NUR101 - Chp. 27 - Growth & Development of the Adolescent: 11 - 18 years

The nurse is teaching the parents of a 12-year-old boy about common approaches when raising an adolescent. Which instruction is most important?

"Try to be open to his views." ** It is most important to be open to the child's views. This will encourage the child to consider parental concerns and promote communication.

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

"Are the guns in your home locked in a safe?" ** Common causes of death in adolescents are homicide and self-harm. These are related to the easy accessibility of guns, especially when added to depression, binge drinking, and impulsivity. Gang violence and the desire to protect themselves are additional factors. Having the gun locked in a safe provides a way for limited access.

A nurse is educating a middle school class of male adolescents about sex education. The topic of multiple partners is discussed. Which of the following statements from the nurse would be the most effective?

"Contraception is a responsibility of both parties involved." ** The nurse should educate the teens that most methods of contraception are designed for females, but that it is a shared responsibility. This age group often feels invulnerable to warnings and statistics.

A 16-year-old female tells the school nurse she is worried her ex-boyfriend is stalking her. What would be most appropriate for the nurse to ask the adolescent?

"How many times a day do you get texts from him?" ** Stalking refers to a repetitive, intrusive, and unwanted actions such as constant and threatening pursuit directed at an individual to gain the individual's attention or to evoke fear. Electronic media can be used for cyberstalking, internet harassment, and internet bullying. Sending numerous texts each day would be considered constant, repetitive, and intrusive stalking.

The parents of an adolescent client are discussing puberty changes with the nurse. The parents want to best prepare their child for changes the child's body will undergo. The parents ask the nurse for guidance on how to prepare and educate their child. Which response by the nurse is appropriate?

"It is best to provide education to your adolescent before puberty starts." ** Entering into puberty and experiencing body changes (e.g., menstruation, nocturnal emissions) without being properly prepared can lead to fear or feeling of shame. Questions should be answered honestly; however, the parents should be proactive and not reactive in providing education.

A 13-year-old male child and their parent are in the office for an annual visit. The parent jokes openly in front of the nurse about the changes in their child's voice and the fact that now the child has hair under their armpits. What is an appropriate response for the nurse when talking with the parent?

"Remember, your child is probably very self-conscious and may be embarrassed by your statements."

The parents are concerned their 14-year-old child is always eating. The child weighs 54 kg and is 65 inches (165 cm) tall. What is the best explanation the nurse can give the parents?

"The calories help his body increase muscle mass." ** Adolescents grow rapidly and mature dramatically during the period from ages 13 to 20 years. An adolescent needs an increased number of calories to support the rapid body growth that occurs. Foods must come from a variety of sources to supply the necessary amounts of carbohydrates, vitamins, protein, and minerals. Boys typically gain about 15 to 55 pounds (7 to 25 kg) during their teenage years.

An adolescent who is depressed states, "Nothing ever seems to be right in my life." How should the nurse respond?

"You are feeling sad right now. It is a hard time." ** Some degree of depression is present in most adolescents because they are not only losing their parents while they grow apart from them but also their carefree childhood. When using therapeutic communication, it is important for the nurse to accept the adolescent's verbalization as real. Support should be real.

A chronically ill adolescent is readmitted to the hospital with an infected wound requiring long-term dressing changes. What is the best way the nurse can encourage independence for this client?

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

A nurse is examining a 17-year-old adolescent in the emergency room who is being disruptive in the waiting area. On assessment, the nurse finds dilated pupils, and the teen is talking very fast. Which of the following drugs does the nurse suspect the teen may be abusing?

Amphetamines ** Amphetamine drug abuse can result in euphoria, rapid talking, and dilated pupils.

Heterosexual

Attracted to the opposite sex.

Homosexual

Attracted to the same sex.

Menarche

Beginning of menstruation.

Early Adolescence (Preadolescence, Pubescence)

Beings with a dramatic growth spurt that signals the advent of puberty.

Transgender

Born with the anatomy of a man or woman but their internal sense is that they are in the wrong body, & they identify themselves as a person of the opposite sex and/or gender.

The nurse is caring for a chronically ill adolescent client. When developing the plan of care for this client, which area would the nurse focus on to maintain stimulation and support the client's sense of identity while hospitalized?

Encourage keeping in contact with friends.

Euphoria

Feeling or state of intense excitement & happiness.

Malocclusion

Improper alignment of teeth; common condition that affects the way the teeth & jaws function.

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? ** 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.

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

Menarche should follow in about 2 years.

Nocturnal Emissions (Wet Dreams)

Often used as the indication that the preadolescent period has ended.

Anorexia Nervosa

Starving oneself & even after the body has become emaciated, the individual truly believes that they are still fat & therefore, unattractive.

