PEDS: Chapter 27: 11-18 years

Question 10 of 20 The nurse is providing suggestions to a female adolescent about foods to help meet her nutritional requirements for iron. Which food would the nurse suggest as a good source of iron? Broccoli White beans Peanut butter Yogurt

Correct response: Peanut butter Explanation: Peanut butter is a good source of iron. Broccoli, yogurt, and white beans are good sources of calcium.

Question 4 of 20 What anticipatory guidance can the nurse provide the girl who has noted the development of breast buds? 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.

Correct response: Menarche should follow in about 2 years. Explanation: 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.

Question 14 of 20 A nurse is preparing a class for a group of adolescents about sexuality and sexual activity. The nurse understands that which of the following are often the biggest influences on an adolescent's actions related to sexual activity? Select all that apply. Scientific evidence Peer pressure Self-esteem Parental concern Education

Correct response: Peer pressure Self-esteem Explanation: With appropriate information regarding prevention of STIs and pregnancy, the adolescent might choose to delay sexual activity. However, education does not always mean that he or she will choose abstinence. Peer pressure and self-esteem often influence adolescents' actions more so than scientific evidence or education.

Question 17 of 20 An 18-year-old client is planning to attend college in the fall. The health care nurse informs the adolescent that a visit with the primary care physician (PCP) will need to be scheduled before the start of college. What primary purpose does this PCP visit serve? To assess for health problems To discuss diet To obtain birth control To update immunizations

Correct response: To update immunizations Explanation: The primary purpose of the PCP visit is to ensure that the adolescent has received recommended immunizations and administer any missing vaccines so that the adolescent is ready for communal living. The other answers may or may not be discussed during the visit, but they are not the primary purpose.

Question 16 of 20 A nurse is examining a 17-year-old adolescent in the emergency room who is being disruptive in the waiting area. On assessment, the nurse finds dilated pupils, and the teen is talking very fast. Which of the following drugs does the nurse suspect the teen may be abusing? Barbiturates Marijuana Amphetamines Opiates

Correct response: Amphetamines Explanation: Amphetamine drug abuse can result in euphoria, rapid talking, and dilated pupils. Opiates can cause a person to be drowsy with constricted pupils. Marijuana users are usually very relaxed. Barbiturates cause euphoria that is followed by depression.

The school nurse is preparing a program on sexuality and birth control for a class of 14- to 16-year-olds. Which behavior will have the most influence on how the information is presented? Teens are adjusting to new body images. Adolescents tend to take risks. Teenagers are able to think in the abstract. Adolescents understand that actions have consequences.

Correct response: Adolescents tend to take risks. Explanation: Adolescents are risk takers. This tendency enables them to overcome common sense and their own better judgment. Although adolescents are capable of abstract thinking and understand that actions have consequences, they are not yet committed to these attributes. Changing body image would not have significant influence on the presentation.

The nurse is describing the nutritional requirements of an adolescent to a local parent group. Which of the following would the nurse include as needing to be increased in the adolescent's diet? Select all that apply. Iron Folate Calcium Potassium Magnesium

Correct response: Iron Folate Calcium Explanation: Several nutrients may need to be added to the adolescent's diet including folate, iron, and calcium. Folate is recommended for all female adolescents who are capable of becoming pregnant to reduce the risk of giving birth to a child with a neural tube defect. Rapid growth during the adolescent years leads to an increase need for iron. Calcium intake also needs to be increased as a result of the bone mass development that occurs during adolescence. Neither potassium or magnesium need to be increased.

An adolescent who admits to using cocaine frequently comes to the emergency center with symptoms of chest pain, is diaphoretic, and is hypertensive. When establishing care, what priority assessment data does the nurse need? heart rhythm temperature time of last cocaine use cardiac enzymes

Correct response: heart rhythm Explanation: Cocaine produces the physical effects of chest pain, increased pulse and respiration rates, increased temperature, increased blood pressure and decreased appetite. It can be a major cause of cardiovascular arrest in young adults. The priority in this situation would be to assess heart rhythm for fatal dysrhythmias. The remainder of answer choices are correct, but they are not the priority.

Question 1 of 20 The nurse is caring for a 12-year-old boy. During a routine wellness examination, the mother tells the nurse that the boy's father has really been teasing him about his sexual development and the boy is very embarrassed. The mother asks for some guidance. How should the nurse respond? "Your son should tell your husband that he does not like to be teased." "At this age, children can be very self-conscious and sensitive." "Advise your husband that good-natured teasing must be avoided at this age." "I would be happy to talk to your husband if necessary."

