HESI Peds School-aged children + Adolescents

A nurse is assessing the impact of pregnancy on the social aspect of an adolescent girl's life. Which statement by the adolescent indicates that the pregnancy is affecting the social aspect of her life directly?

"I am having a lot of trouble in school." Poor school performance usually precedes adolescent pregnancy. The girl in this situation views motherhood, rather than education, as a rite of passage into adult status because she is unable to achieve academic success. Nausea at the sight of food may have a negative impact on the girl's nutrition but likely does not affect her social status. Sleeping for longer periods as a result of fatigue is not an effect of the pregnancy on the girl's social life. Feeling the need to seek emotional support from others is not an effect of pregnancy on the girl's social life.

A nurse teaches the parents of a 5-year-old boy with type 1 diabetes about blood glucose monitoring at home. What statement by the parents indicates that the teaching has been effective?

"We'll notify the clinic if the blood sugar is higher than 200 (11.1 mmol/L)." A blood glucose higher than 200 mg/dL (11.1 mmol/L) indicates that the insulin dosage may need to be adjusted. A 5-year-old child is not old enough to reliably test his or her own blood. The frequency of blood glucose testing depends on the degree of control. The area that is being sampled should be cleansed before the sample is obtained.

A 15-year-old is grounded for 2 weeks by her parents for smoking in school. The adolescent tells the school nurse, "It's not fair that I get punished when my friends get away with doing the same thing." What is the best response by the nurse?

"When errors in judgment are made, people must be prepared to take the consequences for their actions."

A nursing instructor asks a nursing student to explain the characteristics of substance abuse in adolescents. Which statements by the student indicate inadequate learning? Select all that apply.

- "Fifty percent of adolescents have used alcohol by the end of high school." - "Twenty-five percent of adolescents have tried smoking by the end of high school." Current statistics show that by the end of their high school years, 85% of adolescents have used alcohol. Current statistics also show that 65% of adolescents have tried smoking by the end of high school. Hence, the nursing student's statement that only 50% of adolescents have used alcohol by the end of high school and 25% have tried smoking indicates inadequate learning. Adolescents believe that substance abuse imparts a feeling of well-being. They also feel that substance abuse make them feel more mature. Adolescents from dysfunctional families are at greater risk for chronic use and physical dependency.

Which of these thoughts in an individual correspond to the society-maintaining orientation stage? Select all that apply.

- "I should avoid parties where alcohol is served." - "I should avoid risky driving and follow traffic rules." During the society-maintaining orientation stage, an individual's thoughts are influenced by moral values and societal concerns. These individuals would avoid going to parties where alcohol is served, avoid risky driving, and follow traffic rules in order to be a good member of society. When an individual thinks that breaking the rule will lead to a physical punishment, this thought corresponds to the punishment and obedience orientation stage. Under this stage, an individual's moral dilemma is in terms of absolute obedience to authority and rules. When an individual thinks that he or she should follow all the laws formulated by the government, this thought corresponds to the universal ethical principle orientation. When an individual thinks that completing his or her homework will help win a reward, this thought corresponds to the good boy-nice girl orientation stage.

A nurse communicates with a mother about the cognitive changes that her child will exhibit after becoming an adolescent. Which statements made by the mother indicate adequate learning? Select all that apply.

- "My child will think in terms of the future." - "My child will be able to deal with hypothetical problems." - "My child will be able to imagine multiple outcomes of a situation." Adolescents think in terms of the future, begin to deal with hypothetical problems, and can think of different outcomes of a situation. An adolescent considers an infinite variety of causes and solutions. An adolescent is also able to understand how an individual's ideas or actions influence others.

What does the nurse identify as an early sign of chronic lead poisoning (plumbism) in school-aged children?

- Anemia The bone marrow is most susceptible to lead toxicity. Interference with hemoglobin biosynthesis leads to early signs and symptoms of anemia. Seizure activity and CI are late responses indicating central nervous system involvement. Renal calcium dysfunction is a late response indicating kidney damage; loss of protein and other substances occurs first.

