Chapter 29: Growth and Development of the Adolescent
The mother of a 13-year-old boy confides to the pediatric nurse practitioner that her son has recently had a nocturnal seminal emission. The mother is concerned, and the nurse explains "wet dreams" and the other male traits of puberty to the mother. Which response indicates a need for further discussion? "My son is developing normally and the traits of puberty vary from child to child." "My son must be sexually active or having overly sexual thoughts to have a nocturnal emission." "My son is not doing anything to cause the nocturnal emissions; they occur spontaneously." "My son's spontaneous erections and nocturnal emissions are very normal."
"My son must be sexually active or having overly sexual thoughts to have a nocturnal emission." Spontaneous erections and nocturnal seminal emissions do not mean that the child is sexually active or having overactive sexual thoughts. Parents need to be instructed that these occurrences are spontaneous and that the child is not doing anything to cause them.
A 13-year-old girl has grown rapidly in height over the past 2 years and is taller than most of the boys in her class. She wonders when she will stop growing. What should the nurse tell her as a general guideline for the ages at which most girls stop growing? 14 to 15 years old 18 to 19 years old 20 to 21 years old 16 to 17 years old
16 to 17 years old Growth stops with closure of the epiphyseal lines of long bones which occurs at about 16 or 17 years of age in females and about 18 to 20 years of age in males.
The school nurse is developing a school wellness program to promote healthy eating habits and regular physical activity. What is the most important element to emphasize to maximize compliance, healthy habits, and long-term change? Eliminate sweetened, carbonated beverages in the cafeteria. Include both parents and children in the wellness program. Incorporate activity in parts of the daily schedule. Serve fruits and vegetables in the cafeteria.
Include both parents and children in the wellness program. Every campaign to support good nutrition and daily physical activity must include parents and their children as active members of the learning community. Although the other actions can accomplish in-school enhancements to health, long-term change tends to be more likely when the programs implemented involve the family. Programs implemented without a family-centered approach often fail when the child's home life and school life are disconnected.
The nurse is educating a 17-year-old adolescent after a new diagnosis of diabetes. What does the nurse understand about teaching an adolescent? The siblings of the adolescent will need to be taught healthy cooking classes related to diabetes. The adolescent will respond best to teaching about how to avoid future complications. The adolescent will likely have the greatest influence on one's own decisions. The parents will need to be instructed separately from the adolescent.
The adolescent will likely have the greatest influence on one's own decisions. In late adolescence, the client likely has the greatest influence on his or her own decision making. While offering teaching to the parents and healthy cooking classes to the siblings are options, the adolescent will most benefit from being the one to make choices about care. Focusing on more recent concerns rather than the idea of future complications with the adolescent will gain more credibility.
The nurse is performing a health surveillance visit with a 12-year-old boy. Which characteristic suggests the boy has entered adolescence? shows growing interest in attracting girls' attention feels secure with his body image understands that actions have consequences experiences frequent mood changes
experiences frequent mood changes If the boy has just entered adolescence, he is likely to exhibit frequent mood changes. A growing interest in attracting girls' attention and understanding that actions have consequences are typical of the middle stage of adolescence. Feeling secure with his body image does not occur until late adolescence.
A nurse is reading a journal article about adolescents and major causes of injuries in this age group. The nurse demonstrates understanding of this information by identifying which situation as the major cause of adolescent injuries? suicide motor vehicle crashes drowning violence
motor vehicle crashes Although drowning, violence, and suicide are causes of adolescent injury, the largest number of adolescent injuries are due to motor vehicle crashes.
The nurse is assessing a 14-year-old male client when the client's parent jokes about the changes in the client's voice and the hair under his armpits. Which response by the nurse to the client's parent is most appropriate? "Your child can become modest and self-conscious and teasing may cause embarrassment." "It would be helpful to discuss with your child your trials with puberty and the changes you experienced." "I remember that time in my life, it was so awkward and uncomfortable." "Based on your child's age, changes in hair distribution and voice pitch are expected."
"Your child can become modest and self-conscious and teasing may cause embarrassment." It is never appropriate to discuss what is happening with a client in a way that is demeaning and hurtful. A 14-year-old adolescent is experiencing many bodily changes and is very self conscious. The nurse can share experiences with the client and the family, but it should not be in a way that the adolescent is embarrassed. Parents can share their experiences with the child, but they have to be open to this discussion or it can lead to an awkward experience for the adolescent. Reminding the parent of how the child is feeling and the possible feelings that can come from their interactions will bring the parent's attention to a delicate situation and is most appropriate. Simply stating these are expected findings does not address the joking manner of the parent.
A 17-year-old female is meeting with the nurse for an annual well-visit and is asking the nurse questions about how to know when one is in love. The nurs e should point out which factor to help decide if both individuals have reached a mutual agreement and are ready for an intimate relationship? An understanding of socialization and of isolation A sense of trust and identity An ability to be autonomous A willingness to take initiative
A sense of trust and identity In order to be intimate or to share one's deepest feelings with another person, it is impossible unless both persons have established a sense of trust and a sense of identity. Being autonomous or taking initiative are not aspects that lead toward intimate relationships. Socialization and isolation are not relevant to the establishment of intimate relationships.
The nurse is providing anticipatory guidance for violence prevention to a group of parents with adolescents. Which parental action should the nurse include as the most effective in preventing suicide? Checking for signs of depression or lack of friends. Monitoring video games, TV shows, and music. Becoming acquainted with the teen's friends. Watching for aggressive behavior or racist remarks.
