from the adolescent.

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

The 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 CNS depressant inhalant opiate

methamphetamine RATIONALE: Euphoria, increased energy and alertness, agitation, weight loss, insomnia, tachycardia, and hypertension are symptoms of methamphetamine use. Stimulants have similar effects as alcohol but the high only lasts a few minutes and includes slurred speech, lack of coordination, euphoria, and dizziness. Opiates produce feelings of relaxation and euphoria. CNS depressants cause euphoria followed by depression or hostility, impaired judgment, decreased inhibitions, slurred speech, and incoordination.

A client has confided in a nurse that her 13-year-old daughter has recently changed dramatically in her social interactions with others. What is a social behavior most likely to be exhibited by a girl at this age? Banding together with other girls and dressing like them Banding together with boys and girls but maintaining her own unique style Hanging out primarily with boys her own age Hanging out with girls but maintaining her own unique style

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

A nurse is teaching a female adolescent diagnosed with a vitamin A deficiency about appropriate nutritional recommendations to address this issue. The nurse determines that the teaching was successful based on which statement(s) by the adolescent? Select all that apply. "Peanuts and bananas should help quite a bit." "I am willing to try liver and see if I like it." "I will try to eat more broccoli and tomatoes from now on." "Egg yolks will be really helpful to get my vitamin A levels higher." "I guess I should start eating more yellow vegetables."

"I am willing to try liver and see if I like it." "I will try to eat more broccoli and tomatoes from now on." "I guess I should start eating more yellow vegetables." RATIONALE: With a vitamin A deficiency, the adolescent needs to increase intake of foods high in that vitamin, such as liver, whole milk, carotene sources such as yellow vegetables as well as green leafy vegetables and tomatoes. Egg yolks, peanuts and bananas are good sources of vitamin B6. Egg yolks are also high in vitamin D.

A 16-year-old adolescent is talking with the nurse at a local health clinic about skin care. Which comments by the teen does the nurse determine require additional conversation? Select all that apply. "I only tan before going on spring break to get a base tan so I won't burn." "My mom had melanoma so she always makes me wear a sunscreen with an SPF of 30." "Our coach makes us wear sun-protective clothes when we practice outside on the weekends." "The more exposure and burns I get now will toughen my skin so I won't get skin cancer when I'm older." "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." "My favorite time of day to be outside is the middle of the day, around noon." RATIONALE: 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.

The parents are concerned their 14-year-old child is always eating. The child weighs 54 kg and is 65 inches (165 cm) tall. What is the best explanation the nurse can give the parents? "He needs the calories because he participates in sports." "He is substituting food for unfilled needs." "The calories help his body increase muscle mass." "His calorie intake predisposes him to future obesity."

"The calories help his body increase muscle mass." RATIONALE: Adolescents grow rapidly and mature dramatically during the period from ages 13 to 20 years. An adolescent needs an increased number of calories to support the rapid body growth that occurs. Foods must come from a variety of sources to supply the necessary amounts of carbohydrates, vitamins, protein, and minerals. Boys typically gain about 15 to 55 pounds (7 to 25 kg) during their teenage years. The calorie intake will not predispose him to future obesity unless it is continuously excessive. The majority of adolescents eat as part of their development, not as an emotional need.

A 15-year-old client tells the nurse he has been having wet dreams and is ashamed and afraid he will get into trouble because he believes his parents think he is too young to understand or know about sex. To which statement would be the most appropriate for the nurse to respond? "Since your parents feel you are not ready to talk about sex, you need to honor their wishes and not bother them with this." "Don't worry, it is perfectly normal for 15-year-olds to have the kinds of fantasies that lead to wet dreams. You should tell your parents about this." "You don't need to feel ashamed. I will speak to your parents about the importance of allowing you to experiment with and feel good about your sexuality." "Wet dreams are not the result of anything you are doing but are simply the body's way of ridding itself of excess semen."

"Wet dreams are not the result of anything you are doing but are simply the body's way of ridding itself of excess semen." RATIONALE: Boys who are unprepared for nocturnal emissions may feel guilty, believing that they have caused these "wet dreams" by sexual fantasies or masturbation. They need to understand that this is a normal occurrence and is simply the body's method of getting rid of surplus semen. The other suggestions do not address the situation in a professional manner.

The school nurse is assessing a 15-year-old female client. The client states, "I just want to be pretty and to look like everyone else." Which response by the nurse is appropriate? "Do you not think you are pretty now?" "Looking like everyone else is not what makes someone pretty." "I think you are beautiful just as you are." "You seem concerned. Let's talk about your feelings."

