Chapter 15 Pregnancy in Selected Populations

30) The community nurse is preparing to visit the home of an adolescent who is 18 weeks pregnant. Which health problems should the nurse focus on when assessing this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Preeclampsia 2. Preterm birth 3. Low-birth-weight 4. Gestational diabetes 5. Iron deficiency anemia

Answer: 1, 2, 3, 5 Explanation: Risks for pregnant adolescents include preterm births, low-birth-weight (LBW) infants, preeclampsia-eclampsia and its sequelae, iron deficiency anemia, and cephalopelvic disproportion (CPD). Gestational diabetes is not identified as a health risk for pregnant adolescents. Page Ref: 308—309

33) A pregnant adolescent is scheduled for her first prenatal visit. For which sexually transmitted infections (STIs) should the nurse anticipate testing will occur? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. HPV 2. Candida 3. Gonorrhea 4. Chlamydia 5. Trichomonas

Answer: 2, 3, 4, 5 Explanation: Adolescents have an increased incidence of STIs. The initial prenatal examination should include gonococcal and chlamydial cultures and wet prep for Candida, Trichomonas, and Gardnerella. HPV is not identified as a sexually transmitted infection to be tested during the initial prenatal examination. Page Ref: 308

32) The nurse is preparing an educational program for pregnant adolescents in the community. What goals should the nurse identify as appropriate for this teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Managing finances 2. Increasing self-esteem 3. Preparing for labor and birth 4. Developing adaptive coping skills 5. Providing information about resources

Answer: 2, 3, 4, 5 Explanation: Goals for prenatal classes include preparing the participants for labor and birth, increasing self-esteem, developing adaptive coping skills, and providing information about available community resources. Managing finances is not an identified goal for adolescent prenatal classes. Page Ref: 308—310

29) The nurse is preparing an educational session for parents of adolescents. In which order should the nurse explain the psychosocial development for this population? 1. Thinks abstractly 2. Lack impulse control 3. Formal operational thought 4. Egocentric and a concrete thinker 5. Experiments with drugs and alcohol

Answer: 2, 4, 5, 1, 3 Explanation: The early adolescent (age 14 and under) lacks impulse control, is very egocentric, and is a concrete thinker. The middle adolescent (15 to 17 years) experiments with drugs, alcohol, and sex. The late adolescent (18 to 19 years) thinks abstractly and is capable of formal operational thought. Page Ref: 306—307

31) An adolescent in the third trimester of pregnancy comes into the clinic for a routine examination. What should the nurse assess to determine if the patient is working through this trimester's developmental tasks? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Amount of weight gained 2. Adequacy of nutritional intake 3. Supplies purchased for the baby 4. Presence of heartburn or constipation 5. Place in the home identified for the baby

Answer: 3, 4, 5 Explanation: During the third trimester, the nurse should assess whether the adolescent is preparing for the baby by buying supplies and preparing a place in the home. Assess for discomforts of pregnancy, such as heartburn and constipation. Adolescent may be uncomfortable mentioning these and other problems. Weight gain and nutritional intake are developmental tasks associated with the second trimester of pregnancy. Page Ref: 308—309

2) The school nurse is planning a presentation on pregnancy for 13- and 14-year-olds who are currently pregnant. When planning the content of this presentation, what should the nurse keep in mind about these teens? A) They are working on independence and autonomy. B) They are no longer developing a sense of achievement. C) They are confident in their own identity. D) They are in control of their impulses.

Answer: A Explanation: A) The developmental tasks of adolescence include developing an identity, gaining autonomy and independence, developing intimacy in a relationship, developing comfort with one's own sexuality, and developing a sense of achievement. Teens in early adolescence will not have achieved all of these tasks yet. B) One developmental task of adolescence is developing a sense of achievement. C) One developmental task of adolescence is developing an identity. D) Teens in early adolescence may lack impulse control, which can result in risk-taking behaviors. Page Ref: 306

19) The nurse is working with male teens whose partners are pregnant. What statement by the father-to-be requires that the nurse intervene? A) He will be the only other person who will be present for the birth, although his girlfriend wants her mother to be with her. B) He was very sexually active at an earlier age and he has had more sexual partners than his girlfriend. C) The pregnancy does not seem real to him, and he is not sure what he should do to plan for the future. D) He does not want to be married.