Checking for signs of depression or lack of friends. Checking for signs of depression or lack of friends would be most effective for preventing suicide. All other choices are more effective for preventing violence to others.
The nurse is providing education to an adolescent prescribed oral tetracycline. What statement should the nurse include in this teaching? Take the prescribed 500 mg throughout treatment. Take the medication on an empty stomach. Improvement should be seen in 1 week. Limit the amount of sun exposure.
Take the medication on an empty stomach. In pustular and cystic acne, oral antibiotics can be helpful because they are effective against P acnes. Tetracycline is effective against the anerobic bacteria that break down sebum to form irritating acids. It should be started at 500 mg twice daily the first week and then tapered to 250 mg daily for maintenance. Food impairs the absorption of tetracycline, so it should be taken on an empty stomach. Improvement is generally not seen for 2 to 4 weeks. Sun exposure does not affect the drug.
The school nurse is preparing health promotion presentations regarding unintentional injuries for a high school health fair. On which topic should the nurse place as the priority when preparing the presentation? water sports injuries drug and alcohol use prevention poison prevention motor vehicle safety
motor vehicle safety All options should be included in the presentation, but motor vehicle safety has the highest priority because motor vehicle accidents are the leading cause of injury and death, followed by poisoning (which includes prescription drug overdose).
With summer approaching, the nurse discusses sun safety with a group of teen girls. Which suggestion is most likely to be followed? Wear sunglasses. Wear a hat when in the sun. Do not attempt to get a tan. Limit sun exposure between 10:00 AM and 2:00 PM.
Wear sunglasses. Sunglasses can be a fashion statement and are likely to be accepted. The other pieces of advice are less appealing to adolescents who link a tan body to beauty. Unfortunately, sun exposure is cumulative over a lifetime, and much of it occurs in youth, making protecting young skin important.
Which behavior by an 18-year-old is consistent with successful progression through the stages of Piaget's theory of development? reflects a strong moral code is able to be part of a large group of peers while maintaining a sense of self uses critical thought processes to handle a problem has a strong sense of understanding of internal identity
uses critical thought processes to handle a problem Piaget's developmental theories focus on the cognitive maturation of the child. The ability to critically think is a sign of successful cognitive maturation. A sense of internal identity is consistent with Erikson's theories of development. Kohlberg's theories development focus on morals and values.
The nurse is assessing an adolescent's risk for harm from guns being present in the home. What question would be best to ask during the assessment? "Do you and your dad hunt?" "Have you been taught how to use a gun?" "Do you understand that it is important for you not to handle a gun?" "Are the guns in your home locked in a safe?"
"Are the guns in your home locked in a safe?" Common causes of death in adolescents are homicide and self-harm. These are related to the easy accessibility of guns, especially when added to depression, binge drinking, and impulsivity. Gang violence and the desire to protect themselves are additional factors. Having the gun locked in a safe provides a way for limited access. Knowing how to use a gun and going hunting demonstrate expertise, but the safest way to prevent harm is to have the gun locked when not in use for these purposes. Telling the adolescent it is important not to use a gun provides no explanation why and comes across as a rule to be broken.
A 16-year-old girl has arrived for her sports physical with a new piercing in her navel. Which response by the nurse is best? "This is a wound and can become infected." "This is a risk for hepatitis, tetanus, and AIDS." "Be sure to clean the navel several times a day." "I hope for your sake the needle was clean."
"Be sure to clean the navel several times a day." The best response is to describe the proper care using frequent cleansing with antibacterial soap. It is too late for warnings about the dangers of piercing such as skin- or blood-borne infections, or disease from unclean needles.
The nurse is counseling an overweight, sedentary 15-year-old girl. The nurse is assisting her to make appropriate menu choices. Which statement indicates the adolescent understands how to make appropriate dietary selections? "To lose weight my protein intake should be limited to 2 to 4 servings per day." "Because of my age, my dairy intake is unlimited." "I avoid all fat intake." "I need to eat plenty of fruit each day."
"I need to eat plenty of fruit each day." The sedentary teen needs to consume approximately 1,600 calories each day. A balanced diet includes plenty of fresh fruit and a small amount of fat. To avoid all fat could place the child's health at risk. Protein intake is important for the development of tissue. The teen will need about 5 ounces of protein daily.
For reasons of anticipatory guidance, nurses should be aware that menarche appears earlier in some ethnic groups than others. In which ethnic group is menarche likely to appear first? Black South Asian Hispanic White
Black Black girls on average reach menarche slightly earlier than White, Hispanic, and South Asian girls.
The nurse is admitting a 15-year-old adolescent to the hospital pediatric unit. What does the nurse recognize as a priority for this adolescent? The adolescent should be encouraged to call friends often. The adolescent's need for parental support should be discussed. The adolescent's need for privacy should be respected. The adolescent should be given freedom to participate in unit activities as desired.
The adolescent's need for privacy should be respected. When an adolescent is ill or injured, it affects the body and body image. A hospitalized adolescent's primary concerns are pain and the loss of privacy. The adolescent is also anxious about being separated from friends and losing control of one's life. When an adolescent is hospitalized, it is very important the adolescent be given privacy. The adolescent needs individualized attention, confidentiality, and the right to participate in decisions about one's own health care. The adolescent should have contact with friends and be allowed in unit activities. Because the adolescent is under the age of 18, the parents should be involved and informed of the care. The nurse can talk with the adolescent and parents about care decisions and the adolescent's need for support from family.
