Ch. 29 Growth and Development of the Adolescents

The nurse is planning a presentation to an adolescent group. What recommendations would the nurse include in the presentation? a. Engage in aerobic exercise for 30 minutes, three days per week. b. Participate in weekly physical activities that cause sweating and rapid breathing. c. Engage in at least one competitive sport during the school year. d. Participate in 60 minutes of moderate to vigorous physical activity each day.

Ans A The U.S. Department of Health and Human Services and the Canadian Physical Activity Guidelines recommend that adolescents participate in 60 minutes of moderate to vigorous physical activity each day. Aerobic exercise for 30 minutes, three times weekly, is not the recommended amount of exercise. The other recommendations lack adequate activity or specificity.

A teacher refers a student to the school nurse because the student is frequently falling asleep during class. After talking with the student, the nurse is most concerned by which statement by the student? a. "I get 7 hours of sleep every night so I don't know why I am so tired." b. "My mom keeps telling me to turn off my television when I go to bed." c. "I just can't seem to stay awake during that class because it's boring." d. "I guess I need to be more careful about my curfew on school nights.

Ans A The average number of hours of sleep that teens require per night is 8.5 to 9.5 due to rapid growth that occurs during these years. Following a curfew and limiting distractions at bedtime can help provide the student with adequate hours of sleep each night.

With summer approaching, the nurse discusses sun safety with a group of adolescents. Which suggestion is most likely to be followed? a. Limit sun exposure between 10:00 AM and 2:00 PM. b. Wear sunglasses. c. Do not attempt to get a tan. d. Wear a hat when in the sun.

Ans B 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.

The nurse is promoting nutrition to a teen who is going through a growth spurt. Which food should the nurse recommended for its high iron content? a. fat-free milk b. whole grain bread c. organic carrots d. fresh orange juice

Ans B Whole grain bread contains high amounts of iron and is a type of food the child would not have an aversion to. Milk is a good source of vitamin D. Carrots are high in vitamin A. Orange juice is a good source for vitamin C.

The parent of a 14-year-old girl voices concerns that the child is likely to be not getting enough nutrients. How many calories should be ingested by the child daily? a. The adolescent girl who is active should consume about 2,000 calories per day. b. The range for caloric intake for an adolescent girl is 1,700--2,000 per day. c. At least 1,800 calories per day is recommended for an adolescent girl. d. The adolescent should not consume more than 2,500 calories per day.

Ans A Adolescent girls who are moderately active require about 2,000 calories per day.

An adolescent who admits to using cocaine frequently comes to the emergency center with symptoms of chest pain, is diaphoretic, and is hypertensive. When establishing care, what priority assessment data does the nurse need? a. heart rhythm b. temperature c. time of last cocaine use d. cardiac enzymes

Ans A Cocaine produces the physical effects of chest pain, increased pulse and respiration rates, increased temperature, increased blood pressure and decreased appetite. It can be a major cause of cardiovascular arrest in young adults. The priority in this situation would be to assess heart rhythm for fatal arrhythmias. The remainder of answer choices are correct, but they are not the priority.

The parent of a Black adolescent voices concern to the nurse because the child, "has gotten her period before all of her friends." How should the nurse respond? a. "I will be sure to let the health care provider know this. We don't want to miss something that may be wrong." b. "How old are most of her friends? Maybe that's the issue instead of it being a sign of something abnormal." c. "That must be difficult, but on average Black girls start their period earlier than other ethnicities." d. "Some girls just get their period earlier than others."

Ans C Menarche, the first menstrual period, usually begins between the ages of 9 and 15 years (average 12.8 years), but on average Black girls reach menarche earlier than girls of other ethnic groups. 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.

The nurse is collecting data from an adolescent being seen for a well-child check-up. During the interview, the adolescent reports sleeping about 6 hours per night during the week but is able to sleep 8 to 9 hours per night on the weekend. What response by the nurse is most appropriate? a. "I am glad to see you are getting the amount of rest you need." b. "You would benefit by trying to sleep a little less on the weekends." c. "Sleeping during the weekend to catch up on missed rest is a good thing to do." d. "Let's talk about ways to increase the amount of rest you get during the week."

Ans D It is recommended that adolescents get 8 to 9.5 hours of sleep per night. Adolescents who do not get adequate rest during the week often sleep more hours on the weekend. The best practice would be to determine ways to improve daily rest patterns.

Teachers are in a class on drug use taught by the school nurse. The nurse instructs the teachers to observe for which physical symptoms from misuse of cough medications with codeine? Select all that apply. a. lack of coordination b. enlarged pupils c. excessive itching d. confusion e. giggling

Ans A, C, and D Adolescents who misuse cough medications with codeine can have a drunken appearance, a lack of coordination, confusion, and excessive itching. They may also be found with empty bottles of cough medications. Enlarged pupils would be seen with marijuana use. Excessive giggling and silliness can be seen with stimulant ingestion.

