Passpoint: Ch 22 Health Promotion of the Adolescent

A nurse is reinforcing education about type 1 diabetes with an adolescent. Which instruction by the nurse about how to prevent hypoglycemia would be most appropriate for the adolescent? "Limit participation in planned exercise activities that involve competition." "Carry crackers or fruit to eat before or during periods of increased activity." "Increase the insulin dosage before planned or unplanned strenuous exercise." "Check your blood glucose level before exercising, and eat a protein snack if the level is elevated."

"Carry crackers or fruit to eat before or during periods of increased activity." Hypoglycemia can usually be prevented if an adolescent with diabetes eats more food before or during exercise. Because exercise with adolescents is not commonly planned, carrying additional carbohydrate foods, such as crackers or fruit, is a good preventive measure.

The parent of a 16-year-old child calls the emergency department, suspecting their child's abdominal pain may be appendicitis. In addition to pain, the child has a fever of 100° F (37.8° C) and has vomited twice. What would be appropriate advice for the nurse to give the parent? "Give your child a laxative to rule out the possibility that constipation is causing the pain." "Gently press on the lower left quadrant of your child's abdomen to test for rebound tenderness." "It's most likely the flu because your child is too young to have appendicitis." "Immediately bring your child into the emergency department."

"Immediately bring your child into the emergency department." Abdominal pain, low-grade fever, and vomiting are cardinal signs of appendicitis. The teen should be brought to the emergency department immediately. Rebound tenderness is also a symptom but would be located in the right lower quadrant, and that assessment should be made by a health care provider. Administration of a laxative during appendicitis is very dangerous because it can cause the appendix to rupture. Appendicitis is seen most frequently in school-age children and adolescents.

A 13-year-old client tells the nurse, "I have not yet started my period, but all my friends have." Which nursing response is appropriate? "Let's talk with your health care provider about this." "I am concerned that you have not started to menstruate yet." "Some individuals do not start menstruating until age 15 or 16." "You should not be worried about having a period at this age."

"Some individuals do not start menstruating until age 15 or 16." Menstruation, or period, is the normal shedding of blood and tissue from the endometrium of the uterus. It usually has a duration of 3 to 5 days, but can last from 2 to 7 days. A period occurs about every 28 days, although the interval can range from 21 to 45 days. Menstrual cycles are often irregular for up to 6 years after onset. Additional signs and symptoms that accompany a period include abdominal pain, pelvic cramping, lower-back pain, bloating, sore breasts, food cravings, irritability, mood swings, headache, and fatigue. The nurse will not express concern over the client not menstruating yet, because some clients do not begin menses until later. If a girl does not start her menstrual cycle by the age of 15 to 16, a health care provider should be consulted; the nurse will share this information with the client to alleviate concerns. The nurse does not need to defer this conversation to the health care provider, as the nurse has knowledge that can address the client's concern. The nurse will not tell the client to not be worried, as this discounts the client's concern and feelings.

After a nurse reinforces education with an adolescent about syphilis, which statement by the adolescent indicates the need for further education? "The disease is divided into four stages: primary, secondary, latent, and tertiary." "Affected persons are most infectious during the first year." "Syphilis is easily treated with penicillin or doxycycline." "Syphilis is rarely transmitted sexually."

"Syphilis is rarely transmitted sexually." About 95% of the cases of syphilis are transmitted sexually. There are four stages to syphilis, although some people may only experience the first three stages. Affected persons are most contagious in the first year of the disease. The drug of choice for treating syphilis is penicillin or doxycycline.

The parent of an adolescent diagnosed with Legg-Calvé-Perthes disease (LCPD) asks the nurse, "What caused this condition?" Which nursing response is appropriate? "The health care provider can give you more information." "The hip joint has been damaged due to lack of blood supply." "Exposure to toxins in the womb can result in this condition." "Taking antibiotics causes this disorder."

"The hip joint has been damaged due to lack of blood supply." Legg-Calvé-Perthes disease (LCPD) is a disease of one or both hips. The nurse will convey that this condition results from a lack of blood supply to the hip joint. Poor blood supply to bones results in fractures and poor bone healing. The cause of this spontaneous, yet temporary, reduction of blood flow to the femoral head is unknown. It may be caused by an injury or another disease process. It tends to run in families and affects boys five times more frequently than girls. The nurse will not defer the question to the health care provider, as a reasonable and objective response can be given. LCPD is not caused by exposure to toxins in the womb nor by taking antibiotics.

