MP Ch 37

An adolescent is visiting the clinic for the first time. What should the nurse keep in mind when attending to this patient? a The nurse should explain procedures and introduce personnel to adolescents. b Adolescents usually are quiet and will offer no opinions. c The nurse should attend to and discharge adolescents quickly. d Adolescents are comfortable with their surroundings.

a If the setting is new to the adolescent, explain the procedures and introduce personnel so the adolescent feels more at ease. Adolescents usually will offer their opinions readily.It is important that adolescents feel welcome, important, and unrushed, in order to gain their trust. When adolescents are visiting the same office or clinic that they came to during childhood, they usually know and feel comfortable with the care providers. This is not the case if it is a first visit.

A mother reports that her adolescent daughter is always late. The mother states, "She was born late and has been late every day of her life." Which response should the nurse make to this mother? a "Setting specific alarms and then reinforce the value of being 'on-time' may be helpful strategies to assist her to be more of an 'on-time' individual." b "Just let it go for now. Teachers and, in the future, employers will be the best people to help her be 'on-time'." c "You need to establish specific time frames for your adolescent and be certain she adheres to them." d "You have a major problem. There must be a lot of screaming in your home."

a The best response is to help the mother find a way to help the teen deal with the problem of lateness.

A school nurse is performing annual height and weight screening. The nurse notes that three females who are close friends each lost 15 pounds over the past year. The priority nursing action is to: a Obtain a nutritional history for each of these adolescents. b Refer these adolescents to the school psychologist. c Speaking with the parents would not be appropriate at this time. d Speak with the girls in a group to discuss the problems associated with anorexia nervosa.

a The school nurse must evaluate why these three friends have all lost 15 pounds in one year. The best way to begin this assessment is to obtain a nutritional history for each client.

An adolescent is being seen in the clinic to discuss health promotion behaviors. The nurse develops and implements a health promotion plan. What will the nurse include in the evaluation of the plan? a The effectiveness of the health promotion plan and methods to expand and sustain successful approaches b Instruction on what is considered healthy behavior c Advice to the adolescent that promoting health behaviors will maintain a healthy lifestyle d Information on the adolescent's attitude toward health

a When establishing youth programs, whether with individual adolescents or with groups, the nurse includes evaluation of the effectiveness of the plan and methods to expand and sustain successful approaches.

While completing the health history of a 15-year-old girl, the nurse learns that the girl is sexually active. Based on this finding, the nurse will screen for which conditions? Select all that apply. a Herpes simplex virus. b Gonorrhea c Chlamyd d Impetigo e Mononucleosis

a, b, c Herpes simplex 1 and 2 can be sexually transmitted and should be included in the screening. Some individuals with gonorrhea may display no symptoms. Because it is a sexually transmitted infection, screening for it would be appropriate. Chlamydia is the most common sexually transmitted infection in the United States. Screening is appropriate. Impetigo is a skin infection caused by staphylococcus or streptococcus; it is not a sexually transmitted infection. Although mononucleosis is sometimes called "the kissing disease," it is not considered a sexually transmitted infection. Sexual intercourse is not required for transmission.

The school nurse recognizes that an adolescent comes from a family with limited financial resources. The nurse is developing a nursing care plan to assist the adolescent with his needs. An appropriate nursing diagnosis would be: a Altered financial support related to inadequate parental support. b Imbalanced nutrition: Less than body requirements related to familial financial difficulties. c Knowledge deficit related to sources of financial support. d Risk for injury related to imbalanced nutrition.

b Imbalanced nutrition is a nursing diagnosis and is appropriate.

The nurse is preparing to see an adolescent patient to assess his relationships with others. What should the nurse do when conducting this assessment? a Let the parents know the nurse will share the information with them after the exam. b Provide separate time to communicate with both the adolescent and the parents. c Avoid asking the parents their opinions of the adolescent's friends. d Tell the parents they are not allowed to come into the examination room.

b Provide time alone with both the adolescent and the parents so that everyone has time to talk freely and ask questions. The nurse cannot share the information about the exam, as this is a breach of patient confidentiality. The nurse should include the parents' opinions of their child's friends. The nurse cannot keep the parents out of the examination room, especially if the adolescent wants the parents there.

