Maternity PrepU CH. 33
The parent of a 14-year-old adolescent states to the nurse that the adolescent is moody, shuts oneself in the bedroom, and fights with a younger sibling. Which comment is most helpful to support the parent? "Calmly talk to your adolescent about your concerns." "This is normal for the age." "Take away all of the adolescent's privileges until your adolescent starts acting better." "Set some rules for family etiquette."
"Calmly talk to your adolescent about your concerns." Explanation: Families and parents of adolescents experience changes that require adjustments and the understanding of adolescent development. The adolescent is striving for self-identity and increased independence. Thus, getting the parent and adolescent talking and sharing information is the most helpful advice. Telling the parent that this is normal does nothing for the family situation. Setting rules will likely alienate the adolescent, and taking away privileges will likely cause conflict between the parent and adolescent.
The school nurse is preparing a program on sexuality and birth control for a class of 14- to 16-year-olds. Which behavior will have the most influence on how the information is presented? Teens are adjusting to new body images. Adolescents tend to take risks. Teenagers are able to think in the abstract. Adolescents understand that actions have consequences.
Adolescents tend to take risks. Explanation: Adolescents are risk takers. This tendency enables them to overcome common sense and their own better judgment. Although adolescents are capable of abstract thinking and understand that actions have consequences, they are not yet committed to these attributes. Changing body image would not have significant influence on the presentation.
A 15-year-old is hospitalized for acute appendicitis. Which activities would the nurse include in the client's plan of care? Select all that apply. Allow friends to visit during visiting hours. Include the parents when educating the client. Have the nurse control the patient's care as much as possible. Arrange care to provide for extra rest and sleep. Keep the client in hospital gowns for sanitary reasons.
Allow friends to visit during visiting hours. Include the parents when educating the client. Arrange care to provide for extra rest and sleep.
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?" "Do you take human growth hormone?" "Do you take amphetamines?" "Do you take cocaine?"
"Do you take anabolic steroids?" Explanation: Anabolic steroids are used by adolescents who play sports. They are used to enhance the adolescent's athletic ability. They produce euphoria and lessened fatigue. Unfortunately, steroid use can also lead to early closure of the epiphyseal plate, acne, elevated triglyceride levels, hypertension, aggressiveness, and possibly psychosis. Human growth hormone is also used to enhance athletic performance. The side effects of it are joint pain and swelling and the development of diabetes. Amphetamines provide a sense of well-being, alertness, and self-esteem. They can produce paranoia and extreme restlessness. Cocaine produces increased pulse and respirations, increased temperature, and blood pressure and decreased appetite.
A male nurse is meeting with a group of high school boys to discuss various health topics. After the session on testicular self-exam, the nurse determines the session is successful when one of the students responds with which comment? "It sounds like we will need to know how to do this when we are in our 20s, so we might as well learn now." "My uncle had testicular cancer after he got married and had my cousin." "I am almost 15 now, so that means I could possibly get this disease." "Men my grandfather's age will probably die if they don't do these exams."
"I am almost 15 now, so that means I could possibly get this disease." Explanation: Testicular cancer is one of the most common cancers in young men between the ages of 15 and 34. Teaching the boys how and when to perform testicular self-examination is an important health maintenance activity. It is easier to treat testicular cancer if it is caught early and the best way to catch it is routine self-exams. A family history of testicular cancer increases the chances of the younger family members developing the cancer. The self-exam should be continued on a routine basis at least until the individual is 35 years old.
The school nurse is teaching a health class on nutrition with some adolescents. Which comment by a student should the nurse prioritize and provide more teaching? "I hate eating with my family. I would much rather snack all day." "I had lunch with my boyfriend before his game and all he ate were carbohydrates." "I am feeling so fat. I think I need to exercise a few extra hours today." "I don't really like it, but I have been drinking lots of skim milk."
"I am feeling so fat. I think I need to exercise a few extra hours today." Explanation: Even after the body has become emaciated, the adolescent may believe that he or she is still fat and, therefore, unattractive. This condition is called anorexia nervosa and is a serious health concern related to adolescents and their nutritional status. Even if the adolescent doesn't eat with the family, he or she can still consume needed nutrients. Although carbohydrate-loading is a concern, this statement does not indicate the adolescent girl was following this eating pattern. Skim milk has adequate nutrients.
