CH 18

What are the three main focus goals for the therapeutic management of anorexia nervosa?

- reinstitute normal nutrition/reverse state of malnutrition - resolve disturbed family interaction - indiv psychotherapy to correct deficits and distortions

What should the physical exam of an obese child include?

- stretch marks/discolorations -joint swelling/pain - airway for obstruction and enlarged tonsils

What are SANEs?

sexual assault nurse examiners

Anorexia nervosa is characterized by:

strong fears of becoming fat, distorted body image, progressive wt loss - no prevalence diff b/w sexes -high mortality, 6% die 20% suicide

Characterized by a primary lesion, the chancre, which appears 5 to 90 days after infection and begins as a painless papule at site of inoculation and erades to form a nontender, shallow, indurated, clean ulcer

syphilis - 50% of cases are in black women secondary syphilis 6wk-6mo after primary lesion; widespread, symmetric maculopapular rash on palms and soles with generalized lymphadenopathy if left untreated, goes into latent asymptomatic and 1/3 go to TERTIARY SYPHILIS- neuro, CV, multiorgan complication negative seroconversion for 6-8wk after exposure tx: Penicillin G

Manifested by scrotum that is swollen, painful, red, and warm; pain radiating to groin, accompanied by nausea, vomiting, and abdominal pain; typically, an absence of fever and urinary symptoms; immediate surgery required to treat

testicular torsion

Marked by the testis hanging free from its vascular structure; results in partial or complete venous occlusion

testicular torsion - 13 is peak age - acute/insidious onset - scrotal pain/redness/swelling

An STI caused by an anaerobic parasitic protozoa

trichomoniasis - greenish, frothy, mucopurulent, copious, malodorous discharge that often worsens after menstruation

Condition that may manifest with vaginal pruritus and dysuria and is not a sexually transmitted infection (STI); treated with over-the-counter topical antifungal creams; characterized by "cottage cheese-like" discharge

yeast infection

Produce signals that promote cessation of appetite

anorexigenic substances

Which one of the following is associated with 65% of all penile neoplasias? a. Human papillomavirus (HPV) types 6 and 11 b. HPV type 16 c. Uncircumcised males d. Paraphimosis

b. HPV type 16 HPV 6/11 associated with genital warts uncircumcised males may encounter paraphimosis (inretractable foreskin over glans; may cause gangrene)

Janie, age 14, wants to discuss with the nurse how to modify her eating habits to reduce her weight. Which one of the following methods does the nurse recognize as least helpful in assisting Janie to meet her goals? a. Have Janie keep a list of everything she eats. b. Request that Janie's parents remind Janie not to eat junk foods. c. Establish a system of rewards for changes in eating habits. d. Discuss with Janie methods other than eating that can be used to deal with emotional stress.

b. Request that Janie's parents remind Janie not to eat junk foods.

Associated with ovulatory cycles; usually appears 6 to 12 months after menarche when ovulation is established

primary dysmenorrhea secondary dymenorrhea occurs typically after age 25, associated with pathology

Prolonged penile erection

priapism

T/F Adolescents who have at least one supportive parent engage in less risky behavior.

T

Nurse role when teen finds out prego?

don't do prego test without her knowledge, ask who her support is before test after test mention expected due date

Clear to cloudy vaginal discharge

leukorrhea - physiologic

Sexual assault

Comprehensive term that includes various types of forced or inappropriate sexual activity. Sexual assault includes both physical and psychologic coercion as well as touch, penetration, and other sexual contact.

What can patients treated with syphilis experience?

Jarisch-Herxhemer reaction acute febrile rxn, HA, myalgias, arthralgias dvp within first 24 horu's of tx

Which adolescent population has greatest risk for obesity?

Mexican American boys and black girls

Characterized by hypogonadism; slow intellectual development; short stature; they lack the internal mechanism that regulates food satiety and as a result go to great lengths to obtain food

Prader -Willi syndrome

Nurse care/management of a rape victim

STI/STD testing and prophylaxis (chlamydia, gonorrhea, trichomoniasis, hep B vaccine) emergency contraception female chaperone during hx/exam if done by male practitioner

Condition that may be caused by the presence of endometrial tissue outside the uterine cavity

endometriosis - during/after menses, T bleeds and inflammation causes fibrosis and adhesions

Characterized by an eating disorder, amenorrhea, and osteoporosis

female athlete triad

Bariatric surgery should be limited to what youth population?