The nurse is working with adolescents. Which developmental rationale explains risk-taking behavior? Adolescents are concrete thinkers and concentrate only on what is happening at that time. Belief in their own invulnerability persuades adolescents that they can take risks safely. Risk of parents' anger and disappointment usually deters adolescents from risky behavior. Peer pressure usually does not play an important part in an adolescent's decision to become sexually active.

Belief in their own invulnerability persuades adolescents that they can take risks safely. Understanding the growth and development of adolescents helps the nurse recognize that teenagers feel they are invulnerable and can take risks safely. Peer pressure plays an important role in risk-taking behaviors, more so than fear of parents' anger or disappointment. Adolescents can and do think about the future, but are willing to take risks that more mature adults might not take.

A 15-year-old client who sustained a spinal cord injury is on bedrest. Which intervention by the nurse might best help the adolescent cope with the prolonged bedrest? Allowing his parents unrestricted visiting Encouraging visitation by his friends Providing the client with reading material Providing the client with video games

Encouraging visitation by his friends Encouraging visitation by friends might best help the adolescent cope with prolonged bedrest. Friends are much more important than family to this age-group. Providing reading material and video games might be somewhat helpful, but not as helpful as encouraging visits from friends.

A 16-year-old client comes to the physician's office for a physical examination that's required to play sports. The mother reports that her son is unusually tired during the day. She explains that he works at a part-time job, is socially active, and gets about 7 hours of sleep each night. Physical examination reveals that the client grew 3" during the past year. Which intervention by the nurse is most appropriate? Explaining that his sleep requirements have increased related to the increased metabolic demands of growth Doing nothing because fatigue is normal during adolescence Informing the physician so he can order diagnostic tests to further investigate the fatigue Referring the client to a mental health specialist because he might be exhibiting signs of depression

Explaining that his sleep requirements have increased related to the increased metabolic demands of growth The nurse should explain that fatigue is common in adolescents who don't get enough sleep. The metabolic demands associated with growth cause an increased demand for sleep in adolescents. Not intervening at all might cause the client and his parents unnecessary anxiety. The nurse can inform the physician, but fatigue is a common finding in adolescents who don't get enough sleep. Referring the client to a mental health specialist isn't appropriate.

An adolescent is diagnosed with iron deficiency anemia. After emphasizing the importance of consuming dietary iron, the nurse asks the child to select iron-rich breakfast items from a sample menu. Which selection demonstrates knowledge of dietary iron sources? Grapefruit and white toast Pancakes and a banana Ham and eggs Bagel and cream cheese

Ham and eggs Good sources of dietary iron include red meat, egg yolks, whole wheat breads, seafood, nuts, legumes, iron-fortified cereals, and green, leafy vegetables. Fresh fruits and milk products contain only small amounts of iron. Breads (except for whole wheat and iron-fortified breads) aren't good iron sources.

The nurse cares for an older adolescent client. The nurse observes a visitor wearing a gun and gun holster. Which action does the nurse take? Ask the visitor to take the weapon out of the building. Evacuate the unit for the safety of the clients and staff. Notify security personnel of the observation and location. Watch the visitor for signs of threatening behavior or aggression.

Notify security personnel of the observation and location. Someone carrying a weapon does not automatically indicate that the person is going to cause trouble or harm. Facilities do typically require that no weapons be brought into the building though. It is the job of trained security officers to discuss this with the visitor. The nurse does not confront the visitor due to the potential for harm. The nurse does not alarm others without cause, so no evacuation or similar action is warranted. This action could also trigger aggression in the visitor. The nurse cannot continue to observe only, however. If a situation arose, the nurse would have been neglectful by not alerting security.

When planning a program to educate adolescents about acquired immunodeficiency syndrome (AIDS), which action might lead to better acceptance of the program? Survey the community to evaluate the level of education. Obtain peer educators to provide information about AIDS. Set up clinics in community centers and supply condoms readily. Invite health care providers to host workshops in community centers.

Obtain peer educators to provide information about AIDS. Peer education programs have shown that teens are more likely to pose questions to peer educators than to adults, and that peer education can change personal attitudes and the perception of the risk of HIV infection. The other approaches would be helpful but wouldn't necessarily make the outreach program more successful.

