Adolescent NCO

An adolescent female suffering from severe cystic acne is placed on isotretinoin. What important facts should the nurse tell the client about isotretinoin? Select all that apply. 1. Inform the client to use vinyl helmet straps. 2. Inform the client about the risk of teratogenicity. 3. Inform the client that skin improvement may take time. 4. Inform the client to scrub vigorously to remove blackheads. 5. Inform the client to use abrasive cleansers to remove blackheads

2 3 Even if an adolescent states that she is sexually inactive, the nurse should discuss viable birth control options with the client due to the risk of teratogenicity with isotretinoin. The client should be informed that it takes weeks to months for the skin to improve. Vinyl helmet straps may cause a mechanical irritation of acne leading to the development of lesions and therefore should not be used. Vigorous scrubbing may aggravate acne and cause damage to the skin and should be avoided. Using abrasive cleansers may cause skin trauma.

Which of these statements about pregnancy in the adolescent population are true? Select all that apply. 1. Infants of teen mothers are at risk of delivering babies late. 2. Pregnant adolescents often seek out less prenatal care. 3. Adolescent mothers need competent day care for their infants. 4. Infants of adolescent mothers are at increased risk for prematurity. 5. Fetuses of adolescent mothers are at higher risk for chromosomal defects.

2 3 4 Pregnant adolescents are less likely to seek out prenatal care. Adolescent mothers need competent day care for their infants. Infants born to adolescent mothers are more likely to be premature than are infants born to adult mothers. Infants born to teen mothers are at risk of being born prematurely. Pregnancies in older mothers are at greater risk for chromosomal defects.

Which questions should be asked by the nurse of an adolescent client before a pregnancy test is performed? Select all that apply. 1. "Are you sexually active?" 2. "When was your last period?" 3. "Are you having any nausea?" 4. "Do you have a history of pregnancy?" 5. "How will you tell your parents if the test result is positive?"

1 2 3 A detailed sexual history and menstrual history should be part of routine healthcare for adolescents. Reviewing specific symptoms of pregnancy, including amenorrhea, breast tenderness, urinary frequency, fatigue, and nausea, may help the nurse determine whether a pregnancy test is warranted. Asking about a history of pregnancy is not required before a nurse performs a pregnancy test for an adolescent client. Once a positive result is confirmed, the nurse should determine how the client would like to tell her parents about her pregnancy.

What are the considerations for bariatric surgery in an adolescent? Select all that apply. 1. Attainment of physical maturity 2. Failed attempt at weight loss for at least six months 3. Ability to give informed consent to surgical treatment 4. Agreement to avoid pregnancy for at least six months 5. Body mass index of at least 30 with obesity-related comorbidities

1 2 3 The considerations for bariatric surgery in an adolescent are the attainment of physical maturity, a failure to attain weight loss for at least six months, and the ability to give informed consent to surgical treatment. The other considerations are agreement to avoid pregnancy for at least one year and a body mass index of at least 50 with obesity-related comorbidities.

What is the most common cause of ophthalmia neonatorum in infants born to adolescent mothers? 1. Chlamydia 2. Gonorrhea 3. Human papilloma virus 4. Herpes simplex virus

1 Ophthalmia neonatorum is a neonatal infection caused when the infant is born to a mother who has a chlamydia infection.

A client with positive family history of testicular cancer arrives at the hospital and reports testicular pain. The primary healthcare provider reviews the laboratory reports and makes a diagnosis of testicular cancer. After surgery, the client will undergo chemotherapy. What conditions might occur in this client after chemotherapy? Select all that apply. 1. Infertility 2. Varicocele 3. Heart disease 4. Penile carcinoma 5. Metabolic syndrome

1 3 5 A family history of testicular cancer is a risk factor for testicular cancer. The client with testicular cancer may report pain in the testicular region. Radical inguinal orchiectomy, chemotherapy, and radiotherapy would be beneficial for this client. Chemotherapy can cause infertility. It can also cause cardiovascular disease and metabolic syndrome. Varicocele is characterized by elongation, dilation, and tortuosity of the veins of the spermatic cord superior to the testicle, not with chemotherapy for testicular cancer. Penile carcinoma is commonly associated with human papillomavirus type 16 infection.