12-18y.o., >40 BMI, with mod-severe comorbidities

At what ages is the highest incidence of eating disorders?

15-19y.o.; peak onset at 14 and 18y.o.

Obesity and overweight nutritional counseling is aimed at preventing an increase in body fat during growth. List the four aspects of changing eating habits that can best accomplish this

reducing quantity, alter quality, regular meals/snakc, sever associations between eating and other stimuli (watching TV) ID satisfying substitutes to fave foods

T/F The teenage pregnancy rate continues to increase for all age-groups.

F

The nurse is conducting a sexual education program. What technique has been found helpful when dealing with the subject of sexual abstinence?

role-playing refusal skills/condom use

T/F Instruction in the skills needed to resist sexual intercourse has less influence on reducing sexual activity than does providing information on the dangers associated with sexual activity (STIs or pregnancy).

F has stronger influence on reducing sexual activity

T/F The less familiar an adolescent is with his or her partner, the more likely he or she is to use contraception during intercourse.

F less familiar, less likely

T/F During a second pregnancy for a teenager, obstetric risk and risk to the infant are lower.

F

Rape

Forced sexual intercourse that occurs by physical force or psychologic coercion. Rape includes vaginal, anal, or oral penetration by body parts or inanimate objects.

gonorrhea s/sx and RF

RF: <20y.o., multiple partners often asymoptomatic; greenish-yellow discharge, irregular period potential infertility if retracted

Uterine bleeding that is irregular in amount, duration, or timing and is not related to regular menstrual bleeding

abnormal uterine bleeding (AUB) - most common in extremes of productive years - most effective tx is oral/IV estrogen for 3mo after acute phase has passed; also endometrial ablation

T/F Contraception use increases among girls as the duration of the relationship increases.

T

T/F Easy access to cars, unsupervised time at home, and changing family composition have contributed to the incidence of sexual experimentation among adolescents.

T

T/F Effective parent-child communication about sexuality can delay the onset of first sexual intercourse.

T

T/F Teens between 12 and 16 years are at high risk for prolonged labor related to fetopelvic incompatibility.

T d/t incomplete growth; highest in <14 y.o. pelvic adequacy at 15y.o.

T/F Pregnant adolescents often have diets deficient in iron, calcium, and folic acid.

T often gain more than the avg 40lbs > birth complication wt gain should be d/t by preprego BMI, not age

T/F The pregnancies of adolescents under 15 years old are less frequently complicated by obstetric problems.

T social risk factors improved if second prego doesn't occur in adolescence or 26mo after first

T/F There is evidence that low self-esteem in females and males is associated with sexual intercourse at an earlier age.

T things that postpone sexual involvement: parental monitoring, effective parent-child communication, school/program involvement, family meals helpful to ask about intention for sexual initiation if still virgin

Postpartum care of adolescents should be directed toward what goal?

preventing subsequent prego, enhance life outcomes for parents/kids, contraceptives, positive parentng/self-esteem/career goals

The absence of menses by 16.5 years, regardless of normal growth and development

primary amenorrhea

The practitioner has prescribed tretinoin cream (Retin-A) for Nancy's acne. Nancy has been using the cream for 2 weeks and is concerned she is not improving. Nancy tells the nurse that she has "done everything" that she was told to do and asks, "Why is my acne no better?" The nurse's best reply is: a. "Since the medication prevents the formation of new comedones, it will take at least 6 weeks for improvement to be obvious." b. "You must not be using the medication right. Show me how you apply it to your face." c. "Acne is caused by dirt or oil on the surface of the skin. You will need to increase the number of times you wash these areas each day." d. "You will probably need to ask the practitioner about changing your medicine as soon as possible."