What are the considerations for bariatric surgery in an adolescent? Select all that apply.

- Attainment of physical maturity - Failed attempt at weight loss for at least six months - Ability to give informed consent to surgical treatment

An 18-year-old adolescent reports irregularity in menses. Physical examination reveals decreased blood pressure. Her mother complains that her child often fears gaining weight and has a distorted self-image. What could be the reason for irregular menses?

Anorexia

The nurse is caring for several adolescent clients. Which are at increased risk for testicular cancer? Select all that apply.

- Client with infertility - Client with cryptorchidism - Client with Klinefelter syndrome Risk factors for testicular cancer include cryptorchidism, Klinefelter syndrome, and infertility. The client with liver disease may be at increased risk of gynecomastia. Hemophilia, a hematologic disorder, is not a risk factor for testicular cancer.

A nurse in the pediatric clinic is evaluating a 6-year-old child with sickle cell anemia whose spleen autoinfarcted by age 4. What is the priority nursing care at this time?

- Determining parental knowledge about infection The spleen plays a role in immunity. Initially the spleen enlarges and becomes congested with accumulated sickled red blood cells; in time, fibrous material replaces the tissue in the spleen, and by age 5 the spleen is obliterated. Without a spleen the child is prone to infection, which can precipitate a sickle cell crisis. Assessing the child for jaundice is not a priority, because jaundice is an expected adaptation that is not life threatening. Abdominal assessments are important but not required frequently in this situation. Serial hematocrit readings are necessary only if the child is in sickle cell crisis.

Which statements about acne in adolescents are true? Select all that apply.

- Early acne occurs in the midface region. - Acne usually occurs in middle to late adolescence - Intake of dairy products can contribute to acne severity.

A nurse is performing an assessment on a fifth-grader who has been admitted to the pediatric unit with the diagnosis of acute lymphocytic leukemia (ALL). What early clinical findings does the nurse expect to identify?

- Fatigue and ecchymotic areas Fatigue and ecchymoses are early clinical findings to ALL. They are caused by decreased white blood cell, red blood cell (RBC), and platelet production that results when the bone marrow is crowded with abnormal lymph cells. Although epistaxis does occur, papilledema is not a common presenting sign because the blood-brain barrier is an initial deterrent. Pain is not an early symptom of ALL. The skin will be pale, not reddened, because of a decreased RBC count. Enlargement of lymph nodes in the axillae and groin is a sign of lymphoma or a late, not early, sign of leukemia.

A registered nurse is teaching a nursing student about the role of estrogen in adolescents. Which statements made by the nursing student indicates the need for further teaching? Select all that apply.

- High levels of estrogen tend to promote skeletal growth - Estrogen has an inhibitory effect on the growth of axillary hair Low levels of estrogen promote skeletal growth in adolescence while high levels of estrogen inhibit growth. Estrogen promotes the growth of pubic and axillary hair. Estrogen causes the growth and darkening of nipples, the enlargement of breasts, and the formation of an endometrial lining.

An adolescent is found to have type 1 diabetes. The nurse plans to teach the adolescent that dietary control and exercise can help regulate the disorder. What additional information should the nurse include in the teaching plan? Select all that apply.

- Insulin therapy - Blood glucose monitoring - Adherence to the treatment regimen Because clients with type 1 diabetes have little or no endogenous insulin, they must take insulin. Blood glucose monitoring is an important aspect of therapy because it aids evaluation of the effectiveness of diabetic control. Dietary control and exercise reduce the amount of exogenous insulin needed. Although adhering to the diabetic regimen is difficult, especially for adolescents who need to identify with their peers, its importance in promoting euglycemia should be discussed. Although infection increases insulin requirements, prophylactic antibiotics are not needed. Oral hypoglycemics are ineffective in stimulating insulin secretion in clients with type 1 diabetes.

