CHAP 18 PEDI

Which of the following is the most commonly used method in completed suicides? A. Firearms B. Drug overdose C. Self-inflicted laceration D. Carbon monoxide poisoning

A. Firearms are the most commonly used instruments in completed suicides among both males and females. For adolescent boys, firearms are followed by hanging and overdose. For adolescent females, overdose and strangulation are the next most common means of completed suicide. The most common method of suicide attempt is overdose or ingestion of potentially toxic substances such as drugs. The second most common method of suicide attempt is self-inflicted laceration. Carbon monoxide poisoning is not one of the more frequent forms of suicide completion.

Which of the following statements is correct about childhood obesity? A. Heredity is an important factor. B. Most children have an underlying disease as a cause. C. The percentage of children who are obese is decreasing. D. The prevalence of childhood obesity is similar across socioeconomic groups.

A. Heredity is an important factor that contributes to obesity. Identical twins reared apart tend to resemble their biologic parents to a greater extent than their adoptive parent. It is difficult to distinguish between hereditary and environmental factors. Underlying diseases such as hypothyroidism and hyperinsulinism account for only a small number of cases of childhood obesity. The number of overweight and obese children is increasing in the United States. In the United States, lower socioeconomic groups have a higher prevalence of obesity, especially among girls.

An adolescent girl tells the nurse that she thinks about death all of the time. The nurse asks her if she has a specific plan. This question should be considered which of the following? A. An essential part of the assessment B. Suggesting that the adolescent needs a plan C. Inappropriate until parents are present for discussion D. A closed-ended question that will inhibit assessment

A. Routine health assessments of adolescents should include questions that assess the presence of suicidal ideation or intent. They are essential if the child expresses thoughts about death. Questions such as "Have you ever developed a plan to hurt yourself or kill yourself?" should be part of the assessment. The information about having a plan is an essential part of the assessment and greatly affects the treatment plan. Safety of the adolescent is of primary concern. Asking about a specific plan is a closed-ended question, requiring a yes or no answer. Adolescents who express suicidal feelings and have a specific plan are at particular risk and require further assessment and constant monitoring.

Drug abuse is suspected in an adolescent being seen in the emergency department. Which of the following physical signs is suggestive of barbiturate ingestion? A. Ataxia B. Cyanosis C. Sweating D. Tachycardia

A. The physical signs of barbiturate ingestion include ataxia and slurred speech. Cyanosis is indicative of opiate use. Sweating may be suggestive of amphetamines administered by a parenteral route. Cocaine use will produce tachycardia.

A 13-year-old boy comes to the school nurse complaining of sudden and severe scrotal pain. He denies any trauma to the scrotum. What is the most appropriate nursing action? a. Refer him for immediate medical evaluation. b. Administer analgesics and recommend scrotal support. c. Apply an ice bag and observe for increasing pain. d. Reassure the adolescent that occasional pain is common with the changes of puberty.

ANS: A Any adolescent boy with redness, swelling, or pain in the scrotum is referred for immediate evaluation. These are signs of testicular torsion, which is a medical emergency. If the possibility of testicular torsion is eliminated, appropriate interventions include administering analgesics and recommending scrotal support. applying an ice bag and observing for increasing pain. and reassuring the adolescent that occasional pain is common with the changes of puberty.

An important distinction in understanding substance abuse is that drug misuse, abuse, and addiction are considered what? a. Voluntary behaviors based on psychosocial needs b. Problems that occur in conjunction with addiction c. Involuntary physiologic responses to the pharmacologic characteristics of drugs d. Legal use of substances for purposes other than medicinal.

ANS: A Drug misuse, abuse, and addiction are considered voluntary behaviors. Cultural norms define what is abuse and misuse. Addiction is a psychologic dependence on a substance with or without physical dependence. Physical dependence is an involuntary response to the pharmacologic characteristics of the drug such as an opiate or alcohol. Legality is not always a factor in substance abuse. Legal substances such as alcohol and tobacco can also be misused or abused and can cause addiction.

What method is the most commonly used in completed suicides? a. Firearms b. Drug overdose c. Self-inflicted laceration d. Carbon monoxide poisoning

ANS: A Firearms are the most commonly used instruments in completed suicides among both males and females. For completed suicides in adolescent boys, firearms are followed by hanging and overdose. For adolescent girls, overdose and strangulation are the next most common means of completed suicide. The most common method of suicide attempt is overdose or ingestion of potentially toxic substances such as drugs. The second most common method of suicide attempt is self-inflicted laceration. Carbon monoxide poisoning is not one of the more frequent forms of suicide completion.

What is a priority goal in the postpartum care of an adolescent mother? a. Prevention of subsequent pregnancies b. Ensuring that the father of the baby cares for the child c. Returning the mother to a prepregnancy lifestyle d. Facilitating formula feeding to minimize interruptions

ANS: A Postpartum care of the adolescent is directed at preventing subsequent pregnancies and enhancing life outcomes for the teen parents and child. Health care programs should provide comprehensive contraceptive services at the same time the child is seen for appointments. Ensuring the father of the baby cares for the child is not part of the postpartum care of the mother. The adolescent mother cannot return to a prepregnancy lifestyle. She now has an infant to care for. Breastfeeding is recommended for the infant. The nurse and mother should explore the best nutrition for both the mother's needs and those of the infant.

A pregnant 15-year-old adolescent tells the nurse that she did not use any form of contraception because she was afraid her parents would find out. The nurse should recognize what? a. This is a frequent reason given by adolescents. b. This suggests a poor parent-child relationship. c. This is not a good reason to not get contraception. d. This indicates that the adolescent is unaware of her legal rights.

