Evolve : Adolescents

What is a primary factor influencing the onset of puberty in adolescents?

Genetics

After orthopedic surgery a 15-year-old adolescent reports pain and rates it a 5 on a scale of 0 to 10. A nurse administers the prescribed 5 mg of oxycodone every 3 hours as needed. Two hours after having been given this medication, the adolescent reports pain and rates it a 10 of 10. What action should the nurse take next?

Request that the health care provider evaluate the need for additional medication

A 16-year-old male asks the nurse about the use of condoms. He states, "I've used condoms in the past, but I'm not sure I'm using them correctly." What should be included as part of the teaching about condoms?

The condom must be positioned after an erection has occurred.

A 16-year-old single mother of a 1-month-old infant and the infant's grandmother bring the baby to the emergency department and report that the infant accidentally fell down the stairs. The nurse knows that a consent form for treatment should be signed. Who has the responsibility for signing the consent?

The mother, despite her age

A nurse instructs the parents of an adolescent with asthma how to reduce the allergens in the child's bedroom. The mother tells the nurse what she plans to do to make the room hypoallergenic. Which idea indicates that further teaching is needed?

Using flat outdoor carpeting to cover hardwood floors

A girl comes to the physician's office for her 14-year-old check-up. What is the most important anticipatory guidance that can be offered to the client?

Ways to prevent accidents

After 3 months of supplemental oral iron therapy, there is no significant increase in a female adolescent's hemoglobin level. Iron dextran (Imferon) is ordered. What is the best way for the nurse to administer this medication?

With the use of the Z-track method

A broad-spectrum oral antibiotic is prescribed for an adolescent with a bacterial infection. The prescription reads, "Take three times a day." At which times should the nurse recommend that the medication be taken to maintain a therapeutic blood level?

6 am, 2 pm, 10 pm

Which is the cognitive developmental stage of adolescents according to Piaget?

Formal operations stage

What is the cognitive developmental stage of school-age children?

Concrete operations

A school-aged child with celiac disease has been eating a gluten-free diet for 2 days. What criterion should the nurse and parent use to determine the effectiveness of the diet?

Decreased irritability

Methylphenidate (Ritalin) has been prescribed for a 7-year-old child with attention deficit-hyperactivity disorder (ADHD) and is to be taken with meals. What rationale should the nurse provide for the parents about the timing of medication administration?

Ritalin depresses the appetite.

A nurse is caring for a 13-year-old child who has an external fixation device on a leg. What is the nurse's priority goal when providing pin care?

Preventing infection

A teenager is being discharged with a cast. What should the nurse recommend if the client experiences pruritus around the cast edges?

"Put an ice pack on the affected area."

An adolescent is admitted to the unit with a tentative diagnosis of a bone tumor of the left femur. During the admission procedure the adolescent casually asks, "Do they ever have to cut off a leg if someone has bone cancer?" How should the nurse respond?

"Sometimes it's necessary. What do you think about that treatment?"

Which complication of anaphylactic shock in the adolescent client is most important for the nurse to detect early?

Laryngeal edema

A nurse is teaching a 15-year-old adolescent with newly diagnosed type 1 diabetes about self-care. The nurse and client agree that the primary long-term goal for this teenager is:

Maintaining normoglycemia

A nurse teaches an adolescent undergoing chemotherapy for cancer about the need for special mouth care because of the potential for oral lesions. What statement indicates to the nurse that the instructions have been understood?

"I can use foam-tipped applicators to wipe my teeth and gums."

The mother of a 17-year-old adolescent who is going to be a foreign exchange student asks the nurse why her child must have a tetanus toxoid immunization instead of the immune globulin. The nurse responds that the tetanus toxoid immunization provides:

Longer-lasting active immunity

The clinic nurse is teaching an adolescent about lifestyle modifications to prevent hyperlipidemia. Which statement by the adolescent indicates a need for further teaching?