The nurse is caring for an adolescent athlete who is being seen for a fractured arm. The parent reports that this is the third sports injury in the past 2 years. The parent asks the nurse why the adolescent—who is healthy overall— continues to have injuries. How should the nurse respond? The bones, joints, and tendons of adolescents are vulnerable to injury due to their rapid state of growth. These are accidents and random in occurrence. Some adolescents are accident-prone. There may be some underlying problems that your adolescent should be evaluated for.
The bones, joints, and tendons of adolescents are vulnerable to injury due to their rapid state of growth. Rapidly growing bones, muscles, joints, and tendons are more vulnerable to unusual strains and fractures. While some people may seem to be accident-prone, this adolescent's injuries are most likely the result of the stage of physical growth. There is no evidence the adolescent has any underlying medical conditions.
A client has confided in a nurse that her 13-year-old daughter has recently changed dramatically in her social interactions with others. What is a social behavior most likely to be exhibited by a girl at this age? Banding together with other girls and dressing like them Banding together with boys and girls but maintaining her own unique style Hanging out with girls but maintaining her own unique style Hanging out primarily with boys her own age
Banding together with other girls and dressing like them In early adolescence, girls tend to band together with girls. They dress identically with other members of their group: jeans and sweatshirts, special jackets, or whatever the fashion may be. On the surface, this makes adolescents appear to be losing their identities rather than finding them.
To help prevent obesity, which intervention would the nurse include in an adolescent's plan of care? Plan a diet of 2,000 calories per day. Describe sources of low calorie proteins. Describe a normal serving size. Plan a diet of 1,500 calories per day.
Describe a normal serving size. Some adolescents may be unaware that their food intake is excessive because they have been told they need excess nutrients for healthy adolescent growth and everyone in their family eats large portions. Health teaching with these adolescents may need to begin with a discussion of "normal" weight and standard food portions. If adolescents eat a diet too low in protein for any length of time, they can develop a negative nitrogen balance, which can lead to seriously impaired growth. Therefore, a diet of fewer than 1,400 to 1,600 calories a day can rarely be tolerated by adolescents. They generally will do better and will stick closer to 1,800 calories per day. A diet of 2,000 calories a day will provide excess amounts of food and may lead to obesity.
The adolescent comes to the clinic seeking information about sexuality concerns. The clinic nurse assures the adolescent that confidentiality and privacy will be maintained unless a life-threatening situation occurs. Maintaining confidentiality demonstrates which nursing goal? Select all that apply. an environment where adolescents can be truthful development of a trusting relationship inappropriate response because adolescents are minors compliance with existing laws concern from parents who pay the office visit bill
an environment where adolescents can be truthful development of a trusting relationship compliance with existing laws Adolescents may seek a health care appointment for an unrelated health concern as a reason to discuss a sexual health question with a health care professional. Reassurance should be given to the adolescent that all questions and concerns will be addressed and will be kept confidential. This is the basis for the nurse-client relationship. All questions and concerns do not involve treatment and therefore do not involve parental consent. Parents may voice concerns because they are responsible for the insurance and billing. The nurse should act as a client advocate and work with the parents to develop a mutual understanding of the situation.
The school nurse is providing nutritional guidance to a 9th-grade health class. Which foods should the nurse recommend as good sources for calcium? beans, poultry, and fish peanut butter, tomato juice, and whole grain bread cheese, yogurt, and white beans strawberries, watermelon, and raisins
cheese, yogurt, and white beans Cheese, yogurt, white beans, milk, and broccoli are good sources of calcium. Strawberries, watermelon, raisins, peanut butter, tomato juice, and whole grain bread are all foods high in iron.
According to Erikson, the adolescent develops their own sense of being an independent person with individual thoughts and goals. This stage is referred to as: identity vs. role confusion. autonomy vs. doubt and shame. industry vs. inferiority. intimacy vs. isolation.
identity vs. role confusion. Adolescents must develop their own personal identity—a sense of being independent people with unique ideals and goals. This is the period Erikson calls identity versus role confusion. Erikson believes during this time the adolescent goes back through all previous developmental periods to achieve this identity. The stage of autonomy versus shame and doubt occurs between 18 months and 3 years. Industry versus inferiority occurs between 5 to 12 years. Intimacy versus isolation occurs in adulthood between the ages of 19 to 40 years.
The school nurse is monitoring a student athlete who experienced a concussion 2 weeks ago during a soccer game. The student reports having difficulty in a course in which the child previously performed well. Which action should the nurse take first? Notify the student's parents that their child should see the family health care provider. Perform a neurologic assessment on the student to see if there are any changes in neurologic status. Ask the student to describe the issues he is having in the class. Ask the student's teacher if the child is achieving the recommended level of cognitive activity.
Ask the student to describe the issues he is having in the class. Talking with the teacher and performing a neurological assessment are actions that may be necessary, but the nurse must first determine if the student is following the recommended level of cognitive activity; this can be accomplished by asking the child to describe the issues he is having in class. Contacting the parents immediately would not be warranted until sufficient information is collected.
