Chapter 29 growth and development of the adolescent

During a visit to the school nurse, an adolescent confides in recently having homosexual feelings. How should the nurse best respond to the adolescent?

"Would you like to talk about these feelings?"

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?

"You are feeling sad right now. It's a hard time."

The school nurse is meeting with a group of 11-year-old girls to discuss expected puberty changes in their bodies. When one of the girls states, "I just feel like my whole body is changing and I don't know why" what should the nurse point out to this group?

"You have lots of hormone changes going on right now."

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?

Allow the adolescent to choose the time for the dressing change.

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?

Assess the client for signs of infection.

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?

Banding together with other girls and dressing like 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?

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

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 who are showing pubertal changes

A nurse is conducting an assessment of a 16-year-old's cognitive development. The nurse determines that the adolescent's cognitive development is within acceptable parameters for the adolescent's age based on which assessment finding? Select all that apply.

Demonstrates thinking that the adolescent is invincible. Uses scientific methods to solve verbal problems. Shows a beginning interest and concern with societal and political issues.

The nurse is assessing a teenage client and notes his lower front teeth are slightly crossed over. The nurse points out to his caregiver that he should see an orthodontist about this to prevent which potential situation?

Even slight malocclusions make chewing and jaw function less efficient.

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?

Formal operational thought

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?

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.

What anticipatory guidance can the nurse provide the girl who has noted the development of breast buds?

Menarche should follow in about 2 years.

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?

Offer to assist the girl in washing her hair and let her pick the shampoo.

The nurse is planning a presentation to an adolescent group. What recommendations would the nurse include in the presentation?

Participate in 60 minutes of moderate to vigorous physical activity each day.

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.

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 other teens, use a phone, and check her email.

What activity would best foster the developmental task of an adolescent who uses a wheelchair to ambulate?

Talking to another adolescent who has a similar situation

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?

Tattooing carries risks such as infection, disease, and nerve damage.

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?

Teens are busy developing their own personal identity.

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?

Teens can be exposed to inappropriate materials, harassment, threats, and potential for molestation.

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

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's need for privacy should be respected.

The nurse is caring for 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?

The bones, joints and tendons of adolescents are vulnerable to injury due to their rapid state of growth.

The mother of a 14-year-old girl voices concerns that her daughter is likely to be not getting enough nutrients. How many calories should be ingested by the teen daily?

The teen girl who is active should consume about 2000 calories per day.

While assessing a 17-year-old client, the nurse notes the following: blood pressure 152/96 mm Hg, pulse 124 beats/minute, respirations 20 breaths/minute, temperature 98.8°F (37.1°C), dilated pupils, euphoric state, and pressured speech. Which prescription will the nurse anticipate first from the primary health care provider?

Urine drug screen

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?

be sure to clean the navel several times a day

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?

black

During the admission process the nurse learns a 14-year-old female client has not experienced menarche yet. Which nursing action is appropriate?

continue the admission process

The nurse is caring for a 16-year-old client. The client confides in the nurse the use of marijuana daily. Which action by the nurse is appropriate?

discuss side effects with the client

According to Erikson, the adolescent develops his or her own sense of being an independent person with individual thoughts and goals. This stage is referred to as:

identity vs. role confusion.

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?

include both parents and children in the wellness program

The nurse is talking with parents of a depressed 16-year-old boy. Which question is of the most importance?

is there a gun in your home?

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?

methamphetamine

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?

motor vehicle safety

Nurses should provide anticipatory guidance to males to prepare them for what particular pubertal change in middle-to-late adolescence?

nocturnal emissions

The parent of an adolescent diagnosed with iron-deficient anemia asks the nurse for help with incorporating more iron into the adolescent's diet when packing lunches and snacks for school. Which foods would be good sources of iron that could be easily incorporated into the diet when taking lunches and snacks to school? Select all that apply.

peanut butter eggs strawberries nuts

With summer approaching, the nurse discusses sun safety with a group of teen girls. Which suggestion is most likely to be followed?

wear sunglasses

The nurse is assessing an adolescent's risk for harm from guns being present in the home. What question would be best to ask during the assessment?

"Are the guns in your home locked in a safe?"

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 anabolic steroids?"

A black adolescent male has been diagnosed with hypertension. Which statement made by the adolescent indicates to the nurse that additional teaching is needed?

"Drinking sodas is not related to my blood pressure."

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?

"Give her some options; it's important to find something she enjoys."

The nursing student is discussing the effects on hormone production for an 11-year-old boy who has been admitted with a brain injury. Which statements by the nursing student are accurate? Select all that apply

"Gonadotropin-releasing hormone (GnRH) is produced by the hypothalamus. Since this child has a brain injury, this could be a concern for normal production of other hormones." "The production and secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) could be effected by his brain injury." "Sperm production could be impacted because follicle-stimulating hormone (FSH) and luteinizing hormone (LH) stimulate its production." "Maturation of the testicles is directly impacted by luteinizing hormone (LH). Having a brain injury at this age could cause problems with this stage of puberty."

The nurse is caring for a 13-year-old girl. The child has been identified as overweight with no underlying psychological or secondary causes. The nurse is reviewing the child's weight-loss progress and nutrition at a follow-up visit. What finding indicates a need for further discussion and teaching?

"Her goal is to be a size smaller by our vacation in two weeks."

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

The health care provider has prescribed oral tetracycline for an adolescent girl to help clear acne. What statement about the medication made by the girl would require additional teaching from the nurse?

"I need to take the medication with food every day."

The nurse is providing anticipatory guidance to a 12-year-old client and parent regarding psychosocial, cognitive and moral development. Which statement by the parent demonstrates the need for further teaching?

"My child will tend to think of oneself as invincible and increase risky behaviors."

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?

"Reinforce the family rules but also allow the adolescent to develop one's own routine."

The nurse is providing education on adolescent safety to a group of caregivers. Which statement by a caregiver indicates additional teaching is needed?

"Taking a course on driving safety is sufficient to teach safe driving skills."

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?

"That must be difficult, but on average black girls start their period earlier than other ethnicities."

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

"That must be hard for you to manage. Perhaps we can explore some strategies with her to establish more predictable sleep patterns."

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?

"The calories help his body increase muscle mass."

During an examination, an adolescent client tells the nurse about being anxious and frustrated because of the facial acne. Which nursing response is appropriate?

"This is one of the most common physical changes during adolescence."