Chapter 29: Growth and Development of the Adolescent

The mother of a 15-year-old boy confides in the nurse that she is concerned because her son is about to turn 16 and is pressuring her and her husband to buy him a motorcycle. Her husband is okay with the idea, but she is concerned about his safety. What information should the nurse mention to the mother regarding motorcycle safety? Select all that apply. a) Insist on age and not emotional maturity as the qualification for obtaining a driver's license. b) Require the son to wear full body covering. c) Require the son to wear a seat belt. d) Require the son to wear long pants. e) Require the son to wear a helmet. f) Require the son to learn all relevant safety rules.

Selected Answer: B, D, E, F Explanation: Equally dangerous as cars for adolescents are motorcycles, motorbikes, and motor scooters, which are appealing because of their low cost and convenience in parking. Both drivers and riders should wear safety helmets to prevent head injury; long pants to prevent leg burns from exhaust pipes; and full body covering to prevent abrasions in case of an accident. Advise adolescents who choose these forms of transportation to be as familiar with safety rules as automobile drivers and to wait until they are emotionally mature enough to use sound driving judgment. In the interest of an adolescent's safety and that of others, parents need to have the courage to insist on emotional maturity rather than age as the qualification for obtaining a driver's license. Motorcycles do not have seat belts.

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. a) "Our coach makes us wear sun-protective clothes when we practice outside on the weekends." b) "My favorite time of day to be outside is the middle of the day, around noon." c) "I only tan before going on spring break to get a base tan so I won't burn." d) "The more exposure and burns I get now will toughen my skin so I won't get skin cancer when I'm older." e) "My mom had melanoma so she always makes me wear a sunscreen with an SPF of 30."

Selected Answers: B, C, D Explanation: 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 adolescent comes to the clinic seeking information about sexuality concerns. The clinic nurse assures the adolescent that confidentiality and privacy will be maintained unless a life-threatening situation occurs. Which nursing goal(s) is the nurse highlighting in this process? Select all that apply. a) an environment where adolescents can be truthful b) development of a trusting relationship c) concern from parents who pay the office visit bill d) compliance with existing laws e) inappropriate response because adolescents are minors

Selected answers: A, B, D Explanation: Adolescents may seek a health care appointment for an unrelated health concern as a reason to discuss a sexual health question with a health care professional. Reassurance should be given to the adolescent that all questions and concerns will be addressed and will be kept confidential. This is the basis for the nurse-client relationship. All questions and concerns do not involve treatment and, therefore, do not involve parental consent. Parents may voice concerns because they are responsible for the insurance and billing. The nurse should act as a client advocate and work with the parents to develop a mutual understanding of the situation.

The nurse is caring for an 11-year-old girl. The girl's mother reports that the girl does not want to play team sports like soccer or volleyball anymore. Her daughter insists she does not enjoy them. The mother is concerned that her daughter will not get enough physical activity and asks the nurse for guidance. How should the nurse respond? a) "Give her some options; it's important to find something she enjoys." b) "Remind her of the importance of regular physical activity for good health." c) "Organized sports are just a complementary activity to other physical activities." d) "Why don't you sign her up for an aerobics or dance class?"

a) "Give her some options; it's important to find something she enjoys." Explanation: With the onset of puberty and accompanying changes in physique and coordination, sports must be matched to the physical and emotional development of the child. It is important to give the girl some options and find something that she enjoys doing. Making a suggestion for activities without the girl's input is unhelpful. Reminding the girl that she needs regular physical activity does not address the mother's concern and is not constructive. Making a statement that organized sports are just a complement to other physical activity is accurate but does not teach or offer solutions.

A 14-year-old boy is far quieter than usual when he visits his physician's office. The nurse asks him if anything is wrong, and the boy replies that he did not make the cut for the football team. What would be most appropriate for the nurse to say? a) "I'm really sorry; I know that must be a big disappointment." b) "Don't let it get you down; sports are a waste of time, anyway." c) "That's okay; you can try out for basketball in a few months." d) "It's not that big of a deal; a lot of kids don't make the football team."

a) "I'm really sorry; I know that must be a big disappointment." Explanation: It is important for adolescents to have immediate successes such as making the high school football team or having a date for the senior prom. Comments such as "When you're older, these things won't be so important," are not likely to erase the hurt that comes from being 16 and not being included in such major events. Compassionate understanding ("I'm really sorry; I know that must be a big disappointment") is a better communication technique. The other responses dismiss the client's feelings rather than acknowledging and validating them.

