Chapter 21: Adolescent

The third leading cause of death in adolescents between 10 and 24 years of age is ______

suicide

The nurse is preparing an educational activity for adolescents. The primary reason that emphasis is placed on teaching testicular self-examination is because: A. Adolescents are naturally interested in their developing bodies B. Baseline assessment data is necessary for comparison in the future C. Rapid anatomical changes are occurring in the testes D. Testicular cancer is the number one cancer in the adolescent male

D.

The nurse provides educational information to a group of adolescents on decreasing the incidence of acne. Information presented includes which of the following? A. "Decrease chocolate intake in your diet." B. "Expose your face to sunlight at least 2 hours per day." C. "Remove all pustules and papules with special instruments." D. "Wash your face with soap and water 2 times per day."

D.

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

D. A typical period lasts about 6 days. A teenager who starts her period on May 14 should perform a breast self-exam on May 23 (14 + 6 = 20 + 3 = 23).

To facilitate the adolescent's need for controlling behaviors, the nurse implements an intervention that: A. Asks the adolescent how he or she would like to handle the situation B. Consults with the parents regarding the adolescent's health care needs C. Gives specific, detailed instructions in writing D. Partners with the adolescent to develop a plan

D. Adolescents need to control extends to health care. The nurse cannot simply give directions or instructions, but rather present the options and allow the adolescent to partner together to work out an acceptable plan. The primary discussion needs to be performed with the adolescent, instead of with the parents.

The nurse facilitates the adolescent's self-perception-self-concept development by: A. Complementing the adolescent for what is accomplished B. Developing a plan for the adolescent's future growth C. Encouraging the adolescent to join in group activities D. Praising the adolescent for who he or she is

D. It is important for nurses to remember to praise adolescents for who they are rather than for what they do, value each of them as unique, demonstrate belief in their abilities to grow and develop, and delight in their discoveries of themselves and their unique means of expressing it.

What percentage of adolescent females suffer from an eating disorder in the United States?

10%

The onset of puberty usually begins around ___ to ___ years of age

11 to 13

Females usually begin puberty __ years ___ males and experience their growth spurts _____

- 2 years before males - earlier growth spurts

Scoliosis

- Curve typically convex to the right - Approx. 10% of all adolescents have a mild truncal asymmetry - Curves > 20 degrees are abnormal & can progress to significant curvature during the growth spurt

Erikson's identity vs. role confusion

- attempt to "try on" roles characterized by shifting interests & sudden extremes - restaging of each previous dev. stage - identity confusion can result in delinquent behavior & mental health alterations

Kohlberg's Postconventional Stage of Moral Development

- expanded understanding of right/wrong & good/bad - ideas of justice & universal principles underlying laws/social agreements

Piaget's Formal Operations Stage

- lays groundwork for abstract thinking - introspective: ability to think about their thinking (internalized audience) - egocentrism reemerges - intolerance of status quo - idealism

Gilligan's Theory of Moral Development for Females

- see "good" as involving self-sacrifice & caring for relationships - learns balance between what is good for HER & OTHERS in relationships

Which stage is the usual time of peak height velocity for girls?

2

What is the best day to perform a self-breast exam?

2 to 3 days after one's period (when breasts are least likely to be tender or swollen)

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 food D. Dramatic weight fluctuations

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.

The nurse emphasizes warning signs of suicidal risks in adolescents during a health-education class. These signs include: Select all that apply. A. Difficulty concentrating B. Increased accidents C. Hyperactivity D. Lethargy E. Sleep disorders

A,B,E

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?

A.

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

A.

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

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.

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

A. 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.

Research has documented what symptom one of the strongest predictors of adolescent obesity? A. Depression B. Excessive TV watching C. Lack of physical activity D. Meal skipping

A. Research has identified depression as one of the strongest predictors of adolescent obesity.

After offering a teenager the HPV vaccine, the teenager responds by saying, I cant 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

A. The HPV vaccine is recommended for 11-12 y/o girls & for 13-26 y/o 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 HPV types covered by the vaccine will receive the full benefits. 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.