An adolescent client with diabetes checks the blood glucose at 9:00 p.m. before going to bed. It has been 4 hours since dinner and the regular insulin dose. The current blood glucose is 60 mg/dl (3.3 mmol/L). The client feels a little "shaky." Which action does the nurse take? Provide the client with a snack. Suggest the client go to sleep. Provide glucagon to the client. Recheck the glucose using an institutional monitor.

Provide the client with a snack. The client needs a snack. Milk is a readily absorbed form of carbohydrate and will elevate blood glucose rapidly, thus alleviating hypoglycemia. Crackers and peanut butter contain complex nutrients and will maintain the blood glucose levels. The client should not go to sleep when feeling symptomatic. Glucagon should be reserved for more severe signs of hypoglycemia, such as disorientation and unconsciousness. To avoid rapid deterioration, steps should always be taken whenever hypoglycemia is suspected, regardless of which glucometer was used for the measurement.

A nurse is caring for a 16-year-old male client who needs an appendectomy. His parents are not present at the hospital. Prior to the surgery, the nurse needs to ensure that informed consent is obtained. Which situations allows the healthcare provider to obtain an informed consent from an adolescent? The adolescent is the appropriate age to sign an informed consent. The adolescent has declared himself emancipated. The adolescent has a power-of-attorney document. The adolescent is under the protection of a court guardian.

The adolescent has declared himself emancipated. Individuals under the age of 18 need a parent or guardian to provide an informed consent, unless the individual is an "emancipated minor," an adolescent who is legally recognized as an adult. Otherwise, an adolescent is considered a minor until his 18th birthday. The power-of-attorney document allows another individual who is over the age of 18 to make decisions.

The nurse is working with a group of adolescents reviewing information regarding the human immunodeficiency virus (HIV). What fact is important for the nurse to include in the review? The incidence of HIV in the adolescent population has declined since 1995. The virus can be spread through many routes, including sexual contact. Knowledge about HIV spread and transmission has led to a decrease in the spread of the virus among adolescents. About 50% of all new HIV infections in the United States occur in people younger than age 22.

The virus can be spread through many routes, including sexual contact. HIV can be spread through many routes, including sexual contact and contact with infected blood or other body fluids. The incidence of HIV in the adolescent population has increased since 1995, even though more information about the virus is targeted to reach the adolescent population. Only about 25% of all new HIV infections in the United States occurs in people younger than age 22.

An otherwise-healthy adolescent has meningitis and is receiving I.V. and oral fluids. The nurse should monitor this client's fluid intake because fluid overload may cause: cerebral edema. dehydration. heart failure. hypovolemic shock.

cerebral edema. Because of the inflammation of the meninges, the client is vulnerable to developing cerebral edema and increased intracranial pressure. Fluid overload won't cause dehydration. It would be unusual for an adolescent to develop heart failure unless the overhydration was extreme. Hypovolemic shock would occur with an extreme loss of fluid or blood.

An adolescent typically achieves formal operational thought, Piaget's final stage of cognitive development. Which cognitive abilities are achieved during this stage? Select all that apply. flexibility complex deductive reasoning transductive reasoning representational language abstract thinking

flexibility complex deductive reasoning abstract thinking The formal operational thought stage is characterized by adaptability and flexibility, abstract thinking, inductive reasoning, and complex deductive reasoning. During the pre-operational stage, which begins at age 2 and ends around age 7, the child masters representational language and transductive reasoning.

A 13-year-old has received third--degree burns over 20% of the body. When observing this client 72 hours after the burn, which finding should the nurse expect? increased urine output severe peripheral edema respiratory distress absent bowel sounds

increased urine output During the resuscitative-emergent phase of a burn, fluids shift back into the interstitial space, resulting in the onset of diuresis. Edema resolves during the emergent phase, when fluid shifts back to the intravascular space. Respiratory rate increases during the first few hours as a result of edema. When edema resolves, respirations return to normal. Absent bowel sounds occur in the initial stage.