Answer: A Explanation: A) Even if the adolescent father has been included in the healthcare of the client throughout the pregnancy, it is not unusual for her to want her mother as her primary support person during labor and birth. Overriding his girlfriend's expressed desire could be an indication that their relationship is abusive. B) This may be true, but is not a reason for the nurse to intervene. C) The adolescent who attempts to assume his responsibility as a father faces many of the same psychologic and sociologic risks as the adolescent mother. It is normal for a teen to be unsure about the future. D) Although not married, many adolescent couples are involved in meaningful relationships. This is not a reason for the nurse to intervene. Page Ref: 309—310

14) The 19-year-old pregnant woman begins a job to "save money for the baby." What is the most significant developmental task the nurse understands this statement to demonstrate? A) Striving for gaining autonomy and independence B) Completed development of a sense of identity C) Attainment of a sense of achievement D) Having developed an intimate relationship

Answer: A Explanation: A) Having a job is how most teens develop financial independence and autonomy. B) Having a job can give teens a sense of identity, but it is not an indication that the development of a sense of identity is completed. C) Having a job does give teens a sense of achievement, but this is not the most significant developmental task. D) Having a job does not indicate that the teen has developed an intimate relationship. Page Ref: 306

16) The nurse is working with a group of pregnant teens. Which statement indicates that teaching has been successful? A) "Pregnant teens are more likely to quit school prior to graduation." B) "Because I am young, I have a low risk for preeclampsia." C) "My baby could come late because I am a teenager." D) "I am more likely to use birth control after I have this baby."

Answer: A Explanation: A) Many teenage mothers drop out of school during their pregnancy and then are less likely to complete their schooling. B) Preeclampsia-eclampsia is the most prevalent medical complication of pregnant adolescents. C) A physical risk of adolescent pregnancies includes preterm births. D) Many factors contribute to the high teenage pregnancy rate, including lack of knowledge about conception and lack of easy access to contraception. Page Ref: 308

18) The nurse seeks to involve the adolescent father in the prenatal care of his girlfriend. What is the rationale for this nursing strategy? A) Having the father more involved with the birth B) Avoiding conflict between the adolescent father and pregnant teenager C) Including his name on the birth certificate D) Avoiding legal action by the adolescent father's family

Answer: A Explanation: A) Many young fathers genuinely want to be involved with their children and would have more contact and input if they could. B) Issues such as conflicts with the teen mother or maternal grandparents and a lack of financial resources may act as additional barriers for the young father, but is not the reason for involving the father in prenatal care for his girlfriend. C) Fathers are being included on birth certificates far more frequently today than in the past. This helps ensure the father's rights and encourages him to meet his responsibilities to his child, but this is not the reason for involving the father in prenatal care for his girlfriend. D) Avoiding legal action by the adolescent father's family is not the reason for involving the father in the prenatal care of his girlfriend. Page Ref: 309—310

27) The nurse discussing different pregnancy programs explains that which of the following is critical to the success of an adolescent pregnancy-prevention program? A) Including role models from the same cultural and racial backgrounds as the participants B) Focusing on the adolescent female C) Having short-term, informal programs available twice per year D) Focusing on the expectations of the adolescents' parents

Answer: A Explanation: A) The National Campaign to Prevent Teen and Unplanned Pregnancy's task forces found that the programs most effective at preventing teen pregnancy include models from the same cultural and racial backgrounds as the participants. B) The National Campaign to Prevent Teen and Unplanned Pregnancy's task forces found that the programs most effective at preventing teen pregnancy include focusing on the adolescent male. C) The National Campaign to Prevent Teen and Unplanned Pregnancy's task forces found that the programs most effective at preventing teen pregnancy are both long-term and intensive. D) The National Campaign to Prevent Teen and Unplanned Pregnancy's task forces found that the programs most effective at preventing teen pregnancy focus on adolescent males. Page Ref: 316

34) The nurse is presenting a class to women who are currently pregnant or are planning pregnancy in the near future. Which client statement indicates that additional teaching is required? A) "The older a woman is when she conceives, the safer the pregnancy is." B) "Pregnant teens can have additional nutritional needs." C) "A woman whose sisters all had hypertension will be watched carefully." D) "Pregnancy may be more difficult to achieve in my 40s."