a. "Since the medication prevents the formation of new comedones, it will take at least 6 weeks for improvement to be obvious." can be extremely irritating to skin, pt edu - peas sized dot divided by 3, gently rub in 20-30 minutes after washing to reduce burning - avoid sun/SPF 15 in daytime - daily moisturizer

Which of the following is least appropriate when developing an outpatient contract between the patient with an eating disorder and the therapist? a. Begin the psychotherapy immediately before the contract is developed and before weight gain. b. Develop the contract so that the patient's feeling of control and responsibility toward recovery is established. c. Specify in the contract the weight at which tube feedings will be implemented. d. Specify in the contract when rewards for achievement will be implemented.

a. Begin the psychotherapy immediately before the contract is developed and before weight gain. * little benefit if no wt gain primary goal is wt restoration, accomplished by B contracts monitor post-meal for 1-3hr

When initiating a treatment plan for obesity, the nurse should do which of the following? a. Defer treatment until the family is ready to begin. b. Proceed with the plan regardless of the family's readiness if the adolescent is ready. c. Understand that the adolescent cannot take personal responsibility for dietary habits and physical activity. d. Understand that adolescents who are forced by their parents to seek help can easily become motivated.

a. Defer treatment until the family is ready to begin. explore motivation behind wanting to lose wt, is key to success need to take personal responsibility teens forced by parents seldom motivated, become rebellious

Lesley is a sexually active adolescent. She comes to the clinic with abdominal pain and vaginal bleeding. The nurse recognizes that which of the following must be ruled out immediately? a. Ectopic pregnancy b. Ovarian cyst c. STIs d. Endometriosis

a. Ectopic pregnancy bleeding common in early prego, 50% end in spontaneous abortion HoTN + ab pain = ruptured ectopic prego, emergency surgery req.d

In teaching the adolescent male how to perform testicular self-examination, the nurse includes which of the following in the instructions? a. Perform the procedure once a month after a warm shower. b. A raised swelling palpated on the superior aspect of the testicle indicates an abnormality. c. Use the second and third fingers on each hand, holding each testicle between the fingers while palpating it with the other fingers. d. The normal testicle will feel soft with a round, smooth contour.

a. Perform the procedure once a month after a warm shower.

Which of the following diagnostic findings would most likely confirm the diagnosis of bulimia in Karen? a. Presence of distinctive lesions on the hands (Russell sign), that is, scars and cuts from repeated abrasions of the skin b. Hypertension, weakness, and cool skin c. Elevated potassium, magnesium, and erythrocyte sedimentation rate d. A heart murmur diagnosed as mitral valve prolapse

a. Presence of distinctive lesions on the hands (Russell sign), that is, scars and cuts from repeated abrasions of the skin * from scratching hand on incisors to induce V HoTN, low BP, low temp associated w/ low wt AN have dry skin, lanugo mitral valve prolapse may also dvp in AN

Psychologic and social findings in the obese adolescent include: a. negative self-image that persists into adulthood. b. decreased practice of unhealthy weight control behaviors as compared to thin adolescents. c. increased practice of bullying their classmates. d. being less sensitized to obesity and less inclined to incorporate the culture's preference for thinness.

a. negative self-image that persists into adulthood. low body satisfaction and self-esteem more likely to engage in unhealthy wt control B more frequently bullying victims

The primary goal of nursing care for the adolescent rape victim is: a. not to inflict further stress on the victim. b. obtaining a complete history of the incident. c. assisting in the physical examination. d. notifying the police and the parents of the victim before proceeding with assessment.

a. not to inflict further stress on the victim.

The best approach to the management of obesity in children and adolescents is: a. prevention. b. pharmacologic agents sibutramine and orlistat. c. bariatric surgery. d. behavior modification.

a. prevention.

