Chapter 7: Growth and Development of the Adolescent
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. Which of the following indicates a need for further discussion and teaching? a) "My daughter is helping us plan our family's weekly menu." b) "We are using family outings and activities as a reward for weight loss." c) "Her goal is to be a size smaller by our vacation in two weeks." d) "Our whole family has changed our eating habits."
"Her goal is to be a size smaller by our vacation in two weeks." Explanation: The mother 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.
The nurse is discussing psychosocial development of the adolescent with a group of family caregivers. Which of the following statements made by the caregiver is an example of the most effective way the caregiver can support the adolescent? a) "I leave pamphlets about topics such as drugs and alcohol in his room so he can read them any time." b) "We discourage him from spending too much time with his school friends since we know they can be a negative influence." c) "The hairstyles she chooses are not what I think looks good on her, but I just let her do what she wants to with her hair." d) "Our house rules are strict and we know many of his friends are not, but they all follow the same rules at our house."
"The hairstyles she chooses are not what I think looks good on her, but I just let her do what she wants to with her hair." Explanation: 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 substance abuse is important to share, but the topics would be better discussed with the child. It is important the adolescent spend time with peers.
When discussing the growth and development of an adolescent, the nurse refers to various theories and phases of development. A nurse is discussing Erikson's theory of psychological development with an adolescent client. Based on Erikson's theory of psychosocial development, which should the nurse identify as the major priority challenge faced by adolescents? a) Helping others achieving their goals b) Achieving independence from parental dominance c) Developing trust d) Achieving their own identity
Achieving their own 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.
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) Mexican-American b) African-American c) Caucasian
African-American Explanation: Menarche begins, on average, at 12.06 years in African-American girls, 12.25 years in Mexican-American girls, and 12.55 years in Caucasians.
The school nurse is providing nutritional guidance during a 9th grade health class. Which foods should the nurse recommend as good sources for calcium? a) Strawberries, watermelon, and raisins b) Cheese, yogurt, and white beans c) Beans, poultry, and fish d) Peanut butter, tomato juice, and whole grain bread
Cheese, yogurt, and white beans Explanation: Cheese, yogurt, white beans, milk, and broccoli are good sources of calcium. Strawberries, watermelon, raisins, peanut butter, tomato juice, and whole grain bread are all foods high in iron.
Based on the most frequent cause of death in adolescents, what preventive measure would you most want to teach an adolescent? a) Home safety b) Motor-vehicle safety c) Water safety d) Firearm safety
Motor-vehicle safety Explanation: Motor-vehicle accidents are the number one cause of death in adolescents.
A client tells the nurse that she has noticed an increase in weight and fat deposits during the last 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) Encourage increased exercise to control weight gain. b) Review dietary measures to assist in controlling the weight gain. c) Provide reassurance that these are normal changes. d) Share what foods can be eaten on a low fat diet to prevent fat deposits.
Provide reassurance that these are normal changes. Explanation: Increased fat deposits, weight and height changes are normal as girls begin hormonal changes of puberty. During adolescence, girls are very sensitive about their appearance and 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. Teenagers should be encouraged to participate in appropriate exercise programs. Dieting issues such as anorexia and bulimia can threaten the health of adolescence.
A client tells the nurse that she has noticed an increase in weight and fat deposits during the last 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) Review dietary measures to assist in controlling the weight gain. b) Encourage increased exercise to control weight gain. c) Provide reassurance that these are normal changes. d) Share what foods can be eaten on a low fat diet to prevent fat deposits.
Provide reassurance that these are normal changes. Explanation: Increased fat deposits, weight and height changes are normal as girls begin hormonal changes of puberty. During adolescence, girls are very sensitive about their appearance and 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. Teenagers should be encouraged to participate in appropriate exercise programs. Dieting issues such as anorexia and bulimia can threaten the health of adolescence.
Nurses work to prevent tobacco use by teens because: (Select all that apply.) a) Smokeless tobacco damages gums and teeth. b) Tobacco use is addicting (nicotine). c) Teens who smoke are more likely to use alcohol and drugs. d) Smoking damages the respiratory system. e) Smoking is associated with fighting and unprotected sex.
