Chapter 29: Growth and Development of the Adolescent

The parent of a Black adolescent voices concern to the nurse because the daughter, "has gotten her period before all of her friends." How should the nurse respond? "How old are most of her friends? Maybe that is the issue instead of it being a sign of something abnormal." "I will be sure to let the health care provider know this. We do not want to miss something that may be wrong." "On average Black girls start their period earlier than other ethnicities." "Some girls just get their period earlier than others."

"On average Black girls start their period earlier than other ethnicities." Menarche, the first menstrual period, usually begins between the ages of 9 and 15 years (average 12.8 years), but on average Black adolescents reach menarche earlier than adolescents of other ethnicitic backgrounds. 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.

A 16-year-old girl has arrived for her sports physical with a new piercing in her navel. Which response by the nurse is best? "This is a wound and can become infected." "This is a risk for hepatitis, tetanus, and AIDS." "Be sure to clean the navel several times a day." "I hope for your sake the needle was clean."

"Be sure to clean the navel several times a day." The best response is to describe the proper care using frequent cleansing with antibacterial soap. It is too late for warnings about the dangers of piercing such as skin- or blood-borne infections, or disease from unclean needles.

The mother of a 13-year-old boy confides to the pediatric nurse practitioner that her son has recently had a nocturnal seminal emission. The mother is concerned, and the nurse explains "wet dreams" and the other male traits of puberty to the mother. Which response indicates a need for further discussion? "My son is developing normally and the traits of puberty vary from child to child." "My son is not doing anything to cause the nocturnal emissions; they occur spontaneously." "My son must be sexually active or having overly sexual thoughts to have a nocturnal emission." "My son's spontaneous erections and nocturnal emissions are very normal."

"My son must be sexually active or having overly sexual thoughts to have a nocturnal emission." Spontaneous erections and nocturnal seminal emissions do not mean that the child is sexually active or having overactive sexual thoughts. Parents need to be instructed that these occurrences are spontaneous and that the child is not doing anything to cause them.

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? "It is most important for our adolescent to achieve independence from our dominance." "We will work toward ensuring our adolescent is developing trusting relationships." "Our adolescent is working toward achieving a sense of personal identity." "It is vital our adolescent learns to help others achieve their goals."

"Our adolescent is working toward achieving a sense of personal identity." 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.

A 16-year-old female adolescent reports to the nurse that she is trying to improve her diet to lose weight. When assessing her dietary intake for adequacy, which finding(s) indicates the need for further education? Select all that apply. Protein comprises approximately 30% of the daily dietary intake. Average caloric intake is 2,500 per day. Fat comprises about 40% of the daily intake. Iron intake is between 8 and 10 mg per day. Calcium intake is 1,000 mg per day.

Calcium intake is 1,000 mg per day. Average caloric intake is 2,500 per day. Fat comprises about 40% of the daily intake. Iron intake is between 8 and 10 mg per day. The recommended calcium intake for female adolescents 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 comprise 20% to 35% of the daily diet. Daily iron intake for female adolescents should be approximately 15 mg per day.

The nurse is providing anticipatory guidance for violence prevention to a group of parents with adolescents. Which parental action should the nurse include as the most effective in preventing suicide? Monitoring video games, TV shows, and music. Watching for aggressive behavior or racist remarks. Becoming acquainted with the teen's friends. Checking for signs of depression or lack of friends.

Checking for signs of depression or lack of friends. Checking for signs of depression or lack of friends would be most effective for preventing suicide. All other choices are more effective for preventing violence to others.

The nurse is providing a class for a group of girls. When discussing the changes surrounding puberty, what information should be included? Select all that apply. Breast bud development will normally precede menarche by about 3 years. Most girls begin menstruation between ages 12 and 13. Black girls experience menarche earlier than white girls. Thelarche occurs as early as age 9 years. Pubic hair starts prior to breast bud development.

Most girls begin menstruation between ages 12 and 13. Thelarche occurs as early as age 9 years. Black girls experience menarche earlier than white girls. Girls reach physical maturity before boys, and menarche, the first menstrual period, usually begins between the ages of 9 and 15 years (average 12.8 years). Breast budding (thelarche) occurs at approximately age 9 to 11 years and is followed by the growth of pubic hair. Black girls on average reach menarche slightly earlier than white girls.