A nurse is caring for a 6-year-old child who has undergone laparoscopic appendectomy. What interventions should the nurse document on the child's clinical record? Select all that apply.

- Intake and output - Measurement of pain - Presence or absence of bowel sounds Assessment and documentation of fluid balance are critical aspects of all postoperative care. Laparoscopic surgery involves insufflating the abdominal cavity with air, which is painful until it has been absorbed. The degree of pain should be assessed and documented. Pain can be measured with the use of numbers 1 through 10 for the older child and with the use of the Wong FACES scale for the younger child. Auscultating for bowel sounds and documenting their presence or absence help the nurse evaluate the child's adaptation to the intestinal trauma caused by the surgery. A special diet is not indicated after this surgery. After a laparoscopic appendectomy there is little drainage and no dressings.

How does sexual identity aid psychosocial development in the adolescent? Select all that apply.

- It helps develop masculine and feminine behaviors. - It helps them lessen the feeling that they are different from peers. Physical evidence of maturity encourages the development of masculine and feminine behaviors and enhances sexual identity in the adolescent. Sexual identity assuages the adolescent's fear of being different from his or her peers. Adolescents depend on sexual clues because they want assurance of maleness or femaleness and do not wish to be different from their peers. Health identity helps the adolescent evaluate his or her own health. A group identity helps the adolescent develop a sense of being admired and accepted. A peer group provides the adolescent with a sense of belonging and approval and the opportunity to learn acceptable behavior. A family identity helps the adolescent develop decision-making and budgeting skills.

After an assessment, an adolescent is diagnosed with a perceived inability to ingest food. Which nursing interventions would be appropriate for identifying hyponatremia? Select all that apply.

- Monitor vital signs - Monitor fluid and electrolyte status The nurse should monitor an adolescent's vital signs and fluid and electrolyte balance to identify hyponatremia. Nutritional intake and behavior are monitored to identify physiological changes that may be life-threatening. The target daily calorie intake should be monitored for clients who are underweight. Detrimental behaviors such as excessive exercise are monitored to help identify behaviors that are not acceptable.

During a period of heavy play activity, a first-grader with a known history of anemia complains of feeling "woozy." What should be the school nurse's initial response?

- Sitting the child in a chair until the dizziness subsides The child's immediate physical safety takes priority. The child must sit down to avoid falling. The child's vital signs will eventually be checked; immediate physical safety takes priority over further assessment. Walking at this time is unsafe. Having the child breathe spirits of ammonia is premature; the subjective symptom of dizziness alone does not warrant this intervention.

Which statements are true regarding ectopic pregnancy? Select all that apply.

- Smoking is one of the risk factors for ectopic pregnancy. - Ectopic pregnancy occurs when the fertilized egg implants in the fallopian tubes. - If the adolescent exhibits abdominal pain and hypotension, the ectopic pregnancy may have ruptured. Smoking is a risk factor for ectopic pregnancy. Ectopic pregnancy occurs when the fertilized egg implants outside the uterus, in the fallopian tubes. An adolescent exhibiting severe abdominal pain with hypotension is indicative of rupture of ectopic pregnancy and may need immediate surgery. Fetopelvic incompatibility is related to prolonged labor in younger teenagers of 12 to 16 years of age. However, it is not associated with ectopic pregnancy. Abdominal pain associated with bleeding rules out ectopic pregnancy.

According to Erikson's theory, which behaviors will a nurse notice in 13-year-old students? Select all that apply.

- Such students want to know "Who am I?" - Such students show a marked preoccupation with body appearance. The nurse is likely to notice that during puberty, students want an answer to "Who am I?" This stage is called identity versus role confusion in Erikson's theory. At this stage, adolescents are concerned about their own body appearance. Young adults exhibit the sense of care for others at the stage of intimacy versus isolation. Children from 6 to 11 years of age show eagerness to learn social skills. This stage is identified as industry versus inferiority. Children like to pretend and try out new roles at the stage of initiative versus guilt. This is seen at the age of three to six years.