Abnormal vaginal bleeding, usually associated with anovulation

abnormal uterine bleeding (AUB) - most common in extremes of productive years - most effective tx is oral/IV estrogen for 3mo after acute phase has passed; also endometrial ablation

The absence of menstrual flow

amenorrhea - common if >20% underweight - overweight commonly have early onset period - if d/t excessive exercise, vitD + K + Ca may help

A drug approved for medical abortion is mifepristone. Which of the following statements about this drug is true? a. The drug can be used to provide nonsurgical abortion up to 49 days of pregnancy. b. The drug promotes receptor binding of endogenous or exogenous progesterone. c. The abortion completion rate is 100% in pregnancies if used correctly. d. The drug is administered intramuscularly up to 49 days after the last menstrual period.

b. The drug promotes receptor binding of endogenous or exogenous progesterone. - required for prego - po administration up to 7 wks after LMP - ineffective in 1 to 5% methotrexate blocks folic acid; IV/po + intravaginal placement misoprostol stimulates uterine contractions bleeding and craping common

Which of the following statements related to human immunodeficiency virus (HIV) is true? a. Clinical and epidemiologic studies have shown that increasing levels of CD4 are associated with increased incidence of AIDS-related diseases. b. Transmission of the virus from the mother to the infant can occur as early as the first trimester of pregnancy. c. The FDA has approved six methods of rapid testing for HIV, requiring vaginal, anal, or oral fluid samples. d. Intravenous zidovudine is recommended for all HIV-infected pregnant women during the postpartum period.

b. Transmission of the virus from the mother to the infant can occur as early as the first trimester of pregnancy. secondary opportunistic diseases: jivrovecii pneumonia, candida esophagitis, wasting syndrome seroconversion within 6-12wk; flu-like response declining CD4 associated with increasing incidence of AIDS-related diseases IV prophylactic zidovudine in pre-/perinatal periods; major AE is BMS scheduled C-section at 38-39wk depending on viral load; IV ZDV throughout birth, oral admin to bb x6wk NO BREASTFEEDING (in dvp countries)

Human papillomavirus (HPV): a. has 10 serotypes associated with causing genital warts. b. has lesions that resolve on their own in young women because their immune systems may be strong enough to fight the infection. c. has lesions that decrease in size or disappear during pregnancy. d. has lesions always visible to the naked eye on the cervix.

b. has lesions that resolve on their own in young women because their immune systems may be strong enough to fight the infection. * no tx, just wart removal and sx relief has 30 types, 5 cause genital warts, 8 oncogenic (cervical neoplasia) lesions occur in genital/anal-rectal region, often require magnifying glass in darker-skinned - painless but size may make them uncomfortable more common in pregnancy, preexisting lesions enlarge during pregnancy s/sx: postcoital bleeding, profuse/irritating vaginal discharge

BMI measurement in adolescents: a. is currently considered the most reliable method to predict future obesity. b. is recommended as the most accurate method for screening for obesity. c. is calculated based on skin thickness and muscle mass. d. requires determining total body density by total submersion in a water-filled tank

b. is recommended as the most accurate method for screening for obesity. calculated on ht/wt, in kids varies to accommodate age and sex

The first goal in nursing care of the pregnant teenager is: a. to arrange for the pregnant teen to register for food supplement programs to ensure proper nutrition. b. to assist the pregnant teen in obtaining health care. c. to involve the boyfriend and parents in the pregnancy so that the pregnant teen will have support during her pregnancy. d. to educate the pregnant teen regarding child care.

b. to assist the pregnant teen in obtaining health care. teens often reluctant to seek med help d/t denial of prego important to jointly choose goals the teen deems important too explore prego risk factors refer for food supplement programs

Symptoms that include thin, malodorous, "fishy" vaginal discharge; diagnosis confirmed by clue cells on microscopic examination

bacterial vaginities - profuse, thin, gray/milky - clue cells are vaginal epithelial cells coated with bacteria - pH is basic - tx with Flagyl/metronidazole

Numerous factors have been identified as predisposing a woman to a vaginal yeast infection. Describe them.

broad spectrum antibiotics, uncontrolled DM, prego, obesity, high sugar diet, corticosteroids/exogenous hormones, immunosuppression - vulvar/vaginal itching and redness; no char. smell - thick, white, lumpy/cottage cheese like discharge - antifungals and probiotics for C. albicans