A 15-year-old girl is in the hospital for surgery and is confined to bed. The nurse can tell that the client is nervous about being in the hospital. She tells the nurse that she feels "gross" and "on display" in her hospital gown. What should the nurse do to encourage a sense of autonomy and dignity related to the girl's body image? Brush the girl's hair for her. Allow the girl to wear her own clothes, despite hospital policy. Offer to assist the girl in washing her hair and let her pick the shampoo. Assist the girl with using the bed pan to urinate.

Offer to assist the girl in washing her hair and let her pick the shampoo. When caring for hospitalized adolescents, providing time for self-care, such as shampooing hair, is important to include in an adolescent's nursing care plan. Offering to assist the client in washing her hair and letting her pick the shampoo both encourages a sense of autonomy to the client and offers her dignity related to her body image. Brushing the girl's hair for her and assisting her with using the bed pan for urination do not encourage a sense of autonomy. If it is the hospital's policy to require clients to be dressed in a hospital gown while admitted, the nurse should not allow the girl to wear her own clothes.

The school nurse is assessing a 16-year-old girl who was removed from class because of disruptive behavior. She arrives in the nurse's office with dilated pupils and is talking rapidly. Which drug might she be using? barbiturates amphetamines marijuana opiates

amphetamines Amphetamine use manifests as euphoria with rapid talking and dilated pupils. Signs of opiate use are drowsiness and constricted pupils. Barbiturates typically cause a sense of euphoria followed by depression. Marijuana users are typically relaxed and uninhibited.

The nurse is educating an adolescent female who needs to increase dietary iron but has expressed concern about weight gain. What dietary choices would the nurse recommend? raspberry yogurt, granola, apple pasta, broccoli, pear chicken, whole-wheat bread, watermelon cottage cheese, crackers, oranges

chicken, whole-wheat bread, watermelon Chicken, whole-wheat bread, and watermelon are all foods high in iron. The calorie content will not promote weight gain. All the other options do not include good sources of iron but are nutritious foods. The calorie content is also acceptable.

The nurse is assessing the psychosocial development of an adolescent. The nurse determines that the client is in the middle post-conventional phase with which observation? The nurse hears the adolescent asking the parents, "How does God decide that some people get sick and some people don't?" The nurse hears the adolescent talking with a friend and states, "I don't understand how some of the rich in our society don't help the poor." The adolescent tells the nurse, "I'm starting to think that some of my friends care a lot more about what other people think of them than what I do." The adolescent states, "I am glad my parents instilled such a good work ethic in me."

The adolescent tells the nurse, "I'm starting to think that some of my friends care a lot more about what other people think of them than what I do." According to Kohlberg, the middle post-conventional phase is characterized by the adolescent developing his or her own set of morals by evaluating individual morals in relation to peer, family, and societal morals. This is demonstrated when the adolescent stated. "I'm starting to think that some of my friends care a lot more about what other people think of them than what I do." The early post-conventional phase is characterized by asking broad, usually unanswerable questions about life such as the question about God. During the late post-conventional phase, the adolescent internalizes his or her own morals and values, and continues to compare morals and values to those of society. During this phase, the adolescent also evaluates the morals of others. The statements regarding the rich in society and work ethic demonstrate this late phase.

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

The adolescent will likely have the greatest influence on one's own decisions. 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.

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

The adolescent's need for privacy should be respected. 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.

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? "Do you take amphetamines?" "Do you take human growth hormone?" "Do you take cocaine?" "Do you take anabolic steroids?"

"Do you take anabolic steroids?" 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.

A male nurse is meeting with a group of 12-year-old boys to discuss expected bodily changes. After one of the boy's says, "My older brother told me my bed might be wet and that means I had a wet dream. Is that true?" What is the best response from the nurse? "When you are thinking about people you find sexually attractive or dating those people you might have a wet dream." "Having wet dreams indicates that your body is going through a process of maturing." "It is not common to wet the bed or urinate when you have a wet dream." "It will be several years before you will start having wet dreams."

"Having wet dreams indicates that your body is going through a process of maturing." In boys, the appearance of nocturnal emissions ("wet dreams") is often used as the indication that the preadolescent period has ended and that the adolescent is maturing into an adult. Nocturnal emissions usually occur at about the age of 11 in boys. Wet dreams are not associated with urination. Boys at this age start thinking of relationships with people they find sexually attractive, but this is not the best response.

