Chapter 29: Growth and Development of the Adolescent
Nurses should provide anticipatory guidance to males to prepare them for what particular pubertal change in late adolescence? Lengthening of the penis Breast enlargement Reddening of the scrotum Nocturnal emissions
Nocturnal emissions
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? "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." "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."
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 amphetamines?" "Do you take cocaine?" "Do you take anabolic steroids?" "Do you take human growth hormone?"
"Do you take anabolic steroids?"
A teacher refers a student to the school nurse because the student is frequently falling asleep during class. After talking with the student, the nurse is most concerned by which statement by the student? "I get 7 hours of sleep every night so I don't know why I am so tired." "I just can't seem to stay awake during that class because it's boring." "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."
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? "To lose weight my protein intake should be limited to 2 to 4 servings per day." "I need to have 4 servings of fruit each day." "Because of my age, my dairy intake is unlimited." "I avoid all fat intake."
"I need to have 4 servings of fruit each day."
During the assessment of a 15-year-old female, the nurse notes a new body piercing in the navel. Which statements by the nurse would be appropriate in regard to this new piercing? Select all that apply. "I really like your belly ring. Where did you get it?" "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." "You are very young to have a navel piercing. Do your parents know you have this?" "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."
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? "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." "This is rather young to be developing breasts. I will be sure to let the doctor know." "I am sure you are concerned but children develop at different rates."
"I understand your concern, but girls typically enter puberty around the age of 9 or 10."
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's spontaneous erections and nocturnal emissions are very normal." "My son is developing normally and the traits of puberty vary from child to child." "My son must be sexually active or having overly sexual thoughts to have a nocturnal emission." "My son is not doing anything to cause the nocturnal emissions; they occur spontaneously."
"My son must be sexually active or having overly sexual thoughts to have a nocturnal emission."
An adolescent's parent states not knowing what to do with the adolescent. The parent reports the teenager is taking two or three showers a day when not that long ago the parent could barely get the teen to take a shower at all. What should the nurse's reply be to the parent? "Reevaluate the adolescent's ability to perform hygiene care since showering is so frequent." "Do not encourage multiple baths; it can be very drying to the skin." "Reinforce the family rules but also allow the adolescent to develop one's own routine." "Remind the adolescent about needing to be on a schedule so as to not disrupt the family."
"Reinforce the family rules but also allow the adolescent to develop one's own routine."
The parent of a black adolescent voices concern to the nurse because the daughter, "has gotten her period before all of her friends." How should the nurse respond? "I will be sure to let the health care provider know this. We don't want to miss something that may be wrong." "How old are most of her friends? Maybe that's the issue instead of it being a sign of something abnormal." "Some girls just get their period earlier than others." "That must be difficult, but on average black girls start their period earlier than other ethnicities."
"That must be difficult, but on average black girls start their period earlier than other ethnicities."
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? "The calories help his body increase muscle mass." "He needs the calories because he participates in sports." "His calorie intake predisposes him to future obesity." "He is substituting food for unfilled needs."
"The calories help his body increase muscle mass."
A 15-year-old client's parent comments on the fact that the adolescent seems to always choose the opposite of what everyone else wants and that mood swings are a common occurrence. What statement shows the nurse that the client's parent understands these changes? "I know that my adolescent is doing this because of all the hormones." "My adolescent will never find anyone to live with if the adolescent acts like this." "This is common for this age group and it will get better with time." "This is my adolescent's temperament, and we will have to learn how to deal with it."
"This is common for this age group and it will get better with time."
During a visit to the school nurse, an adolescent confides in recently having homosexual feelings. How should the nurse best respond to the adolescent? "Would you like to talk about these feelings?" "These feelings are normal for your age." "How long have you been having these feelings?" "Do these feelings make you feel bad about yourself?"
"Would you like to talk about these feelings?"
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? "Being a teenager is hard work." "Things will be better when you go off to college." "Try to look at the bright side of things." "You are feeling sad right now. It's a hard time."
"You are feeling sad right now. It's a hard time."
The school nurse is meeting with a group of 11-year-old girls to discuss expected puberty changes in their bodies. When one of the girls states, "I just feel like my whole body is changing and I don't know why" what should the nurse point out to this group? "Your other friends are feeling like this too." "You may feel like you are changing, but you still look the same." "You will feel better about yourself as you get older." "You have lots of hormone changes going on right now."
"You have lots of hormone changes going on right now."
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? "Based on your child's age, changes in hair distribution and voice pitch are expected." "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." "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."