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 will see improvement on my face after 4 weeks of therapy." "I need to take the medication with food every day." "It is important for me to check the expiration date on the bottle." "My periods will continue to be regular while on the medication."
"I need to take the medication with food every day." Explanation: Acne improvement is generally not seen for 2 to 4 weeks after beginning antibiotic therapy. Adolescents need to be supported and urged to continue to take the medication as prescribed during the waiting period. Without noticeable improvement, adolescents have a tendency to continue taking the higher initial dose or even increase the dose hoping to initiate a faster effect. Food impairs the absorption of oral tetracycline, so the drug should be taken on an empty stomach (2 hours before or after eating). Adolescents must be certain of the date of expiration of the drug. Outdated tetracycline breaks down into an extremely toxic composition. Antibiotics have no effect on menses.
An adolescent who plays catcher on the baseball team begins shouting at the nurses, slams the doors, and refuses to talk to anyone after being given the news that his right arm will require surgery. Which response by the nurse would be the most appropriate in this situation? "Stop shouting at the nurses. We're only trying to help you." "I am really sorry about your arm, but surgery is needed to correct the problem." "Once surgery is over you'll be back playing baseball in no time." "I understand you are angry, but please don't shout or slam doors."
"I understand you are angry, but please don't shout or slam doors." Explanation: All children grow angry at some time, boys generally more than girls. It is difficult to work with angry children because the nurse can get pulled into their anger. The typical response at hearing an angry outburst is to imitate it (e.g., the child shouts at you and you shout back). This is not a therapeutic response and many times escalates the situation. The nurse should acknowledge the child's anger and help the child focus the anger so the child can better identify why there is anger and begin to deal with it. Saying surgery is needed to correct the problem is stating a fact the adolescent already knows and is the cause of the anger. Saying, "You'll be back playing baseball in no time" is offering false reassurance. It also addresses the issue in the future and not in the present.
The nurse is promoting nutrition to a 13-year-old child who is overweight. Which instruction should the nurse include? "You need to go on a low-fat diet." "Eliminate sugar from your diet." "Go out for a sport at school." "Keep a food diary."
"Keep a food diary." Explanation: Having the child keep a detailed food diary for 1 week will determine current patterns of eating. This can then be used to show the child how to make small changes with results, especially if eating is done before periods of inactivity such as before going to bed or when bored. Speaking and thinking in terms of diet or eliminating sugar are negative and can lead to poor body image. The child could too easily choose the wrong sport or do poorly. It is best to offer solutions with more variety.
A nurse is providing teaching on safety to a group of parents whose children are diagnosed with hemophilia. Which statement made by a parent requires follow-up by the nurse? "We make sure our toddler wears a helmet and knee pads." "Our child has a medical alert bracelet that is worn at all times." "Our child always wears a helmet and body padding when playing football." "We had a trampoline but got rid of it after our child was diagnosed."
"Our child always wears a helmet and body padding when playing football." Explanation: Contact sports such as football and soccer are safety issues for children diagnosed with hemophilia. There is more chance of sustaining an injury resulting in severe bleeding. Safer sports include swimming and golf. Toddlers who are just learning to walk may have frequent falls, so a soft helmet and knee pads can help prevent injuries. Children diagnosed with hemophilia should wear a medical alert bracelet at all times. Jumping on a trampoline can result in a serious fall resulting in extensive bleeding.
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." "Remind the adolescent about needing to be on a schedule so as to not disrupt the family." "Do not encourage multiple baths; it can be very drying to the skin." "Reevaluate the adolescent's ability to perform hygiene care since showering is so frequent."
"Reinforce the family rules but also allow the adolescent to develop one's own routine." Explanation: Adolescents find that frequent baths and deodorants are important due to the apocrine sweat gland secretion activity. The increases in sex hormones and steroids cause the skin to be oily. This leads to more showers or baths daily. This is a time when the adolescent is defining what type of personal hygiene products are preferred. Hygiene and personal care can become a source of family arguments as the young person develops a style of personal care. Parents need to be mindful of the adolescent yet maintain family rules and boundaries regarding aspects of personal care. It is important for teenagers to feel that they have some ability to develop their own personal care standards and daily patterns.
A mother calls the school nurse and is concerned because her 13-year-old daughter's friends wear heavy makeup and black clothes. Which is the best advice for the mother? "This can lead to piercings and tattoos." "The teen years are a time for experimenting." "Encourage her to socialize with the kids at church." "Teen appearance might not accurately reflect their actual values."
