Chapter 21: Adolescent

5. Which of the following disorders is characterized by males having an extra chromosome, typically being tall and initially thin, and not developing secondary sex characteristics? a. Gynecomastia b. Menstruation c. Turner syndrome d. Klinefelter syndrome

ANS: D A disorder in which males have an extra chromosome and typically are tall and initially thin, and do not develop secondary sex characteristics is known as Klinefelter syndrome.

16. A mother is concerned because her 13-year-old daughter comes home happy one day and sad the next. The girl also argues with her younger sister more than she did in the past, and does not like participating in family activities anymore. Which of the following is the best initial response from the nurse? a. "The changes during adolescence can be stressful as they struggle to come to terms with who they are. What other types of behaviors has she been displaying?" b. "Changes in affect can be a warning sign for suicide. Has she had any increase in risk-taking behaviors or physical violence?" c. "Is there any history of psychological disorders in your family?" d. "Withdrawal can be a sign of substance abuse. Has she given you any indication she might be using illicit drugs?"

ANS: A Although dramatic swings in affect can be a warning sign for suicide, and withdrawal can be a sign of substance abuse, additional information is required before suggesting a diagnosis. Often, mood swings and spending more time with peers and less time with the family is normal adolescent behavior during this period of rapid change in physical, psychosocial, spiritual, moral, and cognitive growth. Parents and teenagers should be aware of and prepared for these changes.

9. During a physical exam, a teenager asks the nurse if she can have a stronger medication for her constipation because the laxatives she has been taking are not helping. During the physical exam, the nurse observes mild to moderate erosion of the tooth enamel. Which of the following disorders is the client most likely experiencing? a. Bulimia nervosa b. Binge eating disorder c. Idiopathic constipation d. Irritable bowel syndrome

ANS: A Bulimia nervosa is characterized by binge eating and then purging by self-induced vomiting and/or laxatives. Purging can also lead to erosion of the tooth enamel. Bulimia nervosa occurs more commonly in females. A teenage girl asking for stronger laxatives with tooth enamel erosion should cause any health care provider to consider the possibility of bulimia nervosa.

7. Which of the following behaviors is most reflective of a teenager? a. Riding an ATV without a helmet b. Not skiing for fear of falling and getting hurt c. Obeying a new parental rule without a challenge d. Walking away from a group of friends who are smoking cigarettes

ANS: A Teenagers are known for their risk-taking behaviors. They do not always consider the health risks associated with their behaviors. In addition, they often do things because their friends do it. Therefore, riding an ATV without a helmet and risking a head injury is most reflective of a teenager's behavior.

18. After offering a teenager the HPV vaccine, the teenager responds by saying, "I can't have the vaccine because I have already been sexually active." Which of the following statements is the best response by the nurse? a. "You can still benefit from the vaccine, but there is a chance it will not be as effective." b. "The best way to protect yourself now is to make sure all your future sexual partners have received the vaccine." c. "You are correct, the vaccine is only indicated for females who have never been sexually active." d. "It depends on the number of partners you have had. If you have had less than five partners, you are still eligible for the vaccine."

ANS: A The HPV vaccine is recommended for 11- to 12-year-old girls and for 13- to 26-year olds who have not yet received or completed the vaccine series. Ideally, females should receive the vaccine before they are sexually active because girls who have not been infected with any of the four HPV types covered by the vaccine will receive the full benefits of the vaccine. Females who are sexually active may also benefit but to a lesser degree. It is not known if the vaccine is effective in boys or men. Thus, the best response is, "You can still benefit from the vaccine, but there is a chance it will not be as effective."

13. Which of the following teenagers is at risk for not meeting his developmental task? a. Arrested for petty theft b. Decided he wants to major in accounting c. Has recently broke up with his girlfriend d. Is a member of the varsity basketball team

ANS: A The central task of adolescence according to Erikson is the establishment of identity, with the primary risk being role confusion. As the adolescent searches for direction, he makes choices in social, recreational, volunteer, academic, familial, and occupational activities. When the threat of confusion is exceedingly great, delinquent behavior and alterations in mental health can occur. Thus, a teenager arrested for petty theft is displaying delinquent behavior that may place him at risk for not meeting his developmental task of identity.