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? "I guess I need to be more careful about my curfew on school nights." "My mom keeps telling me to turn off my television when I go to bed." "I just can't seem to stay awake during that class because it's boring." "I get 7 hours of sleep every night so I don't know why I am so tired."

"I get 7 hours of sleep every night so I don't know why I am so tired." 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.

During the assessment of a 15-year-old female, the nurse notes a new body piercing in the navel. Which statements by the nurse would be appropriate in regard to this new piercing? Select all that apply. "A navel piercing is a lot better than a tattoo. At least the piercing doesn't have to be permanent if you don't want it to be." "You are very young to have a navel piercing. Do your parents know you have this?" "I really like your belly ring. Where did you get it?" "Did they tell you when you got your piercing how important cleaning it is? Infections can take up to a year to heal in a naval piercing." "I notice you have a new piercing. Be sure to clean it twice a day so you don't get an infection."

"I notice you have a new piercing. Be sure to clean it twice a day so you don't get an infection." "Did they tell you when you got your piercing how important cleaning it is? Infections can take up to a year to heal in a naval piercing." Informing the client about infection risks and prevention are appropriate responses by the nurse when noticing a new body piercing. Judgmental responses and personal responses are not appropriate from the nurse.

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

"I only tan before going on spring break to get a base tan so I won't burn." "My favorite time of day to be outside is the middle of the day, around noon." "The more exposure and burns I get now will toughen my skin so I won't get skin cancer when I'm older." 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 parents are concerned their 14-year-old child is always eating. The child weighs 54 kg and is 65 inches (165 cm) tall. What is the best explanation the nurse can give the parents? "He is substituting food for unfilled needs." "He needs the calories because he participates in sports." "His calorie intake predisposes him to future obesity." "The calories help his body increase muscle mass."

"The calories help his body increase muscle mass." Adolescents grow rapidly and mature dramatically during the period from ages 13 to 20 years. An adolescent needs an increased number of calories to support the rapid body growth that occurs. Foods must come from a variety of sources to supply the necessary amounts of carbohydrates, vitamins, protein, and minerals. Boys typically gain about 15 to 55 pounds (7 to 25 kg) during their teenage years. The calorie intake will not predispose him to future obesity unless it is continuously excessive. The majority of adolescents eat as part of their development, not as an emotional need.

An adolescent who is depressed states, "Nothing ever seems to be right in my life." Which would be the most appropriate response by the nurse? "Try to look at the bright side of things." "Things will be better when you go off to college." "Being a teenager is hard work." "You are feeling sad right now. It's a hard time."

"You are feeling sad right now. It's a hard time." Some degree of depression is present in most adolescents because they are not only losing their parents while they grow apart from them but also their carefree childhood. When using therapeutic communication, it is important for the nurse to accept the client's verbalization as real. Support should be real. Telling the adolescent that things will be better in college provides false reassurance. Telling the adolescent to "look on the bright side of things" or that "being a teen is hard work" offer platitudes and interrupt the client's interactions.

The nurse is assessing a 14-year-old male client when the client's parent jokes about the changes in the client's voice and the hair under his armpits. Which response by the nurse to the client's parent is most appropriate? "Based on your child's age, changes in hair distribution and voice pitch are expected." "I remember that time in my life, it was so awkward and uncomfortable." "It would be helpful to discuss with your child your trials with puberty and the changes you experienced." "Your child can become modest and self-conscious and teasing may cause embarrassment."

"Your child can become modest and self-conscious and teasing may cause embarrassment." It is never appropriate to discuss what is happening with a client in a way that is demeaning and hurtful. A 14-year-old adolescent is experiencing many bodily changes and is very self conscious. The nurse can share experiences with the client and the family, but it should not be in a way that the adolescent is embarrassed. Parents can share their experiences with the child, but they have to be open to this discussion or it can lead to an awkward experience for the adolescent. Reminding the parent of how the child is feeling and the possible feelings that can come from their interactions will bring the parent's attention to a delicate situation and is most appropriate. Simply stating these are expected findings does not address the joking manner of the parent.