At the conclusion of visiting hours, the parent of a 14-year-old adolescent scheduled for orthopedic surgery the next day hands the nurse a bottle of capsules and says, "These are for my child's allergy. Will you be sure my child takes one about 9 pm tonight?" What is the nurse's best response? 1. "I will give one capsule tonight before bedtime." 2. "I will get a prescription so that the medicine can be taken." 3. "Does your healthcare provider know about your child's allergy?" 4. "Did you ask your healthcare provider if your child should have this tonight?"

2 Legally, a nurse cannot administer medications without a prescription from a legally licensed individual. The nurse cannot give the medication without a current healthcare provider's prescription; this is a dependent function of the nurse. The nurse should not ask if the healthcare provider is aware of the problem; it is the nurse's responsibility to document the client's health history. It is the nurse's responsibility to review the healthcare provider's prescriptions and question them when appropriate.

A nurse educates an obese adolescent about healthy dietary habits and risks associated with obesity. Which statements by the adolescent indicate the need for further counseling? Select all that apply. 1. "I should exercise regularly." 2. "I should play more outdoor games." 3. "I should watch more television to reduce the stress." 4. "I should add lots of vegetables to my diet." 5. "I should contact a surgeon about bariatric surgery."

3 5 Stress is a major cause of obesity. Rather than watching television to reduce stress, physical activities such as playing outdoor games and regular exercise should be undertaken. Bariatric surgery is performed only when there is morbid obesity. Reducing the consumption of fat-rich foods and increasing the consumption of vegetables will help with weight reduction.

After orthopedic surgery a 15-year-old adolescent reports pain and rates it a 5 on a scale of 0 to 10. A nurse administers the prescribed 5 mg of oxycodone every 3 hours as needed. Two hours after having been given this medication, the adolescent reports pain and rates it a 10 of 10. What action should the nurse take next? 1. Administer another dose of oxycodone within 30 minutes. 2. Report the adolescent's apparent idiosyncratic reaction to oxycodone. 3. Tell the adolescent that additional medication cannot be given for 1 more hour. 4. Request that the primary healthcare provider evaluate the need for additional medication.

4 The nurse has made the assessment that the medication has been ineffective in relieving the adolescent's pain for the duration that it was prescribed to cover. This information should be communicated to the primary healthcare provider for evaluation. The prescription is for administration every 3 hours; legally the drug may be given only within these guidelines. There are no data to support an idiosyncratic reaction to the oxycodone; the amount of medication was probably inadequate for the adolescent's pain tolerance level. The nurse should not ignore the adolescent's need for pain relief.

A nurse gives a teenager discharge instructions regarding cast care. The nurse concludes that the instructions have been understood when the teenager makes what statement? 1. "If I get itchy around the cast, I'll rub the itchy area gently." 2. "If I get itchy around the cast, I'll pat the area with an alcohol swab." 3. "If I get itchy around the cast, I'll ask my doctor for a prednisone prescription." 4. "If I get itchy around the cast, I'll sprinkle a layer of powder around the itchy spots."

1 Gentle rubbing may soothe the skin; stimulation of sensory neurons by rubbing may decrease the itching sensation. Alcohol is a drying agent and should not be used. Steroids such as prednisone are not routinely given for itching caused by a cast. Powder may become caked, slip under the cast, and cause additional discomfort. Also, powder, which is a respiratory irritant, may be inhaled.

An adolescent girl is concerned about her body image after amputation of a leg for bone cancer. After the nurse has obtained the girl's consent, what nursing action is most therapeutic? 1. Encouraging her peers to visit 2. Keeping her lower body covered 3.Placing her in a room by herself 4. Limiting her visitors to the family

1 Peer acceptance is crucial during this period; friends must have the opportunity to accept the client with one leg. Concealment does not help the adolescent or others accept the loss. Isolating the adolescent will increase feelings of alienation and being different. An adolescent needs to relate to and be accepted by peers as well as family.