The nurse is talking to a 13-year-old boy about choosing friends. Which function do peer groups provide that can have a negative result? sharing problems negotiating differences developing stability following role models
following role models Peers serve as role models for social behaviors, so their impact on an adolescent can be negative if the group is using drugs, or the group leader is in trouble. Sharing problems with peers helps the adolescent work through conflicts with parents. The desire to be part of the group teaches the child to negotiate differences and develop loyalties and stability.
The parent of a Black adolescent voices concern to the nurse because the daughter, "has gotten her period before all of her friends." How should the nurse respond? "I will be sure to let the health care provider know this. We do not want to miss something that may be wrong." "On average Black girls start their period earlier than other ethnicities." "Some girls just get their period earlier than others." "How old are most of her friends? Maybe that is the issue instead of it being a sign of something abnormal."
"On average Black girls start their period earlier than other ethnicities." Menarche, the first menstrual period, usually begins between the ages of 9 and 15 years (average 12.8 years), but on average Black adolescents reach menarche earlier than adolescents of other ethnicitic backgrounds. This response addresses the parent's concern. The other responses do not address the parent's concern or may lead the parent to think this is an abnormal occurrence.
Glycogen loading is practiced regularly by the local high school football team. What is most important for the nurse to monitor in these students? how often the students engage in this practice the amount of carbohydrates the student is eating how many hours the student exercises each day the amount of protein the student is eating
the amount of carbohydrates the student is eating Glycogen loading is a procedure used to ensure there is adequate glycogen to sustain energy through an athletic event. Several days before a sports event, athletes lower their carbohydrate intake and exercise heavily to deplete muscle glycogen stores. They then switch to a diet high in carbohydrates. With the renewed carbohydrate intake, muscle glycogen is stored at 2 to 3 times the usual level, which supplies them with up to 2 times the glucose needed for sustained energy. Athletes need more energy from carbohydrates than protein. Participating in this practice would cause a negative nitrogen balance, not a positive one.
An adolescent who is depressed states, "Nothing ever seems to be right in my life." Which would be the most appropriate response by the nurse? "Being a teenager is hard work." "Things will be better when you go off to college." "You are feeling sad right now. It's a hard time." "Try to look at the bright side of things."
"You are feeling sad right now. It's a hard time." Some degree of depression is present in most adolescents because they are not only losing their parents while they grow apart from them but also their carefree childhood. When using therapeutic communication, it is important for the nurse to accept the client's verbalization as real. Support should be real. Telling the adolescent that things will be better in college provides false reassurance. Telling the adolescent to "look on the bright side of things" or that "being a teen is hard work" offer platitudes and interrupt the client's interactions.
The physician has made a notation in the medical record of a 17-year-old that the teen is not demonstrating successful completion of Erikson's stages of development. What behavior would be consistent with this assessment? The teen is sexually promiscuous. The teen is anxious to move away from his parent's home. The teen is distrustful of others. The teen is uncertain and frequently unable to make decisions.
The teen is uncertain and frequently unable to make decisions. According to Erikson's stages of development, the teen develops a sense of identity. Failure to successfully complete this stage will result in a lack of self confidence and an inability to see one's self as in independent being. The establishment of the ability to trust is completed in an earlier stage of psychosocial development. A desire to move away from the parental home is not uncommon and is not a sign of impaired navigation of this level of psychosocial development.
The nurse is educating an adolescent female who needs to increase dietary iron but has expressed concern about weight gain. What dietary choices would the nurse recommend? chicken, whole-wheat bread, watermelon pasta, broccoli, pear raspberry yogurt, granola, apple cottage cheese, crackers, oranges
chicken, whole-wheat bread, watermelon Chicken, whole-wheat bread, and watermelon are all foods high in iron. The calorie content will not promote weight gain. All the other options do not include good sources of iron but are nutritious foods. The calorie content is also acceptable.
A nurse is attending to a group of boys at a school. The nurse is required to document the sexual development in boys on a regular basis. The nurse would anticipate which clients having the highest incidence of nocturnal emissions? Clients who have reached adulthood Clients in the age group of 18 to 20 years Clients who are showing pubertal changes Clients with strong, muscular appearance
Clients who are showing pubertal changes The nurse should know that boys who are undergoing pubertal changes are more likely to experience nocturnal emissions. The first sign of pubertal changes and sex maturation is testosterone secretion. As this increased so does the penis and scrotum enlargement. This is a time when nocturnal emissions occur. In late adolescence, which lasts from age 18 to 20, the transition into adulthood is completed. The nurse should also know that boys in the age group of age 12 to 20 experience various chemical and physical changes taking place within their body. A strong, muscular appearance does not indicate the presence of nocturnal emissions.
The physician has made a notation in the medical record of a 17-year-old that the teen is not demonstrating successful completion of Erikson's stages of development. What behavior would be consistent with this assessment? The teen is sexually promiscuous. The teen is distrustful of others. The teen is anxious to move away from his parent's home. The teen is uncertain and frequently unable to make decisions.
The teen is uncertain and frequently unable to make decisions. According to Erikson's stages of development, the teen develops a sense of identity. Failure to successfully complete this stage will result in a lack of self confidence and an inability to see one's self as in independent being. The establishment of the ability to trust is completed in an earlier stage of psychosocial development. A desire to move away from the parental home is not uncommon and is not a sign of impaired navigation of this level of psychosocial development.