• Smoking damages the respiratory system. • Smokeless tobacco damages gums and teeth. • Teens who smoke are more likely to use alcohol and drugs. • Smoking is associated with fighting and unprotected sex. • Tobacco use is addicting (nicotine).
The nurse is discussing the topics of sex and sexuality and how to discuss these issues with a group of caregivers of adolescents. Which of the following statements made by the nurse is most appropriate to tell this group of caregivers? a) "Being honest and straightforward with teenagers will encourage them to ask their parents about subjects like sexuality." b) "Most schools have excellent programs to teach adolescents about sex and sexuality." c) "Teenagers spend so much time with their peers, and that is usually how they find out about sex." d) "Internet resources, movies, and television have the most accurate and current information for your adolescent to learn about sexuality issues."
"Being honest and straightforward with teenagers will encourage them to ask their parents about subjects like sexuality." Explanation: The most important aspect of discussions about sexuality with adolescents is giving honest, straightforward answers in an atmosphere of caring concern. Children whose need for information is not met through family, school, or community programs will get the information—often inaccurate—from peers, movies, television, or other media.
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. Which of the following indicates a need for further discussion and teaching? a) "We are using family outings and activities as a reward for weight loss." b) "Her goal is to be a size smaller by our vacation in two weeks." c) "My daughter is helping us plan our family's weekly menu." d) "Our whole family has changed our eating habits."
"Her goal is to be a size smaller by our vacation in two weeks." Explanation: The mother 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.
During the annual physical examination, a teenage client tells the nurse that she is anxious as well as frustrated because of the acne on her face. Which is the best response for the nurse? a) "You must be eating fried foods or sweets in large quantities." b) "This is one of the most common physical changes during adolescence." c) "Most of us get acne during adolescence. Even some adults do. Don't worry." d) "It could be serious; seek consultation when your primary care physician examines you."
"This is one of the most common physical changes during adolescence." It is important for the nurse to inform the client that acne is one of the physical changes that characterizes adolescence as a result of increased glandular activity. The client need not seek consultation with the primary care provider, because the condition is not serious. The client should not be reprimanded; the condition should be explained as a natural phase. The client's worries should not be trivialized or ignored either.
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) Children from ages 2 to 7 years investigate and explore the environment and look at things from their own point of view. b) Up to age 2, children learn by touching, tasting, and feeling. They learn to control body movement. c) From ages 7 to 11 years, children internalize actions and can perform them in the mind. d) After age 12 children can think in the abstract including complex problem solving.
After age 12 children can think in the abstract including complex problem solving.
A 17-year-old girl needs to increase her iron intake but is concerned about weight gain. The nurse will suggest which of the following? a) Raspberry yogurt, granola, apple b) Chicken, whole-wheat bread, watermelon c) Egg white omelet, broccoli, pear d) Cottage cheese, crackers, oranges
Chicken, whole-wheat bread, watermelon Correct Explanation: 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. Calorie content is also acceptable.
A nurse is attending to a group of boys at a school. The nurse is required to document for the sexual development in boys on a regular basis. The nurse would anticipate which clients of having the highest incidence of experiencing nocturnal emissions? a) Clients in the age group of 18 to 20 years b) Clients with strong, muscular appearance c) Clients who are showing pubertal changes d) Clients who have reached adulthood
Clients who are showing pubertal changes
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? a) Negotiating differences b) Sharing problems c) Following role models d) Developing loyalties
Explanation: 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.
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? a) Developing loyalties b) Following role models c) Sharing problems d) Negotiating differences
Following role models Explanation: 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.
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 reviews "wet dreams" and the other male traits of puberty to the mother. Which of the following responses indicates a need for further discussion? a) "My son must be sexually active or having overly sexual thoughts to have a nocturnal emission." b) "My son is not doing anything to cause the nocturnal emissions; they occur spontaneously." c) "My son is developing normally and the traits of puberty vary from child to child." d) "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." 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.