Answer: A Explanation: A) The health risks associated with pregnancy vary by age. The risk for maternal death is significantly higher for women over age 35 and even higher for women age 40 and older. The incidence of low-birth-weight infants, preterm births, miscarriage, stillbirth, and perinatal morbidity and mortality is higher among women age 35 or older. B) The health risks associated with pregnancy vary by age. Young teens who are still growing need additional calories and protein. C) The health risks associated with pregnancy vary by age. The risk of pregnancy complications is higher in women over age 35 who have a chronic condition such as hypertension or diabetes, or who are in poor general health. D) The decreased fertility of women over age 35 may make conception more difficult. Page Ref: 317

22) After telling a mother that her 13-year-old daughter is pregnant, the nurse would expect the mother to respond with which statement? A) "We had such high hopes for you." B) "But you have always been a happy child." C) "I've always liked that boy." D) "This is just one of those things that happen."

Answer: A Explanation: A) When an adolescent pregnancy is first revealed to the teen's mother, the result is often anger, shame, or sorrow. The degree of negative response will be determined by the age of the teen, the family expectations for the teen, and the presence or absence of other teen pregnancies in the family or support network. B) This response is not necessarily typical of parental responses to their young teen daughter's pregnancy. C) When an adolescent pregnancy is first revealed to the teen's mother, the result is often anger and shame and not expressions of fondness for the father. D) This attitude of indifference is not typical of the response of most parents of teen daughters who are pregnant. Page Ref: 311

9) Which statements might a pregnant teenager be likely to make at her initial prenatal examination? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) "I didn't know I could get pregnant the first time I had sex." B) "Several of my friends go to clinics to get contraception." C) "It's no big deal; two of my best friends have babies, too." D) "I was 13 years old when I had sex the first time." E) "My family and my boyfriend are really happy and supportive."

Answer: A, C, D Explanation: A) Many factors contribute to the high teenage pregnancy rate, and one of them is lack of knowledge about conception. B) A teen whose friends go to clinics for contraception would be more likely to use contraception herself. C) Many factors contribute to the high teenage pregnancy rate, and one of them is a decreased social stigma of being a young and single mother. D) Many factors contribute to the high teenage pregnancy rate, and one of them is a younger age at onset of sexual activity. E) Lack of support from the partner and parents is the norm, especially when the pregnancy is first diagnosed and disclosed. Page Ref: 307—308

23) The nurse's goals for prenatal classes may include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Increasing self-esteem B) Preparing the participants for childrearing C) Offering information on the risks of breastfeeding D) Providing anticipatory guidance about pregnancy E) Helping participants develop more adaptive coping skills

Answer: A, D, E Explanation: A) Goals for prenatal classes would include increasing self-esteem. B) The nurse would be preparing the participants for labor and birth, not childrearing. C) Goals for prenatal classes would include information on the benefits of breastfeeding. D) Goals for prenatal class would include providing anticipatory guidance about pregnancy. E) Goals for prenatal class would include helping participants develop more adaptive coping skills. Page Ref: 317

12) A 16-year-old is making her first prenatal visit to the clinic in her fourth month of pregnancy. What is the nurse's first responsibility? A) Contact the social worker. B) Develop a trusting relationship. C) Schedule the client for prenatal classes. D) Teach the client about proper nutrition.