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 An ability to be autonomous A willingness to take initiative
A sense of trust and identity
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? Children from ages 2 to 7 years investigate and explore the environment and look at things from their own point of view. After age 12 children can think in the abstract, including complex problem solving. From ages 7 to 11 years, children internalize actions and can perform them in the mind. 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.
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. Include the parents when educating the client. Have the nurse control the patient's care as much as possible. Arrange care to provide for extra rest and sleep. Allow friends to visit during visiting hours. Keep the client in hospital gowns for sanitary reasons.
Allow friends to visit during visiting hours. Include the parents when educating the client. Arrange care to provide for extra rest and sleep.
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. Keep the client in hospital gowns for sanitary reasons. Include the parents when educating the client. Allow friends to visit during visiting hours. Arrange care to provide for extra rest and sleep. 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.
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 school provide homework. 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.
Allow the adolescent to choose the time for the dressing change.
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 Marijuana Barbiturates Amphetamines
Amphetamines
An adolescent with a new piercing comes to the health center at the school. The client reports feeling hot. Which action will the nurse complete first? Ask the client if any other piercings are present. Determine when the client started feeling hot. Inquire about the piercing technique used. Assess the client for signs of infection.
Assess the client for signs of infection.
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? Autonomy Industry Generativity Initiative
Autonomy
The nurse is preparing a presentation for a local health fair depicting the differences in maturity between preadolescents. Which differing factor should the nurse prioritize in the presentation? Boys grow at a rapid, sporadic rate. Boys and girls grow at the same rate. Boys grow at a slower, steadier rate than do girls. Girls grow at a slower, steadier rate than do boys.
Boys grow at a slower, steadier rate than do girls.
The nurse is providing anticipatory guidance for violence prevention to a group of parents with adolescents. Which parental action should the nurse include as the most effective in preventing suicide? Monitoring video games, TV shows, and music Becoming acquainted with the teen's friends Watching for aggressive behavior or racist remarks Checking for signs of depression or lack of friends
Checking for signs of depression or lack of friends
A nurse is attending to a group of boys at a school. The nurse is required to document the sexual development in boys on a regular basis. The nurse would anticipate which clients having the highest incidence of nocturnal emissions? Clients with strong, muscular appearance Clients in the age group of 18 to 20 years Clients who are showing pubertal changes Clients who have reached adulthood
Clients who are showing pubertal changes
The nurse is performing an assessment on a 12-year-old boy. Which finding is consistent with the child's age? Curling pubic hair No pubic hair Coarse pubic hair Sparse pubic hair
Curling pubic hair
A nurse is conducting an assessment of a 16-year-old's cognitive development. The nurse determines that the adolescent's cognitive development is within acceptable parameters for the adolescent's age based on which assessment finding? Select all that apply. Uses scientific methods to solve verbal problems. Exhibits limited abstract thought processes Able to develop career plans Shows a beginning interest and concern with societal and political issues. Demonstrates thinking that the adolescent is invincible.
Demonstrates thinking that the adolescent is invincible. Uses scientific methods to solve verbal problems. Shows a beginning interest and concern with societal and political issues.
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. This could have a lasting effect on his future to include everything from dating to hiring. Even slight malocclusions make chewing and jaw function less efficient. Uncorrected malocclusions lead to infection and ultimately tooth loss.
Even slight malocclusions make chewing and jaw function less efficient.
A 15-year-old adolescent shows a pattern of gaining weight, not a large amount but a little more each visit. The adolescent is not active in any sports and eats out frequently with parents. What is the best way for the nurse to assess the adolescent's eating pattern? Have the adolescent keep a food diary for 1 week. Have the adolescent guess the calorie intake in a 24-hour period. Ask the adolescent to recall what was eaten in the last 3 days. Ask the adolescent to show the nurse what a healthy portion looks like.
Have the adolescent keep a food diary for 1 week.
A nurse is reading a journal article about adolescents and major causes of injuries in this age group. The nurse demonstrates understanding of this information by identifying which situation as the major cause of adolescent injuries? Drowning Motor vehicle crashes Suicide Violence
Motor vehicle crashes
A nurse is reading a journal article about adolescents and major causes of injuries in this age group. The nurse demonstrates understanding of this information by identifying which situation as the major cause of adolescent injuries? Drowning Suicide Motor vehicle crashes Violence
Motor vehicle crashes
The parents of a 16-year-old male are worried about recent changes in his behavior, ignoring his schoolwork and sports, and spending almost all of his free time interacting with his girlfriend. Which suggestion should the nurse point out would best address this situation? He has chosen a girl who is overly dependent on him. They should talk to him about making sure he meets his own needs, including doing the schoolwork he enjoys, in any relationship. 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. He is not developmentally mature enough to make healthy choices about the ways in which he spends his time, so it would be helpful if they would make a schedule for him that includes about a half-hour per day to talk with his girlfriend. He is not developmentally mature enough to have an intimate relationship with one girl; they should encourage him to spend time with groups of friends rather than time alone with his girlfriend.