20. The school nurse is working on a campaign in the school to prevent adolescent pregnancies. Which of the following interventions should the nurse implement? a. Talk to teenagers about sex, including abstinence, contraception, and sexually transmitted diseases. b. Tell the teenagers they should abstain from sex until they are old enough to cope with the potential consequences such as an unwanted pregnancy. c. Encourage parents of all teenage girls to make sure their daughters start oral contraceptives early. d. Offer all teenagers free condoms when they come in for physical exams.

ANS: A The emergence of secondary sexual characteristics increases adolescents' awareness of themselves as sexual human beings leading to experimentation. Primary prevention is necessary to help prevent adolescent pregnancies. Parents, teachers, and health care providers will be more successful in assisting teens to manage their health needs if they treat them as joint partners. Talking to teenagers about sex, contraceptive options, and sexually transmitted diseases gives them the information and anticipatory guidance they need to help them make a decision.

1. Which of the following are symptoms or warning signs of anorexia nervosa? (select all that apply) a. Lack of menstruation in females b. Preoccupation with food c. Eating only small amounts of certain foods d. Dramatic weight fluctuations

ANS: A, B, C, D Symptoms or warning signs of anorexia nervosa include the relentless pursuit of thinness, self-starving with significant weight loss, lack of menstruation in females, decreased sexual interests in males, compulsive physical activity, preoccupation with food, portioning food carefully, eating only small amounts of only certain foods, and a distorted body image. Dramatic weight fluctuations are seen with bulimia nervosa.

2. A teenager has been using acne medications for the last 14 days. Her acne is no better, and in fact, it is a little worse. What information should the nurse offer this girl? a. "Wash your face at least four times a day, making sure to scrub well." b. "The medications can make acne appear worse at first; try to give it a few more weeks." c. "Avoid all chocolate products." d. "Because it is summertime, it would be good for your skin if you lie out in the sun for a few hours each day."

ANS: B Acne is common in adolescents. Evidence indicates that dietary restrictions for acne are unnecessary. Although washing with soap and water is the best way to remove dirt, vigorous scrubbing should be discouraged. Furthermore, although sunlight can have a beneficial effect on acne, prolonged exposure should be avoided. Topical acne products make acne appear worse initially, and improvement occurs slowly over several months. Nurses should provide this information to teenagers planning to use acne products, so they are not discouraged early in therapy.

15. Which of the following teenagers is at increased risk for acquiring a sexually transmitted disease and should be provided with anticipatory guidance? a. Asks the nurse for information about condoms b. Feels her friends and family do not care about her c. Has multiple friends and feels good about herself d. Talks to her boyfriend on the phone for hours

ANS: B Adolescents often talk on the phone for hours, providing a safe way for them to interact with members of the opposite sex. However, adolescence is a time when teenagers fantasize about relationships and sex. Teenagers decide to become sexually active for a number of reasons, including affection. This can put them at increased risk for sexually transmitted diseases; therefore, anticipatory guidance regarding protection from sexually transmitted diseases needs to be provided before the adolescent is in a situation that can place him or her at risk.

14. Which of the following actions should parents take to help their teenager meet his developmental task? a. Set strict rules to prevent the teenager from getting into any trouble. b. Maintain an ongoing dialogue about important issues and upcoming challenges. c. Maintain a friendship with the teenager, so he views parents as peers. d. Be very lenient with the teenager so that he can figure out who he is as a person.

ANS: B Imposing strict limits and eliminating all rules are not helpful to teenagers. Families in which parents maintain a willingness to listen, demonstrate an ongoing affection for and acceptance of their adolescent, yet still maintain some consistent limits, experience more constructive, positive outcomes during adolescence. Thus, maintaining an ongoing dialogue about important issues and upcoming challenges demonstrates the parents' willingness to listen and their concern.