Answer: B Explanation: A) A social worker might be able to provide assistance, but contacting one is not the first priority. B) Developing a trusting relationship with the pregnant adolescent is essential. Honesty and respect for the individual and a caring attitude promote the client's self-esteem. C) Childbirth education is important, however, scheduling classes is not the first goal when dealing with a pregnant teen. D) Although nutrition is an important physiologic need, it is not the first priority in dealing with the pregnant adolescent. Page Ref: 315

15) Which of the following is the most prevalent medical complication of pregnant adolescents? A) Constipation B) Preeclampsia-eclampsia C) Heartburn D) Rapid enlargement and sensitivity of breasts

Answer: B Explanation: A) Constipation is a discomfort of pregnancy, but not a medical complication. B) Preeclampsia-eclampsia is the most prevalent medical complication of pregnant adolescents and is typically characterized by high blood pressure, proteinuria, and edema. C) Heartburn is a discomfort of pregnancy, but not a medical complication. D) Rapid enlargement and sensitivity of breasts are discomforts of pregnancy, but not medical complications. Page Ref: 308

26) The nurse is working in a teen pregnancy clinic. In order to give the pregnant adolescent a role in her prenatal care, the nurse should allow the teen to do which of the following? A) Choose the type of prenatal vitamin she takes B) Measure and record her weight at each visit C) Choose the schedule of her prenatal visits D) Decide whether she wants her labor to be induced

Answer: B Explanation: A) Prenatal vitamins are prescribed by healthcare professionals. The client would not be given a choice. B) Having the client weigh herself and record her weight provides her the opportunity to participate in her own care plan. C) Prenatal visit schedules are set to detect developing complications of pregnancy. D) Induction of labor is a medical decision, and not one to be made at the client's discretion. Page Ref: 311

11) In planning a conference for adolescents, the nurse researches the most common socioeconomic and cultural factors that contribute to adolescent pregnancy. Which true statements should be included in this conference? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Economic status has a relatively low impact on an adolescent's sexual activity. B) Nearly three quarters of all teens ages 15-19 have had sex at least once. C) Poor self-esteem contributes to adolescent pregnancy. D) 38% percent of sexually active students use a condom. E) Sexual abuse is not an issue with teen mothers.

Answer: B, C Explanation: A) Poverty is a major risk factor for adolescent pregnancy. B) By 19 years of age, 70% of all teens have had intercourse. C) This is a true statement. Poor self-esteem is a major contributing factor in adolescent pregnancy. D) 68% of females aged 15 to 19 and 80% of males use condoms during their first sexual intercourse. E) More teens who become pregnant, compared with teens who have not been pregnant, have been physically, emotionally, or sexually abused. Page Ref: 306, 308

5) The nurse is preparing an in-service presentation for a group of middle-school nurses. Which statements by the nurse would indicate that the middle-school nurse understood the role of culture in adolescent pregnancy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) "Studies show that 85% of teen mothers are middle class, and give birth to gain adult status." B) "Teenage pregnancy is the leading reason why adolescent women drop out of school." C) "Teens of color are more likely to become pregnant." D) "Intelligence and academic ability are positively associated with delayed sexual activity, greater use of contraception, and lower rates of pregnancy." E) "Over 50% of adolescents who have had an abortion or recent birth become pregnant again within two years."

Answer: B, C, D Explanation: A) Poverty is a major risk factor for adolescent pregnancy. Studies show that 85% of births to unmarried teens occur to those from poor or low-income families. Adolescents who do not have access to middle-class opportunities tend to maintain their pregnancies, because they see pregnancy as their only option for adult status. B) An estimated 30% to 40% of female teenage dropouts are mothers. C) In the United States, the adolescent birth rate is higher among African American and Hispanic teens than among white teens. To some degree, the higher teenage pregnancy rate in these groups reflects the impact of poverty because a disproportionately higher number of African American and Hispanic youths live in poverty. D) Teens with future goals (i.e., college or job) tend to use birth control more consistently compared with other teens; if they become pregnant, they are also more likely to have abortions. E) Just over one-third (35%) of adolescents who have had an abortion or recent birth become pregnant again within two years. Page Ref: 307—308

35) The nurse is preparing a brochure for couples considering pregnancy after the age of 35. Which statements should be included? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) There is a decreased risk of Down syndrome. B) Preexisting medical conditions can complicate pregnancy. C) Preterm births are more common. D) Amniocentesis can be performed to detect genetic anomalies. E) The increased fertility of women over age 35 makes conception easier.