The parents are concerned their 14-year-old child is always eating. The child weighs 54 kg and is 65 inches (165 cm) tall. What is the best explanation the nurse can give the parents? "His calorie intake predisposes him to future obesity." "The calories help his body increase muscle mass." "He is substituting food for unfilled needs." "He needs the calories because he participates in sports."
"The calories help his body increase muscle mass." Adolescents grow rapidly and mature dramatically during the period from ages 13 to 20 years. An adolescent needs an increased number of calories to support the rapid body growth that occurs. Foods must come from a variety of sources to supply the necessary amounts of carbohydrates, vitamins, protein, and minerals. Boys typically gain about 15 to 55 pounds (7 to 25 kg) during their teenage years. The calorie intake will not predispose him to future obesity unless it is continuously excessive. The majority of adolescents eat as part of their development, not as an emotional need.
A 15-year-old client tells the nurse he has been having wet dreams and is ashamed and afraid he will get into trouble because he believes his parents think he is too young to understand or know about sex. To which statement would be the most appropriate for the nurse to respond? "Don't worry, it is perfectly normal for 15-year-olds to have the kinds of fantasies that lead to wet dreams. You should tell your parents about this." "You don't need to feel ashamed. I will speak to your parents about the importance of allowing you to experiment with and feel good about your sexuality." "Wet dreams are not the result of anything you are doing but are simply the body's way of ridding itself of excess semen." "Since your parents feel you are not ready to talk about sex, you need to honor their wishes and not bother them with this."
"Wet dreams are not the result of anything you are doing but are simply the body's way of ridding itself of excess semen." Boys who are unprepared for nocturnal emissions may feel guilty, believing that they have caused these "wet dreams" by sexual fantasies or masturbation. They need to understand that this is a normal occurrence and is simply the body's method of getting rid of surplus semen. The other suggestions do not address the situation in a professional manner.
A 17-year-old male adolescent on the high school swim team tells the nurse that during swim season he cuts the carbohydrates in his diet to 30% to help his swim times. What responses by the nurse are appropriate? Select all that apply. "Since you are so active, your carbohydrate intake should comprise 45% to 65% of your daily diet." "Twenty-five to 35 percent of your diet should be carbohydrates so you fall into the acceptable range." "As long as you are taking in around 2,000 calories per day you should be just fine." "Can you tell me the reason you feel the need to cut your carbohydrates when your activity level is high?" "Cutting carbohydrates is a good way to keep your weight down during swim season."
"Can you tell me the reason you feel the need to cut your carbohydrates when your activity level is high?" "Since you are so active, your carbohydrate intake should comprise 45% to 65% of your daily diet." Teenage boys who are moderately active require between 2,200 and 2,800 calories per day and 45% to 65% should come from carbohydrates. Carbohydrates should not be cut, especially during an athletic season when energy use is increased. Asking the student why he or she is cutting carbohydrates is appropriate in order to help the nurse address the issue effectively.
During the assessment of a 15-year-old female, the nurse notes a new body piercing in the navel. Which statements by the nurse would be appropriate in regard to this new piercing? Select all that apply. "I really like your belly ring. Where did you get it?" "You are very young to have a navel piercing. Do your parents know you have this?" "I notice you have a new piercing. Be sure to clean it twice a day so you don't get an infection." "Did they tell you when you got your piercing how important cleaning it is? Infections can take up to a year to heal in a naval piercing." "A navel piercing is a lot better than a tattoo. At least the piercing doesn't have to be permanent if you don't want it to be."
"I notice you have a new piercing. Be sure to clean it twice a day so you don't get an infection." "Did they tell you when you got your piercing how important cleaning it is? Infections can take up to a year to heal in a naval piercing." Informing the client about infection risks and prevention are appropriate responses by the nurse when noticing a new body piercing. Judgmental responses and personal responses are not appropriate from the nurse.
Which nursing action will best assist a 15-year-old client accomplish the developmental task according to Erikson? Provide the client with crafts and puzzles to complete independently Praise the client for correctly performing self-care Permit the client to make decision regarding one's care Allow the client's friends to visit while the client is hospitalized
Allow the client's friends to visit while the client is hospitalized The developmental task of adolescence is to develop a sense of identity, or deciding who and what kind of person one is. Friends and peers are important to facilitating the adolescent in determining one's identity. Permitting the client to make decisions assists in developing autonomy, which is a toddler task. Praising facilitates initiative, which is a preschool task. Independently performing tasks assists in developing industry, which is a school-age task.
The nurse is preparing a presentation for a local health fair depicting the differences in maturity between preadolescents. Which differing factor should the nurse prioritize in the presentation? Boys and girls grow at the same rate. Girls grow at a slower, steadier rate than do boys. Boys grow at a slower, steadier rate than do girls. Boys grow at a rapid, sporadic rate.
Boys grow at a slower, steadier rate than do girls. Preadolescent boys grow generally at a slower, steadier rate than do girls. Girls grow more rapidly during preadolescence and then their growth rate slows dramatically after menarche.
The nurse is caring for a 16-year-old client. The client confides in the nurse that they use of marijuana daily. Which action by the nurse is appropriate? Determine how long the client has used marijuana. Notify local law enforcement. Discuss adverse side effects with the client. Ask the client where the marijuana is obtained.
