Unit 9- Pediatric Nursing; Adolescent

A 15-year-old girl visits the neighborhood clinic seeking information on "how to keep from getting pregnant." What should the nurse say in response to her request?

"Can you tell me about the precautions you're taking now?" An attitude that requests only the information the girl is willing to give is nonthreatening and nonjudgmental. This may enhance the girl's willingness to talk about her experiences, thus enabling the nurse to better assess her needs. Asking what the girl would like to know assumes the girl knows what information she needs. The precautions her friends are taking are irrelevant at this time. Referencing the girl's parents may make her defensive and fearful.

A nurse is caring for a 16-year-old girl who isn't sexually active. The girl asks if she needs a Papanicolaou (Pap) test. How should the nurse respond?

"No, it isn't necessary because you aren't sexually active." A 16-year-old girl who isn't sexually active doesn't need a Pap test. When a girl is sexually active or reaches age 18, she should have a Pap test.

An adolescent with pneumonia shares fears of having contracted human immunodeficiency virus (HIV). The adolescent wants to be tested but does not want parental involvement. What should the nurse say?

"The healthcare provider will run the test confidentially." Federal laws state that adolescents may be tested for sexually transmitted diseases without their parents' permission. The rules of confidentiality apply to this adolescent. The adolescent doesn't have to speak with anyone before the test. HIV can be contracted at any age, even during infancy and childhood. Asking why the client thinks HIV is possible may exhbit therapeutic communication, but it does not address the client's concern.

A hospitalized adolescent diagnosed with anorexia nervosa refuses to comply with her daily before-breakfast weigh-in. She states that she just drank a glass of water, which she feels will unfairly increase her weight. What is the nurse's best response to the client?

"You must weigh in every day at this time. Please step on the scale." In responding to the client, the nurse must be nonjudgmental and matter of fact. Telling her that weight gain is in her favor ignores the client's extreme fear of gaining weight. Putting off the weigh-in for 2 hours allows the client to manipulate the nurse and interferes with the need to weigh the client at the same time each day. Threatening to call the health care provider is not likely to build rapport or a working relationship with the client.

Which suggestion should the nurse give to an adolescent athlete with Osgood-Schlatter disease of the left knee?

Apply ice on the knee after playing. Most adolescents with Osgood-Schlatter disease are able to continue to exercise and use ice afterward. Ibuprofen also may be prescribed. Because Osgood-Schlatter disease is self-limited, crutches or physical therapy are usually unnecessary, and the adolescent usually does not need to stop playing sports. Only in severe cases would the adolescent have to stop playing sports.

The nurse is providing nutrition counseling for an obese adolescent. What is the most effective way for the nurse to obtain a nutrition history from this client?

Ask her what she ate yesterday if it was a typical day. A 24-hour recall history is the best method to obtain a dietary history from an adolescent. Open-ended questions tend not to provide sufficient details for a nutrition history. Asking what the client plans to eat in the future gives the client an opportunity to report the "right" answer. The nurse obtains the information directly from the client; asking the mother has the potential to undermine trust.

An adolescent female arrives in the emergency department after a physical assault. How could the male nurse best protect the client's rights during the physical examination?

Have a female health care worker present. A female health care provider should be present to observe an examination performed by a male health care provider. Leaving the door open and informing the client's friends about her condition violates her right to privacy and confidentiality. Although the suspected attacker should be kept away from the examination room, having a female health care worker present during the examination best protects the girl's rights.

An adolescent is brought to the emergency department in a coma and is diagnosed with diabetic ketoacidosis. What is the correct action for the nurse to take?

Infuse intravenous fluids as prescribed. Dehydration results from the osmotic diuresis associated with hyperglycemia and polyuria. The client is at risk for shock from dehydration. Chovostek sign is exhibited by clients with hypocalcemia. Calcium and sodium are not concerningly altered in the acute phase of diabetic ketoacidosis (DKA). People experiencing DKA have classic metabolic acidosis manifestations with a low bicarbonate level. Eventually, the body should try to shift toward respiratory alkalosis to compensate.

An adolescent is at risk for injury related to intracranial pathology following a motor vehicle collision. Which nursing action is the priority?

Monitor intrancranial pressure. Increased intracranial pressure contributes to increasingly severe pathology, including potential for brain stem herniation, so monitoring and maintaining stable intracranial pressure is priority. Systemic parameters and intracranial parameters are both essential, though. The nurse takes actions to keep the intracranial pressure low by controlling factors that can cause elevated ICP such as monitoring for changes in oxygenation, temperature, glucose, blood pressure, and heart rhythm and rate. Maintaining the head in a neutral position is essential to keeping ICP within the desired limits.

A 16-year-old client is prescribed 10 mg of paroxetine at bedtime for major depression. The nurse should instruct the client and parents to monitor the client closely for which adverse effect?

agitation The nurse closely monitors the client taking paroxetine for the development of agitation, which could lead to self-harm in the form of a suicide attempt. Headache, nausea, and fatigue are transient adverse effects of paroxetine.

When planning counseling sessions with adolescents, the nurse must incorporate measures to consider which abilities?

capacity to deal with abstract possibilities The ability to deal with abstract possibilities develops during adolescence.Assimilation and accommodation are characteristics of an infant's sensorimotor development.Representational thought is associated with the preconceptual phase of development, from the ages of 2 to 4 years.Problems of conservation are part of concrete operations learned by children between ages 4 and 7 years.

After conducting a presentation to a group of adolescent parents on the topic of adolescent pregnancy, the nurse determines that one of the parents needs further instruction when the parent says that adolescents are at greater risk for which complication?

congenital anomalies Additional teaching is needed when the parent says that adolescents are at greater risk for congenital anomalies. Although adolescents are at greater risk for denial of the pregnancy, lack of prenatal care, low-birth-weight infant, cephalopelvic disproportion, anemia, and nutritional deficits and have a higher maternal mortality rate, studies reveal that congenital anomalies are not more common in adolescent pregnancies.

A 14-year-old is admitted to the hospital with a diagnosis of acute rheumatic fever. The nurse should assess the client for which signs and symptoms? Select all that apply.

fatigue skin rash sore throat Acute rheumatic fever is a systemic disease that occurs after a streptococcal pharyngitis or skin infection. It may result in serious cardiac valvular involvement of the mitral or aortic valve, including stenosis or regurgitation, and clients may present with fatigue.Rheumatic fever often present with a rash on the trunk and upper extremities.Streptococcal pharyngitis frequently precedes rheumatic fever. Clients with rheumatic fever do not have peripheral edema.Migraine headaches are not associated with having rheumatic fever.

An adolescent is admitted for treatment of bulimia nervosa. When developing the care plan, the nurse anticipates including interventions that address which metabolic disorder?

metabolic alkalosis In a client with bulimia nervosa, metabolic alkalosis may occur secondary to hydrogen loss caused by frequent, self-induced vomiting. Typically, the blood glucose level is within normal limits, making hypoglycemia unlikely. In bulimia nervosa, hypokalemia is more common than hyperkalemia and typically results from potassium loss related to frequent vomiting.

The school nurse is counseling a female client who is concerned about an incident that occurred at a school dance. The young client describes becoming drowsy and disoriented after drinking punch and waking up hours later in the back of a stranger's car. What is the most appropriate advice for the nurse to give the adolescent?

"It's possible that you were raped and will need information on pregnancy testing." It is highly likely that the punch contained flunitrazepam, a date rape drug. It is colorless, odorless, and tasteless. The effects are drowsiness, impaired motor skills, and amnesia, making the victim an easy target for rape.

A member of a nurse-led group for depressed adolescents tells the group that she is not coming back because she is taking medication and no longer needs to talk about her problems. Which response by the nurse is most appropriate?

"The purpose of the group is to provide each of you with a place to discuss the problems of being a teenager with depression with others who also are experiencing a similar situation." Focusing on the purpose of the group is the best response. Adolescents are greatly influenced by their peers. Medication alone is not typically the most successful treatment strategy. Questioning whether the client will continue the medication is negative and is not the reason for her to stay in the group. Asking the rest of the group to respond may or may not give the nurse support for the teenager remaining in the group. Groups commonly have rules regarding movement of members in and out of the group, but this does not address the reasons for the client to remain in the group.

An adolescent girl with a seizure disorder controlled with phenytoin and carbamazepine asks the nurse about getting married and having children. Which response by the nurse would be most appropriate?

"When you decide to have children, talk to the health care provider about changing your medication." Phenytoin sodium is a known teratogenic agent, causing numerous fetal problems. Therefore, the adolescent should be advised to talk to the HCP to see if changing the medication is possible. Additionally, anticonvulsant requirements usually increase during pregnancy. Seizures can be controlled but cannot be cured. There is a familial tendency for seizure disorders. Seizure disorders and infertility are not related.

A 12-year-old client says, "Give me my pajamas. I'm not putting your silly gown on." What is the most appropriate response by the nurse?

"You're upset because you feel awkward and embarrassed in these gowns." The nurse uses active listening, in which the client's feelings are reflected back to him. Telling the client that everyone wears them does not consider the client's feelings. Telling the client that what he said is not what he meant discounts the validity of his statement. Interpreting the reason for the client being upset as the rule being unreasonable does not take into account how it affects the client personally.

A nurse is reviewing discharge instructions with the parents of an adolescent who sustained a head injury to the frontal lobe of the brain. When discussing possible consequences of the injury, which of the following is the most important information to give the parents?An overweight adolescent client has lost 12 lb (5.4 kg) in 8 weeks using diet strategies. The client reaches a weight loss plateau and is discouraged. The nurse instructs the client to keep a food diary for what purpose?

"Your child may exhibit drastic personality changes." The frontal lobe regulates personality and judgment. The occipital lobe regulates vision, the temporal lobe regulates hearing, and the parietal lobe regulates sensation.

A 19-year-old nulligravid client visiting the clinic for a routine examination asks the nurse about cervical mucus changes that occur during the menstrual cycle. Which information would the nurse expect to include in the client's teaching plan?

As ovulation approaches, cervical mucus is abundant and clear. As ovulation approaches, cervical mucus is abundant and clear, resembling raw egg white. Ovulation generally occurs 14 days (±2 days) before the beginning of menses. During the luteal phase of the cycle, which occurs after ovulation, the cervical mucus is thick and sticky, making it difficult for sperm to pass. Changes in the cervical mucus are related to the influences of estrogen and progesterone. Cervical mucus is always present.

The nurse is caring for an adolescent with cancer who is well informed about the medical condition and treatment. The adolescent refused the morning medications and states intentions of refusing all future medications. What is the best action by the nurse?

Document the adolescent's choice and offer to discuss feelings about the medication. The client has the right to choose whether to take the medication. The nurse should try to determine the reason for the adolescent not wanting the medication other than choice (e.g., side effects, fear of falling asleep and not waking). The other options do not support the autonomy of the adolescent to make an informed decision.

A 16-year-old client is admitted to the emergency department following an accident. The client sustained a head injury, is unconscious, and has compound fractures of the right tibia and fibula. No family members accompanied the client and none can be reached by phone. The surgeon instructs the nurse to take the client to the operating room immediately. Which of the following actions should the nurse take regarding informed consent?

Take the client to the operating room for surgery without informed consent. The surgeon can take responsibility for consent in this situation because the condition is life (and limb) threatening and delaying the surgical treatment would have a negative impact on the client. The other options would delay the life-saving surgery and would result in negative outcomes for the client. The hospital chaplain has no authority to sign a consent form on behalf of the client.

The nurse assesses the results of a gentamicin trough blood level for an adolescent with cystic fibrosis who has had been treated with gentamicin several times over the last year. The drug level is high. What is the nurse's primary concern?