25. Which stage of female breast development is characterized by enlargement of the areolar diameter along with a small area of elevation around the papillae? a. 1 b. 2 c. 3 d. 4

ANS: B In stage 2, female breast development is characterized by enlargement of the areolar diameter along with a small area of elevation around the papillae.

12. A mother is concerned because her daughter has been taking a nap every day after school. Which of the following statements would be the best response by the nurse? a. "Don't worry; all teenagers do that." b. "Tell me about your daughter's schedule." c. "Let's bring her in for some blood work." d. "Have you addressed the topic of drugs with you daughter?'

ANS: B Many teenagers take naps, although this does not address the mother's concern. Although the nap can be a symptom of a health problem or drug use, additional information is necessary to make that determination. Asking the mother to tell you about her daughter's schedule provides information to determine whether the behavior is normal or whether it requires further investigation.

23. Which of the following teenagers is exhibiting a behavior that cause for concern and requires further evaluation? a. Is always very happy b. Is agitated and has trouble sleeping c. Has a lot of homework and stays up late to finish it d. Values his friend's opinion more than his parent's opinion

ANS: B Nurses should be aware that the problem of substance abuse exists. They should also be aware of what the signs and symptoms are. Agitation and insomnia are signs of substance abuse and should therefore be evaluated further.

10. A teenager has a family history of Type 2 diabetes mellitus. He asks the nurse what he can do to try to prevent developing it himself. Which of the following instructions should the nurse give this client? a. Tell him to avoid any and all sweets. b. Tell him to be active and eat a balanced diet. c. Tell him he should talk to his physician about genetic testing. d. Tell him that very little can be done to avoid developing this disorder.

ANS: B Obesity is making Type 2 diabetes mellitus common among teens and young adults. Being overweight and inactive increases the risk. Therefore, encouraging activity and a balanced diet is the best information the nurse can give to the client. Telling him to avoid all sweets would be an impossible request, and genetic testing does not detect the development of this disorder.

8. What percentage of adolescent females suffer from an eating disorder in the United States? a. 5% b. 10% c. 15% d. 20%

ANS: B Ten percent of adolescent females suffer from an eating disorder in the United States.

17. Which of the following is the third leading cause of death in adolescents between 10 and 24 years of age? a. Accidents b. Suicide c. Cancer d. Sport injuries

ANS: B The third leading cause of death in adolescents between 10 and 24 years of age is suicide.

2. A nurse is discussing being a safe driver as part of a driver's education course. Which of the following recommendations would the nurse include in this presentation? (select all that apply) a. Carpooling with friends b. Avoiding talking on cell phones c. Driving during daytime hours d. Wearing safety belt

ANS: B, C, D The risk of motor vehicle crashes is four times higher among 16- to 19-year-old adolescents than among any other age group. Research suggests that distractions, such as talking or texting on cell phones, eating, or playing with the radio, increase teen drivers' risk of being involved in a crash. Nurses should talk to teens about these distractions, which can also include riding with a car full of other teens. Teens have a much higher nighttime crash fatality rate as well.

4. Which female disorder is characterized by only one X chromosome present instead of two? a. Gynecomastia b. Menstruation c. Turner syndrome d. Klinefelter syndrome

ANS: C A female disorder in which only one X chromosome is present instead of two is known as Turner syndrome.

6. Parents recently discovered that their teenage daughter has been consuming alcohol on a regular basis. They ask the nurse for advice on how to best help their daughter. Which of the following recommendations should the nurse give to the parents? a. Talk to their daughter at length regarding the dangers associated with drinking. b. Tell their daughter she will not be allowed to use her cell phone if this continues. c. Enroll their daughter in a peer support group focused on teenage drinking. d. Provide their daughter with literature regarding the dangers of drinking.

ANS: C Teens do not always consider health risks associated with their risky behaviors. Additionally, peer influence is primary and parental input is often rejected. In this case, the teenager may risk losing her cell phone and privileges by continuing with her risky behavior, but because peer influence is primary, the parents should enroll her in a peer

11. Which of the following teenage behaviors is cause for concern? a. Has difficulty waking up in the morning and naps during the day b. Goes to bed late and naps during the day c. Takes frequent naps and states it is because he is bored d. Participates in after school activities and has difficulty waking up

ANS: C Adolescents need at least 8 hours of sleep per night. Often, they stay up late and wake up for school before their sleep cycles have finished; therefore, napping is common. However, those with a decreased energy level who use words such as "bored" or "sad" should be further evaluated for suspected depression. Therefore, a teenager who takes frequent naps and states it is because he is bored is cause for concern because this behavior might indicate depression.