A 14-year-old is seen in the pediatrician's office with a history of mild sore throat, low-grade fever, a diffuse maculopapular rash, and reports swelling of the wrists and redness in the eyes. The nurse interprets these findings as indications of which condition? rubella rubeola roseola varicella

rubella Rubella presents with a diffuse maculopapular rash, mild sore throat, low-grade fever, and, occasionally, conjunctivitis, arthralgia, or arthritis. Rubeola is associated with high fever, which reaches its peak at the height of a generalized macular rash and typically lasts for 5 days. Roseola involves high fever and is abruptly followed by a rash. Varicella presents with fever, small erythematous macules on the trunk or scalp, which progress to papules, and clear vesicles on an erythematous base

The nurse is teaching an adolescent female client about premenstrual dysphoric disorder (PMDD). Which unique symptom will the nurse teach that the client may experience in addition to those associated with premenstrual syndrome (PMS)? mood swings moments of crying increase in depression spontaneous outbursts of anger

spontaneous outbursts of anger Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are both characterized by mood swings, moments of crying, increases in depression and/or anxiety, and irritability. The unique symptom associated with PMDD is anger, which is often so powerful that it culminates in spontaneous outbursts and exaggerated, inappropriate behaviors. Therefore, the nurse will teach about anger, as counseling and medical intervention may be needed to address this symptom.

A 15-year-old boy wants to try out for the football team. His parents are concerned that, because he's small for his age, he might be subjecting himself to ridicule. Which response by the parents best supports the adolescent's decision-making process? "We're concerned for your safety because the other players are so much bigger than you are." "Whether or not you play football is your decision; tell us why you want to play." "Why don't we look into another sport in which body size isn't an issue." "Why do you want to play football?"

"Whether or not you play football is your decision; tell us why you want to play." Option 2 promotes independence while demonstrating interest in the adolescent. Option 1 promotes dependence and may cause the adolescent to resent his parents. During this stage of development, it's important for the parents to foster independence. Option 3 promotes dependence and might diminish the adolescent's self-esteem; adolescents are commonly very self-conscious about their bodies. Option 4 could cause the adolescent to feel defensive, leading to hostility.

A school nurse suspects that a 13-year-old has structural scoliosis. Asking the adolescent to perform which maneuver would be the nurse's priority when gathering data for this condition? The child bends over and touches the toes while the nurse observes from behind. The child stands sideways while the nurse observes the profile. The child assumes a knee-chest position on the examination table. The child arches the back while the nurse observes from behind.

The child arches the back while the nurse observes from behind. When the adolescent flexes chest to knees, the curvature of the spine is apparent. The scapula on one side becomes more prominent, and the opposing side hollows. Scoliosis can not be properly assessed from the side or the front. The knee-chest position is used for lumbar puncture, not assessment.

A school nurse is planning a program on skin cancer prevention for a group of teenagers. Which instruction should the nurse emphasize during the program? "Stay out of the sun between 1 p.m. and 3 p.m." "Tanning booths are a safe alternative for those who wish to tan." "Sun exposure is safe, provided you wear protective clothing." "Examine your skin once per month, looking for suspicious lesions or changes in moles."

"Examine your skin once per month, looking for suspicious lesions or changes in moles." To increase the detection of skin cancer in its early stages, the nurse should emphasize to the teenage group the importance of monthly skin self-examinations and yearly examinations by a primary care provider. The nurse should also teach the teens to avoid the sun's ultraviolet rays between 10 a.m. and 3 p.m. to reduce the risk of skin cancer. Repeated exposure to artificial sources of ultraviolet radiation, such as tanning booths, increases the risk of skin cancer. Although protective clothing offers a little defense against skin cancer, some of the sun's harmful rays can penetrate clothing.

A 15-year-old adolescent confides in the nurse that the adolescent has been contemplating suicide. The adolescent has developed a specific plan to carry it out and pleads with the nurse not to tell anyone. What is the nurse's best response? "We can keep this between you and me, but promise me you won't try anything." "I need to protect you. I will tell your physician, but we don't need to involve your parents. We want you to be safe." "For your protection, I can't keep this secret. After I notify the physician, we will need to involve your family. We want you to be safe." "I will need to notify the local authorities of your intentions."

"For your protection, I can't keep this secret. After I notify the physician, we will need to involve your family. We want you to be safe." In situations in which a client is a threat to self, the nurse can't honor confidentiality. Because this adolescent has a specific plan to commit suicide, the nurse must take immediate action to ensure the adolescent's safety. The physician and mental health professionals should be notified as well as the client's family. The nurse should inform the adolescent that this is necessary, while at the same time conveying a sense of caring and understanding. The local authorities needn't be notified in this situation.

A nurse is conducting a health class at the local middle school about testicular self-examination. What statement by a student would indicate a need for further teaching? "I should start performing testicular self-exams when I am 12 to 15 years old." "The best time to perform a testicular self-exam is immediately after a bath or shower." "I do not need to perform testicular self-exams until I become sexually active." "Testicular self-exams should be performed monthly."