The child may suffer hearing loss. When given for an extended period of time, aminoglycoside antibiotics can cause permanent hearing loss. The high trough level may indicate that the child has decreased kidney function and is not clearing the drug out of their system efficiently. While hepatotoxicity has been shown in isolated reports, changes in liver function resolve rapidly once gentamicin is stopped. While errors in medication administration can cause abnormal lab results, the child's clinical history and frequency of gentamicin use support an elevated blood level. The lab result indicates that the dose of gentamicin may need to be decreased.

The charge nurse on the adolescent unit must decide which nurse should admit a new client. Based on the present client care assignments, who is the best candidate to admit the client?

a nurse who was reassigned from another ward at the beginning of the shift The nurse's work load would be low because she was reassigned to the ward at the beginning of the shift. The client with asthma requires constant monitoring by the nurse until the situation is resolved. Simple tasks and procedures are commonly more time-consuming when clients with paralysis are involved because these clients can't directly aid in their own care. Additional time must also be allotted for the nurse about to undertake a complicated procedure, such as a wet-to-damp dressing change.

The nurse reviews the plan of care of an adolescent client with diabetes using an insulin pump. This is the second visit that the client has come without his parent. The client's hemoglobin A1C and blood glucose levels are normal. The client reports that he is playing a sport and has not had any hypoglycemic episodes. Which factor does the nurse determine is the best indicator that the client is transitioning to independent self-management?

attending health care appointments alone During adolescence, the responsibility for chronic disease management is shared. As clients transition to adulthood, they assume more responsibility for their care. Attending appointments alone shows that the client is developing the decision-making skills needed to interact with the health care team without parental assistance. School-age children are often able to manage an insulin pump because they have developed the logical reasoning required to follow protocols. Having normal hemoglobin A1C and blood glucose levels is positive, but the nurse does not know what role the parents may have played in the client's management. The nurse would also not know if a coach or trainer played a significant role in reminding the client to monitor glucose needs during sports.

When developing the plan of care for a 14-year-old boy who is bored due to being immobilized in a cast, which activitiy is most appropriate?

playing a card game with a boy the same age Teenagers usually enjoy activities with peers in preference to socializing with their parents or siblings. Peer relationships help the adolescent develop self-identity.

An adolescent presents with a large round ring with a swollen border on the left arm. The adolescent often plays ball games in a field behind the school. What condition does the nurse suspect?

Lyme disease Lyme disease, which results from a tick bite, is characterized by a large round ring with a raised swollen border at the site of the bite. Treatment at this stage can prevent systemic involvement that could lead to cardiac, neurologic, and musculoskeletal symptoms. Impetigo is a clustering of vesicles that ooze and form a crust on the skin. Cellulitis is caused by a microoganism entering through broken skin, resulting in red, painful, swollen skin that is hot and tender. Actinic keratosis appears on sun-exposed surfaces like the arms and neck and causes thick, scaly, and discolored skin that is sometimes red or pink.

An adolescent client has been diagnosed with acute glomerulonephritis and has been in the hospital for 1 day. Which finding requires immediate action?

urine specific gravity of 1.030 An adolescent with acute glomerulonephritis has a high urine specific gravity related to oliguria caused by inflammation of the glomeruli. The client will have periorbital edema, but not the generalized edema that occurs in nephrotic syndrome. In glomerulonephritis, there is some albumin in the urine, but there are large amounts of red blood cells, giving the urine a brown color. The urine in glomerulonephritis is scanty, averaging about 400 mL in 24 hours, which leads to fluid volume excess and hypertension.

A school nurse is planning a program for parents on "Drugs Commonly Abused by Teenagers". Which information should be included about inhalants? Select all that apply.

Monitor for paper bags and rags that may have been used for breathing inhalants. Deaths from inhalants occur from asphyxiation, suffocation, and aspiration of vomit. Inhalants usually cause depression of the central nervous system. The basic groups of inhalants are hydrocarbon solvents such as glue, aerosol propellants from spray cans, and anesthetics/gases. The nurse should instruct the parents to monitor their children for use of paper bags or rags. The nurse should present information about brain damage from inhalants including damage to the frontal lobe, cerebellum, and hippocampus, and that death is possible. Rather than use being on the decline, teenagers are experimenting even more with many types of inhalants, such as Freon, ground-up candy disks, and spray cleaners for computer and TV screens.

Physical examination of an adolescent reveals an abnormally convex angulation in the curvature of the thoracic spine. How should the nurse should document this finding?

kyphosis An abnormally increased convex angulation in the curvature of the thoracic spine is kyphosis. The most common cause of kyphosis in children is related to poor posture.A Dowager's hump in an abnormal outward curvature of the thoracic vertebrae of the upper back associated with osteoporous.Lordosis is the excessive anterior curvature of the lumbar spine due most commonly to an underlying neuromuscular disease or spinal deformity.Scoliosis is a lateral curvature of the spine.

A female adolescent client refuses to allow male nurses to care for her while she's hospitalized. Which of these health care rights is this adolescent exerting?

right to privacy This adolescent is exhibiting her right to privacy when she requests that she doesn't want a male nurse to care for her. She also has a right to competent care, the right to have an advance directive on file, and a right to confidentiality. However, she isn't exercising these rights in this scenario.

When assessing a 17-year-old client with depression for suicide risk, which question would be best?

"Are you thinking about killing yourself?" Asking whether the client is thinking about killing herself is the most direct and therefore the best way to assess suicide risk. Knowing whether the client has recently watched movies on suicide and death, what the client thinks about suicide, or about previous suicides of family members will not tell the nurse whether the client herself is thinking about committing suicide right now.

Which meal would be most appropriate for an adolescent with glomerulonephritis with severe hypertension?

baked chicken, rice, beans, orange juice The best selection of food would include no added salt or salty food. Because sodium cannot be excreted due to the oliguria and to avoid increasing the hypertension, a low-salt diet is recommended. Most canned foods have sodium added as a preservative. Ham, hot dogs, canned peas, canned carrots, corn chips, pickles, and milk are high in sodium.

Acetaminophen was given to an adolescent for headache. Which of the following parameters would indicate the effectiveness of the medication?

change in behavior Positive changes in behavior and vital signs are indicators of an effective response to pain medication. Sleeping isn't a reliable indicator of pain relief because the teen may use sleep as a coping mechanism. Vital signs may or may not change.

While in the emergency department, an adolescent who was in a motorcycle accident less than 1 hour earlier remains conscious but is agitated and anxious. The nurse observes that his pulse and respirations are increasing and his blood pressure is decreasing. The nurse should initiate interventions to manage which complication?

spinal shock spinal shock occurs 30 to 60 minutes after a spinal cord injury owing to the sudden disruption of central and autonomic pathways. This disruption causes flaccid paralysis, loss of reflexes, vasodilation, hypotension, and increased pulse and respiratory rates.Autonomic dysreflexia occurs only after the return of spinal reflexes and is characterized by hypertension.Increased intracranial pressure is associated with widened pulse pressure and decreased pulse and respiratory rates.Metabolic alkalosis, manifested by vomiting, elevated plasma and urine pH, and elevated plasma bicarbonate levels, does not occur with spinal shock. Rather, hydrogen ion loss leading to metabolic alkalosis would occur with pyloric stenosis, diuretic therapy, and potassium depletion.

When assessing a 13-year-old adolescent, what is an expected finding?

subjective judgments of right and wrong For the adolescent, moral development occurs as abstract reasoning develops. Moral issues are seen to differ based on opinions.Many adolescents at age 13 have reached at least Tanner stage II, an assessment of the development of secondary sex characteristics.Many adolescents at this age do not have a career choice in mind yet.Typically, adolescents have more than one friend.

An adolescent sustains a head injury and develops diabetes insipidus. The healthcare provider orders desmopressin, 10 mcg subcutaneously (SubQ). When does the nurse assess the client to determine the need for an addional dose?

4 to 7 hours The minimum required dose is given to avoid water retention and hyponatremia. Control of polyuria and electrolytes is the goal. Another dose is not administered until the client has another episode of brisk polyuria and diuresis, indicating the initial dose is no longer effective. The drug's half life via this route is 3 hours, indicating the drug will stop working in about 6 hours.

A nurse is preparing to administer the first dose of tobramycin to an adolescent with cystic fibrosis. The order is for 3 mg/kg I.V. daily in three divided doses. The client weighs 95 lb (43.2 kg). How many milligrams should the nurse administer per dose? Record your answer using one decimal place.

43.2 To perform this dosage calculation, the nurse should calculate the client's daily dose using this formula:43.2 kg × 3 mg/kg = 129.6 mgLastly, the nurse should calculate the divided dose:129.6 mg ÷3 doses = 43.2 mg/dose

A nurse reviews the care plan for an adolescent receiving chemotherapy for leukemia. The adolescent's platelet count is 50,000 μl. The client also has pneumonia. Which item in the care plan should the nurse revise?

Administer oxygen at a rate of 4 L/minute using a non-humidified nasal cannula. The platelet level is low, placing the client at risk for bleeding. The nose is a vascular region that can bleed easily if the mucosa is dried by unhumidified oxygen. Therefore, the nurse should revise the care plan to reflect use of humidified oxygen. A sign to remind others to avoid needle sticks and to not give anything via the rectum, the presence of two peripheral IVs, and the use of a tympanic temperature device are all aspects of care that would decrease the adolescent's risk of bleeding.

The nurse is caring for an adolescent client who sustained a head injury in a motor vehicle crash. The client begins to experience extreme thirst and excretes 4 L of urine in a 24-hour period with a specific gravity of 1.002. What pharmacological intervention does the nurse anticipate performing?

Administration of desmopressin. This client is suspected of having diabetes insipidus due to the head trauma and the symptoms, which can be controlled with the administration of desmopressin, or vasopressin. Recombinant human growth hormone would be used in situations where a client has a growth hormone deficiency. Demeclocycline is used in the treatment of syndrome of inappropriate antidiuretic hormone. Levothyroxine treats hypothyroidism.

A nurse is caring for a 14-year-old boy who arrives in the office stating abdominal pain with nausea and vomiting for the past 24 hours. The mother reports the client experiencing sharp pain when hitting a pothole along the road. The vital signs are: temperature, 101.6°F (37.8°C); pulse, 92 beats/minute; respirations, 24 breaths/minute; blood pressure, 142/82 mm Hg. As the nurse is collecting all data, in which location of the abdomen will the nurse obtain definitive assessment data?

All of the data provided (abdominal pain, nausea with vomiting, elevated temperature, and rebound tenderness when hitting a pothole) indicate a potential appendicitis. Appendicitis typically begins with anorexia, nausea, and vomiting for the first 12 to 24 hours. Abdominal pain, a late sign, is usually diffuse at first and gradually localizes to the right lower quadrant. The sharpest pain should be noted at McBurney's point, which is one-third of the way between the anterior and superior iliac crest and the umbilicus.

The nurse is caring for a 17-year-old male client with Duchenne muscular dystrophy. When assisting the client during a hospitalization for pneumonia, which anticipated nursing interventions would reflect client specific care? Select all that apply.

Assisting the client to a Fowler's position for a breathing treatment Clearing a path to the bathroom for safe and easy access Providing directions to the client's educational level Duchenne muscular dystrophy typically occurs in males with symptoms appearing in the preschool years. The course of the disease is fairly predictable with weakness occurring in the voluntary muscles of the legs and trunk. By the teens, the heart and respiratory muscles can also be affected. Nursing interventions anticipated include assisting the client to an upright position for breathing treatments as the client has difficulty sitting up. Clearing a path to the bathroom is important as the client has an unsteady gait with possible braces and is unable to safely step over and around medical equipment. If wheelchair bound, a clear path is important for navigating to the bathroom. Some clients have intellectual challenges and will need instructions at the appropriate level. A well balanced diet is best. Clients are encouraged to exercise and complete all activities of daily living as tolerated. Crushing pills may be needed in the later stages of the disease but not anticipated for a teenager.