Correct response: "Advise your husband that good-natured teasing must be avoided at this age." Explanation: The nurse must provide the mother with concrete information that will help the boy's father understand that good-natured teasing must be avoided at this age. The nurse should first encourage the mother to discuss this matter with the father rather than making the son address the issue. Telling the mother that children can be very self-conscious accurately conveys facts but does not provide direction. The nurse could talk to the boy's father only after the mother tries to address the matter.

Question 3 of 20 An adolescent shares with you that she wishes her breasts would grow larger. Which initial nursing response is best? "Let's talk about your concern. You know that breast size has nothing to do with ability to reproduce." "You look fine to me. Why would you want larger breasts?" "It is unlikely that your breasts will grow any more. I wouldn't spend time thinking about it." "Breast growth usually stops by the age of 16 years. What is the reason you were hoping yours would grow more?"

Correct response: "Breast growth usually stops by the age of 16 years. What is the reason you were hoping yours would grow more?" Explanation: Beginning with the facts is appropriate. It is not unusual that many adolescents are disappointed about their physical appearance. Helping them talk about this helps them work through their feelings and reestablish self-worth. Statements to not "think about it" or not having an impact on reproduction" close communication. Stating that the client looks fine to the nurse may be kind but is inappropriate and closes communication.

A 15-year-old adolescent is seen in the office. During the examination, the client asks the nurse about having sex. The parent states that the adolescent has been asking questions lately regarding this topic. What should be the nurse's response? "That is not something we will discuss today." "Are you actively having sex at this time?" "We can discuss that as well as other aspects of sexuality." "Tell me what you know about sex."

Correct response: "We can discuss that as well as other aspects of sexuality." Explanation: The nurse should discuss sexuality at the appropriate age as a routine part of health care. When the adolescent approaches puberty, the nurse should encourage parents to discuss sexuality, and as the adolescent ages, family planning. The nurse also should assist the adolescent to become his or her own advocates in the health care system. Asking what the adolescent knows might help determine the extent of the education for that visit, but also puts the adolescent on the spot and may cause termination of the conversation.

Question 19 of 20 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. concern from parents who pay the office visit bill an environment where adolescents can be truthful compliance with existing laws development of a trusting relationship inappropriate response because adolescents are minors

Correct response: development of a trusting relationship compliance with existing laws an environment where adolescents can be truthful Explanation: 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.

An adolescent female with anemia has been prescribed a diet high in iron. Selection of which meal indicates to the nurse that the client understands the prescribed diet? meatloaf, steamed cauliflower with cheese, and milk fried chicken, carrots, and mashed potatoes baked chicken, squash casserole, and salad shrimp, corn on the cob with butter, and cookie

Correct response: meatloaf, steamed cauliflower with cheese, and milk Explanation: Iron is necessary to meet expanding blood volume requirements. Females require a high iron intake not only because of this increasing blood volume but also because iron begins to be lost with menstruation. Foods high in iron include meats and green leafy vegetables. Cauliflower is the same specifies of plant as green leafy vegetables and as such is included in this category. Carrots, squash, and corn contain very limited amounts of iron.

Question 5 of 20 The nurse is instructing a 12½-year-old boy who says, "I am too short! Girls are taller than I am. Guess I won't be playing basketball." What instruction is best included in the plan of care? Select all that apply. "There are a lot of size differences in your age group now because everyone enters puberty and grows at slightly different times than others." "Girls begin to grow rapidly at a younger age than boys do. Boys start later and grow longer." "If you know how tall you were at age 3, you can double that and predict fairly well how tall you will get." "You are at the age now when most boys begin their growth spurt and grow very rapidly." "You can't control when and how much you will grow. Basketball can use some really fast guards." "You could add as much as 12 inches to your height before you stop growing."

Correct response: "Girls begin to grow rapidly at a younger age than boys do. Boys start later and grow longer." "There are a lot of size differences in your age group now because everyone enters puberty and grows at slightly different times than others." "You could add as much as 12 inches to your height before you stop growing." Explanation: The information about girls growing faster than boys, about differences in size within his age group, and about his growth potential is accurate and addresses concerns implied in his comments to the nurse. Most boys' growth spurts begin near 14 years, not 12½. Height should be doubled at 2 years to predict adult size. The growth control and basketball remarks minimize his concerns and provide no information.

Question 17 of 20 The adolescent comes to the clinic reporting "being tired all the time." What assessment data is important for the nurse to ask about the adolescent's symptoms? Select all that apply. "What do you like best about school?" "How often do you hang out with friends each week?" "How many hours did you sleep last night?" "Have you been ill recently?" "Do you play in an organized sport?"