ANS: A This is one of the most common reasons given by teenagers for not using contraception. Although it is optimum for the parents to be involved in the health care of adolescents, some adolescents require confidential care. Privacy is important as they develop their personal identity and establish relationships. The adolescent may be concerned about parental judgment. The adolescent should discuss with the health care provider contraception that meets her needs; some of the longer acting birth control methods may be preferable. The adolescent did not tell the nurse that she was unaware that she could legally obtain contraceptive materials; she was concerned about her parents.

During a well-child visit, the nurse practitioner provides guidance about promoting healthy eating in a child who is overweight. What does the nurse advise? a. Slow down eating meals. b. Avoid between-meal snacks. c. Include low-fat foods in meals. d. Use foods that child likes as special treats.

ANS: A When a child slows down the eating process, it is easier to recognize signs of fullness. If food is consumed rapidly, this feedback is lost. Regular meals and snacks are encouraged to prevent the child from becoming too hungry and overeating. Low-fat foods are usually higher in calories than the regular versions. Nutritional labels should be checked and foods high in sugar and calories avoided. Food should not be used as a special treat or reward; this encourages the child to use food as comfort measures in response to boredom and stress.

A sexually active adolescent asks the school nurse about prevention of sexually transmitted infections (STIs). What should the nurse recommend? a. Use of condoms b. Prophylactic antibiotics c. Any type of contraception method d. Withdrawal method of contraception

ANS: A When used appropriately, condoms provide a barrier to the organisms that cause STIs. Prophylactic antibiotics are not recommended; they are effective only against bacteria, not viruses. Only condoms create a physical barrier that prevents contact with the organisms.

The nurse is teaching an adolescent female with primary dysmenorrhea foods that are natural diuretics. What foods should the nurse include in the teaching plan? (Select all that apply.) a. Peaches b. Asparagus c. Watermelon d. Wheat bread e. Dairy products

ANS: A, B, C Natural diuretics such as asparagus, cranberry juice, peaches, parsley, or watermelon may help reduce edema and related discomforts of primary dysmenorrhea. Wheat bread and dairy products are not natural diuretics.

The nurse is preparing to administer danazol (Danocrine) to a patient with endometriosis. What are the side effects of this medication? (Select all that apply.) a. Insomnia b. Hot flashes c. Amenorrhea d. Increased libido e. Vaginal secretions

ANS: A, B, C The side effects of danazol are amenorrhea, hot flashes, vaginal dryness, insomnia, and decreased libido.

The clinic nurse is assessing an adolescent on a topical antibacterial agent. The nurse should assess for which side effects that can be seen with topical antibacterial agents? (Select all that apply.) a. Burning b. Dryness c. Dry eyes d. Erythema e. Nasal irritation

ANS: A, B, D Side effects of topical antibacterial medications include erythema, dryness, and burning; using the medications every other day will decrease the adverse effects. Dry eyes and nasal irritation are seen with use of isotretinoin, 13-cis-retinoic acid (Accutane).

The nurse is teaching an adolescent female about the symptoms of premenstrual syndrome (PMS). What symptoms should the nurse include in the teaching session? (Select all that apply.) a. Headaches b. Fluid retention c. Increased energy d. Emotional changes e. Premenstrual cravings

ANS: A, B, D, E Symptoms of PMS include fluid retention (abdominal bloating, pelvic fullness, edema of the lower extremities, breast tenderness, and weight gain), behavioral or emotional changes (depression, crying spells, irritability, panic attacks, and impaired ability to concentrate), premenstrual cravings (sweets, salt, increased appetite, and food binges), headache, and backache. Fatigue rather than increased energy occurs.

The nurse is teaching an adolescent about the use of tretinoin (Retin-A). What should the nurse include in the teaching session? (Select all that apply.) a. Begin with a pea-sized dot of medication. b. Apply additional medication to the throat. c. Use sunscreen daily and avoid the sun when possible. d. Divide the medication into the three main areas of the face. e. Apply the medication immediately after washing the face.

ANS: A, C, D Tretinoin is available as a cream, gel, or liquid. This drug can be extremely irritating to the skin and requires careful patient education for optimal usage. The patient should be instructed to begin with a pea-sized dot of medication, which is divided into the three main areas of the face and then gently rubbed into each area. The avoidance of the sun and the daily use of sunscreen must be emphasized because sun exposure can result in severe sunburn. The medication should not be applied for at least 20 to 30 minutes after washing to decrease the burning sensation. The medication should not be applied to the throat.

The school nurse is teaching a group of adolescent females which measures to take to prevent genital tract infections. What should the nurse include in the teaching session? (Select all that apply.) a. Use condoms. b. Douche once a week. c. Avoid tight-fitting clothing. d. Limit exposure to bubble baths. e. Avoid colored and scented toilet tissue.

ANS: A, C, D, E Measure to take to prevent genital tract infections include using condoms, avoiding tight-fitting clothing, limiting exposure to bubble baths, and avoiding colored and scented toilet tissue. Douching should be avoided.

What conditions are physical complications of obesity? (Select all that apply.) a. Type 2 diabetes mellitus b. QT interval prolongation c. Fatty liver disease d. Gastrointestinal dysfunction e. Abnormal growth acceleration f. Dental erosion

ANS: A, C, E Physical complications of obesity include type 2 diabetes mellitus, which is reaching epidemic proportions in children and adolescents; fatty liver disease not related to alcohol consumption; and abnormal growth acceleration in which overweight children tend to be taller and mature earlier than children who are not overweight. Prolonged QT intervals, gastrointestinal dysfunction, and dental erosion are physical complications observed in children or adolescents who have eating disorders such as anorexia nervosa or bulimia.