"I'll start eating more red meat."

A nurse is teaching a young adolescent with type 2 diabetes about nutritional needs. Which statement demonstrates that the adolescent understands what was taught?

"It's OK for me to eat one slice of pizza at a party."

An adolescent who has sickle cell anemia is recovering from a painful episode. What does the nurse see as the priority issue for this adolescent?

Alteration in body image resulting from skeletal deformities

An adolescent with leukemia is to be given a chemotherapeutic agent that is known to cause nausea and vomiting. When is the best time for the nurse to administer the prescribed antiemetic?

Before each dose

What should a nurse emphasize when teaching lifelong management of type 1 diabetes to an adolescent?

Inspecting both feet frequently for signs of trauma

A male adolescent with cystic fibrosis, whose parents are both carriers of the disease, asks the nurse, "When I have children, could they have cystic fibrosis like me?" What information should the nurse consider before responding?

Men with cystic fibrosis usually are sterile, although sexual function is not affected.

An adolescent sustains a sports-related fracture of the femur, and open reduction and internal fixation with a rod insertion is performed. After the surgery, a nurse notes that the adolescent is very upset. In light of the client's developmental level, what does the nurse conclude is the most likely explanation for this distress?

The perception that the rod is a body intrusion

An adolescent child is in the terminal stage of cancer. The parents ask how they will know when death is imminent. The nurse discusses the physical manifestations with the parents. What are the signs and symptoms of approaching death? (Select all that apply.)

Weak pulse Difficulty swallowing Loss of bladder control

A nurse is conducting a health class for adolescents. What modifiable risk factor, most closely associated with the development of coronary heart disease (CHD) in both men and women, should the nurse discuss?

Cigarette smoking

An adolescent girl is concerned about her body image after amputation of a leg for bone cancer. After the nurse has obtained the girl's consent, what nursing action is most therapeutic?

Encouraging her peers to visit

What treatment should the nurse suggest to an adolescent with type 1 diabetes if an insulin reaction is experienced while the adolescent is at a basketball game?

"Buy a soda and hamburger to eat."

When teaching an adolescent with type 1 diabetes about dietary management, what instruction should the nurse include?

A ready source of glucose should be available.

An adolescent child who has sustained full-thickness burns is to undergo skin grafting. The nurse explains to the child's parents that for permanent grafts the child must have:

Autografts

The nurse is helping an adolescent with iron-deficiency anemia make breakfast meal choices. Which foods should the nurse suggest?

Bowl of raisin bran

Which clinical findings should cause the nurse to suspect that an adolescent child with type 1 diabetes is hypoglycemic?

Difficulty concentrating, hunger, and diaphoresis

The nurse is caring for a child with a very low platelet count related to chemotherapy. The nurse should monitor this child's urine for the presence of:

Erythrocytes

What is the most appropriate communication strategy for the nurse working with adolescents in a clinic in a large city health center?

Establishing a relationship over time

What behavior does a nurse expect when caring for a 15-year-old adolescent who is undergoing chemotherapy?

Exhibiting concern about being different

A nurse is reviewing the laboratory report of a 13-year-old child with type 1 diabetes. What test is considered the most accurate in the evaluation of the effectiveness of diet and insulin therapy over time?

Glycosylated hemoglobin

A mother expresses concern that her adolescent daughter is not ingesting enough calcium because of her allergy to milk. What alternative foods or liquids should the nurse suggest? (Select all that apply.)

Green leafy vegetables Black or baked beans Oranges Salmon and sardines

A 13-year-old girl is found to have idiopathic scoliosis. She is upset about the treatment regimen and is worried about being different from her friends. What should the nurse do to help the child maintain a positive self-image during treatment?

Help her investigate appropriate clothing to enhance her appearance

An adolescent visits the allergy clinic because of seasonal environmental allergies, and blood is drawn for testing. Which laboratory finding indicates to the nurse that an allergic response is in progress?