Correct response: "How many hours did you sleep last night?" "Do you play in an organized sport?" "How often do you hang out with friends each week?" "What do you like best about school?" Explanation: Because so many adolescents comment that they feel fatigued to some degree, it can be considered normal for this age group. However, fatigue may also be a beginning symptom of disease, so it is important not to underestimate it as a concern. Always address the diet, sleep patterns, and activity schedules. If the adolescent report of fatigue began as a short period of extreme tiredness, it suggests disease more so than a long, ill-defined report of always feeling tired. If an adolescent's sleep and diet appear to be adequate, his or her activity schedule is reasonable, and a physical assessment suggests no illness, then the fatigue may be of emotional origin. It can be a means of avoiding school, conflict with parents, social situations or students who are understimulated by school. Fatigue may be a sign of boredom.

A 19-year-old female adolescent comes to the clinic for a check-up. The nurse observes that she has a new tattoo. She tells the nurse, "I just got it 2 days ago." When reviewing the care of the tattoo with the adolescent, the nurse determines that the adolescent understands how to care for the tattoo when she states which of the following? Select all that apply. "I wash it gently with a mild soap and warm water" "I let it air-dry for about 10 minutes after cleaning it." "I can put on some A&D ointment a couple of times a day for about 2 weeks. I need to rub petroleum jelly over the tattoo to keep it moist. I can use alcohol on the site to allow it to heal faster.

Correct response: "I wash it gently with a mild soap and warm water" "I let it air-dry for about 10 minutes after cleaning it." "I can put on some A&D ointment a couple of times a day for about 2 weeks. Explanation: Post-tattoo care includes wearing a bandage over the area for the first 2 to 13 hours. The site needs to be washed gently with mild soap and warm water, patted dry, and allowed to air-dry for 10 minutes. Apply Polysporin, Bacitracin, or A&D ointment sparingly a few times each day for 3 to 14 days. Use of petroleum jelly will drain the color from the tattoo, and use of alcohol will interfere with healing. The tattooed area should not be soaked in water or shaved until healing is complete. The goal of post-tattoo care is to prevent scab formation and allergic reaction.

Question 2 of 20 An adolescent asks the nurse what the term "puberty" means. What is the nurse's best response? "It is the time span that denotes the onset of maturity." "It denotes the beginning of secondary sex characteristics." "It is the age at which one first becomes capable of sexual reproduction." "It is the time span between 12 and 18 years."

Correct response: "It is the age at which one first becomes capable of sexual reproduction." Explanation: Adolescence is a period of rapid growth with dramatic changes in body size and proportions. It is the time between puberty and the end of physical growth. During this time sexual characteristics develop and reproductive maturity is developed. Puberty is the point at which an individual becomes capable of sexual reproduction. Puberty starts at different ages for males and females. Puberty is defined as sexual maturity only. It does not describe emotional maturity.

Question 12 of 20 The parents of an adolescent boy ask the nurse when they will know that their son has reached puberty. What is the best response by the nurse? "Puberty spans the ages between 11 and 20 years of age. "Emotional needs predominate the puberty period." "Puberty occurs when the person becomes able to reproduce sexually." "A rapid growth spurt occurs during puberty."

Correct response: "Puberty occurs when the person becomes able to reproduce sexually." Explanation: Puberty is the period when a person becomes able to reproduce sexually. Adolescence is the developmental period between puberty and maturity. It spans the ages between 11 and 20 years, after which a person enters early adulthood. Rapid growth spurt marks adolescence, by the end of which individuals achieve adult height. Although tremendous physical growth occurs, emotional needs predominate during this period and adolescents spends much of their time searching for meaning in life and for a sense of identity.

Question 15 of 20 The school nurse is preparing an educational session for adolescents to address the 2020 National Health Goals for healthy habits. What should the nurse include in this presentation? Select all that apply. Attending college preparation programs Maintaining a healthy body weight Abstaining from alcohol Refusing to participate in substance abuse Avoidance of tobacco products

Correct response: Abstaining from alcohol Avoidance of tobacco products Maintaining a healthy body weight Refusing to participate in substance abuse Explanation: Nurses can help the nation achieve the 2020 National Health Goals for adolescent healthy habits by educating adolescents about the use of cigarettes, smokeless tobacco, alcohol, and substance abuse, and reducing the number of adolescents who are obese. College preparation programs will not necessarily help adolescents achieve healthy habits.