"Teen appearance might not accurately reflect their actual values." Explanation: The nurse should inform the mother that the statements adolescents make with their dress and grooming may not indicate what their actual values are. Mentioning piercings and tattoos will only worry the mother more. Minimizing the situation as experimentation is of no value to the mother. Telling the mother to choose her daughter's friends for her will destroy trust between mother and daughter.
The nurse is measuring the height of a 13-year-old girl who was 56 in (142.24 cm) tall at age 9. The nurse predicts the girl will be approximately how tall if following the normal pattern of growth? 58 in (147.32 cm) 62 in (157.48 cm) 68 in (172.72 cm) 76 in (193.04 cm)
68 in (172.72 cm) Explanation: Preadolescence begins in the female between the ages of 9 and 11 years and is marked by a growth spurt that lasts for about 18 months. Girls grow about 3 inches each year until menarche, after which growth slows considerably. The four years between age 9 and 13 would mean the girl should have grown approximately 12 inches making her now 68 in (172.72 cm) tall (56 + 12 = 68 in).
A group of children with chronic renal disease will be attending a class on nutrition. What are factors the nurse needs to consider to make the class effective for these children? Select all that apply. Have everyone share his or her disease history. Assess for common interests and goals. Limit one person from dominating. Avoid competition in the group. Determine the ability to learn self care.
Assess for common interests and goals. Limit one person from dominating. Avoid competition in the group. Explanation: Group teaching can add depth to learning. For many children, learning they are not the only person with a particular problem is very important to hear. When a nurse conducts group teaching, there are several guidelines that are important to follow for an effective teaching session. These include: assess for common interests and goals so the information presented will appeal to as many in the group as possible; be certain all the members of the group can see and hear each other; encourage the members of the group to participate; limit one person from dominating; avoid competition in the group; and ask the members of the group to evaluate the experience. The child's ability to learn self care would depend on the age and disease progression and is not considered a guideline for group teaching. Having every child share their disease history might cause anxiety and is not necessary when the topic is nutrition. It may also be construed as an invasion of privacy.
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. Girls grow at a slower, steadier rate than do boys. Boys grow at a rapid, sporadic rate. Boys and girls grow at the same rate.
Boys grow at a slower, steadier rate than do girls. Explanation: Preadolescent boys grow generally at a slower, steadier rate than do girls. Girls grow more rapidly during preadolescence and then their growth rate slows dramatically after menarche.
To help prevent obesity, which intervention would the nurse include in an adolescent's plan of care? Plan a diet of 1,500 calories per day. Describe a normal serving size. Encourage sources of proteins with fat. Plan a diet of 3,000 calories per day.
Describe a normal serving size. Explanation: Some adolescents may be unaware that their food intake is excessive because they have been told they need excess nutrients for healthy adolescent growth and everyone in their family eats large portions. Health teaching with these adolescents may need to begin with a discussion of "normal" weight and standard food portions. If adolescents eat a diet too low in protein for any length of time, they can develop a negative nitrogen balance, which can lead to seriously impaired growth. Therefore, a diet of fewer than 1,400 to 1,600 calories a day can rarely be tolerated by adolescents. Teenage girls who are moderately active require about 2,000 calories per day and teenage boys who are moderately active require between 2,200 and 2,800 calorie per day. Eating in excess can lead to obesity and should be avoided.
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 Socialization Identification of identity Sensorimotor
Formal operational thought Explanation: The final stage of cognitive development, the stage of formal operational thought, begins at age 12 or 13 years and grows in depth over the adolescent years, though it may not be complete until about age 25. This step involves the ability to think in abstract terms and use the scientific method (deductive reasoning) to arrive at conclusions. With the ability to use scientific reasoning, adolescents can plan their future. They can create a hypothesis (What if I go to college? What if I do not?) and think through the probable consequences (In the long run, I will earn more money; I could begin earning money immediately). This scenario does not pertain to socialization, role identification, or sensorimotor development.
The school nurse is developing a school wellness program to promote healthy eating habits and regular physical activity. What is the most important element to emphasize to maximize compliance, healthy habits, and long-term change? Eliminate sweetened, carbonated beverages in the cafeteria. Serve fruits and vegetables in the cafeteria. Incorporate activity in parts of the daily schedule. Include both parents and children in the wellness program.