When interviewing an adolescent client, in which of the following instances will the nurse be most successful in obtaining relevant health information?

Maintaining objectivity by avoiding assumptions, judgments, and lectures Maintaining objectivity will ensure the best communication with the adolescent client. Including the parents is not conducive to the teen client being open and honest with the nurse. The nurse does not need to know the current slang to communicate. The art of being succinct is not necessarily the best strategy.

An adolescent tells the nurse that she would like to use tampons during her period. What should the nurse do first?

Provide information about preventing toxic shock syndrome. The nurse should provide the adolescent with information about toxic shock syndrome because of the identified relationship between tampon use and the syndrome's development. Additionally, about 95% of cases of toxic shock syndrome occur during menses. Most adolescent females can use tampons safely if they change them frequently. Using tampons is not related to menstrual flow or sexual activity. There is no need to refer the girl to a gynecologist; a nurse can provide health teaching about tampon use.

A nurse is performing a psychosocial assessment on a 14-year-old adolescent. Which response to the assessment questions is not typical during early adolescence?

"I'm sorry for how I acted earlier. Let's finish these questions." Moodiness may occur often during early adolescence. Moodiness occurs due to immature cognitive control and emotional development. Essentially, early adolescent clients (age 10-14) have difficulty coping with emotions. These emotions are affected by the hormonal and maturing issues that occur during this time period. Anger and combativeness are more typical of middle adolescence. Cooperativeness typically occurs during late adolescence. Indications of depression are taken seriously and are not attributed to moody behaviors or statements.

When developing the teaching plan for an adolescent with insulin-dependent diabetes, the nurse should include what information about the relationship between exercise, diet, and insulin?

"If your blood glucose is 240 mg/dL (13.3 mmol/L) or above, do not run." Strenuous exercise, such as running, should be avoided if the adolescent's blood glucose level is 240 mg/dL (13.3 mmol/L) or above because it places the client at risk for hypoglycemia. When insulin levels are not adequate, the cells cannot receive glucose, even though the blood glucose level is high. With low insulin levels, glucagons act to increase hepatic glucose production, thus raising the blood glucose level, which cannot be used at the muscle site. Taking extra insulin prior to strenuous exercise also increases the risk of hypoglycemia. Vigorous muscle contraction increases local blood flow and absorption of insulin injected into that area. Because exercise decreases blood glucose levels, snacks should be given before strenuous exercise to prevent hypoglycemia. If the adolescent cannot tolerate the extra needed food, insulin dosage may have to be reduced.

A nurse is about to conduct a sexual history for a 16-year-old female who is accompanied by her mother. What is an appropriate question for the nurse to ask this client or her mother?

"Mother, I am going to ask you to wait a few minutes in the waiting room now so I can complete the health history with your daughter." Confidentiality and privacy are critical developmental needs for the adolescent. These needs are important to enable the nurse to establish a relationship of trust with the adolescent. A sexual history should be conducted with a teen without parents. Therefore, the nurse should not ask the mother to provide information or put the daughter in a position of having to make a decision about her mother remaining in the room. Inform the adolescent that this information is confidential and will not be shared with the parent. Inform the adolescent that issues of abuse or life-threatening issues are required by law to be disclosed to the authorities, and all other information is private.

A 13-year-old girl is being evaluated for possible Crohn's disease. She is about to undergo a colonoscopy with biopsy. While teaching about the diagnosis, the nurse is asked whether the client's delayed puberty is a result of the disease process. Which is the nurse's best response?

"No definitive diagnosis has been made yet; it's best to wait until testing is complete." Although Crohn's disease may cause growth failure or delayed puberty, the client has not actually been diagnosed with anything yet; therefore, it cannot be said definitively that Crohn's is the culprit, if indeed puberty is delayed. Median age for menarche in the United States is 10.4 years; secondary sex characteristics should precede or follow within a few months. If Crohn's is diagnosed, other appropriate testing can follow if indicated.

A school nurse is teaching an adolescent client about acne. Which of the following statements by the adolescent indicate to the nurse that the teaching has been understood? Select all that apply.

"Picking or squeezing acne lesions may increase symptoms." "Excessive face washing is not necessary to prevent acne." "Some cosmetics may cause an increase in lesion formation." Adolescents should be taught that picking or squeezing acne lesions can worsen the condition. Excessive face washing is not necessary and may actually cause more damage to the skin. Cosmetics may clog pores and trigger the formation of acne lesions. Diet does not actually influence the development of acne lesions; rather, acne is caused by the changes in puberty, specifically the rapid increase in androgen secretion, which causes the sebaceous glands to become active. Stress may worsen acne by triggering an increase in oil production.

A 16-year-old client is in the emergency department for treatment of minor injuries from a car accident. A crisis nurse is with the client because the client became hysterical and was saying, "It's my fault. My Mom is going to kill me. I don't even have a way home." What should be the nurse's initial intervention?

Hold her hands and say, "Slow down. Take a deep breath." The client is in a crisis and has a high anxiety level. Holding the client's hands and encouraging the client to slow down and take a deep breath conveys caring and helps decrease anxiety. Telling the client to calm down or stop worrying offers no concrete directions for accomplishing this task. It is unknown from the data who was at fault in the accident. Therefore, it is inappropriate for the nurse to state that it was not the client's fault.

An adolescent with abdominal pain and a fever is being seen in the clinic. In what order should the nurse assess the abdomen? All options must be used.

Inspect Auscultate Percuss Palpate The nurse should first inspect the abdomen for abnormalities. Auscultation should be done before percussion and palpation as vigorous touching may disturb the intestines. Percussion is next. Palpation is the last step as it is most likely to cause pain.

The nurse reviews the medical record of an adolescent with a history of losing weight and fatigue is admitted to the hospital with a diagnosis of stage I chronic renal failure (see exhibit).

Notify the health care provider (HCP). The nurse would expect a person with a normal glomerular filtration rate (GFR) to have approximately equal inputs and outputs. Chronic renal failure has five stages. In stage I, the GFR is approximately ?90 mL/min/1.73 m2. In stage II, the GFR decreases to approximately 60 to 89 mL/min/1.73 m2. The decreased urine output may indicate worsening disease and should be reported. Assessing the client's intake and output is still important, but notifying the provider is the priority. Fluids are restricted based on decreased sodium. Clients are encouraged to drink to thirst. Therefore, there is not enough information to suggest increasing or restricting fluids.

The nurse talks to an adolescent about how she can tell her friends about her new diagnosis of diabetes. Which behavior by the adolescent indicates that the adolescent has responded positively to the discussion?

She introduces the nurse to her friends as "the one who taught me all about my diabetes." The ability to talk about her diabetes indicates that the adolescent feels good enough about herself to share her problem with her peers. Asking for reference material does not specifically indicate that the client's self-esteem has improved or that she has accepted her diagnosis. Saying that her friends will probably desert her if she tells them about the illness indicates that the adolescent still needs to work on her self-esteem and her feelings about the disease. Asking her friends what they think of someone with a lifelong illness would not indicate that the nurse's interventions targeted toward improving self-esteem have been successful. Rather, this statement demonstrates the adolescent's uncertainty about herself.

The nurse is teaching a group of teenage boys about the risks of chewing tobacco. The nurse should teach the boys to recognize which possible signs or symptoms of oral cancer? Select all that apply.

dysphagia unexplained mouth pain lump in the neck white patches on the mucosa Chewing tobacco has become a more common practice among teenagers. It is important that they understand that this increases their risk for oral cancer. They should be instructed to inspect their mouth frequently and report any observed lesions or other changes in the oral mucosa. Potential indicators of oral cancer are dysphagia, unexplained mouth pain, a lump in the neck, and white patches on the mucosa (leukoplakia). Other indications may be a painless mouth ulcer, a reddened patch (erythroplasia), and rough patches on the mucosa. Sensitive teeth and decreased saliva are not associated with oral cancer.

An adolescent client is admitted to the hospital with the diagnosis of acute lymphocytic leukemia. Which signs and symptoms require the most urgent nursing intervention?

fever and petechiae Fever and petechiae associated with acute lymphocytic leukemia indicate a suppression of normal white blood cells and thrombocytes by the bone marrow and put the client at risk for other infections and bleeding. The nurse should initiate infection control and safety precautions to reduce these risks. Fatigue is a common symptom of leukemia due to red blood cell suppression. Although the client should be told about the need for rest and meal planning, such teaching is not the priority intervention. Swollen glands and lethargy may be uncomfortable, but they do not require immediate intervention. An enlarged liver and spleen do require safety precautions that prevent injury to the abdomen; however, these precautions are not the priority.

Which finding should lead the nurse to decide that spinal shock was resolving in the adolescent with a spinal cord injury?

hyperactive reflexes Spinal shock causes a loss of reflex activity below the level of the injury, resulting in bladder atony and flaccid paralysis. When the reflex arc returns, it tends to be overactive, resulting in spasticity. The reflexes and bladder become hypertonic during this phase of spinal shock resolution; sensation does not return. A widened pulse pressure is not associated with resolution of spinal shock.

After 6 months of treatment with diet and exercise, an adolescent with type 2 diabetes still has a fasting blood glucose level of 140 mg/dL (7.8 mmol/L). The health care provider (HCP) has decided to begin metformin. The client asks how the medication works. The nurse should tell the client that the medicine decreases the glucose production and performs which other function?

increases insulin sensitivity Metformin is currently approved by the FDA and Health Canada to treat type 2 diabetes in children. The medication decreases glucogenesis in the liver and increases insulin sensitivity in the peripheral tissues. Only insulin can actually replace insulin. This treatment is reserved for clients with type 1 diabetes or those with type 2 who do not respond to diet, exercise, and an oral diabetic agent. Other oral medications used to treat diabetes augments insulin production or decreases carbohydrate absorption, but those medications are primarily used in adults.

An adolescent reports sore throat and fatigue. The nurse observes a fever and swollen tonsils. Which diagnostic test(s) does the nurse prepare to collect during this initial encounter? Select all that apply.

monospot test streptococcal antigen test throat culture The common presenting symptoms of infectious mononucleosis vary greatly but commonly include fever, malaise, sore throat, and lymphadenopathy. Other conditions to exclude include strep and viruses. If these tests are negative, depending on other symptoms and severity, additional testing may be ordered, such as those to rule out conditions like leukemia.

A 17-year-old adolescent with a history of muscular dystrophy is admitted with aspiration pneumonia. The client's medical history reveals that this is the third time in the past 6 months that the client has been diagnosed with pneumonia. Which topics should the nurse plan to address for teaching?

need for a feeding tube As muscular dystrophy progresses, the client becomes more susceptible to aspiration due to progressive decreasing ability to clear secretions and muscle weakness. A feeding tube will prevent problems with dysphagia resulting in aspiration. Avoiding crowds and hand hygiene might be a part of the overall teaching but are not a priority. All clients should be instructed regarding the need for an advance directive.

An adolescent is brought to the facility by friends after accidentally ingesting gasoline while siphoning it from a car. Based on the nurse's knowledge of petroleum distillates, which system should be the priority assessment?

respiratory system The primary concern with petroleum distillate ingestion is its effect on the respiratory system. Aspiration or absorption of petroleum distillates can cause severe chemical pneumonitis and impaired gas exchange. The GI, neurologic, and cardiovascular systems may also be affected if the petroleum contains additives such as pesticides, but the respiratory system is the priority assessment.

Which symptom reported by an adolescent's parents suggests that the adolescent may be abusing amphetamines? Select all that apply.

restlessness excessive perspiration talkativeness Amphetamines are central nervous system stimulants. Symptoms of amphetamine abuse include marked nervousness, restlessness, excitability, talkativeness, and excessive perspiration.