What would be the best way for the nurse to teach adolescents regarding health promotion and health maintenance? a Contact the parents and ask what issues they have with their adolescents. b Have the adolescents identify a personal health goal. c Ask the advice of the counselors at school. d Tell the adolescents what you will include in the lecture.

b Teaching topics will be directed at both health promotion and health maintenance. A good starting point is to have the adolescent identify a personal health goal, and begin teaching there.

The nurse is assessing a 15-year-old female. The girl's menses began when she was 12 years old. The girl's body mass index (BMI) is 27.5 and her height is 5 feet, 2 inches. She weighs 160 pounds. Her school performance has been spotty. The priority client teaching would be related to: a Menstrual cycle. b Nutritional intake. c School performance. d Adolescent mini mental health status examination.

b The BMI for this client is too high, placing the adolescent at risk for cardiovascular disease, hypertension, and diabetes mellitus in later life. Therefore, nutritional intake is the most important topic to focus on with this client at this time.

The nurse working in the clinic includes an adolescent history in every client intake interview. Which of these issues should the nurse address when the parents are not present? a The adolescent's role in the family b Teen job responsibilities c Possible domestic violence d Activities done as a family

c If domestic violence is suspected, it would be appropriate to ask these questions only when the teenager is alone with the nurse or healthcare provider. The adolescent's role in the family is not confidential and could be discussed when the parents are present. Job responsibilities are not confidential and could be discussed in front of the parents. The activities of the family are not confidential and could be discussed when the parents are present.

An adolescent who recently moved to a new school in a different town presents to an ambulatory care center and describes the following: "I have no friends in my new school, and I no longer want to go to college. I know I will be lonely there, too." Which takes priority when speaking with the adolescent? a Stressing the importance of remaining in a close parent-child relationship during these stressful times b Promoting healthy mental health outcomes c Acknowledging the fact that it takes several months to make new friends at a new school due to adolescent exclusion behaviors d Helping the adolescent realize the value of postsecondary education

b The adolescent is obviously lonely with the move to the new school. The nurse should focus on appropriate coping skills, which will enhance good mental health outcomes for the child. The parent-child relationship should not be used as a substitute for the development of new peer relationships. It would not be appropriate to discuss the importance of a college education at this time because the adolescent must deal with the loss of friends and with developing new friends first.

A teenager is accompanied by his mother to the annual physical examination. The nurse is aware of privacy issues related to the teenager. While the mother is in the room, which topic should the nurse avoid? a School performance b Cigarette smoking c School friends d Seatbelt use

b The nurse must maintain the nurse-client relationship, which is between the nurse and the adolescent, and the nurse must maintain confidentiality. Therefore, the nurse cannot ask any personal questions while the mother is in the room, such as those related to sexual activity, drug and alcohol use, and smoking cigarettes.

The nurse will want to screen all adolescents for problems associated with the primary developmental task of adolescents. In that area, the nurse will ask questions about: a The adolescent's adaptation to high school. b Establishing positive peer relationships c Finding a life career. d Developing a healthy lifestyle.

b The primary task for the adolescent is to separate from parents and develop positive peer relationships.

The nurse is speaking with a group of adolescents about what can happen when having unprotected sex. The nurse understands that to communicate effectively with teens, the nurse must: a Offer personal opinions on the topic and cite examples of what can happen if they don't listen. b Allow for discussion, and bring peers who have had experience related to the topic being discussed. c Lecture on the topic for the allotted time without any discussion. d Discuss sex education related to religious belief.

b Whatever the setting, the nurse partners with the adolescent, the parents, and other persons, such as teachers or school counselors, to plan appropriate goals and related interventions. Appropriate interventions include applying communication skills effective with teens, such as listening to concerns, allowing for discussion, and bringing peers who have had experiences related to the topic being discussed.