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. Which of the following should the nurse do to encourage a sense of autonomy and dignity related to the girl's body image? a) Assist the girl with using the bed pan to urinate b) Allow the girl to wear her own clothes, despite hospital policy c) Brush the girl's hair for her d) Offer to assist the girl in washing her hair and let her pick the shampoo
Offer to assist the girl in washing her hair and let her pick the shampoo Explanation: Remember 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 patients to be dressed in a hospital gown while admitted, the nurse should not allow the girl to wear her own clothes.
Parents comment that their son seemed more coordinated on the basketball floor at 12 years than he does now at 14. The nurse can include what information in the response? a) Rapid and uneven growth of early adolescence (11 to 14 years) can interfere with coordination. b) Hand-eye coordination is affected negatively by puberty. c) It is more difficult to keep focused at 14 years than at 12. d) This may be a reaction to adult authority.
Rapid and uneven growth of early adolescence (11 to 14 years) can interfere with coordination. Explanation: Uneven growth of soft tissues and bones during growth spurts can cause decreased coordination for boys. The age of 14 years is usually the time of peak height velocity (PHV). Mental focus and reaction to adult authority are not causes of poor coordination. Gains in hand-eye coordination are made during puberty and become precise by late adolescence.
The mother of a 15-year-old boy expresses sadness to the nurse that her son is "much more connected to his friends than his family." What understanding would benefit this parent? (Select all that apply.) a) Adolescents need parental support and guidance as they move toward greater peer involvement. b) Peers are needed for emotional security while stepping away from family. c) Peers provide opportunity to learn and practice social roles. d) Peers can be positive or negative influences.
• Adolescents need parental support and guidance as they move toward greater peer involvement. • Peers provide opportunity to learn and practice social roles. • Peers can be positive or negative influences. • Peers are needed for emotional security while stepping away from family. Explanation: All the statements are true regarding the role peers play in an adolescent's life. The mother may better understand the appeal of the peers.
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. Which of the following 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 a helmet c) Require that the son to wear a seat belt d) Require the son to learn all relevant safety rules e) Require the son to wear full body covering f) Require the son to wear long pants
• Require the son to wear a helmet • Require the son to wear long pants • Require the son to wear full body covering • Require the son to learn all relevant safety rules 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.
The nurse is collecting data from a 15-year-old boy who is being seen at the ambulatory care clinic for immunizations. During the initial assessment, he voices concerns about being shorter than his peers. What response by the nurse is indicated? a) "Boys your age will often continue growing a few more years." b) "I am sure you are not the shortest guy in your class." c) "Being short is nothing to be ashamed of." d) "Are the other men in your family short?"
"Boys your age will often continue growing a few more years." Explanation: Teen age boys can experience growth in height until age 17.5. The nurse should reassure the teen that this may happen for him. Telling the client not to be ashamed, or assuring him it is not as short as his peers fails to provide information or support. Determining the height of the other men in the family may be indicated at a later time but is not the most appropriate initial comment.
The nurse is promoting safe sex to a 14-year old boy who is frequently dating. Which of the following points is most likely to be made during the talk? a) "Adolescents account for 25% of sexually transmitted infection (STI) cases." b) "Girls are more susceptible to STIs than boys." c) "Be careful or you'll wind up being a teenage dad." d) "Contraception is a shared responsibility."
"Contraception is a shared responsibility." Explanation: Since most contraception methods are designed for females, it is important to teach the boy that contraception is a shared responsibility. Statistics about adolescent cases of STIs and warnings about getting the girl pregnant can easily be ignored by the child's sense of invulnerability. The fact that girls are more susceptible to STIs may give the boy a false sense of security.
The nurse is caring for an 11-year-old girl. The girl's mother complains 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) "Why don't you sign her up for an aerobics or dance class?" 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) "Give her some options; it's important to find something she enjoys."
"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.
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) "Because of my age, my dairy intake is unlimited." c) "I need to have 4 servings of fruit each day." d) "To lose weight my protein intake should be limited to 2 to 4 servings per day."
"I need to have 4 servings of fruit each day." Explanation: The sedentary teen needs to consume approximately 1,600 calories each day. The recommended numbers of servings of fruit needed daily are four. A balanced diet includes 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 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 reviews "wet dreams" and the other male traits of puberty to the mother. Which of the following responses indicates a need for further discussion? a) "My son's spontaneous erections and nocturnal emissions are very normal." b) "My son is developing normally and the traits of puberty vary from child to child." c) "My son must be sexually active or having overly sexual thoughts to have a nocturnal emission." d) "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." Correct 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.