An adolescent client who is being seen by the crisis nurse after making several superficial cuts on her wrist states that all her friends are siding with her ex-boyfriend and will not talk to her anymore. She says she knows that the relationship is over, but "If I can't have him, no one else will." Which client problem takes the highest priority?

risk for other-directed violence The threat toward the ex-boyfriend is the most immediate concern now, as the client turns her anger toward him instead of herself. Although situational low self-esteem, risk for suicide, and risk-prone health behavior are evident, these problems are less of a concern at this time.

The health care provider (HCP) prescribes pulse assessments through the night for a school- age child with rheumatic fever who has a daytime heart rate of 120 bpm. The nurse explains to the mother that this is to evaluate if the elevated heart rate is caused by which factor?

routine activity during waking hours An above-average pulse rate that is out of proportion to the degree of activity is an early sign of heart failure in a client with rheumatic fever. The sleeping pulse is used to determine whether the mild tachycardia persists during sleep (inactivity) or whether it is a result of daytime activities. The environmental temperature would need to be quite warmer before it could influence the heart rate. Digitalis lowers the heart rate, so the rate would be decreased during the daytime.

When developing the postoperative plan of care for an adolescent who has undergone an appendectomy for a ruptured appendix, in which position should the nurse expect to place the client during the early postoperative period?

semi-Fowler's position After an appendectomy for a ruptured appendix, assuming the semi-Fowler's or a right side-lying position helps localize the infection. These positions promote drainage from the peritoneal cavity and decrease the incidence of subdiaphragmatic abscess.

An overweight adolescent client has lost 12 lb (5.4 kg) in 8 weeks using diet strategies. The client reaches a weight loss plateau and is discouraged. The nurse instructs the client to keep a food diary for what purpose?

to help the client analyze how much food is consumed and when Keeping a food diary allows the adolescent client to use the cognitive level of formal operations to help identify and evaluate eating behaviors of which he may not be aware. It is primarily a tool to assist in self-correction and behavior modification. The client does not need to be preoccupied with weight loss. The nurse can provide insights based on the diary entries, but this device is not for the nurse.

The nurse is preparing a teaching plan for a 14-year-old child who is newly diagnosed with asthma. Which content should be taught first?

when to seek immediate medical attention The highest priority is to teach what signs or symptoms require immediate medical attention. While peak flow meter could pro-actively prevent an attack, it is not of as great concern as knowing when to seek medical assistance. The client does need to understand what asthma is, and if steriods are ordered long term, it should also be included in the teaching plan, however, neither of these areas for instruction are of highest priority. The ability to breathe takes priority over the other areas.

An adolescent client is brought to the emergency department with suspected appendicitis. Which assessment findings does the nurse expect to find with this diagnosis? Select all that apply.

white blood cell count of 12,000 rebound pain at McBurney's point vomited 100 mL of stomach contents Although not specific to acute appendicitis, a fever and vomiting can indicate an inflammatory process, which accompanies appendicitis. Pain at McBurney's point, which is in the lower right quadrant of the abdomen, is significant for acute appendicitis. Epigastric distress can be indicative of pathology in the stomach but is generally not a sign of appendicitis. Hematuria would indicate that there might be a urinary tract infection rather than appendicitis.

A nurse is caring for an adolescent who is in the hospital for a long-term illness. Which of the following interventions would promote the development of the hospitalized adolescent?

Connect the teen to their peer group as much as possible Peer visitation gives the adolescent an opportunity to continue along the path toward independence and identity. Structured daily activities would benefit the younger child, not the teenager's development. Tutoring may help maintain a positive self-image relative to schoolwork but does not have an impact on adolescent development.

Parents of a 15-year-old state that their child is moody and rude. What should the nurse should advise the parents to do?

Discuss their feelings with their child. Parents need to discuss with their adolescent how they perceive the behavior and how they feel about it. Moodiness is characteristic of adolescents. The adolescent may have a reason for or not be aware of his behavior. Restricting the adolescent's activities will not change the mood or the response to others. It may increase unacceptable responses. Counseling may not be needed at this time if the parents are open to communicating and listening to the adolescent. Talking to other parents may be of some help, but what is helpful to others may not be helpful to their child.

When completing an assessment of a healthy adolescent client, which measure would be most appropriate?

Gather information from the parents and adolescent; then assess the adolescent in private. When assessing an adolescent, it is appropriate to obtain information first from the adolescent and parents and then interview the adolescent privately for additional information. Doing so helps to promote independence and responsibility for self-care.Obtaining prenatal and early developmental history information is usually not important for a healthy adolescent. In addition, this information typically would have already been obtained at an earlier age.No legal reason would prohibit the nurse from discussing sexuality with the adolescent without the parents present.Discussing smoking with the parents present in the room is inappropriate. If the adolescent smokes, the parents may be unaware, and the adolescent would lose trust in the nurse.

An adolescent is on the football team and practices in the morning and afternoon before school starts for the year. The temperature on the field has been high. The school nurse has been called to the practice field because the adolescent is now reporting that he has muscle cramps, nausea, and dizziness. Which action should the school nurse do first?

Move the adolescent to a cool environment. The adolescent is most likely experiencing heat exhaustion or heat collapse, which are common after vigorous exercise in a hot environment. Symptoms result from loss of fluids and include nausea, vomiting, dizziness, headache, and thirst. Treatment consists of moving the adolescent to a cool environment and giving cool liquids. Cool liquids are easier to drink than cold liquids. Taking the adolescent's temperature would be appropriate once these actions have been completed. However, the adolescent's temperature is likely to be normal or only mildly elevated.. Lying in the supine position increases the risk for aspiration if vomiting occurs in a patient with nausea.

The nurse is instructing a client with cancer who is receiving chemotherapy about reporting signs of infection. Which is the most reliable early indicator of infection in a client who is neutropenic?

fever Fever is an early sign requiring clinical intervention to identify potential causes. Chills and dyspnea may or may not be observed. Tachycardia can be an indicator in a variety of clinical situations when associated with infection; it usually occurs in response to an elevated temperature or change in cardiac function.

The nurse is caring for a 15-year-old adolescent mother after birth. The adolescent lives at home with her parents and has a boyfriend who is also 15 years old. Neither is currently working, and they both have plans for higher education. When addressing the psychosocial issues that may occur after the birth of the child, which of the following would be the most important for the nurse to include in client teaching?

increased stress for new mothers The increased psychological stress experienced by new mothers is the priority. A young adolescent mother is faced with the overwhelming situation of caring for a newborn. All other options are relevant, but are not the priority.

A nurse is caring for an adolescent involved in a motor vehicle crash. The adolescent has a chest tube in place. If the chest tube is accidentally removed, the nurse should immediately:

cover the opening with petroleum gauze. If a chest tube is accidentally removed, the nurse should cover the insertion site with sterile petroleum gauze. The nurse should then observe the client for respiratory distress because tension pneumothorax may develop. If tension pneumothorax does develop, the nurse should remove the gauze to allow air to escape. The nurse shouldn't reintroduce the tube. Rather, the nurse should have another staff member call a physician so another tube can be introduced by the physician under sterile conditions.

A nurse is preparing a health promotion program for teenagers focusing on lifestyle choices. Which of the following methods used by the nurse will best ensure the success of the program?

creating a safe environment for sharing information Creating an environment where the teenagers feel safe to share their information leads to therapeutic communication that is client focused. This helps to establish trust, which facilitates a more successful program. The other options block the ability of the teenagers to share their thoughts and feelings openly.

An adolescent, age 14, is hospitalized for nutritional management and drug therapy after experiencing an acute episode of ulcerative colitis. Which nursing intervention is appropriate?

providing small, frequent meals Clients with ulcerative colitis, an inflammatory bowel disorder (IBD), tolerate small, frequent meals better than a few large meals daily. Eating large amounts of food may exacerbate the abdominal distention, cramps, and nausea IBD typically causes. Frequent meals also provide the additional calories needed to restore nutritional balance. This adolescent doesn't lack digestive enzymes and therefore doesn't need enzyme supplementation. Antibiotics are contraindicated because they may interfere with the actions of other ordered drugs and because ulcerative colitis isn't caused by bacteria. High-fiber foods may irritate the bowel further.

The nurse is assessing an adolescent who has been diagnosed with aplastic anemia. Which should be the priority assessment for the nurse?

signs and symptoms of infection Aplastic anemia results in lowering of all blood cell counts, causing the adolescent to be neutropenic. Neutropenia often leads to infection, which can be life-threatening so this is the priority assessment for the nurse. Decreased cardiac output from septic shock is a real threat. Nutritional deficits are difficult to correct while the client is acutely ill. Electrolyte imbalances and weakness do occur with pancytopenia and acute illness in the hospitalized client. These are corrected on a daily basis and are considered urgent when effects such as arrhythmias are likely. An adolescent should be independent in self-care activities whenever possible, but this is low priority for a client this ill.

Which group has experienced the greatest rise in the incidence of sexually transmitted diseases (STDs) over the past two decades?

teenagers Statistics reveal that the incidence of STDs is rising more rapidly among teenagers than among any other age group. Many reasons have been given for this trend, including a change in societal mores and increasing sexual activity among teenagers. During this developmental stage, teenagers may engage in high-risk sexual behaviors because they often are living in the present and feel that it will not happen to them.

Several high-school seniors are referred to the school nurse because of suspected alcohol misuse. When the nurse assesses the situation, what would be most important to determine?

the reasons they choose to use alcohol Information about why adolescents choose to use alcohol or other drugs can be used to determine whether they are becoming responsible users or problem users. The senior students likely know the legal implications of drinking, and the nurse will establish a more effective relationship with the students by understanding motivations for use. The type of alcohol and when and with whom they are using it are not the first data to obtain when assessing the situation.

The nurse developed a plan of care for an adolescent who is receiving chemotherapy for lymphoma and has developed stomatitis. What statement made by the adolescent demonstrates understanding of the education provided from the plan of care?

"I will rinse my mouth every 2-4 hours with baking soda and water." White patches on the tongue and oral mucosa indicate oral candidiasis and the adolescent should report the presence of this to their physician but should not attempt to remove them. Using a hard bristle toothbrush can cause trauma to the mucous membranes of the mouth and the client should be instructed to use a soft bristle brush. Rinsing the mouth every 2 to 4 hours with a nonirritating solution, such as baking soda and water or normal saline solution helps prevent stomatitis. The client should avoid commercial mouthwashes with alcohol, which may dry out the mucous membranes.

A 15-year-old with acute lymphocytic leukemia has been caught hiding her oral chemotherapy each morning. Which nursing intervention will improve compliance?

Have the child meet teenage survivors of cancer who were compliant with treatment. Have the teenager talk to other teenagers who are going through similar experiences. Talking to age-appropriate peers will make a bigger impact than trying to force the teenager to conform.

A 15-year-old with acute lymphocytic leukemia has been caught hiding her oral chemotherapy each morning. Which nursing intervention will improve compliance?Several high-school seniors are referred to the school nurse because of suspected alcohol misuse. When the nurse assesses the situation, what would be most important to determine?

Have the child meet teenage survivors of cancer who were compliant with treatment. Have the teenager talk to other teenagers who are going through similar experiences. Talking to age-appropriate peers will make a bigger impact than trying to force the teenager to conform.

A nurse, who witnesses an accident involving an adolescent being thrown from a motorcycle, stops to help. The adolescent reports that he is now unable to move his legs. While waiting for the emergency medical service to arrive, what should the nurse do?

Leave the adolescent as he is, staying close by. The adolescent's signs and symptoms suggest a spinal cord injury. A client with suspected spinal cord injury should not be moved until the spine has been immobilized. Removing the helmet could further aggravate a spinal cord injury. The nurse could assess for abdominal trauma, but only if it can be done without moving the adolescent.

When caring for an adolescent who is at risk for injury related to intracranial pathology, which action by the nurse would maintain stable intracranial pressure (ICP)?