A 17-year-old female is meeting with the nurse for an annual well-visit and is asking the nurse questions about how to know when one is in love. The nurse should point out which factor to help decide if both individuals have reached a mutual agreement and are ready for an intimate relationship? An ability to be autonomous A willingness to take initiative A sense of trust and identity An understanding of socialization and of isolation

A sense of trust and identity In order to be intimate or to share one's deepest feelings with another person, it is impossible unless both persons have established a sense of trust and a sense of identity. Being autonomous or taking initiative are not aspects that lead toward intimate relationships. Socialization and isolation are not relevant to the establishment of intimate relationships.

A nurse is explaining cognitive development in children to a client, with the help of Piaget's theory of cognitive development. What would be the best explanation by the nurse about the formal operations level of cognitive development? From ages 7 to 11 years, children internalize actions and can perform them in the mind. Up to age 2, children learn by touching, tasting, and feeling. They learn to control body movement. After age 12 children can think in the abstract, including complex problem solving. Children from ages 2 to 7 years investigate and explore the environment and look at things from their own point of view.

After age 12 children can think in the abstract, including complex problem solving. The nurse should explain that there are four levels of cognitive development in Piaget's theory. The sensorimotor level is up to age 2 where children learn by touching, tasting, and feeling. They learn to control body movement. Preoperational level takes place in children ages 2 to 7 years who investigate and explore the environment and look at things from their own point of view. At the concrete operations level, from ages 7 to 11 years, children internalize actions and can perform them in the mind. At the formal operations, after age 12, children can think in the abstract. Complex problem solving is included in this category.

The nurse is preparing a presentation for a local health fair depicting the differences in maturity between preadolescents. Which differing factor should the nurse prioritize in the presentation? Girls grow at a slower, steadier rate than do boys. Boys and girls grow at the same rate. Boys grow at a rapid, sporadic rate. Boys grow at a slower, steadier rate than do girls.

Boys grow at a slower, steadier rate than do girls. Preadolescent boys grow generally at a slower, steadier rate than do girls. Girls grow more rapidly during preadolescence and then their growth rate slows dramatically after menarche.

A chronically ill adolescent is readmitted to the hospital with an infected wound requiring long-term dressing changes. What is the best way the nurse can encourage independence for this client? Teach the parents to perform dressing changes at home. Allow the adolescent to choose the time for the dressing change. Have the school provide homework. Have the adolescent go to the teen room every day.

Allow the adolescent to choose the time for the dressing change. Achieving a sense of identity may be difficult for adolescents who have a chronic illness. Some of the nursing actions which encourage identity in the chronically ill adolescent include the following: respecting food preferences; allowing the adolescent to choose the time for the dressing changes; teaching the name, actions, and possible side effects of medication; and respecting modesty. The school can provide homework so the adolescent does not get further behind in school work, and the teen can go to the teen room each day. These provide a good emotional outlet, but they do not promote independence. Teaching the parents to do the dressing changes makes the adolescent dependent on the parents. If the dressings are at a location the adolescent can reach and dexterity is not limited, then the adolescent should be allowed self-care.

Which nursing action will best assist a 15-year-old client accomplish the developmental task according to Erikson? Praise the client for correctly performing self-care Allow the client's friends to visit while the client is hospitalized Provide the client with crafts and puzzles to complete independently Permit the client to make decision regarding one's care

Allow the client's friends to visit while the client is hospitalized The developmental task of adolescence is to develop a sense of identity, or deciding who and what kind of person one is. Friends and peers are important to facilitating the adolescent in determining one's identity. Permitting the client to make decisions assists in developing autonomy, which is a toddler task. Praising facilitates initiative, which is a preschool task. Independently performing tasks assists in developing industry, which is a school-age task.

The school nurse is monitoring a student athlete who experienced a concussion 2 weeks ago during a soccer game. The student reports having difficulty in a course in which the child previously performed well. Which action should the nurse take first? Ask the student to describe the issues he is having in the class. Ask the student's teacher if the child is achieving the recommended level of cognitive activity. Notify the student's parents that their child should see the family health care provider. Perform a neurologic assessment on the student to see if there are any changes in neurologic status.

Ask the student to describe the issues he is having in the class. Talking with the teacher and performing a neurological 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 is having in class. Contacting the parents immediately would not be warranted until sufficient information is collected.