What instructions should the nurse give to an adolescent to prevent sexually transmitted infections? Select all that apply.

-"Remember to use condoms properly." -"Make sure you are up-to-date with your vaccinations." -"Have sexual contact only if you and your partner are monogamous." The safe use of condoms helps to avoid contact with body fluids and helps prevent sexually transmitted infections. Getting updated with vaccinations helps prevent vaccine-preventable sexually transmitted infections. Monogamous partners have a low risk of contracting sexually transmitted infections. Abstaining from sexual activity is not a practical approach. Regular screening for sexually transmitted infections helps to detect a disease at an early stage, but does not prevent contraction of the disease.

The nurse is assisting in sports physicals of junior high students. Which finding would prompt the nurse to ask whether a student has a history of diabetes?

A velvety darkening of the skin around the neck Children with type 2 diabetes often develop acanthosis nigricans, a velvety darkening of the skin around the neck, in the axillae, and in the groin. Clustered vesicles on the lip, silver plaques on extensor surfaces, and cystic acne are not particularly associated with diabetes.

A pregnant adolescent reports discomfort in her lower abdomen and watery-to-purulent vaginal discharge. The adolescent is diagnosed with a herpes simplex virus infection. Which medication would the nurse expect the primary healthcare provider to prescribe?

Acyclovir Of the drugs used to treat herpes simplex virus, acyclovir is the drug of choice. Penciclovir is used for herpes labialis. Famciclovir and valacyclovir are not prescribed for pregnant adolescents due to their potentially teratogenic effects.

Which topical agent would be beneficial in preventing new lesions and treating preexisting acne?

Azelaic acid Azelaic acid, a topical antibacterial, is used to prevent new lesions and treat existing acne. Doxycycline and isotretinoin may both be used to treat acne, but these are administered orally, not topically. Azithromycin is not a drug of choice for treating acne.

What clinical finding is most important for the nurse to identify when assessing an adolescent child with Reye syndrome?

Bleeding Tendency

A female adolescent complains of breast pain. Which antigonadotropic herb may alleviate breast pain by decreasing prolactin levels?

Bugleweed Bugleweed is an herb used to decrease breast pain by decreasing prolactin levels and facilitating an antigonadotropic effect. Black haw and catnip are herbs that act as uterine antispasmodics. Chaste tree fruit also decreases breast pain by decreasing prolactin levels, but it is not antigonadotropic.

Which drug causes euphoria and hallucinations in an addicted adolescent but does not show any ill effects when withdrawn abruptly?

Cannabis

During a nutritional counseling session, an adolescent says to a nurse, "I am not following my diet properly, but I know I should do it." Which stage of change model does the adolescent belong?

Contemplation An adolescent who acknowledges a problem but is not yet ready or sure of wanting to change belongs to the contemplation stage of change model. The maintenance stage is characterized by maintaining a behavior change. In the precontemplation stage, the adolescent does not yet acknowledge there is a problem behavior that needs to be changed. In the preparation stage, the adolescent gets ready to change.

A nurse in the clinic is taking the health history of a 16-year-old. When the nurse asks questions concerning sexual activity, the adolescent begins to perspire and hyperventilate. As her anxiety increases, she indicates that she feels dizzy and short of breath and that her heart is racing. What condition does the nurse identify?

Hyperventilation Syndrome

An adolescent reports pain in the scrotum and is having dysuria and pyuria. The nurse observes redness and swelling in the scrotal part. What penile abnormality does the nurse infer from these findings?

Epididymitis Epididymitis is an inflammatory reaction of the epididymis characterized by scrotal pain, redness, swelling along with urethral discharge, dysuria, and pyuria. Varicocele is characterized by elongation, dilation of the veins and can be observed as wormlike mass situated above the testicle. Testicular carcinomas are generally characterized by heavy, hard mass that is palpable on the anterior or lateral aspect of a testis. Testicular torsion is a condition in which the tunica vaginalis that normally encases the testicle fails to do so and the testis hangs free from its vascular structures leading to nausea, vomiting, and abdominal pain. Fever and urinary symptoms are generally not present.