"I do not need to perform testicular self-exams until I become sexually active." Testicular cancer most commonly occurs between ages 15 and 34. Therefore, boys should begin doing testicular self-examinations (TSEs) at age 12 to 15, which helps them become familiar with the normal contours and consistency of their genital structures. It is important to do a TSE every month.

The nurse is teaching a 16-year old client who has menstruated for more than a year. Which client statement will the nurse respond to as the priority? "Sometimes I have pain when I have a period." "Two weeks before my period, I get one-sided abdominal cramping." "I feel so moody and anxious around the time of my cycle." "I was having regular periods before but haven't had one for a couple of months."

"I was having regular periods before but haven't had one for a couple of months." Delayed onset of more than 3 months or an absence of a period, amenorrhea, is a reason to consult with a medical professional. This client has experienced the absence of at least one and possibly two periods; therefore, the nurse will respond to this client statement as the concern. Further assessment needs to be conducted to determine if there is a disorder causing the condition or if the client may be pregnant. The nurse can then respond to other comments about painful periods, one-sided abdominal cramping (Mittelschmerz), and moodiness and anxiety around the time of the cycle, as all of these are expected findings.

The nurse completes discharge teaching with an adolescent client related to a sexually transmitted infection. Which statement made by the client best indicates that discharge instructions were understood? "I'm not allergic to this antibiotic, and I'll return at the first sign of infection." "I will notify my sex partners about this infection and explain the need for treatment." "I will be careful not to have intercourse with someone who has an infection." "As long as we use a condom, I will not have to worry about this again."

"I will notify my sex partners about this infection and explain the need for treatment." Goal achievement is indicated by the client's understanding of responsible, preventative behaviors. The client must make sure any partners are also treated to prevent further spread. The client should ensure a condom is used during female-to-male or male-to-male intercourse, but condoms must be used correctly to reduce (but do not eliminate) the risk of infection. For clients in a female-to-female relationship, other precautions must be discussed. It is not adequate that the client knows to return for treatment, as prevention is more important. The client cannot know for certain that a partner does not have an infection and must take caution to treat each sexual encounter as though a sexually transmitted infection may occur.

An adolescent female client at the health clinic is considering having sexual intercourse. The client tells the nurse that she wants to begin taking oral contraception because "Birth control pills would mean I don't have to worry about pregnancy or HIV." What is the most appropriate initial response from the nurse? "Let's talk about where you found this information, and then we can look for better resources about intercourse." "Nothing prevents HIV, but we also need to discuss the potential side effects of oral contraceptives." "Oral contraceptives do protect against any chance of pregnancy, but we should talk about HIV and other infections." "The pill will not protect you from getting sexually transmitted infections, and it isn't 100% effective for preventing pregnancy."

"The pill will not protect you from getting sexually transmitted infections, and it isn't 100% effective for preventing pregnancy." Although birth control pills are highly effective in preventing pregnancy when used correctly, the client should be made aware that they are not 100% effective; improper use lowers their effectiveness substantially. Additionally, the nurse should point out that their use won't prevent any type of infection. The nurse may ask where the client heard or read the incorrect information, but this could feel accusatory. The nurse will offer the client trusted resources about sexually transmitted infections, pregnancy, and intercourse rather than having to look for them with the client. Many actions reduce the transmission of HIV and other infections, such as condom use. Oral contraceptives present the potential for adverse effects, and the client should be made aware of them. However, since the client's statement focuses on pregnancy and the potential for infection, this what the nurse should address first.

The nurse is helping the adolescent deal with diabetes. What characteristic of adolescence should be considered? desire to be an individual need to be like peers preoccupation with future plans ability to educate peers about the seriousness of the disease

need to be like peers Adolescents appear to have the most difficulty adjusting to diabetes. Adolescence is a time when being "perfect" and being like one's peers are emphasized, and having diabetes means the adolescent is different.

An emancipated adolescent is pregnant and plans to raise her child. She has no income or health insurance. Which recommendation should the nurse make to help the client with her health care expenses? Completing a Medicaid application Applying for Medicare Asking her parents for financial aid Providing her with the name of a lawyer to obtain child support from the baby's father

Completing a Medicaid application The nurse can best help the client's situation by recommending that she complete an application for Medicaid. Medicaid is the largest source of funding for medical and health-related services for people with limited income. Medicare is a national health insurance program for people age 65 and older, some people younger than age 65 with disabilities, and people with end-stage renal disease who require dialysis or transplantation. Asking the client's parents for financial aid and providing the client with the name of a lawyer to seek child support aren't appropriate actions for the nurse to take.