Discuss adverse side effects with the client. The nurse will first discuss adverse side effects of marijuana use with the client. The nurse is not legally bound to notify law enforcement and this would be a breach of client confidentiality. Currently, persons living where recreational marijuana use is legal must be at least 18 years of age to legally consume. The nurse would not need to ask about where the client obtains the marijuana as the nurse is focused on the client and not other persons. The client has stated marijuana use. How long the client has used marijuana is not important at this time.
A 15-year-old adolescent shows a pattern of gaining weight, not a large amount but a little more each visit. The adolescent is not active in any sports and eats out frequently with parents. What is the best way for the nurse to assess the adolescent's eating pattern? Have the adolescent keep a food diary for 1 week. Ask the adolescent to show the nurse what a healthy portion looks like. Have the adolescent guess the calorie intake in a 24-hour period. Ask the adolescent to recall what was eaten in the last 3 days.
Have the adolescent keep a food diary for 1 week. Having the adolescent keep a food diary over 1 week allows the nurse as well as the client to examine what the client eats and when the client is eating it. Keeping a food journal allows a discussion of the choices made and the substitutes that the client could possibly make. The times that the client eats may also lead to weight gain. Asking for recall of 3 days' intake would be difficult, and most information would be inaccurate due to forgetting some item of food intake or when the food was eaten. Most people have no idea how many calories are in a food item unless they are specifically counting calories for dieting or health reasons. An adolescent would have a difficult time demonstrating a healthy portion size unless it has been demonstrated first.
What activity would best foster the developmental task of an adolescent who uses a wheelchair to ambulate? Talking to another adolescent who has a similar situation Watching television on the set in the adolescent's room Allowing the adolescent to decide when to bathe Having a teacher bring school work to the adolescent
Talking to another adolescent who has a similar situation A sense of identity is developed by "trying on" roles and discussing values and goals with others. A sense of trust develops when an adolescent is able to find out whom (and what ideas) to have faith in. The adolescent period is also a time where past stages of development are revisited. The sense of autonomy is where the adolescent seeks ways to express individuality. The stage of initiative is where the adolescent develops vision of what he or she might become. Talking with another adolescent who also uses a wheelchair to ambulate will help the adolescent see possibilities and reassurances. Making decisions or having assistance from someone else does not allow the adolescent to "try out" roles.
The nurse is caring for an adolescent athlete who is being seen for a fractured arm. The parent reports that this is the third sports injury in the past 2 years. The parent asks the nurse why the adolescent—who is healthy overall— continues to have injuries. How should the nurse respond? Some adolescents are accident-prone. There may be some underlying problems that your adolescent should be evaluated for. The bones, joints, and tendons of adolescents are vulnerable to injury due to their rapid state of growth. These are accidents and random in occurrence.
The bones, joints, and tendons of adolescents are vulnerable to injury due to their rapid state of growth. Rapidly growing bones, muscles, joints, and tendons are more vulnerable to unusual strains and fractures. While some people may seem to be accident-prone, this adolescent's injuries are most likely the result of the stage of physical growth. There is no evidence the adolescent has any underlying medical conditions. Reference:
The father of a 15-year-old daughter is concerned she is not getting adequate nutrition to play high school basketball. Her games are on Friday nights. Which suggestion should the nurse point out will best suit the needs of this adolescent? Three daily meals that include choices from each of the food groups; Friday's lunch eaten around 2 p.m. with a small amount of fat and a somewhat larger than usual portion of complex carbohydrates. Boiled eggs with bacon or ham and a glass of orange juice for breakfast on Thursday and Friday mornings along with some sliced turkey and a salad at noon on Friday. Three daily meals that include choices from each of the food groups with an additional serving of fruit and several extra glasses of water on Friday. Pasta with a small amount of meat sauce and two slices of bread for dinner on Wednesday and Thursday evenings and again at 2 p.m. on Friday.
Three daily meals that include choices from each of the food groups; Friday's lunch eaten around 2 p.m. with a small amount of fat and a somewhat larger than usual portion of complex carbohydrates. A meal that is low in fat and high in complex carbohydrates, eaten 3 to 4 hours before an event, is appropriate for the teen athlete. Carbohydrate-loading, which some practice during the week before an athletic event, increases the muscle glycogen level to 2 to 3 times normal and may hinder heart function. The other suggested menus would not provide the additional muscle glycogen needed for optimal functioning.
A nurse is conducting an assessment of a 16-year-old's cognitive development. The nurse determines that the adolescent's cognitive development is within acceptable parameters for the adolescent's age based on which assessment finding? Select all that apply. shows a beginning interest and concern with societal and political issues. demonstrates thinking that the adolescent is invincible uses scientific methods to solve verbal problems exhibits limited abstract thought processes able to develop career plans
shows a beginning interest and concern with societal and political issues. demonstrates thinking that the adolescent is invincible uses scientific methods to solve verbal problems An adolescent between the ages of 14 to 17 years of age is able to solve verbal and mental problems using scientific methods, thinks he or she is invincible, and becomes involved in and concerned with society and politics. An adolescent between the ages of 11 to 14 years of age has limited abstract thought processes. An adolescent between 17 to 20 years of age develops realistic goals and career plans.
The nurse is providing anticipatory guidance to the parents of a 15-year-old who voice concerns with their teenager's sleep habits. They state, "Left to her own devices, I'm sure she'd stay up until 3:00 in the morning on the weekends and sleep until after lunchtime." Which should the nurse explain to the parents? "I can hear that this is exasperating for you, but know that children do grow out of this in time, with no ill effects." "This is expected at this stage of development. Are there any ways that you could adjust your family routines to accommodate this?" "It's very important that you communicate to your daughter that this is unacceptable because it can have a negative effect on her health." "That must be hard for you to manage. Perhaps we can explore some strategies with her to establish more predictable sleep patterns."