Increased eosinophil level

A teenager with allergies is using oxymetazoline (Afrin) nasal spray. What effect should the nurse evaluate the client for if more than the recommended dose is taken?

Increased nasal congestion

An adolescent is found to have type 1 diabetes. The nurse plans to teach the adolescent that dietary control and exercise can help regulate the disorder. What additional information should be included in the teaching plan? (Select all that apply.)

Insulin therapy Blood glucose monitoring Adherence to the treatment regimen

The mother of a 13-year-old child with sickle cell anemia tells the nurse that the family is going camping by a lake this summer. She asks what activities are appropriate for her child. Which activity should the nurse suggest?

Motorboat rides around the lake

A 4-year-old child is undergoing a diagnostic workup for pulmonic stenosis. The mother asks the nurse about the diagnosis. The nurse bases the response on the fact that pulmonic stenosis is:

Narrowing of the valve between the right ventricle and the pulmonary artery

An adolescent who was admitted to the hospital with ketoacidosis is stable and receiving Novolin R subcutaneously. One hour after its administration the nurse enters the room and notes that the adolescent is diaphoretic and irritable. What is the nurse's priority intervention?

Obtaining a blood glucose reading

A 14-year-old adolescent is severely injured in a motor vehicle collision. There are multiple fractures, contusions, and muscle spasms, causing the teenager to refuse to move. How can the nurse best support the adolescent and encourage movement?

Permitting decision-making regarding care

Status epilepticus develops in an adolescent with a seizure disorder who is taking antiseizure medication. The nurse remembers that the most common reason for the development of status epilepticus is that the prescribed dosage of medication is:

Probably not taken consistently

An adolescent girl with a seizure disorder refuses to wear a medical alert bracelet. What should the nurse tell the girl that may help her wear the bracelet consistently?

Select a bracelet similar to bracelets worn by her peers

At 7 am a nurse learns that an adolescent with diabetes had a 6:30 am fasting blood glucose level of 180 mg/dL. What is the priority nursing action at this time?

Telling the adolescent that the prescribed dose of rapid-acting insulin should be administered

A new nurse has been assigned to a school-aged child who is in contact isolation for methicillin-resistant Staphylococcus aureus (MRSA). The primary nurse observes the new nurse during morning care. Which behavior should the primary nurse address to improve isolation technique?

While changing the bed the nurse wears gloves but no gown.

A 14-year-old girl in whom scoliosis has been diagnosed undergoes spinal fusion. On the first postoperative day her face is red, she is rigid, and she is crying because she is in pain. She has prescriptions for morphine sulfate for severe pain and an acetaminophen-codeine compound for moderate pain. What information should influence the nurse's choice of analgesic?

Spinal fusion causes considerable pain during the early postoperative days, and morphine is the more effective analgesic.

A 13-year-old adolescent is found to have idiopathic scoliosis. Because exercise and avoidance of fatigue are essential components of care, which sport should the nurse suggest as the most therapeutic for this preadolescent?

Swimming

A 16-year-old adolescent sustains an ankle injury while playing soccer. Crutches and no weight-bearing are prescribed by the practitioner. What must the nurse ensure when adjusting the crutches?

That they extend to 6 inches from the side of each foot

An adolescent is admitted to the hospital in respiratory distress, and the health care provider orders oxygen at 40% by way of a Venturi mask. The instructions for the Venturi mask indicate that delivery of 4 L/min equals 24% to 28% oxygen, delivery of 8 L/min equals 35% to 40% oxygen, and 12 L/min equals 50% to 60% oxygen. Mark where the ball of the flow meter should be raised to deliver the percentage of oxygen ordered by the health care provider.

The ball of the oxygen flowmeter should be set at 8 L/min to deliver 40% oxygen through the Venturi mask.