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.
Which intervention would probably be most effective in preventing an adolescent from attempting suicide with an overdose again? Helping to learn better problem solving Helping to locate a close friend at school Assessing financial situation Teaching the parents to keep medicine in a locked cabinet
Helping to learn better problem solving
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? Eliminate sweetened, carbonated beverages in the cafeteria. Incorporate activity in parts of the daily schedule. Include both parents and children in the wellness program. Serve fruits and vegetables in the cafeteria.
Include both parents and children in the wellness program.
The nurse is talking with parents of a depressed 16-year-old boy. Which question is of the mostimportance? Does he exercise? Is there a gun in your home? Have his sleeping and eating habits changed? How is his personal hygiene?
Is there a gun in your home?
The nurse is meeting with a group of caregivers of adolescents. Which example should the nurse point out is most effective for the caregiver to support the adolescent? Let them choose their hairstyle, even though it may not look the best for them. Our house rules are stricter than their friends but everyone follows the same rules in our home. Leave pamphlets about topics such as drugs and alcohol in their room so they can read them. Discourage spending too much time with school friends since we know they can be a negative influence.
Let them choose their hairstyle, even though it may not look the best for them.
The family reports to the nurse that their adolescent always wants to argue, will not participate in family functions, and has poor school grades. What recommendation should the nurse make for an adolescent client who presents with these symptoms? Supervise homework sessions. Have the child visit the school counselor. Encourage participation in sports. Make an appointment with the health care provider.
Make an appointment with the health care provider.
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? Opiate Inhalant CNS Depressant Methamphetamine
Methamphetamine
A 15-year-old girl is in the hospital for surgery and is confined to bed. The nurse can tell that the client is nervous about being in the hospital. She tells the nurse that she feels "gross" and "on display" in her hospital gown. What should the nurse do to encourage a sense of autonomy and dignity related to the girl's body image? Offer to assist the girl in washing her hair and let her pick the shampoo. Allow the girl to wear her own clothes, despite hospital policy. Assist the girl with using the bed pan to urinate. Brush the girl's hair for her.
Offer to assist the girl in washing her hair and let her pick the shampoo.
The mother of a 15-year-old boy expresses sadness to the nurse that her son is "much more connected to his friends than his family." What understanding would benefit this parent? Select all that apply. Adolescents need parental support and guidance as they move toward greater peer involvement. Parents should wait until the adolescent introduces them to their peers. Peers are needed for emotional security while stepping away from family. Peers provide opportunity to learn and practice social roles. Peers can be positive or negative influences.
Peers are needed for emotional security while stepping away from family. Peers provide opportunity to learn and practice social roles. Peers can be positive or negative influences. Adolescents need parental support and guidance as they move toward greater peer involvement.
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? Provide video games for the client to play. Allow the client to touch equipment before procedures. Permit peers to visit during open visitation hours. Explain medical concepts by providing handouts and brochures.
Permit peers to visit during open visitation hours.
A female client tells the nurse about noticing an increase in weight and fat deposits during the past year. The nurse reviews the client's chart and recognizes that the client is most likely going through puberty. Which nursing action is most appropriate at this time? Provide reassurance that these are normal changes. Encourage increased exercise to control weight gain. Share what foods can be eaten on a low-fat diet to prevent fat deposits. Review dietary measures to assist in controlling weight gain.
Provide reassurance that these are normal changes.
Which action would provide an indication that an adolescent's parents understand their child's need for increased independence? Saying, "We will always be here for her whenever our child needs us." Stating they are encouraging their child in the search for an after-school job Verbalizing, "We try to do everything we can to make things easier for her." Reporting they understand that their child's chief need is for increased privacy
Stating they are encouraging their child in the search for an after-school job
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 other teens, use a phone, and check her email.
Take her to the teen lounge so she can meet other teens, use a phone, and check her email.