A parent of a 7-year-old child asks a nurse how to tell the difference between measles (rubeola) and German measles (rubella). What should the nurse tell the parent differentiates rubeola from rubella?

High fever and Koplik spots The signs and symptoms of rubeola (measles) include a high fever, photophobia, Koplik spots (white patches on the mucous membranes of the oral cavity), and a rash. Rubella (German measles) usually does not cause a high fever, runs a 3- to 6-day course, and never causes Koplik spots. The rash of rubeola (measles) spreads over most of the body. Nausea, vomiting, and abdominal cramps are vague clinical findings and occur with many illnesses. Some signs and symptoms may be similar to those of a severe cold, but rubeola is associated with high fever.

The laboratory findings of an obese hypertensive adolescent reveal hyperinsulinemia and dyslipidemia. Which condition is the adolescent likely to have?

Insulin resistance syndrome

A nurse is assessing an adolescent child with the diagnosis of hemophilia. In what part of the body does the nurse expect bleeding to occur?

Joints Joints are the most commonly involved areas because they are subject to weight-bearing and constant movement. Neither the brain, intestines, nor the pericardium is the most common site of bleeding in hemophilia.

The parent of a 17-year-old adolescent who is going to be a foreign exchange student asks the nurse why the child must have a tetanus toxoid immunization instead of the immune globulin. The nurse responds that the tetanus toxoid immunization provides what?

Longer-lasting active immunity

Immediately after being placed in the supine position, an adolescent child experiences shortness of breath and must sit up to breathe. What term should the nurse use to document this clinical phenomenon?

Orthopnea

A male client with small overgrowths on the skin in the cervical region arrives at the hospital. The laboratory report reveals the presence of human papillomavirus type 16. Which condition is associated with this virus?

Penile carcinoma Human papillomavirus type 16 is commonly associated with penile carcinoma. Uncircumcised males may be at higher risk for infections such as balanitis and prosthitis. Human papillomavirus types 11 and 6 are commonly associated with genital warts.

An adolescent child is admitted to a pediatric unit with the tentative diagnosis of acute poststreptococcal glomerulonephritis (APSGN). What diagnostic tests does the nurse expect will be performed to confirm this diagnosis?

Serum complement (C3) activity level and urinalysis A reduced C3 level is present in the early stages of ASPGN. Urinalysis is necessary to determine the presence of proteinuria and hematuria. An x-ray and glucose level, ECG and antibody titer, and an upper gastrointestinal series and liver function tests are not relevant to a diagnosis of APSGN.

An adolescent has pain, swelling, and inflammation of the testis, abdominal pain, and occasional immobilization of the scrotum. Which condition does the adolescent likely have?

Testicular Torsion

A nurse is planning to discuss the importance of following the prescribed course of treatment with a group of adolescent clients. What is the nurse's priority consideration regarding these clients?

They are involved more with the present than with the future. The future seems far away; immediate gratification takes priority. Adolescents are often confused about their feelings. School-age children (7 to 11 years) use concrete operational reasoning ; adolescents are learning to think in abstract terms and use formal operational reasoning. Striving for industry versus inferiority is the developmental stage of children 6 to 12 years of age; identity versus role confusion is the developmental stage of the adolescent.

Which strategy needs to be employed while interviewing the adolescent as a part of her health-screening?

To explain the limits of confidentiality Explaining the limits of confidentiality helps to obtain reports on physical or sexual abuse. It also helps to get others involved if the client is suicidal. As per the nursing care guidelines, interview should include open-ended questions, when possible, in order to obtain detailed information about the client. As per the guidelines, interview should begin with less sensitive issues followed by more sensitive ones. In order to ensure privacy, it is preferable to interview the adolescent in the absence of parents.