Include both parents and children in the wellness program. Explanation: Every campaign to support good nutrition and daily physical activity must include parents and their children as active members of the learning community. Although the other actions can accomplish in-school enhancements to health, long-term change tends to be more likely when the programs implemented involve the family. Programs implemented without a family-centered approach often fail when the child's home life and school life are disconnected.
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? How is his personal hygiene? Have his sleeping and eating habits changed? 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.
The family reports to the nurse that their adolescent always wants to argue, will not participate in family functions, and has poor school grades. What recommendation should the nurse make for an adolescent client who presents with these symptoms? Encourage participation in sports. Have the child visit the school counselor. Make an appointment with the health care provider. Supervise homework sessions.
Make an appointment with the health care provider. Explanation: Adolescents need to have a thorough physical examination at health maintenance visits to ensure that they are in good physical health. Assessment for depression at these visits includes the assessment for anorexia, insomnia, excessive fatigue and weight loss. In younger adolescents, depression may be manifested not so much by appearing sad, but by behavior problems such as disobedience, temper tantrums, truancy, and running away. Additional signs may be self-destructive behavior, difficulties in school, use of drugs and alcohol, sexual promiscuity or trouble with the legal system. Many adolescents find it hard to be alone, so they seek constant activity as a means of escape.
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. Allow the girl to wear her own clothes, despite hospital policy. Brush the girl's hair for her. Assist the girl with using the bed pan to urinate.
Offer to assist the girl in washing her hair and let her pick the shampoo. Explanation: When caring for hospitalized adolescents, providing time for self-care, such as shampooing hair, is important to include in an adolescent's nursing care plan. Offering to assist the client in washing her hair and letting her pick the shampoo both encourages a sense of autonomy to the client and offers her dignity related to her body image. Brushing the girl's hair for her and assisting her with using the bed pan for urination do not encourage a sense of autonomy. If it is the hospital's policy to require clients to be dressed in a hospital gown while admitted, the nurse should not allow the girl to wear her own clothes.
A female client tells the nurse about noticing an increase in weight and fat deposits during the past year. The nurse reviews the client's chart and recognizes that the client is most likely going through puberty. Which nursing action is most appropriate at this time? Provide reassurance that these are normal changes. Review dietary measures to assist in controlling weight gain. Encourage increased exercise to control weight gain. 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 and weight and height changes are normal as girls begin hormonal changes of puberty. During adolescence, girls are very sensitive about their appearance and experience a constant need for reassurance. Puberty is a period when children are very self-conscious about their overall appearance. Reassurance needs to be provided that increased fat deposits and weight and height changes are normal. Dietary management is indicated if a true weight problem is present, but healthy eating should be encouraged rather than dieting. Adolescents should be encouraged to participate in appropriate exercise programs. Dieting issues such as anorexia and bulimia can threaten the health of adolescents.
The mother of a 15-year-old boy confides in the nurse that she is concerned because her son is about to turn 16 and is pressuring her and her husband to buy him a motorcycle. Her husband is okay with the idea, but she is concerned about his safety. What information should the nurse mention to the mother regarding motorcycle safety? Select all that apply. 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. Require the son to wear a seat belt. Insist on age and not emotional maturity as the qualification for obtaining a driver's license.
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.
The nurse is developing a teaching session on common adolescent injuries. What considerations lead the nurse to pertinent topics? Select all that apply. The adolescent's increased physical growth Common insufficient psychomotor coordination Adolescent comments of tiredness and lack of energy A lack of impulsivity in action and decision making Psychosocial concerns affected by peer pressure Inexperience
The adolescent's increased physical growth Common insufficient psychomotor coordination Psychosocial concerns affected by peer pressure Inexperience Explanation: Common developmental characteristics of the adolescent are used to consider appropriate teaching topics for adolescent injury. Influencing factors related to the prevalence of adolescent injuries include increased physical growth, insufficient psychomotor coordination for the task, abundance of energy, impulsivity, peer pressure, and inexperience. Impulsivity, inexperience, and peer pressure may place the teen in a vulnerable situation between knowing what is right and wanting to impress peers. On the other hand, teens have a feeling of invulnerability, which may contribute to negative outcomes.