A client has confided in a nurse that her 13-year-old daughter has recently changed dramatically in her social interactions with others. What is a social behavior most likely to be exhibited by a girl at this age? Hanging out primarily with boys her own age Hanging out with girls but maintaining her own unique style Banding together with other girls and dressing like them Banding together with boys and girls but maintaining her own unique style

Banding together with other girls and dressing like them In early adolescence, girls tend to band together with girls. They dress identically with other members of their group: jeans and sweatshirts, special jackets, or whatever the fashion may be. On the surface, this makes adolescents appear to be losing their identities rather than finding them.

A nurse is attending to a group of boys at a school. The nurse is required to document the sexual development in boys on a regular basis. The nurse would anticipate which clients having the highest incidence of nocturnal emissions? Clients with strong, muscular appearance Clients who are showing pubertal changes Clients who have reached adulthood Clients in the age group of 18 to 20 years

Clients who are showing pubertal changes The nurse should know that boys who are undergoing pubertal changes are more likely to experience nocturnal emissions. The first sign of pubertal changes and sex maturation is testosterone secretion. As this increased so does the penis and scrotum enlargement. This is a time when nocturnal emissions occur. In late adolescence, which lasts from age 18 to 20, the transition into adulthood is completed. The nurse should also know that boys in the age group of age 12 to 20 experience various chemical and physical changes taking place within their body. A strong, muscular appearance does not indicate the presence of nocturnal emissions.

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

Menarche should follow in about 2 years. 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 caring for a 16-year-old client. The client confides in the nurse that they use of marijuana daily. Which action by the nurse is appropriate? Discuss adverse side effects with the client. Determine how long the client has used marijuana. Ask the client where the marijuana is obtained. Notify local law enforcement.

Discuss adverse side effects with the client. The nurse will first discuss adverse side effects of marijuana use with the client. The nurse is not legally bound to notify law enforcement and this would be a breach of client confidentiality. Currently, persons living where recreational marijuana use is legal must be at least 18 years of age to legally consume. The nurse would not need to ask about where the client obtains the marijuana as the nurse is focused on the client and not other persons. The client has stated marijuana use. How long the client has used marijuana is not important at this time.

A 17-year-old adolescent chats excitedly with the nurse about plans for college and a career. The adolescent states having checked out every college in the region and determined which one is the best fit and would give the adolescent the best career options. The nurse recognizes which developmental aspect in this client? Socialization Identification of identity Sensorimotor Formal operational thought

Formal operational thought The final stage of cognitive development, the stage of formal operational thought, begins at age 12 or 13 years and grows in depth over the adolescent years, though it may not be complete until about age 25. This step involves the ability to think in abstract terms and use the scientific method (deductive reasoning) to arrive at conclusions. With the ability to use scientific reasoning, adolescents can plan their future. They can create a hypothesis (What if I go to college? What if I do not?) and think through the probable consequences (In the long run, I will earn more money; I could begin earning money immediately). This scenario does not pertain to socialization, role identification, or sensorimotor development.

A 15-year-old adolescent shows a pattern of gaining weight, not a large amount but a little more each visit. The adolescent is not active in any sports and eats out frequently with parents. What is the best way for the nurse to assess the adolescent's eating pattern? Ask the adolescent to recall what was eaten in the last 3 days. Ask the adolescent to show the nurse what a healthy portion looks like. Have the adolescent guess the calorie intake in a 24-hour period. Have the adolescent keep a food diary for 1 week.

Have the adolescent keep a food diary for 1 week. Having the adolescent keep a food diary over 1 week allows the nurse as well as the client to examine what the client eats and when the client is eating it. Keeping a food journal allows a discussion of the choices made and the substitutes that the client could possibly make. The times that the client eats may also lead to weight gain. Asking for recall of 3 days' intake would be difficult, and most information would be inaccurate due to forgetting some item of food intake or when the food was eaten. Most people have no idea how many calories are in a food item unless they are specifically counting calories for dieting or health reasons. An adolescent would have a difficult time demonstrating a healthy portion size unless it has been demonstrated first.