"You seem concerned. Let's talk about your feelings." RATIONALE: Body image is closely related to self-esteem. Seeing one's body as attractive and functional contributes to a positive sense of self-esteem. During adolescence, the desire not to be different can extend to feelings about one's body and can cause adolescents to feel that their bodies are inadequate even though they are actually healthy and attractive. The nurse would acknowledge the client's concern and discuss the client's feelings. Stating the client is beautiful as is does not address the client's concern. Closed statements which require no response do not offer any insight for the nurse. The nurse would also avoid yes/no questions.

The nurse is meeting with a group of caregivers of adolescents and discussing sex and sexuality, including how to discuss these issues with their children. Which comment should the nurse prioritize with this group of caregivers? Being honest and straightforward with teenagers will encourage them to ask about subjects like sexuality. Teenagers spend so much time with their peers, and that is usually how they find out about sex. Most schools have excellent programs to teach adolescents about sex and sexuality. Internet resources, movies, and television have the most accurate and current information for your adolescent to learn about sexuality issues.

Being honest and straightforward with teenagers will encourage them to ask about subjects like sexuality. RATIONALE: The most important aspect of discussions about sexuality with adolescents is giving honest, straightforward answers in an atmosphere of caring concern. Children whose need for information is not met through family, school, or community programs will get the information—often inaccurately—from peers, movies, television, or other media.

To help prevent obesity, which intervention would the nurse include in an adolescent's plan of care? Plan a diet of 3,000 calories per day. Encourage sources of proteins with fat. Describe a normal serving size. Plan a diet of 1,500 calories per day.

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

A nurse is taking care of a teenager who reports involuntary discharge of semen while sleeping. The nurse observes that the client is confused and does not know about the pubertal changes that are taking place in his body. Based on this information, what is the highest priority area that should be reviewed with the client? Review about sexually transmitted infections. Educate the client about the changes that occur during adolescence. Inform him that involuntary discharge of semen during sleeping needs immediate attention of the health care provider. Provide information about sex and sexuality.

Educate the client about the changes that occur during adolescence. RATIONALE: The highest priority areas of the nurse's teaching involves informing the client about the expected pubertal changes that take place in the body and convincing him that the involuntary discharge of semen while sleeping is a normal part of reproductive health. Once the adolescent has an understanding of bodily changes during puberty then further education about sex, sexuality and sexually transmitted infections can be discussed.

The nurse is assessing a teenage client and notes his lower front teeth are slightly crossed over. The nurse points out to his caregiver that he should see an orthodontist about this to prevent which potential situation? Leaving even slightly crooked teeth will lead to more cavities later in life. Even slight malocclusions make chewing and jaw function less efficient. This could have a lasting effect on his future to include everything from dating to hiring. Uncorrected malocclusions lead to infection and ultimately tooth loss.

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

The school nurse is developing a school wellness program to promote healthy eating habits and regular physical activity. What is the most important element to emphasize to maximize compliance, healthy habits, and long-term change? Include both parents and children in the wellness program. Eliminate sweetened, carbonated beverages in the cafeteria. Incorporate activity in parts of the daily schedule. Serve fruits and vegetables in the cafeteria.

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

A teenage girl and her mother are in the office. When the teen uses the restroom, her mother asks the nurse about the changes that Linda is going through. She would like to talk to her about sexuality and its changes but she is unsure of how to do this. What reminders should the nurse give to the mother for when she discusses sex? Encourage her to talk to her peers and teachers in health class. Discuss with the teen the experiences that you had so that she can connect on a personal level. Promote open lines of communication; listen instead of lecture; and share family values. Do not initiate any conversation; let the teen come and seek the advice of the parent.

Promote open lines of communication; listen instead of lecture; and share family values. RATIONALE: By promoting open lines of communication between parents and teens, the teenager can go to the parents with problems or questions. There still may be many unanswered questions and parents should be encouraged to listen to their teens rather than lecture them. It is also important for the parents to share family values regarding sexual behavior. Due to the influence of television and movies, many teenagers have an idealized body image or misinformation about sex. In many cases the teenager receives excellent information in health education classes.