Billy's mother is with him at a visit for a sore throat. In the interview she states that she does not know what to do with him: He is taking two or three showers a day, when not that long ago she could barely get him to take a bath at all. What should the nurse's reply be to the mother? a) "Do not encourage multiple baths, it can be very drying to the skin." b) "Reinforce the family rules but also allow him to develop his own routine." c) "Reevaluate his ability to do hygiene care since he is showering so frequently." d) "Remind him that he needs to be on a schedule so that he does not disrupt the family."
"Reinforce the family rules but also allow him to develop his own routine." Explanation: Hygiene and personal care can become a source of family arguments as the young person develops their own 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 adolescents to feel that they have some ability to develop their own personal care standards and daily patterns.
Billy's mother is with him at a visit for a sore throat. In the interview she states that she does not know what to do with him: He is taking two or three showers a day, when not that long ago she could barely get him to take a bath at all. What should the nurse's reply be to the mother? a) "Do not encourage multiple baths, it can be very drying to the skin." b) "Reinforce the family rules but also allow him to develop his own routine." c) "Remind him that he needs to be on a schedule so that he does not disrupt the family." d) "Reevaluate his ability to do hygiene care since he is showering so frequently."
"Reinforce the family rules but also allow him to develop his own routine." Explanation: Hygiene and personal care can become a source of family arguments as the young person develops their own 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 adolescents to feel that they have some ability to develop their own personal care standards and daily patterns.
The nurse is discussing psychosocial development of the adolescent with a group of family caregivers. Which of the following statements made by the caregiver is an example of the most effective way the caregiver can support the adolescent?
"The hairstyles she chooses are not what I think looks good on her, but I just let her do what she wants to with her hair." Explanation: 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 substance abuse is important to share, but the topics would be better discussed with the child. It is important the adolescent spend time with peers.
Jenny is a 15-year-old who is being seen today in the clinic, and her mom comments on the fact that Jenny seems to always choose the opposite of what everyone else wants and that her mood swings are a common occurrence. What statement below shows the nurse that Jenny's mom understands these changes? a) "She will never find anyone to live with her if she acts like this." b) "This is her temperament and we will have to learn how to deal with her." c) "This is common for this age group and it will get better with time." d) "I know that she is doing this because of all the hormones."
"This is common for this age group and it will get better with time." Explanation: During the middle adolescence the teenager 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 and they tend to smooth out and the teen will become more introspective. By late adolescence emotions become more consistent.
By being honest and nonjudgmental with 15-year-old Tony, the nurse has built a relationship in which Tony feels he can talk about things that worry him. He has shared with the nurse that his parents believe he is too young to know about or think about sex. Tony tells the nurse that he has been having wet dreams and is ashamed and afraid he will get into trouble. Which of the following statements would be appropriate for the nurse to respond? a) "Since your parents feel you are not ready to talk about sex, you need to honor their wishes. You should try talking to your parents about this." b) "You don't need to feel ashamed. I will speak to your parents about the importance of allowing you to experiment with and feel good about your sexuality." c) "Wet dreams are not the result of anything you are doing but are simply the body's way of ridding itself of excess semen." d) "Don't worry, it is perfectly normal for 15-year-olds to have the kinds of fantasies that lead to wet dreams. You should tell your parents about this."
"Wet dreams are not the result of anything you are doing but are simply the body's way of ridding itself of excess semen." Explanation: Boys who are unprepared for nocturnal emissions may feel guilty, believing that they have caused these "wet dreams" by sexual fantasies or masturbation. They need to understand that this is a normal occurrence and is simply the body's method of getting rid of surplus semen.