An adolescent is hospitalized with multiple internal injuries after an automobile collision. The adolescent is being kept NPO and is receiving an IV infusion at 125 mL/hr and an antibiotic reconstituted in 10 mL of normal saline every 6 hours (6 am, 12 pm, 6 pm, 12 am). What is the intake from 7 am to 3 pm? Record your answer using a whole number and no punctuation. __________ mL

1010 mL

A nurse working the 8 am-4 pm shift is caring for a 14-year-old adolescent for whom intake and output are being monitored. The health care provider orders an intravenous infusion to be administered at a rate of 50 mL/hr. The adolescent had 4 oz of milk and a muffin for breakfast at 8:30 am. At 9 am the adolescent vomited 200 mL. At 10 am the adolescent had 60 mL of water with medications. At 11 am the adolescent voided 550 mL of urine. For lunch, at 12:30 pm, the adolescent ate 3 oz of soup and 4 oz of ice cream. The adolescent voided 450 mL at 2 pm. Calculate the adolescent's total intake for the 8 am-4 pm shift. Record your answer using a whole number. __________ mL

790 mL

Loratadine (Claritin), 10 mg by mouth once a day in the morning, is prescribed for a 15-year-old girl with hay fever. The girl tells the school nurse that she is concerned that she will be sleepy for a quiz the next day. How should the nurse respond?

By explaining that this medication rarely causes drowsiness

The nurse is teaching a class about nutrition to a group of adolescents. Taking into consideration the prevalence of overweight teenagers, what is the best recommendation the nurse can make?

Decrease fast food intake.

After her child's visit to the pediatrician a mother tells the nurse that she is concerned that an antidepressant has been prescribed for her adolescent son. What is the best response by the nurse?

"Tell me more about what's bothering you."

Which condition is more common in adolescent girls than boys?

Anorexia nervosa

How can a nurse best accomplish therapeutic communication with an adolescent?

By establishing a relationship over time

A 13-year-old girl tells the nurse at the pediatric clinic that she took a pregnancy test and got a positive result. She confides that her grandfather, with whom she, her younger sisters, and her mother live, has repeatedly molested her for the past 3 years. When the nurse asks the girl whether she has told anyone else, she replies, "Yes, but my mother doesn't believe me." Legally, who should the nurse notify?

Child protective services for immediate intervention

One principle to be followed for children with type 1 diabetes is to provide for the variability of the child's activity. What should the nurse teach the child about how to compensate for increased physical activity?

Eat more food when planning to exercise more than usual.

A nurse is discussing insulin needs with an adolescent with recently diagnosed type 1 diabetes. What information is important for the nurse to include concerning insulin administration?

Insulin will be required throughout life.

A nurse is caring for a 15-year-old adolescent who was admitted to the hospital after taking an acetaminophen (Tylenol) overdose. The result of which diagnostic study is most important for the nurse to monitor at this time?

Liver function tests

Spinal fusion is performed in an adolescent with scoliosis. What postoperative nursing intervention is specifically related to surgery for scoliosis?

Log-rolling every 2 hours

A nurse explains to the parents of a toddler with a diagnosis of tetralogy of Fallot that the aim of palliative surgery is to directly increase the blood flow to the:

Lungs

An adolescent is undergoing radiation for Hodgkin's lymphoma. The nurse talks with the family about the importance of:

Overwhelming fatigue and the need for rest

A 16-year-old girl with sickle cell anemia is experiencing a painful episode (vaso-occlusive crisis) and has a patient-controlled analgesia (PCA) pump. She complains of pain (5 on a scale of 1 to 10) in her right elbow. The nurse observes that the pump is "locked out" for another 10 minutes. What action should the nurse implement?