Answer: B, C, D Explanation: A) The incidence of Down syndrome increases somewhat in women over age 35 and increases significantly in those over age 40. B) Preexisting medical conditions, such as hypertension or diabetes, probably play a more significant role than age in maternal well-being and the outcome of pregnancy. C) The incidence of low-birth-weight infants, preterm births, miscarriage, stillbirth, and perinatal morbidity and mortality is higher among women age 35 or older. D) Amniocentesis is offered to all women over age 35 to permit the early detection of several chromosomal abnormalities, including Down syndrome; noninvasive analysis of fetal nucleic acid is now commonly recommended to women of advanced maternal age. E) The decreased fertility of women over age 35 may make conception more difficult. Page Ref: 317

1) The pregnant 16-year-old is seeing the nurse during a prenatal visit. Based on the client's developmental level, which statement would the nurse expect the client to make? A) "My friends and I all wear totally different styles of clothing." B) "Having a baby will change my college plans." C) "I drink alcohol at parties most weekends." D) "My mom is my best friend."

Answer: C Explanation: A) Early and middle adolescents conform to group standards by wearing the same types of clothing that their friends wear. B) Late adolescence (18-19) is when the ability to think about the future develops, including understanding the impact that a baby will have on acquiring education. C) Middle adolescence (15-17) is a time of experimentation, including drinking alcohol, using other drugs, and sex. D) From early adolescence on, friends have an increasingly important role in the search for independence, which includes friends' replacing parents as the primary source of support. Page Ref: 306

28) The nurse has been asked by a community organization to give a presentation on prevention of teen pregnancy. Which statement indicates appropriate steps toward reduction of the local teen pregnancy rate? A) Abstinence-only education will be offered in the school and clinics. B) Classes on how to parent will be mandatory in high school. C) A low-cost reproductive health clinic will be planned. D) Parents will be encouraged to avoid discussing sexual activity.

Answer: C Explanation: A) Abstinence with information on contraception is most effective in reducing teen pregnancy rates. B) Parenting classes for teens who are neither pregnant nor parents do not reduce teen pregnancy. C) Key strategies for prevention of unintended teen pregnancy and sexual health promotion include the provision of services that ensure accessible and high-quality reproductive healthcare; sex education programs that provide developmentally appropriate, evidence-based curricula; and youth development strategies to enhance life skills. A low-cost reproductive health clinic would be able to provide these services. D) Parents are a big influence on teens' decisions to begin or avoid sexual activity. Parents need to talk with their children about sex early and often and be specific in the discussions. Page Ref: 316

10) Several adolescent female students are waiting to be seen by the school sexual health clinic nurse. Which student should the nurse see first? A) 14-year-old whose 17-year-old sister is pregnant B) 15-year-old who reports using condoms regularly C) 16-year-old who had chlamydia treated 2 weeks ago D) 17-year-old with a history of child abuse

Answer: C Explanation: A) It is not known whether this client is sexually active. This student is not the top priority. B) Condom use will decrease the risk of becoming pregnant. This client is a low priority. C) This client is the top priority. Teenagers 15 to 19 years old have a high incidence of STIs. The incidence of chlamydial infection is increased in this age group. The presence of such infections during a pregnancy greatly increases the risk to the fetus. D) Although adolescents with a history of abuse are more likely to become pregnant than are their peers who have not experienced abuse, too little information is given about this client to determine risk for pregnancy. This client is not the top priority. Page Ref: 308

21) The nurse is talking with the parents of a pregnant 15-year-old. Which statement by one of the parents is expected? A) "We're very happy for her. It will be easier to focus on education with a new baby." B) "I'm not going to get involved. She understands how her health insurance works." C) "Her father told her to stop dating that boy. Now look at the trouble she's gotten into." D) "An abortion is the best choice for her. She can deal with our Catholic priest later."