The nurse is planning to talk to a 12½-year-old boy who says, "I am too short! Girls are taller than I am. Guess I won't be playing basketball." What points of information will the nurse share? Select all that apply. a) "If you know how tall you were at age 3, you can double that and predict fairly well how tall you will get." b) "Girls begin to grow rapidly at a younger age than boys do. Boys start later and grow longer." c) "There are a lot of size differences in your age group now because everyone enters puberty and grows at slightly different times than others." d) "You could add as much as 12 inches to your height before you stop growing." e) "You are at the age now when most boys begin their growth spurt and grow very rapidly." f) "You can't control when and how much you will grow. Basketball can use some really fast guards."
-->"You could add as much as 12 inches to your height before you stop growing." -->There are a lot of size differences in your age group now because everyone enters puberty and grows at slightly different times than others." --> "Girls begin to grow rapidly at a younger age than boys do. Boys start later and grow longer." The information about girls growing faster than boys, about differences in size within his age group, and about his growth potential is accurate and addresses concerns implied in his comments to the nurse. Most boys' growth spurts begin near 14 years, not 12r. Height should be doubled at 2 years to predict adult size. The growth control and basketball remarks minimize his concerns and provide no information.
In discussing the psychosocial development of the adolescent, it is important to understand that in order for adolescents to be in intimate relationships in which feelings are mutually shared, both persons must have which of the following? a) An ability to be autonomous b) A willingness to take initiative c) A sense of trust and of identity d) An understanding of socialization and of isolation
Achieving their own 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.
In comparing the rate of growth in preadolescent girls and preadolescent boys, which of the following is the most accurate about growth rate? a) Boys and girls grow at the same rate. b) Girls grow at a slower, steadier rate than do boys. c) Boys grow at a slower, steadier rate than do girls. d) Boys grow at a rapid, sporadic rate.
Boys grow at a slower, steadier rate than do girls. Explanation: Preadolescence 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 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? a) Checking for signs of depression or lack of friends b) Watching for aggressive behavior or racist remarks c) Monitoring video games, TV shows, and music d) Becoming acquainted with the teen's friends
Checking for signs of depression or lack of friends Explanation: 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 working with a teenage patient. He has relatively straight teeth, but his lower front teeth are slightly crossed over. The nurse suggests to the child's caregiver that an orthodontist see him. What is the reason the nurse might make this suggestion? a) Leaving even slightly crooked teeth will lead to more cavities later in life. b) Even slight malocclusions make chewing and jaw function less efficient. c) The more common braces become, the more unacceptable crooked teeth are in society at large, affecting everything from dating possibilities to hiring. d) Uncorrected malocclusions lead to infection and ultimately tooth loss.
Even slight malocclusions make chewing and jaw function less efficient. Explanation: Dental malocclusion (improper alignment of the teeth) is a common condition that affects the way the teeth and jaws function. Correction of the malocclusion with dental braces improves chewing ability and appearance. Crooked teeth do not lead to more cavities, nor do they lead to infection and tooth loss. While appearance and acceptance in society is important to the adolescent, that is not the most important reason for orthodontic care for the adolescent.
The nurse is performing a health surveillance visit with a 12-year-old boy. Which characteristic suggests the boy has entered adolescence? a) Shows growing interest in attracting girls' attention b) Experiences frequent mood changes c) Understands that actions have consequences d) Feels secure with his body image
Experiences frequent mood changes Explanation: If the boy has just entered adolescence, he is likely to exhibit frequent mood changes. A growing interest in attracting girls' attention and understanding that actions have consequences are typical of the middle stage of adolescence. Feeling secure with his body image does not occur until late adolescence.
A 17-year-old boy chats excitedly with the nurse about his plans for college and a career. He says he has checked out every college in the region and determined which one is the best fit for him and which one offers the best career options for him. The nurse recognizes which developmental aspect in this young man? a) Socialization b) Role confusion c) Formal operational thought d) Puberty
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 although may not be complete until about 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 don't?) and think through the probable consequences (In the long run , I'll earn more money; I could begin earning money immediately). This scenario does not pertain to socialization, role confusion, or puberty.
Jordan is coming back to the office for a follow-up visit. He is 15 years old and he shows a pattern of gaining weight, not a large amount but a little more each visit. Jordan says that he is not active in any sports but that he and his father eat out a lot. What is the best way for the nurse to assess Jordan's eating pattern? a) Ask Jordan to show you what a healthy portion looks like. b) Have Jordan keep a food diary for one week. c) Have Jordan guess what his calorie intake is in a 24-hour period. d) Ask Jordan to recall what he has had to eat in the last three days.