What factors may cause an adolescent to develop a smoking addiction? Select all that apply. 1. Peer pressure 2. Academic success 3. Involvement in sports 4. Imitating adult behavior of smoking 5. Imitating lifestyles portrayed in movies and advertisements

1 4 5 Factors that influence an adolescent to smoke include peer pressure and imitating adult behavior of smoking and lifestyles portrayed in movies. Succeeding in academics and being involved in sports are not factors that cause an adolescent to begin smoking.

Menarche is the central event of puberty in females, indicating the new possibility for fertilization. When does menarche occur in young girls? 1. Six months after ovulation 2. 24 months after the beginning of the development of breasts 3. Six months after attaining peak weight velocity 4. 12 months after attaining peak height velocity

2 Menarche in girls occurs two years after the appearance of breast buds, which indicates the start of breast development. Ovulation does not occur before menarche but occurs six to 14 months after menarche. Menarche occurs after attainment of three months of peak weight velocity and nine months of peak height velocity.

An adolescent with type 1 diabetes is brought to the emergency department in ketoacidosis. The adolescent admits to not adhering to the diabetic regimen. What can the nurse do to help the adolescent become more accepting of the diabetic regimen? 1. Determine what the adolescent has been taught about diabetes. 2. Encourage the adolescent to express feelings about having diabetes. 3. Explain to the parents that it is their responsibility to demonstrate their acceptance. 4. Provide the family with printed materials about the consequences of ineffectively controlled diabetes.

2 Psychosociocultural factors related to chronic illness often affect individual adherence to a medical regimen, particularly in an adolescent. These feelings must be explored and addressed before there can be acceptance of the treatment plan. The adolescent's feelings should be explored before it is determined what the adolescent knows about diabetes. Although it is important for the parents to demonstrate acceptance, adolescents need control and therefore the teaching must begin with the adolescent. Printed materials may be helpful later, but scare tactics rarely prompt changes with any lasting benefit.

A 16-year-old client with full-thickness burns of the entire right arm states, "I'll never be able to use my arm again. I'll be scarred forever." What is the best initial response by the nurse? 1. "Think about how lucky you are. You're still alive." 2. "Minimizing scarring is the goal of the entire professional staff." 3. "Being worried is understandable, but it's really too early to tell." 4. "Try not to worry. Concentrate on doing your range-of-motion exercises."

2 Telling the client that a positive outcome is the goal of the staff is a truthful answer that offers some hope without providing false reassurance. The adolescent is not concerned about having escaped death; telling the client to be glad to be alive will cut off communication. Telling the adolescent that it is too early to anticipate scarring is misinformation. Ignoring the adolescent's concerns is not therapeutic and cuts off communication.

Which period of Piaget's theory marks the end of cognitive development? 1. Sensorimotor 2. Preoperational 3. Formal operations 4. Concrete operations

3 According to Piaget's theory, the formal operations period marks the end of cognitive development. During this period, adolescents have the capacity to reason with respect to possibilities. The sensorimotor period is the first period when a newborn develops a schema or pattern for dealing with the environment. The second period is the preoperational period when a child develops egocentrism and animism. During the concrete operations period, children are able to perform mental operations.

While performing preoperative teaching a nurse explores a young adolescent's concern about changes in appearance after surgery to correct scoliosis. What is the most appropriate statement by the nurse? 1. "After surgery your back will be much straighter." 2. "You're concerned about how you'll look after surgery." 3. "Many teenagers who have this type of surgery do very well." 4. "Your parents think it's important for you to have this surgery."

3 By saying, "You're concerned about how you'll look after surgery," the nurse is using the technique of paraphrasing to encourage the adolescent to expand on personal concerns, which may relieve anxiety. Adolescents tend to be focused on the present, not the future; the nurse should focus on the adolescent's current concerns. Focusing on others is not client-centered care; the nurse should focus on the adolescent.