Answer: C Explanation: A) Most parents accept the pregnancy but are not excited when their 15-year-old daughter is pregnant. Education is harder when childcare is involved. Teens who give birth are less likely to complete their education. B) The parent of a pregnant teen is usually the support person, and helps the teen understand how to access prenatal care. It is unlikely that a 15-year-old would understand health insurance. C) This statement indicates anger, which is to be expected when a parent finds out about a teen daughter's pregnancy. D) This is not necessarily expected from a parent. It indicates that the parent might be forcing the teen into abortion despite their being a part of a religious tradition that disapproves of abortion. Page Ref: 311

20) A 14-year-old girl is brought to the clinic by her mother. The nurse determines that the teen is about 28 weeks pregnant. The mother states, "We knew she was gaining weight, but we can't tell anyone she is pregnant." The nurse understands that the client's mother's behavior exemplifies which of the following? A) Low self-esteem B) Anger C) Shame D) Ignorance

Answer: C Explanation: A) Nothing in the scenario indicates that the client's mother has low self-esteem. B) Anger will often manifest as loud or negative speech. Nothing in the scenario indicates that this is true. C) In families who foster educational and career goals for their children, adolescent pregnancy is often a shock. Anger, shame, and sorrow are common reactions. D) The parents might be ignorant of their child's sexual activity, but when faced with weight gain, they acknowledged the pregnancy. Page Ref: 311

8) During the initial prenatal visit, the pregnant teenager states that she does not know how she got pregnant. The nurse can help to educate her regarding anatomy by doing what? A) Allowing her to witness a pelvic exam on another teenager B) Encouraging her to ask her mother about the physiology of pregnancy C) Including anatomic models and drawings in the teaching session D) Discussing the process of fetal development with the client

Answer: C Explanation: A) One client is not allowed to be present during another client's visit or exam. B) The client's mother might not have accurate information, or might be uncomfortable discussing these issues with her teen daughter. C) To teach the client about anatomy and physiology, use simple explanations and lots of audiovisuals. D) While fetal development is important to understand, discussing it now does not address the client's stated concern. Page Ref: 312

6) The nurse who is counseling a group of middle-school girls on pregnancy avoidance should include which statement? A) "Although sexuality is common in the media, peer pressure to have sex is not an important factor." B) "It has become far less acceptable to give birth during your teenage years than it used to be." C) "Although condom use is growing, there is still an increasing rate of STIs among teens." D) "You have learned enough from your friends and families to understand how pregnancy occurs."

Answer: C Explanation: A) Sexual innuendo permeates every aspect of the popular media. Peer pressure to have sex is also common, and is a strong influence on when a teen becomes sexually active. B) Premarital sexual activity is commonplace, and teenage pregnancy is more socially acceptable today than it was in the past. C) Condom use is increasing, but the rate of STI infections, including HIV, is also rising. D) Comprehensive approaches to sex education do not increase initiation of sexual activity at an earlier age. In fact, it helps teens withstand the pressure to have sex too soon. Page Ref: 308

13) Which statement made by the pregnant adolescent would indicate to the nurse that she understood her increased risk of physiologic complications during pregnancy? A) "It's no big deal that I started prenatal care in my seventh month." B) "My anemia and eating mostly fast food are not important." C) "I need to take good care of myself so my baby doesn't come early." D) "Smoking and using crack cocaine won't harm my baby."

Answer: C Explanation: A) There is an increased incidence of maternal complications, premature birth, and low-birth-weight babies among adolescent mothers. This statement indicates a lack of understanding of the client's increased risk of physiologic complications during pregnancy. B) There is an increased incidence of maternal complications, premature birth, and low-birth-weight babies among adolescent mothers. This statement indicates a lack of understanding of the client's increased risk of physiologic complications during pregnancy. C) In the adolescent age group, prenatal care is the critical factor that most influences pregnancy outcome. D) Adolescents are at high risk for experimentation with drugs and alcohol. This statement indicates a lack of understanding of the client's increased risk of physiologic complications during pregnancy. Page Ref: 310

7) The nurse has given a community presentation on adolescent pregnancy. Which statements indicate that further teaching is necessary? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) "Low educational achievement is major risk factor for adolescent pregnancy." B) "Teens who are on a low economic trajectory are more likely to become pregnant." C) "When a teen plans to attend college, abortion is less likely." D) "In the United States, the adolescent birth rate is higher among white teens." E) "Teens from low-income households are less likely to become pregnant."