The parents of an adolescent girl have recently learned that their daughter has a terminal illness. At first, as they try to cope, they display avoidance behaviors. Then they demonstrate behaviors that indicate possible acceptance of the diagnosis. Which of the following behaviors would indicate acceptance? Failure to recognize the seriousness of the child's condition despite physical evidence Intellectualization about the illness in areas unrelated to the child's condition Expression of feelings, such as sorrow and anger, about the child's condition Avoidance of staff, family members, or the child

Expression of feelings, such as sorrow and anger, about the child's condition The ability to express feelings and relate them to the diagnosis is the first step in accepting the situation. Failing to recognize the seriousness of the child's condition despite physical evidence, intellectualizing about the illness in areas unrelated to child's condition, and avoiding staff, family members, or the child are all avoidance behaviors that represent a parent's inability to cope with the situation.

An adolescent, age 17, with acute lymphoblastic leukemia is discharged with written information about chemotherapy administration and the outpatient appointment schedule. The child now is in the maintenance phase of chemotherapy but has missed clinic appointments for blood work and admits to omitting some chemotherapy doses. To improve the client's compliance, the nurse should include which intervention in the plan of care? Emphasizing the long-term consequences of noncompliance Reprimanding the client for failing to comply Letting the client participate in the planning and scheduling of treatments Threatening to discontinue care if the client doesn't comply

Letting the client participate in the planning and scheduling of treatments Because the adolescent is striving for independence, health care providers should promote self-reliance whenever possible such as by letting the child participate in the planning and scheduling of treatments. The client can help establish realistic goals and evaluation outcomes as well as help schedule procedures and chemotherapy doses to minimize lifestyle disruptions. Adolescents are oriented in the present and have relatively little concern for the long-term consequences of their behavior. Reprimanding the client or threatening to discontinue care isn't likely to improve compliance and isn't in the client's best interest.

The nurse is planning sex and contraceptive education for adolescents. Which factor should the nurse consider? Neither sexual activity nor contraception requires planning. Most teenagers today are knowledgeable about reproduction. Most teenagers use pregnancy as a way to rebel against their parents. Most teenagers are open about contraception, but inconsistently use birth control.

Most teenagers are open about contraception, but inconsistently use birth control. Adolescents receive most of their information on reproduction and sexuality from their peers, who generally do not have correct information. Teenagers generally become pregnant because they fail to use birth control for reasons other than rebelling against their parents. Contraception should always be part of sex education and requires planning. Most teenagers today are open about discussing contraception and sexuality, but they may get caught up in the moment of sexuality and forget about birth control measures.

A nurse is caring for a 17-year-old brought to the mental health facility by a family member who is concerned about the client's recent 20-lb (9 kg) weight loss, and weight loss total of 50 lb (22.7 kg) in the last year. What interventions are essential in the treatment of an adolescent diagnosed with an eating disorder?

Provide a highly structured environment; Monitor the clients' weight, vitals, intake and output, caloric intake, and exercise; Assist the client in changing the negative perception to a positive one, and assist in setting realistic goals. Provide a highly structured environment; Monitor the clients' weight, vitals, intake and output, caloric intake, and exercise; Provide an isolation environment to monitor all activities. Monitor the clients' weight, vitals, intake and output, caloric intake, and exercise; Instruct the client and family that treatment for eating disorders takes a few weeks and the family is not involved in the process; Assist the client in changing the negative perception to a positive one, and assist in setting realistic goals. Provide a highly structured environment; Provide an isolation environment to monitor all activities; Instruct the client and family that treatment for eating disorders takes a few weeks and the family is not involved in the process; Assist the client in changing the negative perception to a positive one, and assist in setting realistic goals. Mental health nursing care measures are essential in the treatment of an adolescent diagnosed with an eating disorder. Care measures include providing a highly structured environment; involving client in decision making and participation in the plan of care; assisting the client in setting realistic goals; promoting cognitive reframing; assisting the client in changing the negative perception to a positive one; and monitoring the client's weight, vitals, intake, and output, caloric intake, and exercise. Clients should not be isolated unless they are in danger of harming themselves or others. It is important to instruct families that treatment for eating disorders can take a long time, and family members will be involved in the recovery.