Maintain the adolescent's head in midline position. Elevating the head of the bed to 15 degrees while keeping the client's head in midline position will facilitate venous drainage and avoid jugular compression. Excessive suctioning and raising the head of bed to greater than 30 degrees for prolonged periods could increase pressure in the head and should be avoided. A 30- to 45-degree head elevation is allowed for brief periods. While shivering due to fever must be avoided, hyperthermia due to an overly warm room can increase metabolic demand by up to 10% per degree and cause vasodilation, further increasing ICP.

An adolescent client is hospitalized with bacterial meningitis. At 1730, the client's mother reports her child is "burning up." The nurse is reviewing the client's medication administration records in the medical record. The health care provider (HCP) has prescribed ibuprofen 325 mg every 3 to 4 hours for temperature over 99°F (37.2°C). The child's temperature at 1730 is 102.5°F (39.1°C). What should the nurse do first?

Notify the HCP. Because the client's temperature continues to rise in spite of recently administering ibuprofen, the nurse notifies the HCP. After notifying the HCP, the nurse can bathe the client with tepid water. If the temperature cannot be lowered shortly, the client is also at risk for seizures; the nurse pads side rails and observes for seizure activity. The nurse cannot administer another dose of ibuprofen without the HCP's orders.

An obese adolescent tells the nurse that he would like to lose weight and asks the nurse's opinion on how to accomplish his goal. Which suggestion would be most appropriate?

Participate in an adolescent weight-reduction program. weight loss treatment modalities that include peer involvement have been proven to be the most successful approach with obese adolescents. This is because peer support is critical to adolescents, especially with an all-encompassing problem such as obesity.Increasing the amount of exercise is helpful, but this is just one aspect of a weight-reduction program.Strict calorie restriction is not recommended because it can result in use of muscle protein as well as fat for energy.Although decreased ingestion of nonnutritive snacks is helpful in dietary control, weight loss needs to be about long term behavior changes that also include physical activity.

An adolescent becomes increasingly withdrawn, is irritable with family members, and has been getting lower grades in school. After giving away a stereo and some favorite clothes, the adolescent is brought to the community mental health agency for evaluation. Which aspect of the adolescent's behavior is most suggestive of suicide?

The adolescent has a suicide plan. Changes in academic performance and familial communications, social withdrawal, and giving away treasured possessions suggest that this adolescent is contemplating suicide; thus, a plan has been developed. There is no evidence that a suicide gesture (e.g., cutting), ideation, or threat has been expressed.

A nurse is assigned to an adolescent. Which nursing diagnosis is most appropriate for a hospitalized adolescent?

fear related to altered body image Fear related to altered body image is the most appropriate nursing diagnosis for a hospitalized adolescent because of the adolescent's developmental level and concern for physical appearance. An adolescent may fear disfigurement resulting from procedures and treatments. Separation is rarely a major stressor for the adolescent. Adolescents may have Fear related to the unknown, but they typically ask questions if they want information. A diagnosis of Ineffective coping related to activity restrictions may be appropriate for a toddler who has difficulty tolerating activity restrictions but is an unlikely nursing diagnosis for an adolescent.

When teaching an adolescent with a seizure disorder who is receiving valproic acid, the nurse should instruct the client to immediately report which sign or symptom to the health care provider (HCP)?

jaundice A toxic effect of valproic acid is liver toxicity, which may manifest with jaundice and abdominal pain. If jaundice occurs, the client needs to notify the HCP as soon as possible. Diarrhea and sore throat are not common side effects of this drug. Increased appetite is common with this drug.

The nurse assesses a teenage girl's musculoskeletal system. According to the figure, the nurse should note that the girl which condition?

scoliosis The teenage girl has scoliosis, the lateral deviation of the spine. Kyphosis is noted by a forward curvature of the shoulders. Lordosis is an inward curvature of the lower back. Spondylolisthesis is a slipping of the vertebrae out of position. Pain is the main finding with this condition, not curvature of the spine.

A nurse is caring for a 14-year-old client who was admitted with cellulitis and has been ordered warm compresses. The nurse delegates the treatment to the unlicensed assistive personnel (UAP). The compress causes a first-degree burn to the area. Which actions should the nurse initiate? Select all that apply.

Complete an incident report regarding the event. Notify the healthcare provider of the injury. Based on the rules of delegation, this should have been delegated to a licensed practical/vocational nurse, not the UAP. The nurse is accountable for the action. The nurse needs to complete an incident report and notify the healthcare provider. Ice is not applied to burn wounds, because it increases cellular injury. An incident report should mention all personnel involved—not just the UAP—and objectively describe their actions.

The nurse is caring for an adolescent client after an overdose on barbiturate drugs and alcohol. The client is hypotensive with a mean arterial pressure below 30 mm Hg and a urine output of 5 mL/hr. Serum creatinine and potassium are elevated. The parents of the client ask why there is so little urine in the indwelling catheter drainage bag. What is the best response by the nurse?

"There is not enough blood circulating to the kidneys." The best answer directly and simply explains to the parents that the kidneys are not getting perfused and therefore cannot function. Acute renal failure is often caused by ischemic tubular necrosis. The hypotensive state with a dangerously low mean arterial pressure means the vital organs are not being perfused adequately and are ischemic. Barbiturates are cleared renally and do commonly cause oliguria after an overdose. It is also common to require hemodialysis after a severe overdose.

A 14-year-old brought to the emergency department with right lower quadrant pain is tentatively diagnosed with acute appendicitis. The nurse should further assess the client for which sign or symptom?

low-grade fever The most common manifestations of appendicitis include right lower quadrant pain, localized tenderness, and a low-grade fever. Other signs of inflammation, including increased pulse and respiratory rates, may be present. Costovertebral angle tenderness and gross hematuria are associated with urologic problems. Widening pulse pressure is seen in increased intracranial pressure. .

The nurse discovers that an adolescent client with anorexia nervosa is taking diet pills rather than complying with the diet. What should the nurse do first?

Listen to the client discuss fears of losing control of eating while being treated. A client with anorexia nervosa commonly has an extreme fear of not being able to control weight. The nurse should address this fear. Explaining the dangers of diet pills or discussing the HCP or family concerns focuses on the effect of the client's weight loss on other people rather than the client. Unless the client is motivated to stop, the client will likely not be successful.

An adolescent with insulin-dependent diabetes is being taught the importance of rotating the sites of insulin injections. The nurse should judge that the teaching was successful when the adolescent identifies which complication that can result of using the same site?

destruction of the fat tissue and poor absorption Repeated use of the same injection site can result in atrophy of the fat in the subcutaneous tissue and lead to poor insulin absorption. The neuritis that develops from diabetes is related to microvascular changes that occur. Subcutaneous tissue may thicken and harden, but this leads to decreased, not rapid, insulin absorption. Resistance to insulin is caused by an immune response to the insulin protein.

An adolescent with well-controlled type 1 diabetes has assumed complete management of the disease and wants to participate in gymnastics after school. To ensure safe participation, the nurse should instruct the client to adjust the therapeutic regimen by:

eating a snack before each gymnastics practice. Because exercise decreases the blood glucose level, the nurse should instruct the client to eat a snack before engaging in physical activity to prevent a hypoglycemic episode. Measuring urine glucose level before each gymnastics practice is incorrect because the urine glucose level doesn't reflect the current blood glucose level. To prevent hypoglycemia, the blood glucose level should be measured before the activity, not after the activity. Increasing the morning dosage of intermediate-acting insulin may lead to hypoglycemia during gymnastics practice; to avoid this condition, the adolescent may need to decrease, not increase, the morning dosage of intermediate-acting insulin.

Which substance should the nurse include in the teaching plan for a teenager with acne who has requested information about cleansing the affected skin?

soap and water Acne is a disorder of the pilosebaceous follicles (hair follicles and sebaceous gland complex). During adolescence, the secretions of the sebaceous glands increase, altering the follicular lining and causing occlusion of the ducts with accumulated sebum. Bacteria in the follicle then cause an infection. Frequent washing of affected areas with soap and water is recommended to act as a mild peeling agent and reduce secondary infection.Witch hazel is an astringent that can be used after thoroughly cleansing the skin.Hydrogen peroxide is a poor cleansing agent for skin with acne.Lotions and creams aggravate the condition by adding more oily substances to the already oily skin.

An adolescent is receiving chemotherapy for lymphoma. Which statement by the adolescent supports a nursing diagnosis of Deficient knowledge related to mouth care?

"I remove white patches from my tongue and cheeks with my toothbrush." White patches on the tongue and oral mucosa indicate infection; the adolescent should report the patches, not remove them. Using a soft toothbrush is appropriate because it prevents injury to the fragile oral mucosa. Rinsing the mouth every 2 to 4 hours with a nonirritating solution, such as baking soda and water or normal saline solution helps prevent stomatitis. Avoiding commercial mouthwashes is appropriate because they may contain alcohol, which may dry the oral mucosa.

The nurse instructs parents about the physical signs to look for in their child suspected of using cocaine. What finding should the nurse tell the parents is consistent with cocaine use?

"His pupils would be large." amphetamines, including cocaine, cause pupils to dilate. Marijuana causes eyes to be red and appear bloodshot. Opioids, including heroin, causes pupils to be pinpoints. Having tired-looking eyes would not necessarily be caused by drug use.

A teenage girl has been diagnosed with a urinary tract infection. The nurse recognizes the need for teaching when the client makes which statement?

"I can drink coffee." Drinking coffee and other beverages that contain caffeine can irritate the bladder and should be avoided. Bubble baths, bath oils and hot tubs can irritate the urethra and perineal area. Drinking plenty of water will keep urine flushed through the bladder. Cranberry juice helps to acidify the urine.

An adolescent has skeletal traction for a fractured femur. Which is the most appropriate nursing intervention for this client?

Assess pin sites every shift and as needed. Nursing care for a client in traction includes assessing pin sites every shift and as needed and ensuring that the knots in the rope don't catch on the pulley. The nurse should add and remove weights at the physician's order, not at the adolescent's request. All joints, except those immediately proximal and distal to the fracture, should be put through range of motion every shift.

The parent of a 16-year-old adolescent calls the emergency department, suspecting the adolescent's abdominal pain may be appendicitis. In addition to pain, the adolescent has a temperature of 100°F (37.7°C) and has vomited twice. What should the nurse tell the parent?

"Bring your child into the emergency department immediately before the appendix has a chance to rupture." Abdominal pain, low-grade fever, and vomiting are cardinal signs of appendicitis. The nurse should instruct the parent to take the child to the emergency department. Telling the parent to give the child a laxative is inappropriate because if appendicitis is the cause of the pain the appendix may rupture as a result of the drug. Appendicitis can occur at any age. Rebound tenderness is a symptom of appendicitis, but this finding would be found in the right lower quadrant, not the left.

The nurse is assessing a 17-year-old client with a seizure disorder. Driving privileges were suspended for failure to comply with anti-epileptic medications. The parents express concern because the client is withdrawn, not completing schoolwork, and spends increased time sleeping. Which is the nurse's best response?

"Further evaluation is needed for a mood disorder." adolescence is a time when clients may spend more time sleeping and when changes in mood occur. However, abnormal changes include withdrawal from friends and favorite activities and difficulty completing tasks. The client should be evaluated for a mood disorder, such as situational depression. Assessment for substance abuse and the risk for self-harm will be included in the overall assessment for mood disorder. Asking for the parents' opinion of the risk for self-harm is less important and effective than assessing the adolescent for an actual plan for self-harm. The parents can and should have firm behavioral guidelines for a chronically ill child, but this parenting skill will not assist the client in overcoming the behaviors that are exhibited.

A nurse is caring for a 14-year-old adolescent who states, "No one understands me." Which statement by the nurse best demonstrates empathy?