A 16-year-old client has been hospitalized 100 miles from home for 1 week to repair a fractured patella suffered in a skateboarding accident. She was cheerful and chatty when she first arrived, but the nurse notes in recent days she has become increasingly quiet and seems lonely. Which nursing intervention should the nurse prioritize for this client? Suggest that she read books and magazines from the hospital bookmobile. Ask her caregivers to bring her siblings and friends to visit. Call the hospital's mental health unit to see if she can get some counseling. Take her to the teen lounge so she can meet and interact with other teens.

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

The nurse is educating an adolescent female who needs to increase dietary iron but has expressed concern about weight gain. What dietary choices would the nurse recommend? cottage cheese, crackers, oranges pasta, broccoli, pear chicken, whole-wheat bread, watermelon raspberry yogurt, granola, apple

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

The nurse is working with a 12-year-old who has recently experienced family instability and family violence. When assessing this client in the context of Erikson's developmental theory, the nurse should recognize that the adolescent has a risk of which negative outcome? physical and emotional aggression in relationships dissociative identity disorder confusion about role in the world development of an antisocial identity

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

During the assessment of a 15-year-old female, the nurse notes a new body piercing in the navel. Which statements by the nurse would be appropriate in regard to this new piercing? Select all that apply. "You are very young to have a navel piercing. Do your parents know you have this?" "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." "I notice you have a new piercing. Be sure to clean it twice a day so you don't get an infection." "I really like your belly ring. Where did you get it?" "A navel piercing is a lot better than a tattoo. At least the piercing doesn't have to be permanent if you don't want it to be."

"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." RATIONALE: Informing the client about infection risks and prevention are appropriate responses by the nurse when noticing a new body piercing. Judgmental responses and personal responses are not appropriate from the nurse.

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? From ages 7 to 11 years, children internalize actions and can perform them in the mind. After age 12 children can think in the abstract, including complex problem solving. Children from ages 2 to 7 years investigate and explore the environment and look at things from their own point of view. Up to age 2, children learn by touching, tasting, and feeling. They learn to control body movement.

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

The nurse is preparing to participate in a community discussion on the needs of the adolescents in the local school. The nurse should point out which goal is the primary concern for these young individuals as the committee makes plans? They understand and respond to discipline. They want to successfully complete activities. Each child is learning to do things on his or her own. Teens are busy developing their own personal identity.

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

The nurse is discussing an adolescent's development with the client's parents. Which statement by the parents indicate an understanding of the nurse's teaching? "It is most important for our adolescent to achieve independence from our dominance." "We will work toward ensuring our adolescent is developing trusting relationships." "Our adolescent is working toward achieving a sense of personal identity." "It is vital our adolescent learns to help others achieve their goals."

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

The parent of a 14-year-old adolescent states to the nurse that the adolescent is moody, shuts oneself in the bedroom, and fights with a younger sibling. Which comment is most helpful to support the parent? "Take away all of the adolescent's privileges until your adolescent starts acting better." "Set some rules for family etiquette." "This is normal for the age." "Calmly talk to your adolescent about your concerns."

"Calmly talk to your adolescent about your concerns." RATIONALE: Families and parents of adolescents experience changes that require adjustments and the understanding of adolescent development. The adolescent is striving for self-identity and increased independence. Thus, getting the parent and adolescent talking and sharing information is the most helpful advice. Telling the parent that this is normal does nothing for the family situation. Setting rules will likely alienate the adolescent, and taking away privileges will likely cause conflict between the parent and adolescent.

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? opiates amphetamines marijuana barbiturates

amphetamines RATIONALE: 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.

While speaking to the caregiver of a 13-year-old girl, the nurse learns the client is struggling to accept the changes occurring to her body as a result of puberty. Which statement will the nurse include while responding to the client's caregiver? "Be sure to tell your daughter she is beautiful often to promote a positive self-image." "These are feelings all adolescent girls experience. Have your daughter talk to her peers." "Adolescents are often uncomfortable with their new body images and must learn to accept it." "Once puberty ends, your daughter will feel more confident in her body changes."

"Adolescents are often uncomfortable with their new body images and must learn to accept it." RATIONALE: According to Erikson, the developmental task in early and mid-adolescence is to form a sense of identity versus role confusion. Adjustment to changes in body image is part of forming this sense of identity. The nurse would let the caregiver know this is a normal finding. Adolescents must learn to accept the changes; it is not an immediate acceptance at the end of puberty. Promoting a positive self-image is important; however, telling the child she is beautiful does not address the caregiver's concern. Encouraging the client to speak with peers does not address the caregiver's concern.