Have Jordan keep a food diary for one week. Explanation: Having Jordan keep a food diary over a week allows you as well as him to examine what he is eating and when he is eating it. Keeping a food journal allows Jordan and the nurse to discuss the choices that he has made and the substitutes that he could possibly make. The times that Jordan eats may also lead to his weight gain. When the patterns are set in writing it gives the adolescent the chance for review and change
Which intervention would probably be most effective in preventing an adolescent from attempting suicide with an overdose again? a) Assessing his financial level b) Helping him learn better problem solving c) Helping him locate a close friend at school d) Teaching his parents to keep medicine in a locked cabinet
Helping him learn better problem solving Explanation: Suicide is a solution when there does not appear to be any other solution. Helping an adolescent learn better problem solving can help prevent a second attempt.
The nurse is talking with parents of a depressed 16-year-old boy. Which question is of most importance? a) Have his sleeping and eating habits changed? b) How is his personal hygiene? c) Is there a gun in your home? d) Does he exercise?
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.
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) Breast development will be complete with 12 months. c) Menarche should follow in about 2 years. d) The growth spurt will begin immediately with menarche.
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.
Nurses should provide anticipatory guidance to males to prepare them for what particular pubertal change in late adolescence? a) Nocturnal emissions b) Reddening of the scrotum c) Breast enlargement d) Lengthening of the penis
Nocturnal emissions Explanation: This involuntary ejaculation during the night can be disturbing to the adolescent male who has little or no understanding of what is happening in his body. Lengthening of the penis begins to occur in early adolescence as does reddening of the scrotum. Breast enlargement occurs in some males in middle adolescence and resolves in late adolescence.
Puberty is said to begin when which of the following occurs? a) The voice deepens in the male. b) The production of sperm in the male. c) The areola separate from the contour of the breasts in the female. d) The growth spurt in the female ends.
Puberty Explanation: Puberty is said to begin when which of the following occurs?
The school nurse is discussing various topics with a group of adolescent girls. One of the girls states, "I just want to be pretty and to look like everyone else." The nurse recognizes that the girl's feelings about herself and her body relate to the development of which of the following? a) Modesty b) Self-esteem c) Shyness d) Independence
Self-esteem 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.
A 13-year-old girl has grown rapidly in height over the past 2 years and is still taller than most of the boys in her class. She wonders when she will stop growing. Which of the following should the nurse tell her as a general guideline for the ages at which most girls stop growing? a) 14 to 15 years old b) 18 to 19 years old c) 16 to 17 years old d) 20 to 21 years old
Show Bettina where the teen lounge in the hospital is so she can meet other teens, use a phone, and check her e-mail. Explanation: Adolescents need access to their peers so they can keep up social contacts. Access to a phone, computer, and electronic mail will help the teen stay connected. 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.
An adolescent with multiple tattoos and piercings comes to the health center at the child's school. The child is complaining of feeling hot. In collecting further data the nurse finds the child has a new piercing. The nurse recognizes the need for the adolescent to be given information related to personal health. Which of the following topics would the nurse identify as the area that the child needs immediate information regarding? a) Prevention of sexually transmitted infection b) Prevention of pregnancy c) Signs of infection d) Signs of substance addiction
Signs of infection Explanation: The adolescent with piercings and tattoos needs to be aware of the signs and symptoms of infection (redness, swelling, warmness, drainage, discomfort) and that these must be reported immediately if they occur.
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 become addicted to the online gaming and role-playing that is popular with their peers. b) Teens are at risk for identity theft from sharing personal information with others whom they do not know. c) Computer use can contribute to adolescent obesity due to decreased activity and increased consumption of snacks. d) Teens can be exposed to inappropriate materials, harassment, threats, and potential for molestation.
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.
Which action would provide an indication that an adolescent's parents understand their daughter's need for increased independence? a) Verbalizing, "We try to do everything we can to make things easier for her." b) Telling you that they now understand that their daughter's chief need is for increased privacy c) Saying, "We will always be here for her whenever she needs us." d) Telling you that they are encouraging their daughter in her search for an after-school job
Telling you that they are encouraging their daughter in her search for an after-school job Explanation: 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.