"It's difficult to be a teenager. Tell me more about your experiences." Empathy is the ability to put oneself in another's place and experience a feeling as that person is experiencing it. The correct answer acknowledges the adolescent's feelings and conveys an understanding without intimidating the client. Asking how adults can help and reflecting on parental understanding or favorite coursework is helpful overall but does not demonstrate empathy for the client.

A nurse is reviewing discharge instructions with the parents of an adolescent who sustained a head injury to the frontal lobe of the brain. When discussing possible consequences of the injury, which of the following is the most important information to give the parents?

"Your child may exhibit drastic personality changes." The frontal lobe regulates personality and judgment. The occipital lobe regulates vision, the temporal lobe regulates hearing, and the parietal lobe regulates sensation.

When discussing the onset of adolescence with parents, the nurse explains that it occurs at what time?

1 to 2 years earlier in girls than in boys Girls experience the onset of adolescence about 1 to 2 years earlier than boys. The reason for this is not understood.

An adolescent client is using glargine and lispro to manage type 1 diabetes. The nurse reviews the prescription for sliding scale lispro (see exhibit). Lispro subcutaneous give units according to sliding scale:Blood glucose: 70 - 150 mg/dL (3.9 to 8.3 mmol/L) = 0 units151-200 mg/dL (8.4 to 11.1 mmol/L) = 1 unit201-250 mg/dL (11.2 to 13.9 mmol/L) = 2 units251-300 mg/dL (14 to 16.7 mmol/L) = 3 units301-350 mg/dL (16.8 to 19.4 mmol/L) = 4 unitsCall for blood glucose > 350 (19.4 mmol/L)In addition give 1 unit for every 15 grams of carbohydrate.The morning blood glucose is 202 mg/dL (11.2 mmol/L) and the client is going to eat 2 carbohydrate exchanges. The nurse has the client administer how many units of lispro? Record your answer using a whole number.

4 Each carbohydrate food exchange has 15 grams of carbohydrate. Two units are needed to cover the current blood glucose, and 2 units are needed to cover the anticipated carbohydrate intake.

The nurse assesses a teenage girl's musculoskeletal system (see figure). What finding should the nurse document?

lordosis This girl has an exaggeration of the lumbar spine, swayback, or lordosis. Kyphosis is an increased convexity or roundness of the curve of the thoracic spine. Scoliosis is a lateral curvature of the spine.

The nurse discusses the treatment plan for an adolescent with rheumatic fever with the family. Which parent statement indicates the need for additional teaching about the therapeutic management of rheumatic fever?

"Anticonvulsants will be needed for a lifetime if our child develops involuntary movements." Phenobarbital or diazepam may be needed to treat involuntary movements, but there are typically no residual effects from chorea that require lifetime treatment. Clients who have a second episode of rheumatic fever are at extreme risk of heart valve damage. Clients must stay on prophylactic antibiotics for at least 5 years or until adulthood. Nonsteroidal anti-inflammatory (NSAID) medications like ibuprofen are used as first-line treatments for inflammation and joint pain, but corticosteroids may be needed if the child is not responding to NSAIDS. Children with rheumatic fever may need digitalis and diuretics if heart failure develops.

An adolescent child is admitted to the nursing unit after an attempted suicide. The nurse is discussing the attempted suicide with the parents. Which of the following statements by the parents indicate to the nurse that the parents need more teaching? Select all that apply.

"Our child is just trying to get attention." "Our child would not do this again." "Our child will be fine in a couple of days." Suicide should not be seen just as attention-seeking behavior. It has very serious consequences and should never be minimized. To believe that such an attempt might not happen again or that the adolescent will have resolved the problems that led to the attempt in a couple of days shows a lack of understanding of the seriousness of the situation.

A student with type 1 diabetes tells the nurse she is feeling light-headed. The student's blood sugar is 60 mg/dL (3.3 mmol/L). Using the 15-15 rule, what should the nurse do to treat the blood glucose?

Administer 15 g of carbohydrate and retest the blood sugar in 15 minutes. The 15-15 rule is a general guideline for treating hypoglycemia where the client consumes 15 g of carbohydrate and repeats testing the blood sugar in 15 minutes. Fifteen grams of carbohydrate equals 60 calories and is roughly equal to ½ cup (120 mL) of juice or soda, six to eight lifesavers, or a tablespoon of honey or sugar. The general recommendation is if the blood sugar is still low, the client may repeat the sequence. Fifteen milliliters of juice would only provide 8 calories. This would not be sufficient carbohydrates to treat the hypoglycemia. Protein does not treat insulin-related hypoglycemia; however, a protein-starch snack may be offered after the blood glucose improves. Fifteen ounces of juice would be approximately 440 mL—almost four times the recommended 4 oz (120 mL) of juice.

An adolescent with type 1 diabetes is experiencing a growth spurt. Which treatment approach would be most effective?

administering multiple doses of insulin During an adolescent growth spurt, a regimen of multiple insulin doses achieves better control of the blood glucose level because it more closely simulates endogenous insulin release. A single daily dose of insulin wouldn't control the blood glucose level as effectively. Limiting dietary fat intake wouldn't help the body use glucose at the cellular level. An adolescent with type 1 diabetes doesn't produce insulin and therefore can't receive an oral antidiabetic agent instead of insulin.

A 15-year-old client with a BMI of 20 three months ago has lost 30 lb (13.6 kg) since then. What other finding is the nurse likely to assess?

amenorrhea A significant weight loss in an adolescent who is not obese signals possible anorexia nervosa. Amenorrhea is a common finding in girls and women with anorexia nervosa. Researchers don't know whether the condition results from starvation or from an underlying metabolic disturbance. Dental carries, knuckle abrasions, pharyngeal irritation, and diarrhea are commonly associated with bulimia nervosa. An extreme and fast weight loss is more likely with anorexia than bulimia. People suffering from bulimia tend to have a normal weight.

An adolescent diagnosed with thalassemia major (Cooley's anemia) is at risk for which condition?

chronic hypoxia and iron overload Thalassemia major increases destruction of red blood cells (RBCs), shortens the life span of RBCs, and causes anemia. The body responds by increasing RBC production, but it can't produce adequate numbers of mature cells. This process results in chronic hypoxia. In addition, children with thalassemia major require multiple transfusions of packed RBCs. The combination of excessive RBC destruction and multiple transfusions deposits excess iron that damages organs and tissues. Thalassemia major doesn't place the adolescent at risk for hypertrophy of the thymus or thyroid or polycythemia vera, which involves excessive RBC production that can lead to thrombosis.

The parents of a pregnant adolescent are outraged that they are being refused medical information about their daughter's condition. What is the best response by the nurse to address their anger?

"If we obtain permission from her, we can include you in our discussions." The reality of this situation is that the parents may be included in the exchange of medical information but only with the daughter's consent. Sharing that fact with the parents clearly identifies that the decision is the daughter's to make and that she is entitled to make it. The nurse must support the client's right to privacy and confidentiality. The client is responsible for her own health, and her information is confidential, but stating these facts does not adequately address the parents' concern. The client may not be ready to share any information, but this does not help the parents understand what is occurring. It is best to simply explain that the client's permission is necessary in order to include the parents in the sharing of medical information.

A nurse teaches an adolescent client with asthma to independently administer breathing treatments. Which principle should the nurse keep in mind when planning the teaching session?

Adolescents are worried about appearing different from their peers. Adolescents have a strong need to belong, and they seek social approval from their peers. Knowing this information will help the nurse construct an effective teaching plan. According to Piaget, adolescents are at the formal operations stage and are capable of deductive, reflective, and hypothetical reasoning. According to Erikson's stages of psychosocial development, adolescence is the stage of identity versus role confusion. During this stage, the adolescent strives to establish a sense of identity. There is no reason to think the adolescent will be uncooperative. Many people find video tutorials useful, but a return demonstration is the best way to ensure the client understands and is able to follow the instructions. The nurse can assess the client's abilities without the client requiring supervision at home.

A 16-year-old client requires chemotherapy for leukemia. The client's parents support the health care provider's recommendation, but the client is refusing treatment. What is the nurse's best initial action?

Request that the health care provider thoroughly explain the benefits and consequences of treatment to the client. The nurse has a responsibility to the client and should act as an advocate. In this situation, it is best, and most appropriate, for a 16-year-old client to understand the treatment being discussed. After a discussion and understanding, if the client refuses, then the client can be instructed that the decision of the parents will be honored. The other options do not demonstrate the nurse's understanding of client advocacy and the client's right to choice.

An adolescent presents to a community clinic for treatment of vulvar lesions associated with Type 2 herpes simplex. Which action does the nurse take?

Show the adolescent to a private examination room for further assessment. The nurse should take the adolescent client to an examination room to provide privacy. Federal law states that adolescents may obtain treatment for sexually transmitted diseases without parental notification, although the parents may find out if insurance is used. This adolescent is guaranteed the same confidentiality as older clients.

A nurse is caring for a 16-year-old male client who needs an appendectomy. His parents are not present at the hospital. Prior to the surgery, the nurse needs to ensure that informed consent is obtained. Which situations allows the healthcare provider to obtain an informed consent from an adolescent?

The adolescent has declared himself emancipated. Individuals under the age of 18 need a parent or guardian to provide an informed consent, unless the individual is an "emancipated minor," an adolescent who is legally recognized as an adult. Otherwise, an adolescent is considered a minor until his 18th birthday. The power-of-attorney document allows another individual who is over the age of 18 to make decisions.

The nurse is caring for an adolescent with diabetes who admits to consuming many simple sugars and carbohydrates at a graduation party. The parents brought the client to the emergency room with unusual behavior. The serum glucose level was 375 mg/dL (20.8 mmol/L).The healthcare provider provided a coverage schedule:150 to 200 mg/dL (8.3 to 11.1 mmol/L)—2 units of Humulin R201 to 250 mg/dL (11.1 to 13.9 mmol/L)—4 units of Humulin R251 to 300 mg/dL (13.9 to 16.7 mmol/L)—6 units of Humulin R301 to 350 mg/dL (16.7 to 19.4 mmol/L)—8 units of Humulin R351 to 399 mg/dL (19.5 to 22.1 mmol/L)—10 units of Humulin ROver 400 mg/dL 22.2 (mmol/L)—call the health care providerSelect the line on the low-dose insulin syringe corresponding to the amount of insulin that should be drawn up.

The adolescent's blood sugar is 375 mg/dl (20.8 mmol/L), thus falling within the 10 unit range. The nurse would drawn up 10 units of Humulin R to administer as per healthcare provider's orders.

Which strategies should the nurse use when counseling an adolescent to change eating habits for weight loss? Select all that apply.

Write down all foods eaten. Eat only at certain times. Leave food on your plate. Eat the food at a slower pace. Behavioral interventions, including self-monitoring, should be recommended to the adolescent. Keeping a written record of when, how much, and with whom eating occurs is important to identify eating patterns. Eating also should be restricted to certain times and in certain places. Leaving food on the plate is encouraged, and the pace of eating should be slowed. Other activities should not be done during a meal. Low-fat, low-calorie foods typically are included in the plan.

Family members and friends stage an intervention for an alcoholic adolescent. The intervention is successful when the adolescent:

is motivated to enter an alcohol rehabilitation program. Willingness to enter a rehabilitation program indicates that the adolescent is motivated to change. An intervention is an emotionally charged meeting; crying may be an indication of manipulation, rather than a sign that the intervention has succeeded. Relapses are common among alcoholics who simply stop drinking; success in overcoming alcoholism is more likely when a structured program is part of the rehabilitation process. Talking with friends doesn't indicate a successful intervention.

The nurse is teaching an adolescent with celiac disease about dietary changes that will help maintain a healthy lifestyle. Which of the following foods can the nurse safely recommend as part of the adolescent's diet? Select all that apply.

potatoes apples corn Celiac disease is an intolerance to the gluten factor of protein found in grains. Specific grains to be removed from the diet include wheat, rye, oats, and barley. Clients with a diagnosis of celiac disease can tolerate corn, fruits, and vegetables.