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? "This is a risk for hepatitis, tetanus, and AIDS." "This is a wound and can become infected." "Be sure to clean the navel several times a day." "I hope for your sake the needle was clean."

"Be sure to clean the navel several times a day." RATIONALE: 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 mother of a 14-year-old girl voices concerns that her daughter is likely to be not getting enough nutrients. How many calories should be ingested by the teen daily? At least 1800 calories per day is recommended for a teen girl. The teen should not consume more than 2500 calories per day. The range for caloric intake for the teen girl is 1700-2000 per day. The teen girl who is active should consume about 2000 calories per day.

The teen girl who is active should consume about 2000 calories per day. RATIONALE: Teenage girls who are moderately active require about 2,000 calories per day. Reference:

A high school athlete comes to the emergency department with hypertension, aggressiveness, and psychosis. What question would be important for the nurse to ask the client? "Do you take cocaine?" "Do you take amphetamines?" "Do you take human growth hormone?" "Do you take anabolic steroids?"

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

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 am sure you are concerned but children develop at different rates." "This is rather young to be developing breasts. I will be sure to let the doctor know." "Do the females in your family typically develop at an early age?" "I understand your concern, but girls typically enter puberty around the age of 9 or 10."

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

A 15-year-old female adolescent tells the nurse she would like to get a tattoo. What response by the nurse is most appropriate? "You are too young to have a tattoo." "You need to remember that a tattoo will be with you forever." "Tattoos are invasive and there is the potential for disease with their application." "If you are determined to get a tattoo you need to get a small one so you can hide it if you want."

"Tattoos are invasive and there is the potential for disease with their application." RATIONALE: Piercings and tattoos are becoming increasingly common in adolescents. It is important to ensure that the girl and her family understand the potential risk for disease with the application of the tattoo. The adolescent is young, but that does not change the fact she wants to get a tattoo. Reminding the teen that it is a permanent alteration in the skin is important but not the most important response by the nurse.

During an examination, an adolescent client tells the nurse about being anxious and frustrated because of the facial acne. Which nursing response is appropriate? "This is one of the most common physical changes during adolescence." "I will tell your primary health care provider about your acne." "Consuming fried foods and chocolate can cause acne to develop." "Most people get acne during adolescence. It will go away as you get older."

"This is one of the most common physical changes during adolescence." RATIONALE: It is important for the nurse to inform the client that acne is a normal physical changes that characterizes adolescence as a result of increased glandular activity. The nurse should address the client's concern and not refer the client to the primary health care provider. The client's worries should not be trivialized or ignored as this is a situation that is worrisome for the adolescent. The type of foods consumed do not cause acne.

The clinic nurse is assessing a 14-year-old client. The client states "I am worried I have a brain tumor. I am so clumsy when I play sports now that it is totally embarrassing." Which response by the nurse is appropriate? "I will request the primary health care provider prescribe a magnetic resonance image (MRI)." "You are experiencing rapid and uneven growth now which can interfere with coordination." "Have you noticed any changes in your vision or hearing lately?" "I understand why you are worried. Has anyone else in your family had a brain tumor."

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

An adolescent who is depressed states, "Nothing ever seems to be right in my life." Which would be the most appropriate response by the nurse? "You are feeling sad right now. It's a hard time." "Try to look at the bright side of things." "Things will be better when you go off to college." "Being a teenager is hard work."

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

A 17-year-old female is meeting with the nurse for an annual well-visit and is asking the nurse questions about how to know when one is in love. The nurse should point out which factor to help decide if both individuals have reached a mutual agreement and are ready for an intimate relationship? A sense of trust and identity An understanding of socialization and of isolation A willingness to take initiative An ability to be autonomous

A sense of trust and identity RATIONALE: In order to be intimate or to share one's deepest feelings with another person, it is impossible unless both persons have established a sense of trust and a sense of identity. Being autonomous or taking initiative are not aspects that lead toward intimate relationships. Socialization and isolation are not relevant to the establishment of intimate relationships.

A chronically ill adolescent is readmitted to the hospital with an infected wound requiring long-term dressing changes. What is the best way the nurse can encourage independence for this client? Have the adolescent go to the teen room every day. Allow the adolescent to choose the time for the dressing change. Teach the parents to perform dressing changes at home. Have the school provide homework.

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

The nurse is admitting a 15-year-old adolescent to the hospital pediatric unit. What does the nurse recognize as a priority for this adolescent? The adolescent should be encouraged to call friends often. The adolescent's need for privacy should be respected. The adolescent should be given freedom to participate in unit activities as desired. The adolescent's need for parental support should be discussed.