Question 18 of 20 A nurse working at a pediatric clinic includes an adolescent history for every child aged 11 to 18 years when the child is new to the office. Which issues should the nurse address when the parents are not in the room? Select all that apply. Abuse/domestic violence Self-image Adolescent's fit in the family Job responsibilities Sexual activities

Correct response: Abuse/domestic violence Sexual activities Explanation: A primary reason for addressing abuse and sexual activities while the parent is not in the room is that the child may not want the parent/family member to know about sexual activity; the provider may be able to help the child develop ways of telling the parent about the issue or the child may divulge the "real" reason for coming to the health care agency. The child's self-image, job responsibilities, and his or her fit in the family could all be assessed while the parent/family member is in the room.

Question 11 of 20 The school nurse is planning to teach a segment on smoking during the freshman health classes. The nurse is aware that this needs to be a forum rather than a lecture. Which of the following techniques will also help deliver a "don't smoke" message? Showing a command of the facts on smoking Speaking with a tone of authority Keeping your personal experiences out of it Listening to all comments nonjudgmentally

Correct response: Listening to all comments nonjudgmentally Explanation: It is very important to listen to the students' comments without judgment to avoid creating a resistance to information. Spouting too many facts too often and taking on an authoritative tone will show the audience that their opinions don't matter. Using personal experiences and admitting mistakes you have made can be helpful to communication.

Question 19 of 20 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? Make an appointment with the health care provider. Encourage participation in sports. Have the child visit the school counselor. Supervise homework sessions.

Correct response: Make an appointment with the health care provider. Explanation: Adolescents need to have a thorough physical examination at health maintenance visits to ensure that they are in good physical health. Assessment for depression at these visits includes the assessment for anorexia, insomnia, excessive fatigue and weight loss. In younger adolescents, depression may be manifested not so much by appearing sad, but by behavior problems such as disobedience, temper tantrums, truancy, and running away. Additional signs may be self-destructive behavior, difficulties in school, use of drugs and alcohol, sexual promiscuity or trouble with the legal system. Many adolescents find it hard to be alone, so they seek constant activity as a means of escape.

Question 13 of 20 A nursing instructor is conducting a class on the changes that occur during adolescence. The instructor determines that the teaching was successful when the students identify which of the following. Select all that apply. Pubertal boys require approximately 500 calories more per day than pubertal girls. Male muscle mass is two times greater than in females by age 17. By age 18, most of a female's growth spurt is complete. A female attains her full height by age 21 years. Spontaneous erections in boys usually occurs around age 11 years.

Correct response: Male muscle mass is two times greater than in females by age 17. Pubertal boys require approximately 500 calories more per day than pubertal girls. Explanation: For the adolescent, male muscle mass is two times greater than in females by age 17 and pubertal boys require 2500 to 3000 calories per day in contrast to pubertal girls who require 2000 to 2500 calories per day. Spontaneous erections typically occur in males around the age of 12 to 13 years. Most of a female's growth spurt is completed by age 14 to 15 years. A male attains his full height by age 21 years.

Question 4 of 20 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. Peers provide opportunity to learn and practice social roles. Peers are needed for emotional security while stepping away from family. Adolescents need parental support and guidance as they move toward greater peer involvement. Peers can be positive or negative influences. Parents should wait until the adolescent introduces them to their peers.

Correct response: 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. Explanation: The parent should understand that at this stage of development, it is normal for peers to have a large role in the adolescent's life. The adolescent is finding his/her place outside the home filling a need for emotional security, an opportunity to learn and practice societal roles. It is true that peers can have a positive influence or a negative influence over the adolescent. Adolescents still need their parents involvement in their life with support and guidance. The parents should take a proactive approach at getting to know their adolescent's peers.

Question 6 of 20 The school nurse is conducting a seminar for parents of adolescents on how to communicate with teenagers. Which guidelines might the nurse recommend? Select all that apply. Speak to your child as an authority figure, not an equal. Ask questions to see why he or she feels that way. Talk face to face and be aware of body language. Don't pretend you know all the answers. Do not give praise unless the adolescent deserves it. Don't admit that you make mistakes.

Correct response: Talk face to face and be aware of body language. Ask questions to see why he or she feels that way. Don't pretend you know all the answers. Explanation: In order to improve communication with teenagers, the parents should talk face to face and be aware of body language, ask questions to see why the teenager feels that way, not pretend they know all the answers, give praise and approval to the teenager often, speak to him or her as an equal (not talk down to him or her), and admit that they do make mistakes.