A high school athlete comes to the emergency department with hypertension, aggressiveness, and psychosis. What question would be important for the nurse to ask the client? a. "Do you take anabolic steroids?" b. "Do you take human growth hormone?" c. "Do you take amphetamines?" d. "Do you take cocaine?"

Ans A Anabolic steroids are used by adolescents who play sports. They are used to enhance the adolescent's athletic ability. They produce euphoria and lessened fatigue. Unfortunately, steroid use can also lead to early closure of the epiphyseal plate, acne, elevated triglyceride levels, hypertension, aggressiveness, and possibly psychosis. Human growth hormone is also used to enhance athletic performance. The side effects of it are joint pain and swelling and the development of diabetes. Amphetamines provide a sense of well-being, alertness, and self-esteem. They can produce paranoia and extreme restlessness. Cocaine produces increased pulse and respirations, increased temperature, and blood pressure and decreased appetite.

The school nurse is preparing a presentation for a group of teachers about teen suicide. When discussing risk factors for this occurrence which should be included? (Select all that apply.) a. Sexual promiscuity b. Substance use disorder c. Family history of depression d. Homosexuality e. History of mental illness

Ans B, D, E Suicide is the third leading cause of death in teens and young adults. There are identifiable risk factors that place a teen at an increased risk for suicide. These risk factors include substance use disorder, a history of mental illness, and homosexuality. A history of depression in the teen, not in family members, is considered a risk factor for suicide. Sexual promiscuity is not considered an increased risk for suicide.

The nurse is discussing an adolescent's development with the client's parents. Which statement by the parents indicate an understanding of the nurse's teaching? a. "We will work toward ensuring our adolescent is developing trusting relationships." b. "It is most important for our adolescent to achieve independence from our dominance." c. "Our adolescent is working toward achieving a sense of personal identity." d. "It is vital our adolescent learns to help others achieve their goals."

Ans C According to Erikson's theory of psychosocial development, the major challenge of adolescence is the achievement of identity. Achieving independence from parental domination is another task of adolescence, but not the ultimate one. Helping other adolescents achieve higher goals is not a part of Erikson's theory of psychosocial development. Developing trust occurs in infancy.

The nurse is caring for an adolescent athlete who is being seen for a fractured arm. The adolescent's parent reports that this is the third sports injury in the past 2 years. The parent asks the nurse why the child who seems so healthy seems to continue to have injuries. What information should be included in the nurse's response? a. These are accidents and random in occurrence. b. There may be some underlying problems that the child should be evaluated for. c. The bones, joints and tendons of teens are vulnerable to injury due to their rapid state of growth. d. Some children are accident prone.

Ans C 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 is most likely the result of the stage of physical growth experienced during adolescence. There is no evidence the child has any underlying medical conditions.

The nurse is educating a 17-year-old adolescent after a new diagnosis of diabetes. What does the nurse understand about teaching an adolescent? a. The adolescent will likely have the greatest influence on one's own decisions. b. The parents will need to be instructed separately from the adolescent. c. The siblings of the adolescent will need to be taught healthy cooking classes related to diabetes. d. The adolescent will respond best to teaching about how to avoid future complications.

Ans A 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.

What anticipatory guidance can the nurse provide the girl who has noted the development of breast buds? a. Menarche should follow in about 2 years. b. The growth spurt will begin immediately with menarche. c. Breast development will be complete with 12 months. d. Adult height will be reached at the time of menarche.

Ans A Menarche usually follows within 2 years of the first signs of breast development. Peak height velocity (PVH) in girls occurs 6 to 12 months following menarche. It does not follow immediately. Breast development progresses through several stages and will not be complete until late puberty. Adult height is not reached at the time of menarche but about 6 to 12 months following menarche.

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? a. The adolescent's need for privacy should be respected. b. The adolescent should be encouraged to call friends often. c. The adolescent's need for parental support should be discussed. d. The adolescent should be given freedom to participate in unit activities as desired.

Ans A 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 school nurse has just completed a presentation about normal adolescent physical growth to a group of adolescent students. Which comments by the adolescents indicate understanding of the nurse's presentation? (Select all that apply.) a. "Since I'm a 15-year-old guy, I still have a chance to get taller over the next couple of years." b. "Since I just had my first period and I am 14 years old, I probably haven't reached my peak height yet." c. "It doesn't seem fair that girls typically have more fat than boys." d. "Our hormones are sure going to cause us to change a lot over our teenage years." e. "It's strange how girls start getting taller before boys start getting taller."

Ans A, B, C, D, E All of these statements demonstrate understanding of normal physical growth during adolescence. The rapid growth during adolescence is secondary only to that of the infant years and is a direct result of the hormonal changes of puberty. Boys' growth spurt occurs later than girls' and usually begins between the ages of 10½ and 16 years and ends sometime between the ages of 13½ and 17½ years. Peak height velocity occurs at approximately 12 years of age in girls or at about 6 to 12 months after menarche. Muscle mass increases in boys and fat deposits increase in girls.