An adolescent who is depressed states, "Nothing ever seems to be right in my life." How should the nurse respond? a) "You are feeling sad right now. It is a hard time." b) "Try to look at the bright side of things." c) "Things will be better when you go off to college." d) "Being a teenager is hard work."

a) "You are feeling sad right now. It is a hard time." Explanation: 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 adolescent'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 at the bright side of things" or that "being a teenager is hard work" offers platitudes and interrupts the adolescent's interactions.

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? a) Banding together with other girls and dressing like them b) Hanging out with girls but maintaining her own unique style c) Hanging out primarily with boys her own age d) Banding together with boys and girls but maintaining her own unique style

a) Banding together with other girls and dressing like them Explanation: 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.

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? a) Boys grow at a slower, steadier rate than do girls. b) Girls grow at a slower, steadier rate than do boys. c) Boys grow at a rapid, sporadic rate. d) Boys and girls grow at the same rate.

a) Boys grow at a slower, steadier rate than do girls. Explanation: 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.

The parents of a 16-year-old male are worried about recent changes in his behavior, ignoring his schoolwork and sports, and spending almost all of his free time interacting with his girlfriend. Which suggestion should the nurse point out would best address this situation? Answer + choices in definition section

a) He has chosen a girl who is overly dependent on him. They should talk to him about making sure he meets his own needs, including doing the schoolwork he enjoys, in any relationship. b) He is not developmentally mature enough to make healthy choices about the ways in which he spends his time, so it would be helpful if they would make a schedule for him that includes about a half-hour per day to talk with his girlfriend. c) He has developed his own identity by now; being able to establish close relationships with girls is important preparation for all of his adult relationships. They should honor his need to be with, or talk to, his girlfriend as long as he has completed his schoolwork for the day. d) He is not developmentally mature enough to have an intimate relationship with one girl; they should encourage him to spend time with groups of friends rather than time alone with his girlfriend. Correct choice: C Explanation: When identity has been established, generally between the ages of 16 and 18 years, adolescents seek intimate relationships, usually with members of the opposite sex. Intimacy, which is mutual sharing of one's deepest feelings with another person, is impossible unless both persons have established a sense of trust and a sense of identity. Intimate relationships are a preparation for long-term relationships, and people who fail to achieve intimacy may develop feelings of isolation and experience chronic difficulty in communicating with others.

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? a) Provide reassurance that these are normal changes. b) Review dietary measures to assist in controlling weight gain. c) Share what foods can be eaten on a low-fat diet to prevent fat deposits. d) Encourage increased exercise to control weight gain.

a) Provide reassurance that these are normal changes. Explanation: 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.

What activity would best foster the developmental task of an adolescent who uses a wheelchair to ambulate? a) Talking to another adolescent who has a similar situation b) Allowing the adolescent to decide when to bathe c) Having a teacher bring school work to the adolescent d) Watching television on the set in the adolescent's room

a) Talking to another adolescent who has a similar situation Explanation: A sense of identity is developed by "trying on" roles and discussing values and goals with others. A sense of trust develops when an adolescent is able to find out whom (and what ideas) to have faith in. The adolescent period is also a time where past stages of development are revisited. The sense of autonomy is where the adolescent seeks ways to express individuality. The stage of initiative is where the adolescent develops vision of what he or she might become. Talking with another adolescent who also uses a wheelchair to ambulate will help the adolescent see possibilities and reassurances. Making decisions or having assistance from someone else does not allow the adolescent to "try out" roles.