What is the best explanation of Erikson's theory of psychosocial development during the adolescence period?
The adolescent faces many different decisions during the teen years concerning the future and the adult world. Explanation: The main point of Erikson's theory on which the nurse should focus is that the adolescent faces many different decisions during the teen years concerning the future and the adult world. Piaget states that cognitive development is cumulative; that is, what is learned is based on what has been known before. It is true that the adolescent develops many skills during the teen ages, which help adolescents make educational and career choices, and that the adolescent thinks in the abstract and develops skills to participate in complex problem solving. These aspects, however, are not central to Erikson's theory.
The time period known as adolescence usually begins with which of the following occurrences. a) The beginning of puberty. b) The child becoming self-supported c) The deciduous teeth falling out. d) The fine motor skills fully developed.
The beginning of puberty. Explanation: Early adolescence (preadolescence, pubescence) begins with a dramatic growth spurt that signals the advent of puberty or reproductive maturity. The deciduous teeth are all out around the age of 10 or 11, children usually are not self-supported, and fine motor skills continue to develop through adolescents.
The nurse is admitting a 15-year-old to the pediatric unit. Which of the following does the nurse recognize as a priority for this child? a) The child should be encouraged to call friends often. b) The child should be given freedom to participate in unit activities as desired. c) The child's need for privacy should be respected. d) The child's need for parental support should be discussed.
The child's need for privacy should be respected. Explanation: Adolescents must be given privacy, individualized attention, confidentiality, and the right to participate in decisions about their health care.
Jerry and his mother have come to the office for a routine visit. In the hall away from Jerry, his mother confides that she is concerned because Jerry is playing games that the girls play and she has noticed that when he plays any role-playing games his character is very feminine. She tells you that she is worried about his sexual orientation. What is the best response to her concerns? a) "This is a concern; you should examine what you are exposing him to that could affect his behavior." b) "Close parental monitoring of his activities has been shown to decrease these behaviors." c) "Do not allow him to play any of these games, get him some manly games." d) "This behavior may be exploratory or reflect peer pressure, so do not make assumptions regarding sexual orientation."
This behavior may be exploratory or reflect peer pressure, so do not make assumptions regarding sexual orientation."
The father of a 15-year-old basketball player is following a very low carbohydrate diet. He realizes his daughter should not follow the same eating plan. Which of the following would be most advisable for this father to serve his daughter so that she can perform at her optimum level in a Friday basketball game that starts at 6 p.m.?
Three daily meals that include choices from each of the food groups; Friday's lunch should be eaten around 2 p.m. and include a small amount of fat and a somewhat larger than usual portion of complex carbohydrates
While taking care of a teenager in the late adolescence stage, what behavior of the client will the nurse most likely observe during data collection for annual physical examination? a) True attitude of maturity b) Introspection and fluctuations in self assurance c) Seclusion and moodiness d) Childish ways of appearing, thinking and behaving
True attitude of maturity Explanation: The early adolescence stage is sometimes referred to as an awkward stage, because the person teeters between childish and mature ways of appearing, thinking, and behaving. Seclusion and moodiness, introspection and fluctuations in self-assurance mark the middle adolescence years. By the age of 17 years, most teenagers exhibit true attitudes of maturity.
Sixteen-year-old Bettina has been hospitalized 100 miles from home for a week. She is recovering from surgery to repair a broken kneecap, an injury incurred while skateboarding. 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 of the following nursing interventions would be most appropriate for Bettina? The nurse should a) Show Bettina where the teen lounge in the hospital is so she can meet other teens, use a phone, and check her e-mail. b) Call the hospital's mental health unit to see if Bettina can get some counseling. c) Suggest that she read books and magazines from the hospital bookmobile. d) Ask Bettina's caregivers to bring her siblings and friends to visit.
Uses critical thought processes to handle a problem Explanation: Piaget's developmental theories focus on the cognitive maturation of the child. The ability to critically think is a sign of successful cognitive maturation. A sense of internal identity is consistent with Erikson's theories of development. Kohlberg's theories development focus on morals and values.