The nurse is teaching an adolescent with premenstrual syndrome (PMS) dietary measures to relieve the symptoms of PMS. What should the nurse include in the teaching session? (Select all that apply.) a. Limit salt in the diet. b. Limit legumes in the diet. c. Include red meat in the diet. d. Include whole grains in the diet. e. Limit consumption of refined sugar.

ANS: A, D, E Dietary treatment for PMS includes limiting consumption of refined sugar, salt, red meat, alcohol, and caffeinated beverages. Women can be encouraged to include whole grains, legumes, seeds, nuts, vegetables, fruits, and vegetable oils in their diet.

The nurse is teaching an adolescent girl strategies to relieve dysmenorrhea. What should the nurse include in the teaching session? (Select all that apply.) a. Effleurage b. Diet high in fat c. Limiting exercise d. Use of a heating pad e. Massaging the lower back

ANS: A, D, E Dysmenorrhea can be relieved by heat (heating pad or hot bath), which minimizes cramping by increasing vasodilation and muscle relaxation and minimizing uterine ischemia. Also, massaging the lower back can reduce pain by relaxing paravertebral muscles and increasing the pelvic blood supply. Soft, rhythmic rubbing of the abdomen (effleurage) is useful because it provides a distraction and an alternative focal point. A low-fat, not a high-fat, diet can help with dysmenorrhea, and exercise should not be limited because exercise can be beneficial.

What menstrual disorders are indications for a pelvic examination? (Select all that apply.) a. Amenorrhea b. Dyspareunia c. Impaired fertility d. Irregular uterine or vaginal bleeding e. Dysmenorrhea unresponsive to therapy

ANS: A, D, E Indications for a pelvic examination include amenorrhea, irregular uterine or vaginal bleeding, and dysmenorrhea unresponsive to therapy. Impaired fertility is not an indication for a pelvic examination; it can be a result of endometriosis. Dyspareunia (painful intercourse) is not an indication for a pelvic examination but may be a sign of endometriosis.

A 15-year-old girl tells the school nurse that she has not started to menstruate yet. Onset of secondary sexual characteristics was about 2 1/2 years ago. The nurse should take which action? a. Explain that this is not unusual. b. Refer the adolescent for an evaluation. c. Make an assumption that the adolescent is pregnant. d. Suggest that the adolescent stop exercising until menarche occurs.

ANS: B A referral is indicated. Menarche should follow the onset of secondary sexual development within 2 1/2 years. A careful examination is done to reveal any physical abnormalities, signs of androgen excess, and congenital defects of the genital tract. The lack of the onset of menstruation at this age is a potential indication of a physical problem. Assuming that the adolescent is pregnant is inappropriate. The nurse does not have any indication that the adolescent is sexually active. The amount of exercise should be assessed before suggesting that the adolescent stop exercising until menarche occurs.

What statement is true concerning adolescent suicide? a. A sense of hopelessness and despair is a normal part of adolescence. b. Gay and lesbian adolescents are at a particularly high risk for suicide. c. Problem-solving skills are of limited value to the suicidal adolescent. d. Previous suicide attempts are not an indication for completed suicides.

ANS: B A significant number of teenage suicides occur among homosexual youths. Gay and lesbian adolescents who live in families or communities that do not accept homosexuality are likely to experience low self-esteem, self-loathing, depression, and hopelessness. Most adolescents do not experience this stage of life as a time of despair. Depressive symptoms, acting-out behaviors, and talk of suicide need to be taken seriously. At-risk teenagers include those who are depressed, have poor problem-solving skills, or use drugs and alcohol. A history of a previous suicide attempt is a serious indicator for possible suicide completion in the future.

The nurse is caring for an adolescent brought to the hospital with acute drug toxicity. Cocaine is believed to be the drug involved. Data collection by the nurse should include what information? a. Drug's actual content b. Mode of administration c. Adolescent's level of interest in rehabilitation d. Function the drug plays in the adolescent's life

ANS: B Cocaine is available in two forms, water soluble and non-water soluble, and can be administered through multiple routes. For treatment purposes, it is essential to know the type of drug and route of administration. Because cocaine is a street drug, the actual content usually cannot be identified. The adolescent's level of interest in rehabilitation and the function that drug plays in the adolescent's life are concerns to be addressed after the initial emergency treatment is instituted.

It is important that women with anogenital warts caused by the human papillomavirus (HPV) receive adequate treatment because this sexually transmitted infection increases the risk of what? a. Gonorrhea b. Cervical cancer c. Chlamydial infection d. Urinary tract infection

ANS: B Infection with HPV is associated with cervical dysplasia and cervical cancer. A vaccine has been developed and is recommended for young women.

The clinic nurse is evaluating a patient with a vaginal infection. The nurse knows that the normal vaginal pH is in which range? a. 3.0 to 4.0 b. 4.0 to 5.0 c. 5.0 to 6.0 d. 6.0 to 7.0

ANS: B Normal vaginal secretions are acidic, with a pH range of 4.0 to 5.0.

An adolescent girl is brought to the hospital emergency department by her parents after being raped. The girl is calm and controlled throughout the interview and examination. The nurse should recognize this behavior is what? a. A sign that a rape has not actually occurred b. One of a variety of behaviors normally seen in rape victims c. Indicative of a higher than usual level of maturity in the adolescent d. Suggestive that the adolescent had severe emotional problems before the rape occurred

ANS: B Rape victims display a wide range of behaviors. A controlled manner may be an attempt to maintain composure while hiding the inner turmoil. Because the observed behavior is within the range of expected behavior, there are no data to indicate that a rape has not actually occurred, that the adolescent is unusually mature, or that she had severe emotional problems before the rape occurred.