An 18-year-old adolescent reveals the presence of nipple ring and is looking to get a tattoo in the next few months. What is the most important thing that the nurse can teach the adolescent at this time? a) Tattooing carries risks such as infection, disease, and nerve damage. b) It is not recommended to get the tattoo from your friend in his garage. c) Review the safety rules for those who do the tattooing. d) Complications are more likely when you tattoo yourself.

a) Tattooing carries risks such as infection, disease, and nerve damage. Explanation: The nurse needs to emphasize that tattoos and body piercing can be painful, and carry risks of complications such as infection, blood-borne diseases, keloids and granulomas, allergic reactions, excessive bleeding, nerve damage, or damage to the piercing site. Complications are more likely if a person tattoos oneself or has the tattoo done by a friend. The nurse needs to encourage the adolescent to seek the expertise of a trained technician, doctor, or nurse to have the piercing, tattooing, or branding done. There are developed safety rules for those who do piercing and tattoos.

Computer use at home and at school has increased adolescents' comfort in gaining access to and using the Internet. This has expanded their exposure to risks. What potential risks are there for an adolescent to be exposed to? a) Teens can be exposed to inappropriate materials, harassment, threats, and potential for molestation. b) Teens are at risk for identity theft from sharing personal information with others whom they do not know. c) Teens can become addicted to the online gaming and role-playing that is popular with their peers. d) Computer use can contribute to adolescent obesity due to decreased activity and increased consumption of snacks.

a) Teens can be exposed to inappropriate materials, harassment, threats, and potential for molestation. Explanation: Teens are exposed to a great deal of inappropriate materials, harassments from other online users, and potential threats of molestation or solicitation of sexual favors. Teens are at risk for identity theft, but it is not as big of a concern for them because they do not use their Social Security information or credit card information. Computer use can contribute to obesity, but the risks of inappropriate materials, threats, and sexual exploitation are a greater threat. It is possible for teens to become addicted but the other risks are of more concern to parents.

According to Erikson, the adolescent develops their own sense of being an independent person with individual thoughts and goals. This stage is referred to as: a) identity vs. role confusion. b) intimacy vs. isolation. c) industry vs. inferiority. d) autonomy vs. doubt and shame.

a) identity vs. role confusion. Explanation: Adolescents must develop their own personal identity—a sense of being independent people with unique ideals and goals. This is the period Erikson calls identity versus role confusion. Erikson believes during this time the adolescent goes back through all previous developmental periods to achieve this identity. The stage of autonomy versus shame and doubt occurs between 18 months and 3 years. Industry versus inferiority occurs between 5 to 12 years. Intimacy versus isolation occurs in adulthood between the ages of 19 to 40 years.

The school nurse is preparing health promotion presentations regarding unintentional injuries for a high school health fair. On which topic should the nurse place as the priority when preparing the presentation? a) motor vehicle safety b) drug and alcohol use prevention c) poison prevention d) water sports injuries

a) motor vehicle safety Explanation: 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? a) nocturnal emissions b) reddening of the scrotum c) lengthening of the penis d) pubic hair growth

a) nocturnal emissions Explanation: 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.

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

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

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

The nurse is counseling an overweight, sedentary 15-year-old girl. The nurse is assisting her to make appropriate menu choices. Which statement indicates the adolescent understands how to make appropriate dietary selections? a) "I avoid all fat intake." b) "I need to eat plenty of fruit each day." c) "To lose weight my protein intake should be limited to 2 to 4 servings per day." d) "Because of my age, my dairy intake is unlimited."

b) "I need to eat plenty of fruit each day." Explanation: The sedentary teen needs to consume approximately 1,600 calories each day. A balanced diet includes plenty of fresh fruit and a small amount of fat. To avoid all fat could place the child's health at risk. Protein intake is important for the development of tissue. The teen will need about 5 ounces of protein daily.

The nurse is caring for a 13-year-old adolescent. The adolescent has been identified as overweight with no underlying psychologic or secondary causes. The nurse is reviewing the adolescent's weight-loss progress and nutrition at a follow-up visit. What statement by the parent indicates a need for further discussion and teaching? a) "Our whole family has changed our eating habits." b) "My adolescent's goal is to be a size smaller by our vacation in 2 weeks." c) "My adolescent is helping us plan our family's weekly menu." d) "My adolescent has begun to eat slowly, putting down the fork between bites."

b) "My adolescent's goal is to be a size smaller by our vacation in 2 weeks." Explanation: The parent must be reminded that a successful weight loss program emphasizes long-term permanent changes, not rapid weight loss or short-term diets to meet a short-term goal.