An adolescent reports that after hearing about all the hazards of cigarette smoking, he has changed to chewing tobacco. The nurse will want to inform that adolescent of the risk factors associated with smokeless tobacco, including: Select all that apply. a Lung cancer. b Nicotine addiction. c Mouth cancers. d Emphysema. e Mouth ulcers.

b, c, e Nicotine addiction occurs with chewing tobacco as it does with smoking cigarettes. Cancer of the mouth is associated with chewing tobacco. Mouth ulcers occur in individuals who chew tobacco.

While assessing risk factors in adolescents, the nurse recognizes that dental issues may be related to: Select all that apply a Fluoridated water. b Failure to use a mouth guard when playing physical sports. c Adolescent obesity. d Diagnosis of bulimia.

b, d Injury to teeth can occur, so a mouth guard should be utilized. Repeated vomiting can destroy enamel due to contact with acidic stomach juices.

The school nurse is performing health screenings during the physical education class. The nurse plans to weigh, measure, and determine body mass index of the adolescents. The scale has been set up in the open gym to speed the process. What should the nurse do to maintain confidentiality of the findings? a Have a student worker record the screening findings on the appropriate adolescent's record. b Have a volunteer weigh and measure the adolescents and verbally give the findings to the nurse to calculate the body mass index and record. c Provide a privacy screen and have the health aid record the findings directly on the record. The nurse will then calculate body mass index. d Use a buddy system with the students, having the students measure each other and record the findings.

c A privacy screen and written responses will prevent other adolescents for hearing or seeing results.

An adolescent comes to the clinic because of a concern with a skin lesion, and he is accompanied by a parent. When the adolescent is called back to the exam room, the parent comes with the adolescent. What approach by the nurse would be most appropriate? a Instruct the parent to stay in the waiting room and tell him that the adolescent will give him a report on the exam. b Tell the parent he cannot come into the exam room with the adolescent. c Reassure the parent that you will talk with him about any of his concerns and questions. d Allow the parent to come into the exam room with the adolescent.

c If a parent comes with the adolescent, be alert that you might need to provide some private time by asking the parent to wait outside for a moment. Reassure the parent that you will talk with him about any of his concerns and questions, and provide him with an opportunity to ask questions and get information as well.

An obese adolescent who adamantly denies sexual activity has a positive pregnancy test. Which statements would be most appropriate for the nurse to make to this adolescent? a "When was your last menstrual period (LMP)?" b "Tell me how you feel about your body image." c "Let's discuss some activities that you have done within the past few months that could possibly lead to pregnancy." d "Why are you denying sexual intercourse?"

c The nurse must help the adolescent realize that previous behaviors have led to a positive pregnancy test. The only response by the nurse that will accomplish this goal is to ask a direct question in which the nurse and client search for an answer.

The school nurse is working with an adolescent who reports that he gets six hours or less of sleep at night. The nurse explains to the adolescent that some of the common consequences of inadequate sleep include: Select all that apply. a Hyperactivity. b Increased nocturnal emissions. c Increased risk of automobile accidents when driving. d Moodiness. e Being unable to perform well at school.

c, d, e This is a possibility in the adolescent who is sleep deprived. Parents often report that sleep-deprived adolescents tend to be moody and are difficult to communicate with. Drowsiness will inhibit the performance of the adolescent

The school nurse performs screenings on all students in the high school. In addition, the nurse will perform selected screenings on individual teenagers. When planning the screenings for the year, the nurse will include which screening for all teenagers? a Respiratory rate b Hepatitis B profile c Chest X-ray d Scoliosis

d Routine screening for adolescents includes checking for scoliosis, height, weight, and blood pressure measurements.

The eating disorders clinic sees a number of overweight adolescent girls. In addition to monitoring these adolescents for the health problems related to obesity, the nurse will monitor the girls for which mental health problem? a Substance abuse b School phobia c Spiritual distress d Negative self-esteem

d Self-esteem is tied closely to body image, a common source of distress among obese adolescents. Therefore, the nurse will monitor the girls for issues with self-esteem.