The father of a 15-year-old daughter is concerned she is not getting adequate nutrition to play high school basketball. Her games are on Friday nights. Which suggestion should the nurse point out will best suit the needs of this adolescent? Pasta with a small amount of meat sauce and two slices of bread for dinner on Wednesday and Thursday evenings and again at 2 p.m. on Friday. Boiled eggs with bacon or ham and a glass of orange juice for breakfast on Thursday and Friday mornings along with some sliced turkey and a salad at noon on Friday. Three daily meals that include choices from each of the food groups with an additional serving of fruit and several extra glasses of water on Friday. Three daily meals that include choices from each of the food groups; Friday's lunch eaten around 2 p.m. with a small amount of fat and a somewhat larger than usual portion of complex carbohydrates.
Three daily meals that include choices from each of the food groups; Friday's lunch eaten around 2 p.m. with a small amount of fat and a somewhat larger than usual portion of complex carbohydrates.
The nurse is educating an adolescent female who needs to increase dietary iron but has expressed concern about weight gain. What dietary choices would the nurse recommend? chicken, whole-wheat bread, watermelon cottage cheese, crackers, oranges raspberry yogurt, granola, apple pasta, broccoli, pear
chicken, whole-wheat bread, watermelon 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. The calorie content is also acceptable.
The student nurse is preparing a short oral report for post clinical discussion on adolescent stages of growth and development. Based on the information that adolescence can be divided into stages, what would be the best explanation of the main characteristics of the middle adolescence stage? desire for goal attainment grapple with everyday issues struggle with career choices fluctuations in self-assurance
fluctuations in self-assurance Explanation: Desire for goal attainment occurs during the later school-aged period when the child works on a project through completion. A middle adolescence's main characteristic is fluctuations in self-assurance and the main characteristics of late adolescence are grappling with everyday issues and career choices.
The school nurse is planning to teach a segment on smoking during the freshman health classes. The nurse is aware that this needs to be a forum rather than a lecture. Which technique will also help deliver a "don't smoke" message? showing a command of the facts on smoking speaking with a tone of authority keeping your personal experiences out of it listening to all comments nonjudgmentally
listening to all comments nonjudgmentally Explanation: It is very important to listen to the students' comments without casting judgment to avoid creating resistance to information. Spouting too many facts too often and taking on an authoritative tone will show the audience that their opinions don't matter. Using personal experiences and admitting mistakes you have made can be helpful to communication.
A runaway female adolescent has come to the community clinic because she is pregnant. When developing a plan of care, the nurse should identify which priority goal for this client? returning home to parents adequate nutrition monthly prenatal visits safe housing
safe housing Explanation: Because many adolescents who run away are not good problem solvers, setting goals with them may be difficult. As the adolescent has no money for food, telling her to eat a nutritious diet is not attainable. If the adolescent does not have a means of transportation, she may be unable to return to the health care facility for frequent follow-up visits. The nurse should ask the adolescent if she wants to return home and if possible, ascertain if the parents will allow the adolescent back home. While food and prenatal visits are necessary, safety is the priority for the mother and the baby.
A school nurse performs screenings on all the students in the school. When planning screenings for all students for the year, which screenings will be included? Select all that apply. scoliosis body mass index vision sexually transmitted infection screening hearing
scoliosis body mass index vision hearing
The child states, "I never want to be a nurse or a doctor." The nurse recognizes this statement as reflecting what level of communication? shared personal ideas and judgments cliché conversation fact reporting shared feelings
shared personal ideas and judgments Explanation: The child is making a judgment about his future. This is the third level of communication. Cliché conversation and fact reporting are lower levels of communication; sharing feelings requires a higher level of trust.
A nurse is teaching a 17-year-old boy with type 2 diabetes how to use a glucometer and to self-inject insulin. She also teaches him what foods he should avoid in his diet. Finally, she explains to him the value of these measures in avoiding the dangerous complications of diabetes and in enjoying a healthy life. Which of her teaching points requires primarily cognitive learning on the part of the client? what foods to avoid in his diet how to use a glucometer to check his blood glucose level how to administer a self-injection of insulin the value of these measures in avoiding complications and enjoying a healthy life
what foods to avoid in his diet Explanation: Cognitive learning involves a change in the individual's level of understanding or knowledge, as would occur when the client in this scenario learns which foods to avoid in his diet. Psychomotor learning requires a change in a person's ability to perform a skill, such as using a glucometer and administering a self-injection. Affective learning involves a change in a person's attitude and is the most difficult area in which to bring about change. Learning the value of measures that help the client avoid complications and enjoy a healthy life is an example of this type of learning.