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? a) Teach the parents to perform dressing changes at home. b) Allow the adolescent to choose the time for the dressing change. c) Have the adolescent go to the teen room every day. d) Have the school provide homework.

b) Allow the adolescent to choose the time for the dressing change. Explanation: 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? a) Permit the client to make decision regarding one's care b) Allow the client's friends to visit while the client is hospitalized c) Praise the client for correctly performing self-care d) Provide the client with crafts and puzzles to complete independently

b) Allow the client's friends to visit while the client is hospitalized Explanation: 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? a) Perform a neurologic assessment on the student to see if there are any changes in neurologic status. b) Ask the student to describe the issues he is having in the class. c) Notify the student's parents that their child should see the family health care provider. d) Ask the student's teacher if the child is achieving the recommended level of cognitive activity.

b) Ask the student to describe the issues he is having in the class. Explanation: 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.

An adolescent with a new piercing comes to the health center at the school. The client reports feeling hot. Which action will the nurse complete first? a) Ask the client if any other piercings are present. b) Assess the client for signs of infection. c) Determine when the client started feeling hot. d) Inquire about the piercing technique used

b) Assess the client for signs of infection. Explanation: The nurse will first assess the client for signs of infection. The client reports feeling hot, which could indicate a fever. The nurse would assess the client's temperature and for other signs and symptoms of infection, such as redness, swelling, warmness, drainage, discomfort. The nurse would ask when the client started feeling hot and about the technique used for the piercing to gain additional history and insight. However, these questions are not priority over assessing the client. Determining if the client has any additional piercings is not necessary, as this will not provide information about the client's current situation.

For reasons of anticipatory guidance, nurses should be aware that menarche appears earlier in some ethnic groups than others. In which ethnic group is menarche likely to appear first? a) Black b) Hispanic c) South Asian d) White

b) Hispanic Explanation: Black girls on average reach menarche slightly earlier than White, Hispanic, and South Asian girls

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

b) Is there a gun in your home? Explanation: 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.

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

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

A teenage boy tells the nurse that his parents embarrass him in front of his friends when they kiss him goodbye. The nurse is aware that this teenager is revisiting which stage of development identified by Erikson? a) generativity b) autonomy c) industry d) initiative

b) autonomy Explanation: In revisiting the stage of autonomy, the adolescent is seeking out ways to express his or her individuality in an effective manner. The adolescent would avoid behaviors that would "shame" or ridicule him or her in front of peers. The sense of industry is again encountered as the adolescent makes the choice to participate in different activities at school, in the community, at church, and in the workforce. Initiative is revisited as the adolescent develops a vision for what he or she might become. Generativity largely involves establishment of career and work.

The parents of a 16-year-old are fearful that their child may be using illegal drugs. They report to the nurse that they have noticed recently that their child seems much more focused when doing homework or chores, is losing weight, displays a high level of energy, and becomes agitated easily. The nurse is aware that the teen is displaying symptoms of which type of drug use? a) opiate b) methamphetamine c) CNS depressant d) inhalant

b) methamphetamine Explanation: Euphoria, increased energy and alertness, agitation, weight loss, insomnia, tachycardia, and hypertension are symptoms of methamphetamine use. Stimulants have similar effects as alcohol but the high only lasts a few minutes and includes slurred speech, lack of coordination, euphoria, and dizziness. Opiates produce feelings of relaxation and euphoria. CNS depressants cause euphoria followed by depression or hostility, impaired judgment, decreased inhibitions, slurred speech, and incoordination.

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

c) "Tattoos are invasive and there is the potential for disease with their application." Explanation: Piercings and tattoos are becoming increasingly common in adolescents. It is important to ensure that the girl and her family understand the potential risk for disease with the application of the tattoo. The adolescent is young, but that does not change the fact she wants to get a tattoo. Reminding the teen that it is a permanent alteration in the skin is important but not the most important response by the nurse.