Which behavior by an 18-year-old is consistent with successful progression through the stages of Piaget's theory of development? a) Reflects a strong moral code b) Is able to be part of a large group of peers while maintaining a sense of self c) Has a strong sense of understanding of internal identity d) Uses critical thought processes to handle a problem
Uses critical thought processes to handle a problem Explanation: Piaget's developmental theories focus on the cognitive maturation of the child. The ability to critically think is a sign of successful cognitive maturation. A sense of internal identity is consistent with Erikson's theories of development. Kohlberg's theories development focus on morals and values.
The nurse knows that the 13-year-old girl in the exam room is in the process of developing her own set of values. Which activity will this child be experiencing according to Kohlberg's theory? a) Wondering what is the meaning of life b) Wishing her parents were more understanding c) Assuming everyone is interested in her favorite pop star d) Comparing morals with those of peers
Wondering what is the meaning of life Explanation: Asking broad, unanswerable questions, such as what the meaning of life is, is a Kohlberg activity for early adolescence. An example of Piaget activities for middle adolescence is wondering why things can't change (like wishing her parents were more understanding) and assuming everyone shares her interests. Comparing morals with those of peers is a Kohlberg activity for middle adolescence.
The period in which physical changes relating to sexual maturation take place is called: a) Role confusion. b) Identity diffusion. c) Puberty. d) Adolescent turmoil.
c) Puberty. Explanation: Puberty is the stage in which physical changes related to sexual maturation take place. It does not occur in the other stages.
The activity that would best foster the developmental task of an adolescent who is physically challenged would be a) watching television on the set in her room. b) having a teacher bring her school homework in for her. c) talking to another adolescent who has a similar disorder. d) deciding whether she wants her bath before or after lunch.
talking to another adolescent who has a similar disorder. Explanation: A sense of identity is developed by "trying on" roles and discussing values and goals with others
The activity that would best foster the developmental task of an adolescent who is physically challenged would be a) watching television on the set in her room. b) having a teacher bring her school homework in for her. c) talking to another adolescent who has a similar disorder. d) deciding whether she wants her bath before or after lunch.
talking to another adolescent who has a similar disorder. Explanation: A sense of identity is developed by "trying on" roles and discussing values and goals with others.
The school nurse is talking with a group of 11-year-old girls. One of the girls states, "I just feel like my whole body is changing and I don't know why." The best response by the nurse would be which of the following? a) "Your other friends are feeling like this too." b) " You may feel like you are changing, but you still look the same." c) "You will feel better about yourself as you get older." d) "You have lots of hormone changes going on right now."
"You have lots of hormone changes going on right now." Explanation: Preadolescents need information about their changing bodies and feelings. Sex education that includes information about the hormonal changes that are occurring or will occur is necessary to help them through this developmental stage. Although adjustments will occur as the child gets older and friends are important, these responses are not the most direct and appropriate.
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? a) Barbiturates b) Amphetamines c) Marijuana d) Opiates
16 to 17 years old Explanation: Growth stops with closure of the epiphyseal lines of long bones which occurs at about 16 or 17 years of age in females and about 18 to 20 years of age in males.
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) 2,200 calories per day d) 2,000 calories per day
2,200 calories per day Explanation: The dietary intake for active teen females should include be approximately 2,200 calories daily.
A 15-year-old is seen at a health care facility for facial acne. When counseling him, you would teach him that the basic cause of his acne is
Activation of androgen hormones Explanation: As androgen rises with puberty, sebaceous glands are activated to increase production of sebum, which leads to plugging of ducts (comedones).
According to Erikson, the adolescent develops their own sense of being independent people with their own thoughts and goals. This stage is referred to as which of the following? a) Autonomy vs. doubt and shame b) Identity vs. role confusion c) Industry vs. inferiority d) Intimacy vs. isolation
Identity vs. role confusion They must develop their own personal identity—a sense of being independent people with unique ideals and goals.
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? a) Fresh orange juice b) Fat-free milk c) Whole grain bread d) Organic carrots
Whole grain bread Explanation: 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.