Placing the prescribed as-needed warm, wet compress on the elbow

A nurse in the family planning clinic reviews the health history of a sexually active 16-year-old girl whose chief concern is a thick, burning vaginal discharge accompanied by low abdominal pain. After her examination, the girl is informed that she may have a sexually transmitted infection (STI) that requires treatment. The adolescent is concerned that her parents will discover that she is sexually active. She asks the nurse whether her parents will be contacted. The nurse explains that her parents will:

Not be contacted, because treatment at the clinic is confidential

A nurse is caring for an adolescent in the postanesthesia care unit. What action should the nurse take to ensure accuracy of a pulse oximeter reading?

Placing the probe on a finger or earlobe

A 15-year-old high school student with hay fever has been taking a prescribed long-acting antihistamine/decongestant every 8 hours for the past 2 days. The adolescent tells the nurse, "This medicine is making me sleepy. Can you change it to something else?" How should the nurse respond?

"The drowsiness usually goes away after several days."

A 17-year-old child was recently found to have type 2 diabetes mellitus. What information will the nurse include when providing education to the family?

"The most important interventions are good nutrition and portion control."

An adolescent child is admitted to a pediatric unit with the tentative diagnosis of acute poststreptococcal glomerulonephritis (APSGN). What diagnostic tests does the nurse expect will be performed to confirm this diagnosis?

Serum complement (C3) activity level and urinalysis

A 16-year-old girl has been admitted to the pediatric eating disorders unit with a diagnosis of anorexia and is undergoing behavioral therapy. Unit privileges are based on weight gain and have been explained to the client. What is the most appropriate intervention for the nurse to use when taking the lunch tray to the client's room?

Setting the tray down and say nothing

A 16-year-old adolescent with recently diagnosed type 1 diabetes will receive NPH (Novolin N) insulin subcutaneously. The nurse teaches the adolescent about peak action of the drug and the risk for hypoglycemia. How many hours after the drug does the NPH peak?

4 to 12 hours

An 18-year-old high school student arrives at the local blood drive center to donate blood for the first time. As the site is being prepared for needle insertion, the student becomes agitated, starts to hyperventilate, and complains of dizziness and tingling of the hands. What should the nurse instruct the student to do?

Breathe into cupped hands

An adolescent who has had a leg amputated because of bone cancer begins to experience phantom limb sensations. How should the nurse respond when the client complains of pain and requests medication?

By acknowledging that the pain is real and administering medication to relieve it

An adolescent is admitted with an acute hemophilia episode. Rest, ice, compression, and elevation will be most helpful in:

Controlling bleeding and retaining joint function

An adolescent has been admitted with symptoms of fatigue, intermittent fever, weight loss, and arthralgia, and the diagnosis is systemic lupus erythematous. The nurse knows that the best intervention at this time is:

Education about diet, rest, and exercise

An adolescent who has just been found to have type 1 diabetes asks a nurse about exercise. What is the best response by the nurse?

"Extra snacks are needed before exercise."

A nurse concludes that the teaching about sickle cell anemia has been understood when an adolescent with the disorder states:

"I'll start to have symptoms when I drink less fluid."

The nurse is caring for an adolescent with hemophilia. Which statement by the client indicates a need for further teaching?

"I'll use a straight razor when I start shaving."

A nurse gives a teenager discharge instructions regarding cast care. The nurse concludes that the instructions have been understood when the teenager says:

"If I get itchy around the cast, I'll rub the itchy area gently."

A 16-year-old client with full-thickness burns of the entire right arm states, "I'll never be able to use my arm again. I'll be scarred forever." What is the best initial response by the nurse?

"Minimizing scarring is the goal of the entire professional staff."

The mother of an adolescent asks the nurse, "What's the best way to remove a tick from the skin?" What is the best response by the nurse?

"Remove the tick carefully with tweezers."

A 17-year-old mother is to sign the consent for her son's myringotomy. What should the nurse say to the mother about this procedure?

"Tell me what you know about this procedure."