A nurse is helping an adolescent with type 1 diabetes establish a consistent meal pattern. What feedback from the adolescent indicates that further teaching is needed? 1. Weighs portion sizes for several months 2. Reads nutrition labels on prepared foods 3. Avoids complex carbohydrate substitutes 4. Limits sugar alternatives containing sorbitol

3 Complex carbohydrates may be substituted, depending on caloric content and amount eaten per serving. Flexibility is needed to promote adherence to any dietary regimen. Using consistent portion sizes is a key to maintaining diabetic control. By weighing and measuring portion sizes for several months the adolescent learns to recognize the acceptable amount to be eaten at a glance. The adolescent should read nutrition labels carefully, especially for their carbohydrate and caloric content. Most dietetic foods contain sorbitol. Sorbitol metabolizes to fructose and then glucose, so its use should be restricted when possible.

The primary healthcare provider prescribed benzoyl peroxide to a client with severe acne. During a follow-up visit, the nurse finds that the client did not respond to the therapy. Which other medications should the nurse suspect to be beneficial for the client? Select all that apply. 1. Trazodone 2. Isotretinoin 3. Minocycline 4. Streptomycin 5. Erythromycin

3 4 5 If moderate to severe acne does not respond to topical treatments, then systemic antibiotic therapy is indicated. Systemic antibiotic therapy includes minocycline, streptomycin, and erythromycin. Trazodone may cause priapism; it may not be beneficial for the client. Isotretinoin is an effective oral medication that is reserved for the treatment of severe cystic acne in clients who do not respond to other treatments.

A nursing instructor asks a nursing student about the warning signs that may be seen in an adolescent one month before suicide is attempted. What statement indicates a need for further education? 1. "A suicidal adolescent may sleep for long hours." 2. "A suicidal adolescent may have an increased appetite." 3. "A suicidal adolescent may lose interest in daily activities." 4. "A suicidal adolescent may avoid speaking about suicidal thoughts."

4 A suicidal adolescent tends verbalize his or her suicidal thoughts one month prior to attempting suicide. He or she may have increased or decreased sleep along with increased or decreased appetite. An adolescent will lose interest in daily activities, and there will be lack of initiative.

A client visits the primary healthcare provider and complains of vaginal discharge with a fishy odor. The primary healthcare provider diagnoses the client with bacterial vaginosis and suggests an oral medication. Which medication would be prescribed? 1. Tinidazole 2. Miconazole 3. Clotrimazole 4. Metronidazole

4 Bacterial vaginosis is a condition in which the hydrogen peroxide producing lactobacilli are replaced with high concentrations of anaerobic bacteria. Metronidazole is an oral medication used to treat bacterial vaginosis. Tinidazole is used to treat trichomoniasis. Miconazole and clotrimazole are used to treat candidiasis.

A nurse teaches a teenager who is undergoing chemotherapy about the need for special mouth care because of the potential for lesions. What statement by the teenager leads the nurse to conclude that the instructions have been understood? 1. "I'll brush my teeth with baking soda." 2. "I'll use mouthwash to rinse my mouth." 3. "I'll swish my mouth out with hydrogen peroxide." 4. "I'll use a soft-bristled toothbrush to clean my teeth."

4 Soft bristles are less irritating to the oral mucosa and less likely to cause trauma than irritating substances are. Baking soda, mouthwash, and hydrogen peroxide are all caustic substances that may irritate the mucosa.

A nurse is teaching a 15-year-old adolescent with newly diagnosed type 1 diabetes about self-care. What is the primary long-term goal this nurse and client should agree on? 1. Maintaining normoglycemia 2. Complying with the diabetic diet 3. Adhering to an exercise program 4. Developing a nonstressful lifestyle

1 Maintaining normoglycemia is a realistic goal because it decreases the risk of complications such as neuropathy, retinopathy, and atherosclerosis. A regimen of insulin, exercise, and diet will help the adolescent achieve this goal. Compliance with a diabetic diet is an objective because it will help the adolescent achieve the long-term goal; diet alone is insufficient to achieve normoglycemia. Adherence to an exercise program is an objective because it will help the adolescent achieve the long-term goal; exercise alone is insufficient to achieve normoglycemia. Development of a nonstressful lifestyle is a worthwhile goal, but it is not realistic.