An adolescent girl tells the nurse that she is very suicidal. The nurse asks her if she has a specific plan. How should asking about a specific plan be viewed? a. Not a critical part of the assessment b. An appropriate part of the assessment c. Suggesting that adolescent needs a plan d. Encouraging adolescent to devise a plan

ANS: B Routine health assessments of adolescents should include questions that assess the presence of suicidal ideation or intent. Questions such as "Have you ever developed a plan to hurt yourself or kill yourself?" should be part of that assessment. Adolescents who express suicidal feelings and have a specific plan are at particular risk and require further assessment and constant monitoring. The information about having a plan is an essential part of the assessment and greatly affects the treatment plan.

What is the most significant factor in distinguishing those who commit suicide from those who make suicidal attempts or threats? a. Level of stress b. Social isolation c. Degree of depression d. Desire to punish others

ANS: B Social isolation is a significant factor in distinguishing adolescents who will kill themselves from those who will not. It is also more characteristic of those who complete suicide versus those who make attempts or threats. Although the level of stress, the degree of depression, and the desire to punish others are contributing factors in suicide, they are not the most significant factor in distinguishing those who complete suicide from those who attempt suicide.

What is a major physical risk for young adolescents during pregnancy? a. Osteoporosis frequently develops. b. Fetopelvic disproportion is a common problem. c. Delivery is usually precipitous in this age group. d. Pregnancy will adversely affect the adolescent's development.

ANS: B Teenagers younger than 15 years of age have increased obstetric risks. Fetopelvic disproportion is one of the most common complications. Osteoporosis occurs later in life and is not related to adolescent pregnancy. Prolonged, not precipitous, labor is common in this age group. Teenage mothers are socially, educationally, psychologically, and economically disadvantaged. Support is necessary because the tasks of motherhood are superimposed on adolescent development tasks.

What do nursing responsibilities regarding weight gain for an adolescent with anorexia nervosa include? a. Administer tube feedings until target weight is achieved. b. Restore body weight to within 10% of the adolescent's ideal weight. c. Encourage continuation of strenuous exercise as long as adolescent is not losing weight. d. Facilitate as rapid a weight gain as possible with a high-calorie diet.

ANS: B The restoration of body weight to a target weight or endpoint within 10% of ideal body weight is one of the main goals of therapy. Strenuous exercise is avoided as part of the need to modify behaviors. Tube feedings are intrusive and are avoided. They should only be used when other measures have failed. Weight restoration is accomplished slowly. The goal is 1 kg/wk to avoid the risk of metabolic and cardiac problems. Slow weight gain can minimize anxiety and depression.

What statement is true about gonorrhea? a. It is caused by Treponema pallidum. b. Treatment of all sexual contacts is essential. c. Topical application of medication to the lesions is necessary. d. Therapeutic management includes multidose administration of penicillin.

ANS: B The treatment plan should include finding and treating all sexual partners. Gonorrhea is caused by Neisseria gonorrhoeae. Syphilis is caused by T. pallidum. Systemic therapy is necessary to treat this disease. Primary treatment is with different antibiotics because of N. gonorrhoeae's resistance to penicillin.

What is the usual presenting symptom for testicular cancer? a. Solid, painful mass b. Hard, painless mass c. Scrotal swelling and pain d. Epididymis easily palpated

ANS: B The usual presenting symptom for testicular cancer is a heavy, hard, painless mass that is either smooth or nodular and palpated on the testes. Pain is not usually associated with a testicular tumor. Scrotal swelling needs to be evaluated. The epididymis is easily palpated in a normal scrotum.

The nurse is teaching a class on obesity prevention to parents in the community. What is a contributing factor to childhood obesity? a. Birth weight b. Parental overweight c. Age at the onset of puberty d. Asian ethnic background

ANS: B There is a high correlation between parental adiposity and childhood adiposity. Obese children do not have higher birth weights than nonobese children. Early menarche is associated with obesity, but the age of puberty is not a contributing factor. African Americans and Hispanics have disproportionately high percentages of overweight individuals, but Asians do not.

The nurse is caring for an adolescent male with gynecomastia. What groups of drugs can induce gynecomastia in male adolescents? (Select all that apply.) a. Oral antibiotics b. Oral ketoconazoles c. Calcium channel blockers d. Histamine-2 receptor blockers e. Cancer chemotherapeutic agents

ANS: B, C, D, E Gynecomastia may be drug induced; calcium channel blockers, cancer chemotherapeutic agents, histamine-2 receptor blockers, and oral ketoconazoles have all been shown to cause the disorder. Oral antibiotics have not been shown to cause gynecomastia.

What are risk factors of testicular cancer? (Select all that apply.) a. Hispanic b. Infertility c. Alcohol use d. Tobacco use e. Family history

ANS: B, D, E Risk factors of testicular cancer include infertility, tobacco use, and a family history. White, not Hispanic, ethnicity is a high risk, and alcohol use is not a risk.

An adolescent patient has been diagnosed with a vulvovaginal candidiasis (yeast infection). The nurse expects the health care provider to recommend which vaginal cream? a. Premarin b. Estradiol (Estrace) c. Miconazole (Monistat) d. Clindamycin phosphate (Cleocin)

ANS: C A number of antifungal preparations are available for the treatment of vulvovaginal candidiasis infections. Many of these medications (e.g., miconazole [Monistat] and clotrimazole [Gyne-Lotrimin]) are available as over-the-counter (OTC) agents. Premarin and Estrace are estrogen vaginal creams and are used to treat vaginal dryness. Cleocin is an antibacterial vaginal cream used to treat bacterial vaginal infections.