The school nurse is developing a school wellness program to promote healthy eating habits and regular physical activity. What is the most important element to emphasize to maximize compliance, healthy habits, and long-term change? Incorporate activity in parts of the daily schedule. Serve fruits and vegetables in the cafeteria. Include both parents and children in the wellness program. Eliminate sweetened, carbonated beverages in the cafeteria.

Include both parents and children in the wellness program. Every campaign to support good nutrition and daily physical activity must include parents and their children as active members of the learning community. Although the other actions can accomplish in-school enhancements to health, long-term change tends to be more likely when the programs implemented involve the family. Programs implemented without a family-centered approach often fail when the child's home life and school life are disconnected.

The nurse is talking with parents of a depressed 16-year-old boy. Which question is of the most importance? How is his personal hygiene? Does he exercise? Have his sleeping and eating habits changed? Is there a gun in your home?

Is there a gun in your home? He may be at risk for suicide. Firearm-related suicides have been responsible for a large number of the suicide deaths in 15- to 19-year-olds nationwide. All the other questions assess for depression and do not protect against suicide.

The nurse is meeting with a group of caregivers of adolescents. Which example should the nurse point out is most effective for the caregiver to support the adolescent? Our house rules are stricter than their friends but everyone follows the same rules in our home. Discourage spending too much time with school friends since we know they can be a negative influence. Leave pamphlets about topics such as drugs and alcohol in their room so they can read them. Let them choose their hairstyle, even though it may not look the best for them.

Let them choose their hairstyle, even though it may not look the best for them. The adolescent whose family caregivers make it difficult to conform are adding another stress to an already emotion-laden period. By allowing the adolescent to follow trends and fads in clothing choices, hairstyles, and music, the caregiver decreases the stress for the child. Information about drugs and alcohol is important to share, but these topics would be better discussed with the child. It is important the adolescent spend time with peers.

While caring for a 16-year-old client expected to be hospitalized for several months, the nurse will perform which action to assist the client in meeting the current stage of psychosocial development? Permit peers to visit during open visitation hours. Explain medical concepts by providing handouts and brochures. Provide video games for the client to play. Allow the client to touch equipment before procedures.

Permit peers to visit during open visitation hours. In each stage of development, a significant person or group exerts a lasting influence on the ongoing development of the child. An adolescent striving for self-identity and increased independence spends more time with peers than with family. It is important for the hospitalized adolescent to still be able to visit with peers. Video games may be enjoyed by the adolescent and limit boredom; however, this action would not facilitate psychosocial development. Allowing the client to touch equipment and to explain medical concepts/procedures are methods used to teach toddlers and preschoolers. Providing handouts and brochures are not effective methods to explain medical concepts; the nurse would verbally explain using models, pictures, and diagrams. Handouts and brochures can be used as supplements to teaching.

A female client tells the nurse about noticing an increase in weight and fat deposits during the past year. The nurse reviews the client's chart and recognizes that the client is most likely going through puberty. Which nursing action is most appropriate at this time? Provide reassurance that these are normal changes. Review dietary measures to assist in controlling weight gain. Share what foods can be eaten on a low-fat diet to prevent fat deposits. Encourage increased exercise to control weight gain.

Provide reassurance that these are normal changes. Increased fat deposits and weight and height changes are normal as girls begin hormonal changes of puberty. During adolescence, girls are very sensitive about their appearance and experience a constant need for reassurance. Puberty is a period when children are very self-conscious about their overall appearance. Reassurance needs to be provided that increased fat deposits and weight and height changes are normal. Dietary management is indicated if a true weight problem is present, but healthy eating should be encouraged rather than dieting. Adolescents should be encouraged to participate in appropriate exercise programs. Dieting issues such as anorexia and bulimia can threaten the health of adolescents.

Which action would provide an indication that an adolescent's parents understand their child's need for increased independence? Saying, "We will always be here for her whenever our child needs us." Stating they are encouraging their child in the search for an after-school job Verbalizing, "We try to do everything we can to make things easier for her." Reporting they understand that their child's chief need is for increased privacy

Stating they are encouraging their child in the search for an after-school job Encouraging adolescents to separate from parents, not to continue to rely on them, can be difficult for parents because it involves allowing adolescents to face and solve problems instead of having them solved for them. Fluctuating relationships with parents may limit the teen from seeking assistance with the common issues of the teenage years. The adolescent years are full of unpredictability and inconsistencies. When the parents are aware of the teen's need for developing independence it provides the teen with stability. Making things easier and always being available make the teen more dependent on the parents instead of developing independence.