A child, age 14, is hospitalized for nutritional management and drug therapy after experiencing an acute episode of ulcerative colitis. Which nursing intervention would be appropriate? Administering digestive enzymes before meals as prescribed Providing small, frequent meals Administering antibiotics with meals as prescribed Providing high-fiber snacks

Providing small, frequent meals Clients with ulcerative colitis, also known as inflammatory bowel syndrome, tolerate small, frequent meals better than a few large meals daily. Eating large amounts of food may exacerbate the abdominal distention, cramps, and nausea typically caused by ulcerative colitis. Frequent meals also provide the additional calories needed to restore nutritional balance. This client doesn't lack digestive enzymes and therefore doesn't need enzyme supplementation. Antibiotics are contraindicated because they may interfere with the actions of other prescribed drugs and because ulcerative colitis isn't caused by bacteria. High-fiber foods may irritate the bowel further.

A physician needs to obtain written informed consent for a surgical procedure on an adolescent. Which situation allows the physician to obtain written informed consent from the adolescent rather than the parents? The adolescent's 18th birthday is the following week. The adolescent is estranged from the parents and lives independently. The adolescent gives verbal consent to the procedure. The physician doesn't need to obtain consent because the procedure is a minor one.

The adolescent is estranged from the parents and lives independently. An emancipated minor is a person younger than age 18 who is legally recognized as an adult under certain conditions. These conditions include becoming pregnant, getting married, graduating from high school, and living independently. Otherwise, an adolescent is considered a minor until the adolescent's 18th birthday. Written consent must always be obtained, even if verbal consent is given. Major surgery, minor surgery, diagnostic tests such as biopsies, and treatments such as blood transfusions are all examples of procedures that require written informed consent.

The nurse is reinforcing education with an adolescent about gonorrhea. Which information should be included? It is caused by Treponema pallidum. Treatment of sexual partners is an essential part of treatment. It is usually treated by multidose administration of penicillin. It may be contracted through contact with a contaminated toilet seat.

Treatment of sexual partners is an essential part of treatment. Adolescents should be taught that treatment is needed for all sexual partners. Treponema pallidum is the causative organism of syphilis, not gonorrhea. The medication of choice is a single dose of IM ceftriaxone in males and a single oral dose of cefixime in females. Gonorrhea cannot be contracted from a contaminated toilet seat.

Which adolescent client would the school nurse consider at greatest risk for developing acquired immunodeficiency syndrome (AIDS)? a client living with a parent who uses intravenous drugs a client who states they have multiple sexual partners a client whose sibling died from AIDS last year a client in a committed relationship with one partner

a client who states they have multiple sexual partners The more sexual partners, the higher the incidence of HIV and AIDS. The risk is higher in younger clients. A client with one committed partner should be at lower risk, although the nurse would assess the client's sexual history in more depth. Living in the same household with someone who is infected or who engages in behaviors that increase transmission risk does increase the risk of transmission if other unsafe behaviors (e.g., sharing a razor) are present.

The nurse receives a report for a group of adolescent clients in the acute medical unit. In which order, from highest to lowest, will the nurse prioritize assessing the clients? All options must be used.

a client with astrocytoma who has been reporting mild nausea and headache for the past 4 hours - a client who has just returned to the unit after undergoing an ultrasound-guided renal biopsy - a client with nephrolithiasis requesting analgesia for flank pain rated as 4 on a 10-point scale - a client admitted for an asthma exacerbation who has an oxygen saturation of 88% - a client with spina bifida who needs help transferring a client who has just returned to the unit after undergoing an ultrasound-guided renal biopsy - a client admitted for an asthma exacerbation who has an oxygen saturation of 88% - a client with nephrolithiasis requesting analgesia for flank pain rated as 4 on a 10-point scale - a client with astrocytoma who has been reporting mild nausea and headache for the past 4 hours - a client with spina bifida who needs help transferring a client who has just returned to the unit after undergoing an ultrasound-guided renal biopsy - a client admitted for an asthma exacerbation who has an oxygen saturation of 88% - a client with astrocytoma who has been reporting mild nausea and headache for the past 4 hours - a client with nephrolithiasis requesting analgesia for flank pain rated as 4 on a 10-point scale - a client with spina bifida who needs help transferring a client admitted for an asthma exacerbation who has an oxygen saturation of 88% - a client who has just returned to the unit after undergoing an ultrasound-guided renal biopsy - a client with nephrolithiasis requesting analgesia for flank pain rated as 4 on a 10-point scale - a client with astrocytoma who has been reporting mild nausea and headache for the past 4 hours - a client with spina bifida who needs help transferring