Answer: C, D, E Explanation: A) Teenage pregnancy is the leading reason why adolescent women drop out of school. An estimated 30% to 40% of female teenage dropouts are mothers. B) Teens who are on a low economic trajectory are more likely to become pregnant because of the lack of economic opportunity and the social marginalization that comes with poverty. C) Teens with future goals (i.e., college or job) tend to use birth control more consistently compared with other teens; if they become pregnant, they are also more likely to have abortions. D) In the United States, the adolescent birth rate is higher among African American and Hispanic teens than among white teens. E) Poverty is a major risk factor for adolescent pregnancy. As many as 85% of births to unmarried teens occur to those from low-income families. Page Ref: 307—308

25) The nurse developing a care plan for a pregnant teen knows that what plan is best suited to pregnant teens? A) Assess menstrual history and the presence of any food allergies. B) Inquire about family relationships and location of the home. C) Ask what her body image is, then correct her misconceptions. D) Determine whether there are substance abuse issues.

Answer: D Explanation: A) Menstrual history is important for determining gestational age, and food allergies can impact nutritional intake. However, assessment of these factors is not necessarily better suited to pregnant teens than to pregnant women of other ages. B) Family relationships are important to understand, specifically to find out what support systems are available to the teen. However, the location of the home is not important. C) Body image must be addressed more indirectly, not by asking a client what she thinks about her body. A client's body image is her belief, and cannot be corrected by the nurse. D) Substance abuse issues are important to assess during pregnancy of teens. Page Ref: 307

24) Recommendations for parents to help their teens avoid pregnancy include which of the following? A) Parents need to encourage frequent and steady dating. B) Parents need to let their children set their own goals for the future. C) Parents need to have their children taught about sex by school programs and community resources. D) Parents should be clear about their own sexual attitudes and values.

Answer: D Explanation: A) Parents need to clearly discourage early dating as well as frequent and steady dating. B) Parents need to help children set goals for their future and have options that are more attractive than early pregnancy and childrearing. C) Parents need to talk with their children about sex early and often and be specific in the discussions. D) This is true. Parents should be clear about their own sexual attitudes and values in order to communicate clearly with children. Page Ref: 316

4) The nurse is working at a clinic for pregnant teens. What issues related to development will the nurse expect to encounter in most of the pregnant clients? A) Peer pressure to stop using alcohol once pregnancy is diagnosed B) Contraception failure that resulted in this pregnancy C) The baby's father being emotionally supportive to the client D) Feelings of not living up to parents' expectations

Answer: D Explanation: A) Pregnant teens face risk factors based on the developmental tasks of adolescence. One of these is peer pressure to engage in substance use. B) Pregnant teens face risk factors based on the developmental tasks of adolescence. These include sexual activity without contraception due to lack of a future orientation. C) Pregnant teens face risk factors based on the developmental tasks of adolescence. One of these is sexual activity as experimentation without emotional intimacy. D) Pregnant teens face risk factors based on the developmental tasks of adolescence. One of these is developing an identity. If the adolescent feels she has not lived up to parental expectations by becoming pregnant, she could adopt a negative identity. Page Ref: 306

3) The nurse working in an adolescent prenatal clinic knows which of the following about the clients who are 15-17 years old? A) They are more at ease with their individuality. B) They see authority as resting with parents. C) They are able to solve problems and make decisions. D) They seek independence and identify with their peer group.

Answer: D Explanation: A) Teens in late adolescence are more at ease with their individuality. B) Teens in early adolescence see authority as resting with parents. C) Teens in late adolescence are able to solve problems and make decisions. D) Teens who are in middle adolescence (15-17 years old) seek independence and identify with their peer group. Page Ref: 306

17) The nurse is teaching a pregnant 14-year-old client who is at 10 weeks' gestation about the expected body changes that will occur during pregnancy. Which client statement indicates that additional information is needed? A) "My breasts are going to get even bigger than they've gotten over the past couple of years." B) "My belly will gradually get more round, especially from the middle of pregnancy on." C) "I will feel my baby move in about 16 weeks." D) "My diet can stay the same even though I'm pregnant."

Answer: D Explanation: A) The breasts will enlarge. B) The abdomen will enlarge. C) Fetal movement begins in the second trimester. D) Because the adolescent is at risk for anemia, she will need education regarding the importance of iron in her diet. Page Ref: 313