A practitioner prescribes 160 mg of acetaminophen (Tylenol) elixir for a child. The label on the bottle reads "100 mg/mL." How many milliliters of acetaminophen should the nurse instruct the mother to administer? Record your answer using a whole number. __________ mL

1.6 mL

An intravenous infusion of 30 mg of an antibiotic in 50 mL of D5W every 6 hours is prescribed for an adolescent. It is to run over 30 minutes. At what hourly rate should the nurse set the infusion device? Record your answer using a whole number. __________ mL/hr

100 ml

The health care provider has prescribed 700 mL of intravenous fluid, to be infused over 24 hours. At what rate should the nurse set the volume-control device? Record your answer using a whole number. __________ mL/hr

29 mL/hr

A practitioner recommends that an adolescent with the diagnosis of osteogenic sarcoma have the affected leg amputated and then be treated with chemotherapy. The parents are concerned about what to tell their child and ask the nurse for advice. The nurse suggests that they discuss the:

Amputation and provide information about chemotherapy

An adolescent with type 1 diabetes is brought to the emergency department in ketoacidosis. The adolescent admits to not adhering to the diabetic regimen. What can the nurse do to help the adolescent become more accepting of the diabetic regimen?

Encourage the adolescent to express feelings about having diabetes

A nurse in the clinic is taking the health history of a 16-year-old girl. When the nurse asks questions concerning sexual activity, the adolescent begins to perspire and hyperventilate. As her anxiety increases, she indicates that she feels dizzy and short of breath and that her heart is racing. What condition does the nurse identify?

Hyperventilation syndrome

An adolescent with type 1 diabetes who has a history of inadequate adherence to therapy is admitted to the hospital with a blood glucose level of 700 mg/dL. A continuous insulin infusion is started. What complication should the nurse make a priority of detecting while the adolescent is receiving the infusion?

Hypokalemia

Immediately after being placed in the supine position, an adolescent child experiences shortness of breath and must sit up to breathe. What term should the nurse use to document this clinical phenomenon?

Orthopnea

Which topic would be most appropriate for health education for adolescents?

Safe sexual practices

A nurse is planning to discuss the importance of following the prescribed course of treatment with a group of adolescent clients. What is the nurse's priority consideration regarding these clients?

They are involved more with the present than with the future.

A 14-year-old adolescent with diabetes has been self-administering insulin twice a day. This morning the parents found their child lethargic and confused. After the adolescent's admission to the emergency department, laboratory testing reveals a hemoglobin A1C level of 10% and a blood glucose level of 200 mg/dL. What does the nurse suspect as the most likely cause of this client's condition?

Uncontrolled blood glucose level

An 11-year-old child has gained weight. The mother tells the nurse that she is concerned that her child, who loves sports, may become obese. What is the most appropriate response by the nurse?

Explaining that this is expected during preadolescence

A nurse is reviewing the laboratory report of an adolescent child with nephrotic syndrome. What does the nurse expect analysis of the child's urine to reveal?

High protein level

What findings should a nurse expect when examining the laboratory report of a preschooler with rheumatic fever?

Positive antistreptolysin titer

A 15-year-old adolescent with type 1 diabetes arrives at the diabetic outpatient clinic with a parent. The adolescent sits back in the chair with arms folded, frowns, and displays a withdrawn attitude. The adolescent and parent argue in front of the nurse. What is the best approach for the nurse to use?

Speaking separately with each of them, encouraging them to recognize and vent their anger

A nurse is caring for an underweight adolescent girl with a diagnosis of anorexia nervosa. What common characteristics of girls with this disorder should the nurse recognize when obtaining a health history? (Select all that apply.)

Fatigue Secondary amenorrhea

A nurse is caring for a 15-year-old client who is undergoing chemotherapy for leukemia. The nurse expects that adolescents with health problems are most concerned about:

Feeling different regarding changes in body image

After an above-the-knee amputation for bone cancer, an adolescent boy is returned to his room. He is monitored closely because of the potential for hemorrhage from the residual limb. What should the nurse plan to keep at the bedside?

Pressure dressing