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

The adolescent comes to the clinic seeking information about sexuality concerns. The clinic nurse assures the adolescent that confidentiality and privacy will be maintained unless a life-threatening situation occurs. Maintaining confidentiality demonstrates which nursing goal? Select all that apply. development of a trusting relationship compliance with existing laws inappropriate response because adolescents are minors an environment where adolescents can be truthful concern from parents who pay the office visit bill

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

A teacher refers a student to the school nurse because the student is frequently falling asleep during class. After talking with the student, the nurse is most concerned by which statement by the student? "My mom keeps telling me to turn off my television when I go to bed." "I guess I need to be more careful about my curfew on school nights." "I get 7 hours of sleep every night so I don't know why I am so tired." "I just can't seem to stay awake during that class because it's boring."

"I get 7 hours of sleep every night so I don't know why I am so tired." RATIONALE: The average number of hours of sleep that teens require per night is 8.5 to 9.5 due to rapid growth that occurs during these years. Following a curfew and limiting distractions at bedtime can help provide the student with adequate hours of sleep each night.

The nurse is caring for a 13-year-old adolescent. The adolescent has been identified as overweight with no underlying psychologic or secondary causes. The nurse is reviewing the adolescent's weight-loss progress and nutrition at a follow-up visit. What statement by the parent indicates a need for further discussion and teaching? "My adolescent's goal is to be a size smaller by our vacation in 2 weeks." "Our whole family has changed our eating habits." "My adolescent is helping us plan our family's weekly menu." "My adolescent has begun to eat slowly, putting down the fork between bites."

"My adolescent's goal is to be a size smaller by our vacation in 2 weeks." RATIONALE: The parent 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.

A 17-year-old male adolescent on the high school swim team tells the nurse that during swim season he cuts the carbohydrates in his diet to 30% to help his swim times. What responses by the nurse are appropriate? Select all that apply. "Since you are so active, your carbohydrate intake should comprise 45% to 65% of your daily diet." "Cutting carbohydrates is a good way to keep your weight down during swim season." "As long as you are taking in around 2,000 calories per day you should be just fine." "Twenty-five to 35 percent of your diet should be carbohydrates so you fall into the acceptable range." "Can you tell me the reason you feel the need to cut your carbohydrates when your activity level is high?"

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

The nurse is discussing ways to promote discipline with parents who are becoming increasingly frustrated with their adolescent. What would the nurse suggest to the parents? Avoid discussing situations of misbehavior and instead praise appropriate behavior. Make a chore chart and add stickers for completed chores and activities. Develop consistent expectations and use consistent responses each time. Determine the consequences for misbehavior and explain them to the adolescent.

Develop consistent expectations and use consistent responses each time. RATIONALE: Consistency and predictability are the cornerstones of discipline. The use of a chore chart with stickers would be more appropriate for a preschool-aged or young middle-school-aged child. The parent should include the adolescent in establishing consequences rather than determine them without input. While appropriate behavior should be praised, when occurrences of misbehavior occur, they should be addressed and dealt with according to the agreed-upon consequences.

The nurse is caring for a 16-year-old client. The client confides in the nurse that they use of marijuana daily. Which action by the nurse is appropriate? Notify local law enforcement. Determine how long the client has used marijuana. Ask the client where the marijuana is obtained. Discuss adverse side effects with the client.

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

What anticipatory guidance can the nurse provide the girl who has noted the development of breast buds? Menarche should follow in about 2 years. The growth spurt will begin immediately with menarche. Breast development will be complete with 12 months. Adult height will be reached at the time of menarche.

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

A teenage boy tells the nurse that his parents embarrass him in front of his friends when they kiss him goodbye. The nurse is aware that this teenager is revisiting which stage of development identified by Erikson? industry initiative generativity autonomy

autonomy RATIONALE: In revisiting the stage of autonomy, the adolescent is seeking out ways to express his or her individuality in an effective manner. The adolescent would avoid behaviors that would "shame" or ridicule him or her in front of peers. The sense of industry is again encountered as the adolescent makes the choice to participate in different activities at school, in the community, at church, and in the workforce. Initiative is revisited as the adolescent develops a vision for what he or she might become. Generativity largely involves establishment of career and work.

The nurse is talking to a 13-year-old boy about choosing friends. Which function do peer groups provide that can have a negative result? following role models developing stability sharing problems negotiating differences

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