Which of the following is a normal response from an adolescent who has just returned to her room after an open appendectomy?

"I am worried about the size of my scar." Adolescents are concerned about the immediate state and functioning of their bodies. The adolescent needs to know whether any changes (e.g., illness, trauma, surgery) will alter her lifestyle or interfere with her quest for physical perfection. Having a scar may be devastating to the adolescent. The need for plastic surgery cannot be determined at this point. The adolescent has just returned from surgery and has yet to see the scar. Healing has yet to occur. Typically scars become smaller and fade over time. The desire for no pain is unrealistic. Although adolescents are worried about pain and how they will respond, they typically are discharged within 24 hours after an appendectomy with pain well controlled by oral analgesics. The immediate concern of adolescents is the state and functioning of their bodies. After concerns about themselves, then adolescents are concerned about their peer group and their responses. Although the boyfriend's response will matter, this concern would be more common later in the course of the adolescent's recovery.

A nurse has been caring for an adolescent client in a residential facility. The child has been through a series of foster placements since infancy with no success in any placement until the age of 7 when placed with a middle-aged single woman. The client thrived there until the woman was killed in a car accident. The client attempted suicide after her foster mother died in response to the loss and the child was placed in the residential facility. The nurse has become close to this client and wants to help her address her issues and move on with her life. Which comment to the manager demonstrates that the nurse understands the client's issues and is able to respond appropriately to the client's needs?

"It's difficult for her to love and trust again after her losses. In this facility, she can learn to deal with her loss in a less emotionally charged environment than a foster home." The severe emotional trauma the girl has experienced will likely make it difficult for her to be successful in an adoptive placement at the present time, whether that placement is with someone she knows (the nurse) or another adoptive family. Additionally, adoption by the nurse is inappropriate because it blurs the lines between her professional and personal life and is likely to confuse the client. It is clear that the client has many issues and that love alone is not likely to solve all her problems. Treatment at the residential facility will allow her to work through emotional issues in a more therapeutic environment. Though not currently ready for adoption, she may be ready for adoption in the future after sufficient treatment.

The parents of an adolescent client newly diagnosed with anorexia nervosa are meeting with the nurse during the admission process. Which remarks should the nurse interpret as typical for parents of a client with anorexia nervosa?

"She's been a model child. We've never had any problems with her." Parents commonly describe their child as a model child who is a high achiever and compliant. These adolescents are typically well liked by teachers and peers. It is not typical for behavior problems to be reported. The description about having given the child everything and being repaid is more likely to describe an adolescent who is exhibiting behavior problems.

An adolescent client is sent to the school clinic with dizziness and nausea. While assessing the girl, who denies any health problems, the nurse smells alcohol on her breath. Which response by the nurse is most appropriate?

"Tell me everything that you have had to eat and drink yesterday and today." Asking the client to report everything that she has had to eat and drink yesterday and today is the least judgmental approach and also provides helpful information. Confronting the client about drinking alcohol or asking her to admit the real reason for feeling sick can put the client on the defensive and block further communication. The nurse should avoid putting the client on the defensive to facilitate communication that may eventually enable the nurse to get the truth and identify interventions.

An athletic teenager who is diagnosed with infectious mononucleosis is told to avoid contact sports for 3 to 4 weeks. The teenager protests to the nurse and demands to know why sports must be avoided for so long. What is the best response by the nurse?

"Your spleen is enlarged from your illness and could easily rupture with an injury." In a client with infectious mononucleosis, the spleen enlarges, and the individual is at risk for a spontaneous rupture with any trauma to the area. The client is placed on bed rest during the acute phase of illness, which usually lasts about 7 to 10 days, and should avoid contact sports for 3 to 4 weeks to prevent this complication.

A 14-year-old is using glargine and lispro to manage type 1 diabetes. The prescription for sliding scale lispro reads as follows:Lispro subcutaneous give units according to sliding scale:Blood glucose: 70-150 mg/dL (3.9 to 8.3 mmol/L) = 0 units151-200 mg/dL (8.4 to 11.1 mmol/L) = 1 unit201-250 mg/dL (11.2 to 13.9 mmol/L) = 2 units251-300 mg/dL (13.9 to 16.7 mmol/L) = 3 units301-350 mg/dL (17 to 19.4 mmol/L) = 4 unitsCall for Blood glucose > 350 mg/dL (19.4 mmol/L)In addition give 1 unit for every 15 g of carbohydrate.The morning blood glucose is 202 mg/dL (11.2 mmol/L), and the client is going to eat two carbohydrate exchanges. The nurse has the client administer how many units of lispro? Record your answer using a whole number.

4 Each carbohydrate food exchange has 15 g of carbohydrate. Two units are needed to cover the current blood glucose and 2 units are needed to cover the anticipated carbohydrate intake.

A 16-year-old client visits the clinic. The adolescent tells the nurse about being recently exposed to herpes. The nurse assesses specifically for which finding?

burning on vulva or in vagina Genital burning and tingling is the most common initial finding with primary genital or type 2 herpes simplex. This symptom will advance to vesicular lesions rupturing into ulcerations, which then dry into a crusty erosion. Fever, headache, malaise, myalgia, regional lymphadenopathy, dysuria, and urine retention are later findings in type 2 herpes.

A 14-year-old client in skeletal traction for treatment of a fractured femur is expected to be hospitalized for several weeks. When planning care, the nurse should take into account the client's need to achieve what developmental milestone?

identity According to Erikson's theory of personal development, the adolescent is in the stage of identity versus role confusion. During this stage, the body is changing as secondary sex characteristics emerge. The adolescent is trying to develop a sense of identity, and peer groups take on more importance. The hospitalized adolescent is separated from the peer group and the adolescent's body image may be altered. This alteration in body image may interfere with the ongoing development of the adolescent's identity. Toddlers are in the developmental stage of autonomy versus shame and doubt. Preschool children are in the stage of initiative versus guilt. School-age children are in the stage of industry versus inferiority.

Which client action should the nurse judge to be a healthy coping behavior for a male adolescent after an appendectomy?

insisting on wearing a T-shirt and gym shorts rather than pajamas Adolescents struggle for independence and identity, needing to feel in control of situations and to conform to peers. Control and conformity are often manifested in appearance, including clothing, and this carries over into the hospital experience. The adolescent feels best when he is able to look and act as he normally does, for example, wearing a T-shirt and gym shorts. Adolescents normally want to interact with peers and commonly seek every opportunity to do so. Avoiding other adolescents on the nursing unit or not taking phone calls from friends might suggest ineffective coping behavior. Refusing to fill out the menu and allowing the nurse to do so demonstrate dependent behavior, not a healthy coping mechanism.

A 13-year-old client is dying of cancer. When providing care for this client, the nurse should incorporate the developmental tasks for this age. According to Erikson's developmental model, the child normally is expected to be working on which psychosocial issue?

personal values According to Erikson, a child of 13 years is normally seeking to meet the need to develop personal identity. Personal values are a component of this identity. Developing a conscience is a component of achieving initiative during the preschool years. Developing a sense of competence is a component of achieving industry in the school-age years. Developing a lifetime vocation is a component of achieving generativity in adulthood.

A nurse interviews the parent of a middle school student who is exhibiting behavioral problems, including substance abuse, following a sibling's suicide. The parent says, "I'm a single parent who has to work hard to support my family, and now I've lost my only son, and my daughter is acting out and making me crazy! I just can't take all this stress!" Which issue is the priority?

potential suicidal thoughts/plans of both family members The parent's expression of stress and grief and the adolescent's behavior and drug use could be preludes to suicide, especially since another member of the family succeeded in suicide. Suicide attempts are more likely in families in which there has been a previous suicide attempt or suicide death, especially for young people.The parent's ability to emotionally support the adolescent in this crisis has been compromised, but the safety of both supersedes this concern.Assuring the client's and parent's safety is more important than dealing with anger or frustration at this point.Though the emotional states of both the parent and the child are important, one is not more important than the other.

The parent of an adolescent girl with Down syndrome tells the nurse that her daughter recently stated that she has a boyfriend. The parent is concerned that her daughter might become pregnant. Which is the most appropriate suggestion made by the nurse?

"I understand your concern; you may want to start your daughter on long-acting contraception." Children with Down syndrome range from having severe intellectual disability to having low average intelligence, Thus the adolescent's ability to make informed choices regarding sexual activity is limited. Long-acting contraception, such as an intrauterine device or a progestin implant, greatly reduces the risk of unwanted pregnancy. Most women with Down syndrome are fertile; however, children born to women with Down syndrome often have congenital defects. An abstinence program may not be effective due to the intellectual level of children with Down syndrome. Suggesting that the adolescent break off the relationship does not ensure that she will.

After conducting a class for female adolescents about human reproduction, which student statement indicates that the school nurse's teaching has been effective?

"Under ideal conditions, sperm can reach the ovum in 15 to 30 minutes, resulting in pregnancy." Under ideal conditions, sperm can reach the ovum in 15 to 30 minutes. This is an important point to make with adolescents who may be sexually active. Many people believe that the time interval is much longer and that they can wait until after intercourse to take steps to prevent conception. Without protection, pregnancy and sexually transmitted diseases can occur. When using the abstinence or calendar method, the couple should abstain from intercourse on the days of the menstrual cycle when the woman is most likely to conceive. Using a 28-day cycle as an example, a couple should abstain from coitus 3 to 4 days before ovulation (days 10 through 14) and 3 to 4 days after ovulation (days 15 through 18). Sperm from a healthy male can remain viable for 24 to 72 hours in the female reproductive tract. If the female client ovulates after coitus, there is a possibility that fertilization can occur. Before fertilization, the ovum and sperm each contain 23 chromosomes. After fertilization, the conceptus contains 46 chromosomes unless there is a chromosomal abnormality.

An adolescent client is admitted with a diagnosis of rheumatic fever and is on bed rest. He has a sore throat. His joints are painful and swollen. He has a red rash on his trunk and is experiencing aimless movements of his extremities. Use the chart above to determine what the nurse should do first.

Report the heart rate to the health care provider (HCP). The child's heart rate of 150 bpm is significantly above its rate at the time of his admission. The nurse must notify the HCP. The increase in heart rate may indicate carditis, a possible complication of rheumatic fever that can cause serious and life-long effects on the heart. The HCP will intervene with medication and cardiac monitoring. While lotion may provide comfort, the most important action for the nurse is to notify the HCP of the increased heart rate. Splinting will not help the inflammation that is causing the painful joints. The joint pain will migrate and subside with time. The temperature is not elevated at this time and does not require intervention.

A nurse is assessing a severely depressed adolescent. Which finding indicates the highest risk of suicide?

a preoccupation with death An adolescent who demonstrates a preoccupation with death (such as by talking frequently about death) should be considered at high risk for suicide. Although excessive sleepiness, altered speech, and voluntary seclusion may occur in suicidal adolescents, they also occur in adolescents who aren't suicidal. Verbal and emotional withdrawal and slowed speech are signs of possible depression; however, a focus on death is most concerning.

An adolescent client who has been taking an antidepressant for 6 weeks has returned to the clinic for a medication check. When the nurse talks with the client and her parent, the mother reports that she has to remind the client to take her antidepressant every day. The client says, "Yeah, I'm pretty bad about remembering to take my meds, but I never miss a dose because Mom always bugs me about taking it." Which response would be effective for the nurse to make to the client?

"It seems there are some difficulties with being responsible for your medications that we need to address". The client and mother need to address the issue of responsibility for medication administration. Reinforcing the mother's over involvement in medication taking or making negative comments about the client and mother are unlikely to engage them in problem solving about the matter.