A 16-year-old client has been hospitalized 100 miles from home for 1 week to repair a fractured patella suffered in a skateboarding accident. She was cheerful and chatty when she first arrived, but the nurse notes in recent days she has become increasingly quiet and seems lonely. Which nursing intervention should the nurse prioritize for this client? Take her to the teen lounge so she can meet and interact with other teens. Suggest that she read books and magazines from the hospital bookmobile. Call the hospital's mental health unit to see if she can get some counseling. Ask her caregivers to bring her siblings and friends to visit.

Take her to the teen lounge so she can meet and interact with other teens. Adolescents need access to their peers so they can keep up social contacts. Meeting other teens in the facility is one way to accomplish that. The client most likely also has an electronic device which will enable her to stay in contact with family and friends back home but meeting others can also help meet social needs. Recreation areas are important. In settings specifically designed for adolescents, recreation rooms can provide an area where teens can gather to do schoolwork, play games and cards, and socialize. Because she is 100 miles from home, a visit from friends might be difficult.

The nurse is preparing to participate in a community discussion on the needs of the adolescents in the local school. The nurse should point out which goal is the primary concern for these young individuals as the committee makes plans? They want to successfully complete activities. They understand and respond to discipline. Each child is learning to do things on his or her own. Teens are busy developing their own personal identity.

Teens are busy developing their own personal identity. According to Erikson, the central task of adolescence is to develop unique personality and identity. The developmental task for the school-age child is to develop a sense of industry, and completing activities builds that feeling of confidence. Erikson's psychosocial developmental task for toddlers is to achieve autonomy (independence) and do things on their own. Learning to speak and to understand and respond to discipline are not developmental tasks, according to Erikson.

The nurse is caring for an adolescent athlete who is being seen for a fractured arm. The parent reports that this is the third sports injury in the past 2 years. The parent asks the nurse why the adolescent—who is healthy overall— continues to have injuries. How should the nurse respond? There may be some underlying problems that your adolescent should be evaluated for. Some adolescents are accident-prone. These are accidents and random in occurrence. The bones, joints, and tendons of adolescents are vulnerable to injury due to their rapid state of growth.

The bones, joints, and tendons of adolescents are vulnerable to injury due to their rapid state of growth. 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 adolescent's injuries are most likely the result of the stage of physical growth. There is no evidence the adolescent has any underlying medical conditions.

The physician has made a notation in the medical record of a 17-year-old that the teen is not demonstrating successful completion of Erikson's stages of development. What behavior would be consistent with this assessment? The teen is distrustful of others. The teen is uncertain and frequently unable to make decisions. The teen is sexually promiscuous. The teen is anxious to move away from his parent's home.

The teen is uncertain and frequently unable to make decisions. According to Erikson's stages of development, the teen develops a sense of identity. Failure to successfully complete this stage will result in a lack of self confidence and an inability to see one's self as in independent being. The establishment of the ability to trust is completed in an earlier stage of psychosocial development. A desire to move away from the parental home is not uncommon and is not a sign of impaired navigation of this level of psychosocial development.

The nurse is talking to a 13-year-old boy about choosing friends. Which function do peer groups provide that can have a negative result? following role models developing stability sharing problems negotiating differences

following role models Peers serve as role models for social behaviors, so their impact on an adolescent can be negative if the group is using drugs, or the group leader is in trouble. Sharing problems with peers helps the adolescent work through conflicts with parents. The desire to be part of the group teaches the child to negotiate differences and develop loyalties and stability.

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? poison prevention water sports injuries drug and alcohol use prevention motor vehicle safety

motor vehicle safety 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).

Nurses should provide anticipatory guidance to males to prepare them for what particular pubertal change in middle-to-late adolescence? pubic hair growth lengthening of the penis nocturnal emissions reddening of the scrotum

nocturnal emissions Involuntary ejaculation during the night can be disturbing to the adolescent male who has little or no understanding of what is happening in the body. Lengthening of the penis begins to occur in early adolescence as does reddening of the scrotum and emergence of pubic hair.

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? whole grain bread fresh orange juice fat-free milk organic carrots

whole grain bread 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.