The nurse has determined that an adolescent's body mass index (BMI) is in the 90th percentile. What information should the nurse convey to the adolescent? a. The adolescent is overweight. b. The adolescent has maintained weight within the normal range. c. The adolescent is at risk for becoming overweight. d. Nutritional supplementation should occur at least three times per week

ANS: C Adolescents with BMIs between the 85th and 94th percentile for age and gender are at risk for becoming overweight. Adolescents with BMIs greater than the 95th percentile are classified as overweight. Nutritional guidance, not supplementation, is needed.

What statement is true about smoking in college students? a. The rate of smoking cigarettes is declining. b. Smokeless tobacco use is rising dramatically. c. Regular cigar use is becoming more common. d. Students in the health professions do not smoke.

ANS: C Approximately 8.5% of college students smoke cigars on a regular basis. Among college students, the rate of cigarette smoking is rising. At last report, 28.5% of this group smoked cigarettes. Use of smokeless tobacco is declining overall. Students in the health professions do smoke.

The school nurse suspects a testicular torsion in a young adolescent student. What action should the nurse take? a. Place a warm moist pack on the scrotal area. b. Instruct the adolescent to lie down and elevate the legs. c. Refer the adolescent for immediate medical evaluation. d. Suggest that the adolescent wear a scrotum-protecting guard.

ANS: C Because torsion may result from trauma to the scrotum, school nurses are likely to encounter such injuries and should refer the child or adolescent for medical evaluation immediately. It would not be appropriate to apply warmth, elevate the legs, or tell the adolescent to wear a scrotum-protecting guard because these actions could delay treatment.

The nurse's role in facilitating successful childrearing in unmarried teenage mothers includes what? a. Facilitating marriage between the mother and father of the baby b. Teaching the adolescent the long-term needs of the growing child c. Providing information and feedback about positive parenting skills d. Encouraging the infant's grandmother to take responsibility for care

ANS: C Competence in a teenage mother is increased when feedback is provided about positive parenting skills and use of community resources. The nurse can identify and refer the mother to programs such as support groups for adolescent mothers, infant stimulation programs, and parenting programs. Facilitating marriage between the mother and the father of the baby may produce additional stress and detract from their ability to care for the infant. Encouraging the infant's grandmother to take responsibility for care would decrease the mother's ability to develop successful childrearing behaviors. Supportive families can provide assistance to enable the teenage mother to complete school. Many adolescents do not have a future perspective for themselves. The nurse includes information on normal infant development to aid the mother in having reasonable expectations.

A 14-year-old boy is of normal weight, and his parents are concerned about bilateral breast enlargement. The nurse's discussion of this should be based on what? a. The presence of too much body fat b. Symptom that a hormonal imbalance is present c. Most likely part of normal pubertal development d. Indication that he is developing precocious puberty

ANS: C Gynecomastia is common during midpuberty in about one third of boys. For most, the breast enlargement disappears within 2 years. Although breast enlargement in overweight children can indicate too much body fat, in children of normal body weight, it is a normal occurrence. If the gynecomastia persists beyond 2 years, then a hormonal cause may need to be investigated. Precocious puberty is the early onset of puberty, before age 9 years in boys

What goal is most important when caring for a child with anorexia nervosa (AN)? a. Limit fluid intake. b. Prevent depression. c. Correct malnutrition. d. Encourage weight gain.

ANS: C In children diagnosed with AN or bulimia nervosa, the priority consideration is to correct the malnutrition. Severe malnutrition, electrolyte disturbances, vital sign abnormalities, and psychiatric disorders may be present. Careful monitoring is necessary to avoid complications. Often fluid intake is restricted by individuals with AN. Fluid balance must be restored. Preventing depression is important, but the correction of potentially life-threatening malnutrition takes precedence. After the initial malnutrition is corrected, then a plan is established for nutritional therapy.

Descriptions of young people with anorexia nervosa (AN) often include which criteria? a. Impulsive b. Extroverted c. Perfectionist d. Low achieving

ANS: C Individuals with AN are described as striving for perfection, which may manifest in other compulsive disorders. They are also academically high achievers. Impulsive and extroverted personalities are more characteristic of bulimia nervosa.

What behavior is the nurse most likely to assess in an adolescent with anorexia nervosa (AN)? a. Eats in secrecy b. Uses food as a coping mechanism c. Has a marked preoccupation with food d. Lacks awareness of how eating affects weight loss

ANS: C Individuals with AN display great interest in food. They prepare meals for others, talk about food, and hoard food. During meals, food play may occur to appear as if the person is eating. Persons with AN consume a small amount of food, so they have no need to eat in secrecy. Individuals with bulimia nervosa (BN) usually binge privately. Food is not used as a coping mechanism in AN, as is common in BN. Individuals with AN know about the relationship between calorie intake and calorie expenditure. They can regulate intake and then exercise to not gain or to lose weight.

After a treatment plan for acne has been initiated, which time period should the nurse explain to an adolescent before improvement will be seen? a. 2 to 4 weeks b. 4 to 6 weeks c. 6 to 8 weeks d. 8 to 10 weeks

ANS: C Inform patients that after a treatment plan for acne has been initiated, it will take 6 to 8 weeks to appreciate improvement in their skin.

What is true about pelvic inflammatory disease (PID)? a. It can be prevented by proper personal hygiene. b. It is easily prevented by compliance with any form of contraception. c. It may have devastating effects on the reproductive tract of affected adolescents. d. It can potentially cause life-threatening and serious defects in the future children of affected adolescents.

ANS: C PID is a major concern because of its devastating effects on the reproductive tract. Short-term complications include abscess formation in the fallopian tubes, and long-term complications include ectopic pregnancy, infertility, and dyspareunia. PID is an infection of the upper female genital tract, most commonly caused by sexually transmitted infections. Personal hygiene, oral contraceptives, and many other forms of contraception do not prevent transmission of the disease. There is a possibility of ectopic pregnancy but not birth defects in children.