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

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.

A nurse is discussing being a safe driver as part of a drivers 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

B,C,D The risk of motor vehicle crashes is 4X higher among 16-19 y/o adolescents than any other age group. 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.

The nurse is assessing a 12-year-old female with an admission diagnosis of anorexia nervosa. The data collected that support this diagnosis should include: Select all that apply. A. Binge eating followed by purging B. Compulsive physical activity C. Eating an amount of food that is definitely larger than most people would eat D. Preoccupation with food. E. Self-starvation with significant weight loss

B,D,E

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

B. Adolescents often talk on the phone for hours, providing a safe way for them to interact with members of the opposite sex. Teenagers decide to become sexually active for a number of reasons, including affection.

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

B. Imposing strict limits and eliminating all rules are not helpful to teenagers.

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

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.

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 daughters schedule C. Let's bring her in for some blood work D. Have you addressed the topic of drugs with you daughter?

B. Many teenagers take naps, although this does not address the mothers 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 daughters schedule provides information to determine whether the behavior is normal or whether it requires further investigation.

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 friends opinion more than his parents opinion

B. Nurses should be aware that the problem of substance abuse exists. Agitation and insomnia are signs of substance abuse and should therefore be evaluated further.

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

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.

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

B. 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.

The nurse assesses the cognitive abilities of the adolescent according to Piaget's stage of formal operations as A. Accepting family beliefs and values B. Developing extrovert behaviors C. Having an intolerance of things as they are D. Recognizing the importance of putting others' needs ahead of one's own

C.

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

C. Adolescents need at least 8 hours of sleep per night. 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.

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

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.

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?

C. 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 adolescents feelings about them is a good lead-in approach to a discussion about substance use.

Which of the following diseases has recently increased among adolescents and subsequently resulted in a recommendation for routine administration of a preventive vaccine to adolescents? A. Hepatitis B B. Haemophilus influenzae C. Meningococcal disease D. Measles

C. Rates of meningococcal disease remain highest for infants, but recently rates have increased among adolescents. Reports have identified an increased risk for meningococcal disease among college freshmen who live in dormitories or residence halls, particularly if they are exposed to secondhand smoke.

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

C. Tattoos & 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

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

C. Teens do not always consider health risks associated with their risky behaviors. Additionally, peer influence is primary and parental input is often rejected.

Which of the following statements is correct concerning scoliosis? A. It is more common in adolescent boys than girls B. It involves excessive lordotic curvature to the spine C. There are conflicting recommendations for screening D. Curves greater than 12 degrees are abnormal and can progress during growth spurt

C. The US Preventive Services Task Force has issued a statement that routine screening of asymptomatic children for scoliosis is not cost effective. However, the SOS, AAOS, POSA, and AAP support screening by a trained professional provider for girls at ages 10 and 12, and for boys at age 13 or 14

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

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.

Substance abuse screening test for adolescents

CRAFFT

What is the best time for males to perform testicular self-examination?

During or immediately after a warm shower

Psychosocial assessment for adolescents

HEADSSS - home - education, employment, eating - activities - drugs - sexuality - suicide/depression - safety

_____________ scoliosis is the most common type and is significantly more prevalent in _________

Idiopathic, females

What disorder is characterized by males having an extra chromosome, typically being tall and initially thin, and not developing secondary sex characteristics?

Klinefelter syndrome

Smoking prevention program for adolescents

The 5 A's - ask about use - advise to quit - asses willingness to quit - assist quit attempt - arrange for follow up

Which female disorder is characterized by only one X chromosome present instead of two?

Turner syndrome

Depression vs Dysthymia

depression: alteration in mood, disabling, disinterest w/ normal activities dysthymia: depressed/irritable mood extending for 2 yrs but does not interfere w/ normal activities or performance