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

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

During an examination, an adolescent client tells the nurse about being anxious and frustrated because of the facial acne. Which nursing response is appropriate? a) "Consuming fried foods and chocolate can cause acne to develop." b) "I will tell your primary health care provider about your acne." c) "This is one of the most common physical changes during adolescence." d) "Most people get acne during adolescence. It will go away as you get older."

c) "This is one of the most common physical changes during adolescence." Explanation: It is important for the nurse to inform the client that acne is a normal physical changes that characterizes adolescence as a result of increased glandular activity. The nurse should address the client's concern and not refer the client to the primary health care provider. The client's worries should not be trivialized or ignored as this is a situation that is worrisome for the adolescent. The type of foods consumed do not cause acne.

The school nurse is assessing a 15-year-old female client. The client states, "I just want to be pretty and to look like everyone else." Which response by the nurse is appropriate? a) "I think you are beautiful just as you are." b) "Do you not think you are pretty now?" c) "You seem concerned. Let's talk about your feelings." d) "Looking like everyone else is not what makes someone pretty."

c) "You seem concerned. Let's talk about your feelings." Explanation: Body image is closely related to self-esteem. Seeing one's body as attractive and functional contributes to a positive sense of self-esteem. During adolescence, the desire not to be different can extend to feelings about one's body and can cause adolescents to feel that their bodies are inadequate even though they are actually healthy and attractive. The nurse would acknowledge the client's concern and discuss the client's feelings. Stating the client is beautiful as is does not address the client's concern. Closed statements which require no response do not offer any insight for the nurse. The nurse would also avoid yes/no questions.

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? a) Up to age 2, children learn by touching, tasting, and feeling. They learn to control body movement. b) Children from ages 2 to 7 years investigate and explore the environment and look at things from their own point of view. c) After age 12 children can think in the abstract, including complex problem solving. d) From ages 7 to 11 years, children internalize actions and can perform them in the mind.

c) After age 12 children can think in the abstract, including complex problem solving. Explanation: 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.

A nurse is taking care of a teenager who reports involuntary discharge of semen while sleeping. The nurse observes that the client is confused and does not know about the pubertal changes that are taking place in his body. Based on this information, what is the highest priority area that should be reviewed with the client? a) Provide information about sex and sexuality. b) Review about sexually transmitted infections. c) Educate the client about the changes that occur during adolescence. d) Inform him that involuntary discharge of semen during sleeping needs immediate attention of the health care provider.

c) Educate the client about the changes that occur during adolescence. Explanation: The highest priority areas of the nurse's teaching involves informing the client about the expected pubertal changes that take place in the body and convincing him that the involuntary discharge of semen while sleeping is a normal part of reproductive health. Once the adolescent has an understanding of bodily changes during puberty then further education about sex, sexuality and sexually transmitted infections can be discussed.

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? a) Call the hospital's mental health unit to see if she can get some counseling. b) Ask her caregivers to bring her siblings and friends to visit. c) Take her to the teen lounge so she can meet and interact with other teens. d) Suggest that she read books and magazines from the hospital bookmobile.

c) Take her to the teen lounge so she can meet and interact with other teens. Explanation: 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.

A nurse is preparing a teaching session for a group of high-school students about making safe choices and the consequences when safe choices are not made. Which situation will the nurse point out as the most common cause of adolescent injuries? a) suicide b) sports c) motor vehicle accidents d) drowning

c) motor vehicle accidents Explanation: Although drowning, sports, and suicide are causes of adolescent injury, the most common cause of adolescent injuries is motor vehicle accidents.

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? a) "My son is developing normally and the traits of puberty vary from child to child." b) "My son's spontaneous erections and nocturnal emissions are very normal." c) "My son is not doing anything to cause the nocturnal emissions; they occur spontaneously." d) "My son must be sexually active or having overly sexual thoughts to have a nocturnal emission."

d) "My son must be sexually active or having overly sexual thoughts to have a nocturnal emission." Explanation: 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? a) "We will work toward ensuring our adolescent is developing trusting relationships." b) "It is most important for our adolescent to achieve independence from our dominance." c) "It is vital our adolescent learns to help others achieve their goals." d) "Our adolescent is working toward achieving a sense of personal identity."

d) "Our adolescent is working toward achieving a sense of personal identity." Explanation: 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.