The nurse is caring for a 16-year-old adolescent who was arrested for driving while intoxicated. Which teaching method is most effective in changing the adolescent's behavior?

Stressing that the driver's license can be lost if drinking continues. ** Adolescents are very present-oriented, so a program such as losing the driver's license provides immediate results and will usually be carried out well. In contrast, a regimen oriented toward the future, with long-term goals such as effects of alcohol on the liver or leading to other drug use may not be as successful.

The nurse is caring for an adolescent who is physically challenged. Which activity should the nurse suggest that will foster the developmental task of adolescence?

Talking to another adolescent who has a similar disorder. ** According to Erikson, the developmental task in early and mid-adolescence is to form a sense of identity versus role confusion. Main areas in which an adolescent must make gains to achieve a sense of identity include accepting a changed body image. Talking to another adolescent with the same disorder will help the client achieve the developmental task of identity.

The nurse is helping the parents and their underweight adolescent collaborate on planning a healthy menu. The nurse should be aware of which nutritional requirement of adolescents?

Teenagers have a need for increased calories, zinc, calcium, and iron for growth.

During a physical assessment, a 15-year-old male expresses concern about being short in height. When responding to the client, the nurse would incorporate an understanding of which information about growth?

The epiphyseal lines of long bones close at about 18 to 20 years of age in males.

Orthodontia

Tx of malocclusion with dental braces.

The nurse is discussing an adolescent's development with the client's parents. Which statement by the parents indicate an understanding of the nurse's teaching?

"Our adolescent is working toward achieving a sense of personal identity."

A nurse is teaching a female adolescent diagnosed with a vitamin A deficiency about appropriate nutritional recommendations to address this issue. The nurse determines that the teaching was successful based on which statement(s) by the adolescent? Select all that apply.

- "I guess I should start eating more yellow vegetables." - "I am willing to try liver and see if I like it." - "I will try to eat more broccoli and tomatoes from now on." ** With a vitamin A deficiency, the adolescent needs to increase intake of foods high in that vitamin, such as liver, whole milk, carotene sources such as yellow vegetables as well as green leafy vegetables and tomatoes.

The adolescent comes to the clinic seeking information about sexuality concerns. The clinic nurse assures the adolescent that confidentiality and privacy will be maintained unless a life-threatening situation occurs. Which nursing goal(s) is the nurse highlighting in this process? Select all that apply.

- Development of a trusting relationship - Compliance with existing laws - An environment where adolescents can be truthful

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 - Psychosocial concerns affected by peer pressure - Inexperience

True Adolescence

13 - 18 yrs old; begins with the onset of menstruation in girls & the production of sperm in boys.

The licensed practical nurse (LPN) is assisting the registered nurse (RN) to care for adolescent clients on the pediatric unit. Which finding will the LPN report to the RN as concerning?

17-year-old female client who requests to be alone with the lights off during both day and night shifts. ** At this age, the client should seek companionship with compatible peers, have a support system, and look to others for role models. The client's actions could be a sign of failure to progress through developmental tasks. This could lead to depression or other altered mental health states.

The nurse teaches a 14-year-old client's mother about the adolescent developmental task of identity versus role confusion. What is the best way for the mother to help her adolescent complete this task?

Allow the adolescent to participate in decisions. ** Adolescents must develop their own personal identities—a sense of being independent people with unique ideals and goals.

The nurse is educating an adolescent's parents on the importance of self-esteem. Which factor will the nurse include as being most important to an adolescent's self-esteem?

Body Image ** Self-esteem in a teenager is often tied to body image. Adolescents who perceive their bodies as being different than peers or as less than ideal may view themselves negatively.

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.. ** They are all high in iron.

Which of the following is accurately related to growth patterns in adolescent girls?

Growth slows after the beginning of menstruation. ** Girls grow about 3 in (7.6 cm) each year until menarche (the beginning of menstruation), after which growth slows considerably.

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?

Listen to all comments nonjudgmentally.

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

Nocturnal Emissions ** Involuntary ejaculation during the night can be disturbing to the adolescent male who has little or no understanding of what is happening in the body.

The nurse is promoting learning and school attendance for a 13-year-old girl. Which factor will affect the child's attitude most?

Peer group behaviors and attitudes. ** In this age group, children have a strong desire to conform to their peer group and to be accepted. It is important to know the peer group's attitude about school and learning.

While caring for a 16-year-old client expected to be hospitalized for several months, the nurse will perform which action to assist the client in meeting the current stage of psychosocial development?

Permit peers to visit during open visitation hours. ** It is important for the hospitalized adolescent to still be able to visit with peers.

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.

Puberty

Reproductive maturity usually between 10 - 12 yrs old.