What activity would best foster the developmental task of an adolescent who uses a wheelchair to ambulate? Talking to another adolescent who has a similar situation Watching television on the set in the adolescent's room Having a teacher bring school work to the adolescent Allowing the adolescent to decide when to bathe
Talking to another adolescent who has a similar situation
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 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. They understand and respond to discipline.
Teens are busy developing their own personal identity.
During a complete physical assessment of a preteen boy, the nurse correctly recognizes which finding as being the first change of puberty? Deepening voice Development of axillary hair Testicular enlargement Increase in height
Testicular enlargement
What is the best explanation of Erikson's theory of psychosocial development during adolescence? The adolescent faces many different decisions during the teen years concerning the future and the adult world. The adolescent develops many skills during the teen years that help them make educational and career choices. Cognitive development is cumulative; that is, what is learned is based on what has been known before. The adolescent thinks in the abstract and develops skills to participate in complex problem solving.
The adolescent faces many different decisions during the teen years concerning the future and the adult world.
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's need for parental support should be discussed. The adolescent should be given freedom to participate in unit activities as desired.
The adolescent's need for privacy should be respected.
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 given freedom to participate in unit activities as desired. The adolescent's need for privacy should be respected. The adolescent should be encouraged to call friends often. The adolescent's need for parental support should be discussed.
The adolescent's need for privacy should be respected.
The nurse is caring for adolescent athlete who is being seen for a fractured arm. The parent reports that this is the third sports injury in the past 2 years. The parent asks the nurse why the adolescent who is healthy overall continues to have injuries. How should the nurse respond? The bones, joints and tendons of adolescents are vulnerable to injury due to their rapid state of growth. Some adolescents are accident prone. These are accidents and random in occurrence. There may be some underlying problems that your adolescent should be evaluated for.
The bones, joints and tendons of adolescents are vulnerable to injury due to their rapid state of growth.
The physician has made a notation in the medical record of a 17-year-old that the teen is not demonstrating successful completion of Erikson's stages of development. What behavior would be consistent with this assessment? The teen is anxious to move away from his parent's home. The teen is uncertain and frequently unable to make decisions. The teen is sexually promiscuous. The teen is distrustful of others.
The teen is uncertain and frequently unable to make decisions.
The father of a 15-year-old daughter is concerned she is not getting adequate nutrition to play high school basketball. Her games are on Friday nights. Which suggestion should the nurse point out will best suit the needs of this adolescent? Three daily meals that include choices from each of the food groups; Friday's lunch eaten around 2 p.m. with a small amount of fat and a somewhat larger than usual portion of complex carbohydrates. Boiled eggs with bacon or ham and a glass of orange juice for breakfast on Thursday and Friday mornings along with some sliced turkey and a salad at noon on Friday. Three daily meals that include choices from each of the food groups with an additional serving of fruit and several extra glasses of water on Friday. Pasta with a small amount of meat sauce and two slices of bread for dinner on Wednesday and Thursday evenings and again at 2 p.m. on Friday.
Three daily meals that include choices from each of the food groups; Friday's lunch eaten around 2 p.m. with a small amount of fat and a somewhat larger than usual portion of complex carbohydrates.
With summer approaching, the nurse discusses sun safety with a group of teen girls. Which suggestion is most likely to be followed? Wear sunglasses. Wear a hat when in the sun. Do not attempt to get a tan. Limit sun exposure between 10:00 AM and 2:00 PM.
Wear sunglasses.
The nurse is promoting nutrition to a teen who is going through a growth spurt. Which food should the nurse recommended for its high iron content? Whole grain bread Fat-free milk Organic carrots Fresh orange juice
Whole grain bread
The nurse will monitor which adolescent client most closely for the risk of suicide? a homosexual client who is failing two high school courses and refusing prescribed medication a homosexual client requesting the nurse have the client's necklace and whose parents divorced last month a heterosexual client diagnosed with multiple personality disorder requesting no visitors a heterosexual client with a history of cocaine use whose best friend moved hours away last week
a homosexual client requesting the nurse have the client's necklace and whose parents divorced last month
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. inappropriate response because adolescents are minors compliance with existing laws concern from parents who pay the office visit bill development of a trusting relationship an environment where adolescents can be truthful
development of a trusting relationship compliance with existing laws an environment where adolescents can be truthful
According to Erikson, the adolescent develops his or her own sense of being an independent person with individual thoughts and goals. This stage is referred to as: intimacy vs. isolation. identity vs. role confusion. industry vs. inferiority. autonomy vs. doubt and shame.
identity vs. role confusion.