The middle school nurse is planning a behavior modification program for overweight children. What is the most important goal for participants of the program? a. Learn how to cook low-fat meals. b. Improve relationships with peers. c. Identify and eliminate inappropriate eating habits. d. Achieve normal weight during the program.

ANS: C The goal of behavior modification in weight control is to help the participant identify abnormal eating processes. After the abnormal patterns are identified, then techniques, including problem solving, are taught to eliminate inappropriate eating. Learning how to cook low-fat meals can be a component of the program, but the focus of behavior modification is identifying target behaviors that need to be changed. Improving relationships is not the focus of weight management behavior management programs. Achieving normal weight during the program is an inappropriate goal. As the child incorporates the techniques, weight gain will slow. In childhood obesity, the goal is to stop the increase of weight gain.

What statement regarding chlamydial infections is correct? a. The treatment of choice is oral penicillin. b. The treatment of choice is nystatin or miconazole. c. Both men and women may have asymptomatic infections. d. Clinical manifestations include small, painful vesicles on the genital areas.

ANS: C The incidence of asymptomatic chlamydial infections is as high as 50% of men and 75% of women. Symptoms of chlamydial infection in men include meatal erythema, tenderness, itching, dysuria, and urethral discharge. Oral penicillin, nystatin, and miconazole are not the antibiotics of choice. Small, painful vesicles on genital areas are clinical manifestations of herpetic infections.

Tretinoin (Retin-A) is a commonly used topical agent for the treatment of acne. What do nursing considerations with this drug include? a. Sun exposure increases effectiveness. b. Cosmetics with lanolin and petrolatum are preferred in acne. c. Applying of the medication occurs at least 20 to 30 minutes after washing. d. Erythema and peeling are indications of toxicity and need to be reported.

ANS: C The medication should not be applied for at least 20 to 30 minutes after washing to decrease the burning sensation. The avoidance of sun and the use of sunscreen agents must be emphasized because sun exposure can result in severe sunburn. Cosmetics with lanolin, petrolatum, vegetable oil, lauryl alcohol, butyl stearate, and oleic acid can increase comedone production. Erythema and peeling are common local manifestations.

The clinic nurse is evaluating an adolescent with menses that have stopped occurring. The nurse understands that which minimum amount of time should the menses be absent after a period of menstruation to be diagnosed as secondary amenorrhea? a. 3 months b. 4 months c. 5 months d. 6 months

ANS: D A 6-month or more cessation of menses after a period of menstruation is secondary amenorrhea.

The nurse is presenting an educational program to a group of parents about differences between anorexia nervosa (AN) and bulimia nervosa (BN) at a community outreach program. What statement by a parent would indicate a need for additional teaching? a. "A child with AN will turn away from food to cope, but a child with BN turns to food to cope." b. "A child with AN maintains rigid control and is introverted, but a child with BN is an extrovert and frequently loses control." c. "A child with AN denies the illness, but a child with BN recognizes the illness." d. "A child with AN is usually sexually active and seeks intimacy, but a child with BN avoids intimacy and is usually not sexually active."

ANS: D A child with AN is usually the one who avoids intimacy and is not sexually active, but a child BN often seeks intimacy and is sexually active. A child with AN turns away from food to cope with life, maintains rigid control, is introverted, and denies the illness. A child with BN turns to food to cope, is an extrovert who loses control, and recognizes that he or she has an illness.

During a well-child visit, the nurse plots the child's BMI on the health record. What is the purpose of the BMI? a. To determine medication dosages b. To predict adult height and weight c. To identify coping strategies used by the child d. To provide a consistent measure of obesity

ANS: D A consistent measure of the degree of obesity is important to determine whether modification of the body fat component is indicated. Body surface area (BSA), not BMI, is used for medication dosage calculation. The BMI is not a predictor of adult height. A child with a high BMI may use food as a coping mechanism, but the BMI is not correlated with coping strategy use.

Many adolescents use alcohol for self-medication. How does an adolescent view the benefit of alcohol? a. Believes it has a stimulant effect b. Believes it increases alertness c. Provides a sense of euphoria d. Provides a defense against depression

ANS: D Adolescents who abuse alcohol often rely on it as a defense against depression, anxiety, fear, and anger. Alcohol is a depressant and has a sedative effect. Alcohol does not provide a sense of euphoria. It does reduce inhibitions against aggressive behaviors.

What factor is most likely to increase the likelihood that an adolescent will misuse alcohol? a. Female gender b. Regular school attendance c. Rural environment d. Unconventional behavior

ANS: D Adolescents who are connected and engage in conventional behavior are less likely to misuse alcohol. Those who are disconnected from school, family, and other social supports have fewer assets and are more likely to abuse alcohol. School attendance is a sign of connectedness. Girls and boys report a similar onset and course of experimentation with alcohol. Urban youths have a higher likelihood of alcohol abuse than rural adolescents.

The nurse is teaching an adolescent about acne care. What statement by the adolescent indicates a need for further teaching? a. "I will cleanse my face twice a day." b. "I will frequently shampoo my hair." c. "I will brush my hair away from my forehead." d. "I will use my antibacterial soap to cleanse my face."

ANS: D Antibacterial soaps are ineffective and may be drying when used in combination with topical acne medications. Further teaching is needed if the adolescent indicates using antibacterial soap. Gentle cleansing with a mild cleanser once or twice daily is usually sufficient. For some adolescents, hygiene of the hair and scalp appears to be related to the clinical activity of acne. Acne on the forehead may improve with brushing the hair away from the forehead and more frequent shampooing.