19. A nurse is initiating a discussion about alcohol consumption during a physical exam with a teenager. Which of the following questions would be most appropriate for the nurse to ask? a. "So, what do you and your friends do for fun and excitement?" b. "Do you have access to alcohol?" c. "Do any of your friends drink?" d. "Do you want to talk about alcohol or drinking?"

ANS: C Anticipatory guidance during a physical exam is important. This includes asking about substance use. Questions should not be vague because they may be misinterpreted. Direct questions are useful when discussing sensitive topics. However, asking first about friends and the adolescent's feelings about them is a good lead-in approach to a discussion about substance use.

1. When do females usually begin puberty? a. 1 year before males b. 1 year after males c. 2 years before males d. 2 years after males

ANS: C Females usually begin puberty 2 years before males and experience their growth spurts earlier.

24. Which stage of male genital development is characterized by initial enlargement of the penis, mainly in length along with further growth of the testes and scrotum? a. 1 b. 2 c. 3 d. 4

ANS: C In stage 3, male genital development is characterized by initial enlargement of the penis, mainly in length along with further growth of the testes and scrotum.

21. A teenager asks the school nurse for advice before getting a tattoo. Which of the following responses would be most appropriate for the nurse? a. "You should not get a tattoo." b. "It is okay to get a tattoo if you go to a licensed artist." c. "Tattoos are popular; however, they can lead to infection and/or bleeding." d. "A body piercing would be safer and less permanent."

ANS: C Tattoos and piercings carry similar risks, which include localized infection, bleeding, and dermatitis. In addition, tattoos carry a heightened concern for blood-borne disease such as hepatitis and HIV. When providing anticipatory guidance, nurses should treat teenagers as partners and give them the information they need to make an informed decision. Therefore, informing the teenager about the risk of infection is the best response.

3. The mother of a 13-year-old girl is concerned because her daughter has not started menstruating yet. The girl developed breast buds and started her height spurt at 12 years of age. Which of the following statements would be the most appropriate response from the nurse? a. "Usually, girls start menstruating when they develop breast buds; an endocrine evaluation might be warranted." b. "Everyone is different; it will happen when it happens." c. "Based on when the breast buds first appeared, she should starting menstruating around the age of 14." d. "She will not start menstruating until her breasts are of adult size and contour."

ANS: C The first sign of puberty in females is the appearance of breast buds, followed by a growth spurt. The onset of menstruation occurs approximately 2 years after the appearance of breast buds and near the end of the growth spurt. Thus, based on the age of breast bud appearance, the girl should start menstruating around age 14.

26. A 14-year-old female is in for a physical exam. Which finding requires further investigation? a. A height spurt since her last visit b. Facial acne c. The lack of breast buds d. Noticeable sweating and body odor with activity

ANS: C The onset of puberty usually begins around 11 to 13 years of age. Stage 2 is the usual time of peak height velocity for girls. Additionally, both sweat and sebaceous glands become more active during adolescence leading to sweat, body odor, and acne. Breast buds also usually appear during stage 2 of puberty. Females who have not begun pubertal development by age 14 should have an endocrine evaluation. Thus, the finding of lack of breast buds on this 14-year-old girl requires further investigation.

22. A teenager is expecting her menstrual period on May 14. On which of the following dates would the nurse recommend that she perform a self-breast exam? a. May 11 b. May 14 c. May 17 d. May 23

ANS: D The best day to perform a self-breast exam is 2 to 3 days after one's period when breasts are least likely to be tender or swollen. A typical period lasts about 6 days. Thus, a teenager who starts her period on May 14 should perform a breast self-exam on May 23 (14 + 6 = 20 + 3 = 23).