"That must be hard for you to manage. Perhaps we can explore some strategies with her to establish more predictable sleep patterns." It is common for adolescents to adopt habits of going to bed late and awakening late, especially on weekends. Despite the fact that this is common, it is not ideal; the nurse should explore strategies for changing the adolescent's behavior in a collaborative and inclusive manner. Simply communicating that it is unacceptable is unlikely to bring about change.
The nurse is providing anticipatory guidance to the parents of a 15-year-old who voice concerns with their teenager's sleep habits. They state, "Left to her own devices, I'm sure she'd stay up until 3:00 in the morning on the weekends and sleep until after lunchtime." Which should the nurse explain to the parents? "This is expected at this stage of development. Are there any ways that you could adjust your family routines to accommodate this?" "That must be hard for you to manage. Perhaps we can explore some strategies with her to establish more predictable sleep patterns." "I can hear that this is exasperating for you, but know that children do grow out of this in time, with no ill effects." "It's very important that you communicate to your daughter that this is unacceptable because it can have a negative effect on her health."
"That must be hard for you to manage. Perhaps we can explore some strategies with her to establish more predictable sleep patterns." It is common for adolescents to adopt habits of going to bed late and awakening late, especially on weekends. Despite the fact that this is common, it is not ideal; the nurse should explore strategies for changing the adolescent's behavior in a collaborative and inclusive manner. Simply communicating that it is unacceptable is unlikely to bring about change.
A 16-year-old adolescent is talking with the nurse at a local health clinic about skin care. Which comments by the teen does the nurse determine require additional conversation? Select all that apply. "I only tan before going on spring break to get a base tan so I won't burn." "The more exposure and burns I get now will toughen my skin so I won't get skin cancer when I'm older." "My mom had melanoma so she always makes me wear a sunscreen with an SPF of 30." "Our coach makes us wear sun-protective clothes when we practice outside on the weekends." "My favorite time of day to be outside is the middle of the day, around noon."
"The more exposure and burns I get now will toughen my skin so I won't get skin cancer when I'm older." "My favorite time of day to be outside is the middle of the day, around noon." "I only tan before going on spring break to get a base tan so I won't burn." The nurse should further discuss comments that demonstrate incorrect information about sun exposure. Any exposure to tanning beds should be avoided to prevent skin cancer risks. Other risks for skin cancer include being in the sun between the times of 10:00 am and 4:00 pm, and sun exposure and burns during childhood and adolescence. A minimum SPF of 15 should be used, so SPF 30 is good practice, as is wearing sun-protective clothing when outside during the day.
A male adolescent comes to the clinic for a routine health care follow-up accompanied by the parents. During the visit, the parents tell the nurse, "Our son just doesn't seem to listen to us anymore. It's like he's tuning us out. Is there anything we can do to get him to hear what we're saying to him?" Which suggestions would be appropriate for the nurse to offer? Select all that apply. "Tell him firmly that you have the answers because you are his parents." "Choose words carefully to make sure that he understands you." "Don't be afraid to ask him questions about why he feels a certain way." "Talk to you son as an equal and don't talk down to him." "When you talk to him, speak to him face to face and be careful of your body language."
"When you talk to him, speak to him face to face and be careful of your body language." "Don't be afraid to ask him questions about why he feels a certain way." "Choose words carefully to make sure that he understands you." "Talk to you son as an equal and don't talk down to him." To improve communication with an adolescent, it is important to talk face to face with the adolescent and be aware of body language that could influence what is being said. In addition, parents should not be afraid to ask the adolescent why he or she feels a certain way, Parents need to speak to their teenager as an equal and not talk down to the adolescent, making sure to choose words that the adolescent will understand. Parents also need to be open to not knowing all the answers and be able to admit that they do make mistakes.
The clinic nurse is assessing a 14-year-old client. The client states "I am worried I have a brain tumor. I am so clumsy when I play sports now that it is totally embarrassing." Which response by the nurse is appropriate? "You are experiencing rapid and uneven growth now which can interfere with coordination." "I will request the primary health care provider prescribe a magnetic resonance image (MRI)." "Have you noticed any changes in your vision or hearing lately?" "I understand why you are worried. Has anyone else in your family had a brain tumor."
"You are experiencing rapid and uneven growth now which can interfere with coordination." Uneven growth of soft tissues and bones during growth spurts can cause decreased coordination for boys. The age of 14 years is usually the time of peak height velocity (PHV). The nurse would let the client know this is expected to alleviate the client's fears. There is no need to request an MRI. The nurse would not ask yes/no questions as these do not provide insightful information. Stating the nurse understands why the client is worried indicates the client has reason to fear a brain tumor.
A nurse is explaining cognitive development in children to a client, with the help of Piaget's theory of cognitive development. What would be the best explanation by the nurse about the formal operations level of cognitive development? From ages 7 to 11 years, children internalize actions and can perform them in the mind. Children from ages 2 to 7 years investigate and explore the environment and look at things from their own point of view. After age 12 children can think in the abstract, including complex problem solving. Up to age 2, children learn by touching, tasting, and feeling. They learn to control body movement.