What best describes central nervous system (CNS) stimulants? a. Acute intoxication can lead to coma. b. They produce strong physical dependence. c. Withdrawal symptoms are life threatening. d. They can result in strong psychologic dependence.

ANS: D CNS stimulants such as amphetamines and cocaine produce a strong psychologic dependence. Acute intoxication leads to violent aggressive behavior or psychotic episodes characterized by paranoia, uncontrollable agitation, and restlessness. This class of drugs does not produce strong physical dependence and can be withdrawn without much danger.

An adolescent girl asks the school nurse for advice because she has dysmenorrhea. She says that a friend recommended she try an over-the-counter nonsteroidal anti-inflammatory drug (NSAID). The nurse's response should be based on what? a. Hormone therapy is necessary for the treatment of dysmenorrhea. b. Acetaminophen is the drug of choice for the treatment of dysmenorrhea. c. Over-the-counter NSAIDs are rarely strong enough to provide adequate pain relief. d. NSAIDs are effective because they inhibit prostaglandins, leading to reduction in uterine activity.

ANS: D First-line therapy for adolescents with dysmenorrhea is NSAIDs. NSAIDs are potent anti-inflammatory agents that block the formation of prostaglandins, resulting in decreased uterine activity. Hormone therapy may be indicated if there is no physical abnormality and NSAIDs are ineffective. Acetaminophen does not have an antiprostaglandin action. It can help with pain control but will not be as effective as NSAIDs.

What strategy is considered one of the best for preventing smoking in teenagers? a. Large-scale printed information campaigns b. Emphasis on the long-term effects of smoking on health c. Threatening the social norms of groups most likely to smoke d. Peer-led programs emphasizing the social consequences of smoking

ANS: D Peer-led programs emphasizing the social consequences of smoking have proved most successful. Short-term effects such as an unpleasant odor and stains on the teeth and hands are stressed. If a significant number of peers convince their classmates that smoking is not popular, others will follow. Large-scale printed information campaigns are not effective. A specified curriculum and teaching can increase benefit. Long-term effects do not dissuade adolescents because they do not have a future perspective. Threatening the norms of the social group is one of the least effective means of prevention.

An adolescent girl calls the nurse at the clinic because she had unprotected sex the night before and does not want to be pregnant. What should the nurse explain? a. It is too late to prevent an unwanted pregnancy. b. An abortion may be the best option if she is pregnant. c. The risk of pregnancy is minimal, so no action is necessary. d. Postcoital contraception is available to prevent implantation and therefore pregnancy.

ANS: D Several emergency methods of contraception (ECP) are available and appropriate for use after unprotected sexual intercourse. A progestin-only ECP (levonorgestrel [Plan B]) is approved by the U.S. Food and Drug Administration and has high effectiveness and low rates of side effects. Plan B is effective if given within 72 hours of unprotected intercourse. An abortion is not indicated. Although the risk of pregnancy depends on the time during her menstrual cycle, a low risk of pregnancy exists. ECP is indicated.

During the physical examination of an adolescent with significant weight loss, what finding may indicate an eating disorder? a. Diarrhea b. Amenorrhea c. Appetite suppression d. Erosion of tooth enamel

ANS: D Some of the signs of bulimia include erosion of tooth enamel and increased dental caries. Check the back of the hands for abrasions caused by rubbing against the maxillary incisors during self-induced vomiting. Diarrhea is not a result of vomiting. Rather, it may occur in patients with inflammatory bowel disease and other gastrointestinal diseases. Amenorrhea can occur with anorexia nervosa, but it can also be a result of the weight loss from other causes. It can also indicate pregnancy in adolescent females. Appetite suppression can occur from central nervous system lesions or from oncologic and metabolic disorders.

An adolescent with bulimia has a low potassium level. The nurse is aware of the potential for which of the following complications? A. Anemia B. Cardiac arrhythmias C. Gastrointestinal reflux D. Heightened neurologic reflexes

B. A low potassium level places the adolescent at risk for cardiac arrhythmias. Hospitalization is recommended when the potassium level is less than 3.2 mmol/l. Anemia is a potential problem when iron intake is not sufficient. This is not common with bulimia. Esophageal tears, not gastrointestinal reflux, are a complication of bulimia. Heightened neurologic reflexes are not an expected complication.

Nursing responsibilities in the management of adolescent obesity include which of the following? A. Plan a low-calorie, low-protein diet. B. Incorporate favorite foods into the child's diet. C. Encourage diversional activities during mealtimes. D. Use nutritious foods as a method of reward.

B. Incorporating favorite foods into the child's diet allows the adolescent control over the weight loss process. Special diets are usually not used except in cases of severe obesity. Low-carbohydrate and moderate-protein diets may then be used. Diversional activities (reading, television) are not encouraged during mealtimes. These can contribute to overeating. Food should not be used as a reward.

Anorexia nervosa is best described as A. easily diagnosed and treated. B. emaciation from self-inflicted starvation. C. resulting from a posterior pituitary disorder. D. occurring most frequently in adolescent males.

B. One of the criteria for diagnosis is the refusal to maintain body weight at a minimally normal weight for age and height. Anorexia nervosa can be a difficult disorder to identify. The diagnosis depends on the person meeting certain diagnostic criteria. Without a known cause, treatment is difficult. Reversal of the severe malnutrition usually requires intense nutritional and behavioral-psychologic management. Posterior pituitary disorders are not associated with anorexia nervosa. Females account for 90% to 95% of the cases.