After her child's visit to the pediatrician a mother tells the nurse that she is concerned that an antidepressant has been prescribed for her adolescent son. What is the best response by the nurse? 1. "Tell me more about what's bothering you." 2. "You need to speak with the primary healthcare provider about your concern." 3. "Are you sure it's not a medication for attention deficit disorder?" 4. "Didn't the primary healthcare provider tell you why your son needs an antidepressant?"

1 Reflecting the parent's feelings provides an opportunity for further exploration. It is the nurse's responsibility to assess the mother's concerns before planning further interventions. Implying that either the primary healthcare provider or the mother is wrong is a nontherapeutic response. Implying that the mother didn't listen or understand is a judgmental, nontherapeutic response.

A registered nurse is teaching a nursing student about a ketogenic diet. Which statements made by a nursing student indicates effective learning? Select all that apply. 1. "The diet should include 5 grams of protein per kilogram." 2. "The diet is recommended for obese clients." 3. "Rapid weight loss is observed in clients utilizing this diet." 4. "The diet helps to prevent orthostatic hypotension." 5. "The long-term outcomes have been established in clients following this diet."

2 3 A ketogenic diet is designed to provide enough protein to minimize the loss of lean body mass during weight loss. This diet is recommended for obese clients. Clients using a ketogenic diet benefit from relatively rapid weight loss and anorexia induced by ketosis. This diet consists of 1.5 to 2.5 g of protein per kilogram. Complications such as hypokalemia and orthostatic hypotension are observed in clients following this diet. Long-term outcomes of using this diet have not been established.

A 15-year-old adolescent is diagnosed with endometriosis. The client has severe, acute, and incapacitating symptoms. What would be the anticipated line of treatment? 1. Surgical intervention 2. NSAIDs during menstruation 3. OCP with low estrogen-to-progestin ratio 4. Continuous combined hormone therapy and NSAIDs

1 Surgical intervention is needed in adolescents with severe, acute, and incapacitating symptoms. NSAIDs can be used for symptomatic pain relief. Women having mild symptoms and desire for future pregnancy are treated with limited use of NSAIDs during menstruation. Women having mild symptoms and who can postpone pregnancy are treated with oral contraceptive pills that have low estrogen-to-progestin levels. In adolescents less than 16 years of age diagnosed with endometriosis, continuous combined hormone therapy and NSAIDs is the treatment option.

Prolonged labor is an incident very common in pregnant adolescents. Which age group of adolescents has the highest risk of prolonged labor? 1. 12 to 13 years 2. 14 to 15 years 3. 16 to 18 years 4. 19 to 21 years

1 The adolescents of age group 12 to 13 years are at the higher risk of prolonged labor because of cephalopelvic disproportion and underdevelopment. The age group of 14 to 15 will have moderate chances of prolonged labor as the transition between cephalopelvic disproportion and pelvic adequacy starts. For age group 16 to 21 the labor time shortens as the body completes transition.

In which period of Piaget's theory does the adolescent feel a sense of invulnerability? 1. Sensorimotor 2. Preoperational 3. Formal operations 4. Concrete operations

3 In the formal operation period, the fourth period of Piaget's theory, the adolescent feels a sense of invulnerability. This leads to risk-taking behaviors. In the sensorimotor period, the first period of Piaget's theory, the infant develops a schema or action pattern for dealing with the environment. Period II is the preoperational period. During this time, a child learns to think with the use of symbols and mental images. The period of concrete operations is the third period of Piaget's theory. At this time, the child is able to coordinate two concrete perspectives in social and scientific thinking.

Which drug used to treat syphilis is contraindicated in pregnancy? 1. Miconazole 2. Clotrimazole 3. Tetracycline 4. Metronidazole

3 Tetracycline can be administered to clients with syphilis who are allergic to penicillin G. This drug is contraindicated in pregnant women, as it can cause birth defects or staining/discoloration to the fetus' developing teeth if given during the second trimester. Miconazole and clotrimazole are used to treat candidiasis. Metronidazole is used to treat bacterial vaginosis.