A new client has just been admitted to an adolescent psychiatric inpatient unit. The charge nurse and an unlicensed assistive personnel (UAP) are discussing the client's needs. The UAP says, "She is just showing off to try and get our sympathy. There is no need for her to cut herself. Why would adolescents want to do such a thing to themselves?" What response by the charge nurse would most help the UAP understand the client and her illness?

"It's hard to see a young person harm herself as she does, but she has serious family issues and doesn't know better ways to handle them, so we have to help her with that." The UAP is concerned about the behavior of the client and confused about why it is occurring, so the nurse needs to explain a bit about the issues involved as well as demonstrate empathy for the aide. It is appropriate to explain that the client is not cutting for attention, but the nurse's response does not address the reason for the teen's behavior and is therefore inadequate. It could also appear that the nurse is denigrating the UAP, which will not encourage the aide to listen to what she has to say. The comments that the UAP cannot work with the client or that she should transfer are punitive and do nothing to help the UAP understand self-mutilation.

An adolescent client is admitted to a psychiatric day treatment program due to severe lower back pain since her mother's death 3 years ago. Medical examinations have not discovered a physical cause for her pain. She cares for her four younger siblings after school and on weekends because of her father's long work hours. Which predischarge statement indicates that treatment for her condition has been successful?

"My back pain is worse on weekends with more responsibility and homework." This statement indicates insight into possible emotional causes for her pain. After insight is achieved, the client can make behavior changes to effectively cope with her anxiety-related disorder. Saying that she understands why her father is away so often demonstrates insight into her father's actions rather than her own. Wanting to discuss her pain and not her family indicates denial of any connection between her pain and her stress, which perpetuates her current situation. While rest may help her back, the client's statement does not address psychological issues related to the back pain.

A nurse is providing health teaching to a group of adolescent girls. The focus is urinary tract infections . One of the girls tells the nurse that she wants to know what is cystitis. Which statement by the nurse is the most appropriate response?

"This condition can result from irritation and inflammation from sexual activity." Cystitis is a lower urinary tract infection. One cause seen in young adolescent women is after their first sexual intercourse experience. The urinary tract infections occur because of inflammation and local irritation caused by sexual activity. Bladder infections can lead to complications, and, so, are not minor or harmless. A bladder or uretheral infection is not the result of vaginal cleanses such as douches.

An adolescent in the terminal stage of leukemia cries out for more pain medicine. What is the best action for a nurse to take in caring for this dying adolescent?

Give the adolescent more pain medication to control pain and suffering. The adolescent is in severe pain and requires more pain medication. The goal of treatment at this stage of terminal cancer is to make the adolescent as comfortable as possible. Increased tolerance and addiction potential aren't concerns. Strict timing of medication administration doesn't always coincide with an individual's fluctuating pain. The nurse should give the medication even if the adolescent's need for it doesn't match the administration schedule. Pain is what a client says it is; a nurse shouldn't withhold medication or make judgments about a client's pain threshold.

The nurse prepares to teach an adolescent scheduled for an appendectomy about what to expect. The adolescent says, "I would rather look this up on the Internet." What should the nurse do?

Help the client find information on the Internet. Part of providing client-centered care is to honor the client's preferred method of learning. The nurse should help the adolescent find accurate information about the procedure. By assisting with the information search the nurse can verify learning. Teaching straight from a checklist does not encourage customization. If the client has requested to use the Internet, it is unlikely that written information will be read. While it is true that some information on the Internet is not accurate, the nurse can take this opportunity to help the client learn how to determine if a source is reliable.

The parents of teenagers express concerns about the types and large quantities of food their children eat and their refusal to eat foods served at family meals. Which suggestion would be most helpful for the parents?

Incorporate the adolescents' preferences into meal planning. Preventing food intake from becoming the center of an independence-dependence struggle is important. Nursing responsibilities include helping parents realize that adolescents require a high caloric intake and they need to make individual decisions. Adolescents are subject to peer pressure that commonly supersedes family pressure for a healthy diet.The parents have already evaluated their adolescents' diet, as evidenced by their concerns.Although the adolescents should be informed about the adverse effects of fad diets, doing so does not ensure the adolescents' adequate nutritional intake.Responsibility for grocery shopping for a month may encourage independence but does not ensure adequate nutritional status.

An adolescent with chest pain goes to the school nurse. The nurse determines that the teenager has a history of asthma but has had no problems for years. What should the nurse do next?

Obtain a peak flow reading. Problems of chest pain in children and adolescents are rarely cardiac. With a history of asthma, the most likely cause of the chest pain is related to the asthma. Therefore, the nurse should check the adolescent's peak flow reading to evaluate the status of the air flow. Calling the adolescent's parent would be appropriate, but this would be done after the nurse obtains the peak flow reading and additional assessment data. Having the adolescent lie down may be an option, but more data need to be collected to help establish a possible cause. Because the adolescent has not experienced any asthma problems for a long time, it would be inappropriate for the nurse to administer a short-acting bronchodilator at this time.

The nurse is assessing an adolescent 1 hour after admission for a head injury. The nurse identifies that there have been changes since the baseline assessment, including apnea, bradycardia, and a widening pulse pressure. What is the primary reason for the nurse to notify the healthcare provider?

The changes suggest that the client's intracranial pressure is increasing. Cushing's triad (apnea, bradycardia, and widening pulse pressure) is a hallmark of increasing intracranial pressure, which indicates that the adolescent's condition is deteriorating. It is correct that the healthcare provider must be alerted to significant changes and may need to change orders. The client may need additional testing. However, the primary reason to notify the healthcare provider is so the obvious increase in intracranial pressure can be managed using a holistic and emergent approach.

After the nurse emphasizes to an adolescent with renal failure the importance of maintaining a positive self-concept, which behavior by the adolescent should the nurse identify as an indicator that the plan is working?

demonstration of desire to do the dressing changes and take care of the medications Demonstration of desire to do the dressing changes and manage medications implies compliance with the medical regimen and acceptance of the condition, thereby indicating a positive self-image. Diffuse somatic symptoms could indicate anxiety or problems with coping, with a negative effect on self-concept. Insistence on choosing restricted foods implies that the adolescent has not accepted the diagnosis and is noncompliant, possibly indicating a negative self-concept. Social withdrawal from activities may indicate depression, possibly negatively affecting the self-concept.

A 17-year-old adolescent with acute lymphocytic leukemia is discharged with written information about chemotherapy administration and an outpatient appointment schedule. The client now is in the maintenance phase of chemotherapy but has missed clinic appointments for blood work and admits to omitting some chemotherapy doses. To improve the client's compliance, the nurse should include which intervention in the care plan?

letting the adolescent participate in planning and scheduling of treatments Because the adolescent is striving for independence, healthcare providers should promote self-reliance whenever possible, such as by letting the client participate in planning and scheduling treatments. The client can help establish realistic goals and evaluation outcomes as well as help schedule procedures and chemotherapy doses to minimize lifestyle disruptions. Adolescents are oriented in the present and have relatively little concern for the long-term consequences of their behavior. Reprimanding the client or threatening to discontinue care isn't likely to improve compliance and isn't in the client's best interest.

The nurse is caring for an adolescent who has been admitted several times with uncontrolled type 1 diabetes. The child is now stabilized and is preparing for discharge. Which of the following should be the priority focus for the nurse when conducting discharge teaching?

management of the therapeutic regimen The priority immediately after recovery is therapy management, including reviewing that the interruption of insulin administration may result in diabetic ketoacidosis. The multiple admissions imply that the adolescent either does not understand the consequences of the disease or is making choices that are not consistent with the health teaching. This is an opportunity to review those choices.

During assessment of an adolescent who has sustained a recent thoracic spinal injury, the nurse auscultates the adolescent's abdomen. The nurse explains to the parents that this is necessary because clients with spinal cord injury often develop which problem?

paralytic ileus A thoracic spinal cord injury involves the muscles of the lower extremities, bladder, and rectum. Paralytic ileus often occurs as a result of decreased gastrointestinal muscle innervation. The nurse evaluates this by auscultating the abdomen. Because the client has a thoracic spinal cord injury, the client may not feel abdominal cramping. Additionally, auscultation would provide no evidence of cramping. Hyperactive bowel sounds would be evidenced with increased peristalsis; peristalsis would probably be diminished with this injury. Profuse diarrhea, resulting from increased peristalsis, would not be an expected finding. Diarrhea would be more commonly associated with a gastrointestinal infection.

An adolescent is a heavy user of marijuana and alcohol. When the nurse confronts the client about his drug and alcohol use, he admits previous heavy use in order to feel more comfortable around peers and achieve social acceptance. He says he has been trying to stay clean since his parents found out and had him seek treatment. When the nurse develops a plan of care with the client, what should be the highest priority to help him maintain sobriety?

peer recognition that does not involve substance use Peer acceptance and recognition is a very powerful force in the lives of adolescents, leading to positive or negative behavior depending on the child's peers. While the influence of parents remains strong, peer acceptance combined with the adolescent's desire for independence can lead to disobeying the parents. The sanctions provided at school and in the community by law enforcement will support those teens that have other support in their lives, but are generally not sufficient to prevent substance use in adolescents lacking support at home and with peers.

An adolescent who is immobilized in a cast to stabilize a recent fractured femur suddenly develops chest pain, dyspnea, diaphoresis, and tachycardia. The nurse should further assess the client for what condition?

pulmonary emboli Chest pain and dyspnea in an immobilized adolescent with a large bone fracture suggest a fat embolus. With this condition, fat droplets, rather than a thrombus, are transferred from the marrow into the general blood stream by the venous-arterial route, possibly reaching the lung or brain. Atelectasis may develop; however, the onset of signs and symptoms is usually more gradual and subtler. Pneumonia can occur; however, the signs and symptoms usually do not develop suddenly. Pulmonary edema should not be a problem in a healthy adolescent who has sustained a fracture.

The nurse assesses an adolescent client with lethargy, retractions of the intercostal spaces, a persistent expiratory wheeze, diminished breath sounds, tachycardia, and tachypnea. Arterial blood gas results are pH 7.10; PCO2 80 mm Hg (10.64 kPa); PO2 35 mm Hg (4.66 kPa), HCO3 29 mEq/l (29 mmol/l). What is the priority condition the nurse must address?

respiratory acidosis Based on the results of the arterial blood gases, this client is in respiratory acidosis. The nurse must address this quickly because it could lead to respiratory failure. If the nurse addresses the respiratory acidosis quickly, which means also addressing the cause of the imbalance, the client may not experience respiratory failure. Additionally, assessment data, vital signs, and laboratory work will begin to normalize.

An adolescent with a history of surgical repair for an undescended testis comes to the clinic for a sports physical. Which anticipatory guidance for the parents and adolescent is most important?

technique for monthly testicular self-examinations Because the incidence of testicular cancer is increased in adulthood among children who have had undescended testes, it is extremely important to teach the adolescent how to perform the testicular self-examination monthly. The undescended testicle is removed to reduce the risk of cancer in that testicle. Removal of a testis would not necessarily make the adolescent sterile because the other testicle remains. Although discussing the adolescent's future plans is important, it is not the priority at this time. Because the adolescent has been dealing with the situation for a long time, the need for a sports physical at this time should not be a cause of emotional distress requiring a lot of psychological support.

The nurse is providing an education program to a group of adolescents on the importance of testicular self-examinations. One of the participants asks the nurse, "when is the best time to do the examination?" What is the best response by the nurse?

when you are in the shower or immediately after Testicular cancer occurs most frequently between the ages of 15 and 34; therefore, boys should begin doing testicular self-examinations at age 12, which will help them become familiar with the normal contours and consistency of their genital structures.The nurse should inform the group that the best time to perform a testicular self-examination is in the shower or immediately afterward because the scrotum is relaxed. When the male first rises in the morning, in the evening, or prior to urinating, the scrotum is not in the optimal condition for the examination.