Question 9 of 20 The nurse is helping the parents and their underweight adolescent collaborate on planning a healthy menu. The nurse should be aware of which nutritional requirement of adolescents? Teenage boys who are active require between 2,000 and 2,500 calories per day. Teenagers have a need for increased calories, zinc, calcium, and iron for growth. Adolescents require about 1,000 to 1,200 mg of calcium each day. Teenage girls who are active require about 1,800 calories per day.

Correct response: Teenagers have a need for increased calories, zinc, calcium, and iron for growth. Explanation: Teenagers have a need for increased calories, zinc, calcium, and iron for growth. However, the number of calories needed for adolescence depends on the teen's age and activity level as well as growth patterns. Teenage girls who are active require about 2,200 calories per day. Teenage boys who are active require between 2,500 and 3,000 calories per day. Adolescents require about 1,200 to 1,500 mg of calcium each day.

Question 8 of 20 The nurse is developing a teaching session on common adolescent injuries. What considerations lead the nurse to pertinent topics? Select all that apply. A lack of impulsivity in action and decision making Adolescent comments of tiredness and lack of energy Inexperience Common insufficient psychomotor coordination Psychosocial concerns affected by peer pressure The adolescent's increased physical growth

Correct response: The adolescent's increased physical growth Common insufficient psychomotor coordination Psychosocial concerns affected by peer pressure Inexperience Explanation: Common developmental characteristics of the adolescent are used to consider appropriate teaching topics for adolescent injury. Influencing factors related to the prevalence of adolescent injuries include increased physical growth, insufficient psychomotor coordination for the task, abundance of energy, impulsivity, peer pressure, and inexperience. Impulsivity, inexperience, and peer pressure may place the teen in a vulnerable situation between knowing what is right and wanting to impress peers. On the other hand, teens have a feeling of invulnerability, which may contribute to negative outcomes.

Question 3 of 20 The nurse is admitting a 15-year-old to the hospital pediatric unit. What does the nurse recognize as a priority for this adolescent? 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 adolescent should be encouraged to call friends often.

Correct response: The adolescent's need for privacy should be respected. Explanation: When an adolescent is ill or injured it affects their body and body image. A hospitalized adolescent's primary concerns are pain and the loss of privacy. They are also anxious about being spearated from their from their friends and losing control of their lives. When adolescents are hospitalized it is very important they be given privacy. They need individualized attention, confidentiality, and the right to participate in decisions about their 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 decisons and the adolescent's need for support from family.

Question 7 of 20 The nurse teaching safety to teens knows that which of these is the leading cause of death among adolescents? Drowning Unintentional injuries Diseases Poisoning

Correct response: Unintentional injuries Explanation: Unintentional injuries are the leading causes of death in adolescents (U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 2008). Injuries kill more adolescents than all diseases combined, with 46% of injury-related deaths due to motor vehicle accidents (U.S. Department of Health and Human Services, 2007). Unintentional injury accounts for about 48% of adolescent injury deaths, violence and homicide for 15.2%, and suicide for 11.8% of adolescent injury deaths (U.S. Department of Health and Human Services, 2007). Males are more likely than females to die of any type of injury. Reference:

Question 20 of 20 A runaway female adolescent has come to the community clinic because she is pregnant. When developing a plan of care, the nurse should identify which priority goal for this client? monthly antenatal visits adequate nutrition returning home to parents safe housing

Correct response: safe housing Explanation: Because many adolescents who run away are not good problem solvers, setting goals with them may be difficult. As the adolescent has no money for food, telling her to eat a nutritious diet is not attainable. If the adolescent does not have a means of transportation, she may be unable to return to the health care facility for frequent follow-up visits. The nurse should ask the adolescent if she wants to return home and if possible, ascertain if the parents will allow the adolescent back home. While food and antenatal visits are necessary, safety is the priority for the mother and the baby.

Glycogen loading is practiced regularly by the local high school football team. What is most important for the nurse to monitor in these students? the amount of protein the student is eating how often the students engage in this practice the amount of carbohydrates the student is eating how many hours the student exercises each day

Correct response: the amount of carbohydrates the student is eating Explanation: Glycogen loading is a procedure used to ensure there is adequate glycogen to sustain energy through an athletic event. Several days before a sports event, athletes lower their carbohydrate intake and exercise heavily to deplete muscle glycogen stores. They then switch to a diet high in carbohydrate. With the renewed carbohydrate intake, muscle glycogen is stored at 2 to 3 times the usual level, which supplies them with up to 2 times the glucose needed for sustained energy. Athletes need more energy from carbohydrates than protein. Participating in this practice would cause a negative nitrogen balance, not a positive.