An adolescent's parent states not knowing what to do with the adolescent. The parent reports the teenager is taking two or three showers a day when not that long ago the parent could barely get the teen to take a shower at all. What should the nurse's reply be to the parent? a) "Reevaluate the adolescent's ability to perform hygiene care since showering is so frequent." b) "Remind the adolescent about needing to be on a schedule so as to not disrupt the family." c) "Do not encourage multiple baths; it can be very drying to the skin." d) "Reinforce the family rules but also allow the adolescent to develop one's own routine."

d) "Reinforce the family rules but also allow the adolescent to develop one's own routine." Explanation: Adolescents find that frequent baths and deodorants are important due to the apocrine sweat gland secretion activity. The increases in sex hormones and steroids cause the skin to be oily. This leads to more showers or baths daily. This is a time when the adolescent is defining what type of personal hygiene products are preferred. Hygiene and personal care can become a source of family arguments as the young person develops a style of personal care. Parents need to be mindful of the adolescent yet maintain family rules and boundaries regarding aspects of personal care. It is important for teenagers to feel that they have some ability to develop their own personal care standards and daily patterns.

The nurse is providing anticipatory guidance to the parents of a 15-year-old who voice concerns with their teenager's sleep habits. They state, "Left to her own devices, I'm sure she'd stay up until 3:00 in the morning on the weekends and sleep until after lunchtime." Which should the nurse explain to the parents? a) "I can hear that this is exasperating for you, but know that children do grow out of this in time, with no ill effects." b) "It's very important that you communicate to your daughter that this is unacceptable because it can have a negative effect on her health." c) "This is expected at this stage of development. Are there any ways that you could adjust your family routines to accommodate this?" d) "That must be hard for you to manage. Perhaps we can explore some strategies with her to establish more predictable sleep patterns."

d) "That must be hard for you to manage. Perhaps we can explore some strategies with her to establish more predictable sleep patterns." Explanation: It is common for adolescents to adopt habits of going to bed late and awakening late, especially on weekends. Despite the fact that this is common, it is not ideal; the nurse should explore strategies for changing the adolescent's behavior in a collaborative and inclusive manner. Simply communicating that it is unacceptable is unlikely to bring about change.

The nurse is meeting with a 16-year-old girl who reports being physically active on the track and basketball teams at school. The child reports a weight loss of 7 lb (3.2 kg) since she began training for the track season. When reviewing her caloric needs the nurse recognizes the diet should include how many calories? a) 1,800 calories per day b) 2,400 calories per day c) 2,000 calories per day d) 2,200 calories per day

d) 2,200 calories per day Explanation: The dietary intake for active teen females should include be approximately 2,200 calories daily.

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? a) An understanding of socialization and of isolation b) An ability to be autonomous c) A willingness to take initiative d) A sense of trust and identity

d) A sense of trust and identity Explanation: 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 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? a) Clients in the age group of 18 to 20 years b) Clients with strong, muscular appearance c) Clients who have reached adulthood d) Clients who are showing pubertal changes

d) Clients who are showing pubertal changes Explanation: 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.

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? a) Socialization b) Identification of identity c) Sensorimotor d) Formal operational thought

d) Formal operational thought Explanation: 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.

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? a) Eliminate sweetened, carbonated beverages in the cafeteria. b) Serve fruits and vegetables in the cafeteria. c) Incorporate activity in parts of the daily schedule. d) Include both parents and children in the wellness program.

d) Include both parents and children in the wellness program. Explanation: 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.

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

d) Menarche should follow in about 2 years. Explanation: 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.

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? a) Explain medical concepts by providing handouts and brochures. b) Provide video games for the client to play. c) Allow the client to touch equipment before procedures. d) Permit peers to visit during open visitation hours.

d) Permit peers to visit during open visitation hours. Explanation: 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.

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

d) 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 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? a) Some adolescents are accident-prone. b) These are accidents and random in occurrence. c) There may be some underlying problems that your adolescent should be evaluated for. d) The bones, joints, and tendons of adolescents are vulnerable to injury due to their rapid state of growth.

d) The bones, joints, and tendons of adolescents are vulnerable to injury due to their rapid state of growth. Explanation: 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? a) The teen is anxious to move away from his parent's home. b) The teen is sexually promiscuous. c) The teen is distrustful of others. d) The teen is uncertain and frequently unable to make decisions.

d) The teen is uncertain and frequently unable to make decisions. Explanation: 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.