A 16-year-old female adolescent reports to the nurse that she is trying to improve her diet to loose weight. When assessing her dietary intake for adequacy which findings indicate the need for further education? (Select all that apply.) a. 1,000 mg calcium intake per day b. Fat comprises about 40% of the daily intake c. Protein comprises approximately 30% of the daily dietary intake d. Average caloric intake is 2,500 per day e. Consumes 8--10 mg of iron each day

Ans A, D, E The recommended calcium intake for teens is 1,300 mg/day. The average caloric intake is approximately 2,000. An intake of 2,500 calories per day is likely excessive and should be reduced. Fat intake should compose 25% to 35% of the daily diet. Daily iron intake for teen girls should be approximately 15 mg per day.

A 15-year-old adolescent is seen at a health care facility for facial acne. When counseling the teen, the nurse would teach that the basic cause of acne is: a. lack of showering adequately after gym class. b. activation of androgen hormones. c. vitamin deficiency from an inadequate diet. d. thyroid-gland secretions increasing with adolescence.

Ans B Acne occurs in adolescence as the result of hormone influence. With increased androgen production the sebaceous glands become more active. With increased testosterone production (in both boys and girls) increased sebum is produced. These increased hormone productions lead to the development of acne. Showering will certainly lead to cleaner skin and the removal of oils but the lack of showering does not cause acne. Diet and thyroid hormones do not play a role in the development of acne.

A 15-year-old client's parent comments on the fact that the adolescent seems to always choose the opposite of what everyone else wants and that mood swings are a common occurrence. What statement shows the nurse that the client's parent understands these changes? a. "I know that my adolescent is doing this because of all the hormones." b. "This is common for this age group and it will get better with time." c. "This is my adolescent's temperament, and we will have to learn how to deal with it." d. "My adolescent will never find anyone to live with if the adolescent acts like this."

Ans B During middle adolescence, the adolescent spends more time ignoring adult authority and becomes more reliant on peer relationships. Adolescents might choose a stance directly opposite that of their parents and use peer support to back their ideas. Mood swings are a common occurrence during the adolescent period. They tend to smooth out and the adolescent will become more introspective. By late adolescence emotions become more consistent. Making statements such as "my adolescent will never find anyone to live with" or "we will have to learn to live with [my adolescent's temperament]" does not demonstrate the parent has a good idea of what is happening during the adolescent period.

A 15-year-old adolescent tells the nurse about a desire to get a tattoo. What response by the nurse is most appropriate? a. "You need to remember that a tattoo will be with you forever." b. "Tattoos are invasive and there is the potential for disease with their application." c. "You are too young to have a tattoo." d. "If you are determined to get a tattoo you need to get a small one so you can hide it if you want."

Ans B Piercings and tattoos are becoming increasingly common in teens. It is important to ensure that the teen and family understand the potential risk for disease with the application of the tattoo. The teen is young, but that does not change the fact he wants to get a tattoo. Reminding the teen that it is a permanent alteration in the skin is important but not the most important response by the nurse.

The school nurse is monitoring a student athlete that experienced a concussion 2 weeks ago during a soccer game. The student reports having academic issues in a course in which the student previously had no difficulty. Which action should the nurse's take first? a. Immediately notify the student's parents that their child should see the healthcare provider b. Ask the student to describe the academic issues the student is having in the class c. Ask the student's teacher if the student is following the recommendations given to him or her for cognitive activity d. Perform a neurologic assessment on the student to see if there are any changes in neurologic status

Ans B Talking with the teacher and performing a neurologic 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 or she is having. Contacting the parents immediately would not be warranted until sufficient information is collected.

The nurse is assessing a 12=year-old boy. Which assessment finding(s) are consistent with the child's age? Select all that apply. a. coarse pubic hair b. pubic hair spreading to the sides c. enlargement of the testes d. longer extremities relative to trunk e. changes in voice

Ans B, C, D During early adolescence, 10 to 13 years old, the male has pubic hair that is beginning to curl and spreads laterally. Growth and enlargement of the testes in the scrotum and continued lengthening of the penis occurs. The child has a leggy look due to extremities growing faster than the trunk. During middle adolescence, 14 to 16 years of age, pubic hair of the male becomes coarser in texture and voice changes are noted. The voice becomes more masculine due to the rapid enlargement of the larynx and pharynx as well as lung changes.

A 16-year-old adolescent is talking with the nurse at a local health clinic about skin care. Which comments by the adolescent does the nurse determine require additional conversation? (Select all that apply.) a. "My mom had melanoma so she always makes me wear a sunscreen with an SPF of 30." b. "My favorite time of day to be outside is the middle of the day, around noon." c. "I only tan before going on spring break to get a base tan so I won't burn." d. "The more exposure and burns I get now will toughen my skin so I won't get skin cancer when I'm older." e. "Our coach makes us wear sun-protective clothes when we practice outside on the weekends."

Ans B, C, D 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.

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? a. Water sports injuries b. Drug and alcohol use prevention c. Poison prevention d. Motor vehicle safety

Ans D 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.