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

Talking to another adolescent who has a similar situation.

The nurse instructs an adolescent on the hazards of body piercings and tattoos. Which outcome indicates that teaching has been effective?

The client describes the signs and symptoms to report to the provider. ** Body piercings and tattoos have become a way for adolescents to make a statement of who they are and that they are different from their parents. It is important that they know the symptoms of infection at a piercing or tattoo site (e.g., redness, warmness, drainage, swelling, mild pain) and to report these to their healthcare provider if they occur because serious staphylococcal or streptococcal infections can occur at piercing sites.

An 18-year-old client is planning to attend college in the fall. The health care nurse informs the adolescent that a visit with the primary care physician (PCP) will need to be scheduled before the start of college. What primary purpose does this PCP visit serve?

To update immunizations. ** The primary purpose of the PCP visit is to ensure that the adolescent has received recommended immunizations and administer any missing vaccines so that the adolescent is ready for communal living.

Jenny is a 15-year-old who is being seen today in the clinic accompanied by her mother. The mother states, "She ignores what we tell her and looks to her friends for answers and support. What should we do?" After talking with Jenny's mother, which statement by her mother indicates understanding of the basis for Jenny's behavior?

"Adolescents her age all do this and it will get better with time." ** During the middle adolescence the teenager spends more time ignoring adult authority and becomes more reliant on peer relationships. The adolescent 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.

A 19-year-old female adolescent comes to the clinic for a check-up. The nurse observes that she has a new tattoo. She tells the nurse, "I just got it 2 days ago." When reviewing the care of the tattoo with the adolescent, the nurse determines that the adolescent understands how to care for the tattoo when she states which of the following? Select all that apply.

- "I wash it gently with a mild soap and warm water." - "I let it air-dry for about 10 minutes after cleaning it." - "I can put on some A&D ointment a couple of times a day for about 2 weeks."

An adolescent with a new piercing comes to the health center at the school. The client reports feeling hot. Which action will the nurse complete first?

Assess the client for signs of infection. ** The nurse will first assess the client for signs of infection. The client reports feeling hot, which could indicate a fever. The nurse would assess the client's temperature and for other signs and symptoms of infection, such as redness, swelling, warmness, drainage, discomfort. The nurse would ask when the client started feeling hot and about the technique used for the piercing to gain additional history and insight.

The nurse is assisting in the care of a 15-year-old client during a routine annual examination. Which finding will the nurse report to the primary health care provider?

Indicates little value in having friends. ** At this age, peer relationships are of high importance and help the adolescent develop. Not having an interest in friends indicates a deviation from normal psychosocial development and should be further assessed.

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. ** 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.

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.

- Arrange care to provide for extra rest and sleep. - Allow friends to visit during visiting hours. - Include the parents when educating the client.

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." ** 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.

A nurse is admitting a 16-year-old male to the floor for an appendectomy. How can the nurse prepare this client for hospitalization? Select all that apply.

- Encourage him to keep his cell phone nearby to communicate with his friends. - Interview the adolescent separately from the parent to allow expression of information that he may not be comfortable sharing in front of the parent. - Provide privacy when client is changing into the hospital gown or going to the bathroom.

An adolescent client presents to the clinic for an annual examination. The client's laboratory results indicate low iron and folic acid levels. Which food choice(s) will the nurse reinforce for this client? Select all that apply.

- Green leafy vegetables - Sardines - Liver - Dried fruits ** Foods high in iron include lean meats, liver, legumes, dried fruits, green leafy vegetables, and whole-grain and fortified cereals. Foods high in folic acid include green leafy vegetables, enriched cereals, liver, dried peas and beans, and whole grains. The nurse will also reinforce teaching on why the body needs adequate iron and folic acid for growth and development.

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.

The nurse is selecting meal options for an adolescent client. The client is prescribed a vegan diet. Which meal option is appropriate for the nurse to select for this client?

Tofu burger, french fries, cherry sorbet, and tea. ** A client following a vegan diet excludes all food of animal origin, including dairy products, eggs, fish, meat, and poultry.

An adolescent is concerned that although he has pubic hair, he has no facial hair yet. He wishes facial hair would grow to cover acne lesions. The nurse would advise him that facial hair:

Usually follows pubic hair growth. ** In the average adolescent, pubic hair develops at 13 to 15 years, facial hair at 15 to 16.

A school nurse is assisting in Sports Physical Day with a 15-year-old teen who has a pierced navel. Which of the following statements by the nurse would be the best for health promotion?

"You will need to clean the navel several times a day." ** The best health promotion would be to educate the teen on prevention of infection and complications. Educating the teen on proper cleaning and its importance promotes health.