An adolescent girl tells the nurse she has some type of vaginitis. Which of the following clinical manifestations is most suggestive of candidiasis? A. Dysuria B. Vaginal pruritus C. Malodorous vaginal discharge D. Solitary clusters of nontender papules

B. The adolescent with vulvovaginal candidiasis generally has vaginal pruritus. Thick, cottage cheese-like discharge is seen in a minority of individuals. Dysuria, malodorous vaginal discharge, and solitary clusters of nontender papules are not primarily suggestive of candidiasis.

The nurse is caring for an adolescent brought to the hospital with acute drug toxicity. Cocaine is believed to be the drug involved. Initial data collection should include which of the following? A. Chemical content of the drug B. Method of administration C. Function the drug plays in the adolescent's life D. Adolescent's level of interest in rehabilitation

B. When the drug is questionable or unknown, every effort must be made to determine the type, amount of drug taken, method and time of administration, and factors relating to the onset of presenting symptoms. The actual content of most street drugs is highly questionable. Pharmacologic agents should be administered with caution, except for the narcotic antagonists in case of suspected opiate use. The function the drug plays in the adolescent's life and the adolescent's level of interest in rehabilitation are important considerations in the long-term management in the nonacute stage.

Which of the following is associated with social drinking in adolescents? A. Heavy drinking as an adult B. Increasing rates of liver disease C. Significant morbidity and mortality D. Use of stimulants to counter the depressive effects of alcohol

C. Alcohol-related motor vehicle incidents result in 8000 adolescent deaths and 45,000 injuries each year and are the leading cause of unintentional injury and deaths among adolescents. Heavy drinking as an adult and increasing rates of liver disease are associated with heavy drinking in adolescence. Adolescents who abuse alcohol may use sedatives as they become tolerant to the effects of alcohol.

Which of the following statements is true about adolescents who attempt suicide? A. Suicide attempts are rarely associated with mental health problems. B. The adolescent has mastered problem-solving skills. C. Gay and lesbian adolescents are at high risk for suicide. D. They may have parents with idealistic expectations of academic performance.

C. Approximately four times as many gay, lesbian, and bisexual teens attempt suicide compared with others in this age group. Gay and lesbian adolescents who live in families or communities that do not accept homosexuality are likely to suffer low self-esteem, self-loathing, depression, and hopelessness as a result of a lack of acceptance. Retrospectively, 90% of adolescents who committed suicide met the criteria for at least one major psychiatric disorder. Adolescents with developed problem-solving and social skills are less likely to commit suicide. Many adolescents have parents with idealistic expectations.

Prevention of pelvic inflammatory disease (PID) in adolescents is important because it A. is easily prevented by proper personal hygiene. B. is easily prevented by compliance with any form of contraception. C. can have devastating effects on the reproductive tract of affected adolescents. D. can cause life-threatening and serious defects in the future children of affected adolescents.

C. PID is a major concern because of its devastating effects on the reproductive tract. Short-term complications include abscess formation in the fallopian tubes; long-term complications include ectopic pregnancy, infertility, and dyspareunia. PID is an infection of the upper female genital tract, most commonly caused by sexually transmitted infections. Personal hygiene, oral contraceptives, and many other forms of contraception do not prevent transmission of the disease. PID does not cause birth defects in children.

Correct terminology is necessary in understanding substance abuse. Physical dependence is which of the following? A. A voluntary behavior based on psychosocial needs B. A problem that occurs in conjunction with addiction C. Culturally defined use of drugs for purposes other than accepted medical purposes D. An involuntary physiologic response to the pharmacologic characteristics of drugs

D. Physical dependence is an involuntary response to the pharmacologic characteristics of a drug such as an opiate or alcohol. Dependence is a physiologic response; it is not culturally determined or subject to voluntary control. A person can be physically dependent on a narcotic without being addicted; for example, patients who use an opiate to control pain need increasing doses to achieve the same effect. An individual can be addicted to a drug without being physically dependent.

Which of the following symptoms would the nurse expect to observe during the physical assessment of an adolescent girl with severe weight loss and disrupted metabolism associated with anorexia nervosa? A. Tachycardia B. Dysmenorrhea C. Heat intolerance D. Lowered body temperature

D. Symptoms of anorexia nervosa include low body temperature, severe weight loss, decreased blood pressure, dry skin, brittle nails, altered metabolic activity, and lanugo hair. Bradycardia, rather than tachycardia, may be present. Amenorrhea, rather than dysmenorrhea, is a manifestation of anorexia nervosa. Cold intolerance is a manifestation of anorexia nervosa.

Which of the following statements is true about smoking in adolescence? A. Smoking among adolescents is becoming more prevalent. B. Smoking will not continue unless peer pressure continues. C. Adolescents with identified personality traits are more likely to smoke. D. Smoking is less common when an adolescent's parents disapprove of smoking.

D. Teenagers who do not smoke usually have parents and friends who oppose smoking and who do not smoke. The percentage of young people who report current cigarette use and frequent cigarette use has declined significantly. Teenagers begin smoking for a variety of reasons, such as imitation of adult behavior, peer pressure, a desire to imitate behaviors portrayed in movies and advertisements, and a desire to control weight. The absence of peer pressure alone will not stop smoking. Research has not been able to identify significant differences in the personality traits of adolescents who smoke and those who do not.

Which of the following is descriptive of bulimia during adolescence? A. Strong sense of control over eating behavior B. Feelings of elation after the binge and purge cycle C. Profound lack of awareness that the eating pattern is abnormal D. Consumption of large quantities of food used as a coping mechanism

D. The individual with bulimia uses food as a means of control and coping. As the disease progresses, the adolescent loses the control aspect and continues the binge and purge cycle as a coping measure. The adolescent has a lack of control over eating during the episode. Patients with bulimia commonly have self-deprecating thoughts and a depressed mood after binge and purge cycles. Individuals with bulimia are aware that the eating pattern is abnormal but are unable to stop.