The nurse is caring for a teenage client involved in a motor vehicle accident. The client has a chest tube in place. If the chest tube is accidentally removed, the nurse should immediately: reintroduce the tube and attach it to water seal drainage. call the physician and obtain a chest tray. cover the opening with sterile petroleum gauze. clean the wound with povidone-iodine and apply a gauze dressing.

cover the opening with sterile petroleum gauze. If a chest tube is accidentally removed, the nurse should cover the insertion site with sterile petroleum gauze. The nurse should then observe the client for respiratory distress, as tension pneumothorax may develop. If so, the nurse should remove the gauze to allow air to escape. The nurse shouldn't reintroduce the tube. Rather, the nurse should have another staff member call a physician so another tube can be introduced by the physician under sterile conditions.

The nurse is reinforcing education on how to change a sterile dressing. The client is an older adolescent. During the education session, the nurse observes redness, swelling, and induration at the incision site. What does this indicate to the nurse? infection dehiscence hemorrhage evisceration

infection An infection produces such signs as redness, swelling, induration, warmth, and possibly drainage. Dehiscence may cause unexplained fever and tachycardia, unusual wound pain, prolonged paralytic ileus, and separation of the surgical incision. Hemorrhage can result in increased pulse and respiratory rate, decreased blood pressure, restlessness, thirst, and cold, clammy skin. Evisceration produces visible protrusion of organs, usually through an incision.

Which interview strategy contributes to a poor nurse-adolescent relationship? maintaining objectivity by avoiding assumptions, judgments, and lectures beginning with less-sensitive issues and proceeding to more-sensitive ones interviewing adolescents with their parents present asking open-ended questions and moving to more directive questions when possible

interviewing adolescents with their parents present When possible, adolescents should be interviewed without their parents present to ensure confidentiality and privacy. Interviewing adolescents with their parents present hinders the formation of the nurse-adolescent relationship. Avoiding assumptions, judgments, and lectures will increase the adolescents' comfort in disclosing sensitive information. Begin with less-sensitive questions so the adolescents won't feel threatened and uncomfortable and become uncooperative during the interview. Ask open-ended questions to give adolescents opportunities to share their psychosocial context.

The nurse has conducted a vision assessment for an adolescent client. Which term will the nurse use to document the finding of the client's nearsightedness? myopia astigmatism hyperopia retinitis pigmentosa

myopia Myopia, or nearsightedness, is a common refractive disorder. Clients with myopia can see clearly when something is close to the visual field but have difficulty seeing objects in the distance clearly; therefore, the nurse will use the term myopia to document the finding. Astigmatism is the unequal curvatures of the eyes. Hyperopia, or farsightedness, is the inability to see objects near to the eyes clearly. Retinitis pigmentosa is a rare, genetic disorder that involves the breakdown and loss of cells in the retinas of both eyes.

An adolescent is admitted to the adolescent unit with pain caused by sickle cell crisis. Who should be consulted first about this adolescent's care? nutritionist physical therapist pediatric pain specialist case manager

pediatric pain specialist Children and adolescents hospitalized with sickle cell crisis are commonly in excruciating pain. Therefore, the pediatric pain specialist should be consulted first to help relieve the adolescent's pain. The adolescent also requires hydration with I.V. fluids, but consulting a nutritionist isn't important at this time. Bed rest is commonly ordered to minimize energy expenditure and oxygen demand; therefore, consulting a physical therapist isn't necessary at this time. It isn't necessary to consult the case manager first; pain relief is most important at this time.

An adolescent with diabetes is learning to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the teen, would indicate the need for further instruction? withdraws the NPH insulin first injects air into the NPH insulin bottle first after drawing up the first insulin, removes air bubbles from the syringe injects an amount of air equal to the desired dose of insulin

withdraws the NPH insulin first Regular insulin is always withdrawn first so it won't become contaminated with NPH insulin. The adolescent with diabetes is instructed to inject air into the NPH insulin bottle equal to the amount of insulin to be withdrawn, because there will be regular insulin in the syringe and he won't be able to inject air when he needs to withdraw the NPH. It's necessary to remove the air bubbles from the syringe to ensure a correct dosage before drawing up the second insulin.