After age 12 children can think in the abstract, including complex problem solving. The nurse should explain that there are four levels of cognitive development in Piaget's theory. The sensorimotor level is up to age 2 where children learn by touching, tasting, and feeling. They learn to control body movement. Preoperational level takes place in children ages 2 to 7 years who investigate and explore the environment and look at things from their own point of view. At the concrete operations level, from ages 7 to 11 years, children internalize actions and can perform them in the mind. At the formal operations, after age 12, children can think in the abstract. Complex problem solving is included in this category.
A 15-year-old is hospitalized for acute appendicitis. Which activities would the nurse include in the client's plan of care? Select all that apply. Include the parents when educating the client. Keep the client in hospital gowns for sanitary reasons. Have the nurse control the patient's care as much as possible. Allow friends to visit during visiting hours. Arrange care to provide for extra rest and sleep.
Arrange care to provide for extra rest and sleep. Allow friends to visit during visiting hours. Include the parents when educating the client. Because protein synthesis occurs most readily during sleep, and adolescents are building so many new cells, this age group may need proportionately more sleep than any other age group. When adolescents are admitted to the hospital they may sleep as if exhausted. Adolescents are capable of total self-care and because of their body awareness, may even be overly conscientious about personal hygiene and appearance. When caring for hospitalized provide time for self-care, such as shampooing the hair. Confidentiality is of utmost important as adolescents do not like to feel different than their peers and do not want their information shared unless they share it. At the beginning of care, the adolescent and the parents need to decide how much involvement the parents will have in care (e.g., will they stay in the room, will the adolescent be able to have a role in decision making).
The nurse is meeting with a group of caregivers of adolescents and discussing sex and sexuality, including how to discuss these issues with their children. Which comment should the nurse prioritize with this group of caregivers? Internet resources, movies, and television have the most accurate and current information for your adolescent to learn about sexuality issues. Being honest and straightforward with teenagers will encourage them to ask about subjects like sexuality. Teenagers spend so much time with their peers, and that is usually how they find out about sex. Most schools have excellent programs to teach adolescents about sex and sexuality.
Being honest and straightforward with teenagers will encourage them to ask about subjects like sexuality. The most important aspect of discussions about sexuality with adolescents is giving honest, straightforward answers in an atmosphere of caring concern. Children whose need for information is not met through family, school, or community programs will get the information—often inaccurately—from peers, movies, television, or other media. Reference:
A 15-year-old girl is in the hospital for surgery and is confined to bed. The nurse can tell that the client is nervous about being in the hospital. She tells the nurse that she feels "gross" and "on display" in her hospital gown. What should the nurse do to encourage a sense of autonomy and dignity related to the girl's body image? Assist the girl with using the bed pan to urinate. Allow the girl to wear her own clothes, despite hospital policy. Offer to assist the girl in washing her hair and let her pick the shampoo. Brush the girl's hair for her.
Offer to assist the girl in washing her hair and let her pick the shampoo. When caring for hospitalized adolescents, providing time for self-care, such as shampooing hair, is important to include in an adolescent's nursing care plan. Offering to assist the client in washing her hair and letting her pick the shampoo both encourages a sense of autonomy to the client and offers her dignity related to her body image. Brushing the girl's hair for her and assisting her with using the bed pan for urination do not encourage a sense of autonomy. If it is the hospital's policy to require clients to be dressed in a hospital gown while admitted, the nurse should not allow the girl to wear her own clothes.
While caring for a 16-year-old client expected to be hospitalized for several months, the nurse will perform which action to assist the client in meeting the current stage of psychosocial development? Explain medical concepts by providing handouts and brochures. Provide video games for the client to play. Allow the client to touch equipment before procedures. Permit peers to visit during open visitation hours.
Permit peers to visit during open visitation hours. In each stage of development, a significant person or group exerts a lasting influence on the ongoing development of the child. An adolescent striving for self-identity and increased independence spends more time with peers than with family. It is important for the hospitalized adolescent to still be able to visit with peers. Video games may be enjoyed by the adolescent and limit boredom; however, this action would not facilitate psychosocial development. Allowing the client to touch equipment and to explain medical concepts/procedures are methods used to teach toddlers and preschoolers. Providing handouts and brochures are not effective methods to explain medical concepts; the nurse would verbally explain using models, pictures, and diagrams. Handouts and brochures can be used as supplements to teaching.
A female client tells the nurse about noticing an increase in weight and fat deposits during the past year. The nurse reviews the client's chart and recognizes that the client is most likely going through puberty. Which nursing action is most appropriate at this time? Review dietary measures to assist in controlling weight gain. Encourage increased exercise to control weight gain. Share what foods can be eaten on a low-fat diet to prevent fat deposits. Provide reassurance that these are normal changes.
Provide reassurance that these are normal changes. Increased fat deposits and weight and height changes are normal as girls begin hormonal changes of puberty. During adolescence, girls are very sensitive about their appearance and experience a constant need for reassurance. Puberty is a period when children are very self-conscious about their overall appearance. Reassurance needs to be provided that increased fat deposits and weight and height changes are normal. Dietary management is indicated if a true weight problem is present, but healthy eating should be encouraged rather than dieting. Adolescents should be encouraged to participate in appropriate exercise programs. Dieting issues such as anorexia and bulimia can threaten the health of adolescents.