The adolescent with testicular cancer is most likely to be initially seen with which of the following signs and symptoms? a. Tender, painful swelling of the testes b. A mass in the posterior aspect of the scrotum that can be transilluminated c. A heavy, hard, painless mass palpable on the anterior or lateral surface of the testicle d. An asymptomatic scrotal mass that aches, especially after exercise or penile erection

c. A heavy, hard, painless mass palpable on the anterior or lateral surface of the testicle - usually on R testicle metastasis may cause back pain, hemoptysis, and SOB 99% survival rate

Which one of the following current beliefs about acne formation is true? a. Cosmetics containing lanolin and lauryl alcohol are not known to contribute to acne formation. b. There is scientific research to support the theory that stress will cause an acne outbreak. c. Exposure to oils in cooking grease can be a precursor to acne in adolescents working over fast-food restaurant oils. d. Acne usually worsens with dietary intake of chocolates and other foods high in sugars.

c. Exposure to oils in cooking grease can be a precursor to acne in adolescents working over fast-food restaurant oils. occurs 16-17y.o. in F, often occurs premenstrually; 17-18y.o. in M, more common in boys cosmetics with lanolin, petralatum, veggie oils, lauryl alcohol contributes to acne stress not proven to cause acne; dirt/oil doesn't cause acne * clinical improvement can take weeks-month open comedone = blackhead; closed comedone = whitehead

Which of the following is not a complication of obesity in adolescents? a. Type 2 diabetes and insulin resistance b. Fatty liver disease c. Heart failure d. Sleep apnea

c. Heart failure other pumlonary complications (asthma) musculoskeletal problems from increased weight on supporting structures

Adolescents with anorexia nervosa are at risk for refeeding syndrome. Which one of the following best describes refeeding syndrome? a. It reduces the risk for osteoporosis and returns the menses to normal. b. The risk for heart failure is greatest during the first 2 days of treatment. c. It occurs because of shifts in phosphate from extracellular to intracellular spaces in persons with total body phosphorus depletion. d. It causes mitral valve prolapse and significant electrolyte imbalance.

c. It occurs because of shifts in phosphate from extracellular to intracellular spaces in persons with total body phosphorus depletion. - risk of heart failure greatest in first 2 weeks of refeeding - can cause cardiac arrest and delirium (slow feeding, avoid high Na, replace Ph to prevent) osteoporosis, cardiac impairments, GI dysunction, dental erosions, electrolyte changes (hypokalemia, metabolic alkalosis) mitral valve prolapse in AN

Cindy has been diagnosed with anorexia nervosa. Her therapeutic management plan includes dietary interventions combined with family psychotherapy. Which one of the following would the nurse recognize as appropriate? a. Weight gain is a sign that the patient is not relapsing from the plan. b. The patient is only allowed to participate in setting up a food plan as a reward for weight gain. c. The plan needs to be firm but flexible. d. A reasonable goal for weight gain is about 4 lb/wk

c. The plan needs to be firm but flexible. wt gain alone not considered cure; unreliable sign of progress let pt participate in food plan only resort to NG/IV feeding if other methods have failed reasonable wt gain is 1kg/2lbs per week - pushing for more can cause anxiety, bulimia, or more severe relapses

Infants of adolescents are at risk because: a. teenage mothers often neglect their infants, leaving them for long periods with grandparents. b. teenage mothers supply excessive amounts of cognitive stimulation to their infants. c. adolescents often lack knowledge about normal infant growth and development. d. adolescents are less likely to treat their infant as love objects or playthings.

c. adolescents often lack knowledge about normal infant growth and development. often treat baby as plaything/love object maternal personal stress influence sensitivity to infant's needs lower acceptance of their children

A treatment of choice for adolescents with dysmenorrhea is: a. acetaminophen. b. oral contraceptives. c. nonsteroidal antiinflammatory drugs. d. estrogen-suppression drugs.

c. nonsteroidal antiinflammatory drugs. * especially if started several days before menses or by onset of bleeding heating pad, exercise, less salt/sugar the week before,

Weight-reduction management in adolescents should include: a. significant caloric restriction. b. elimination of physical hunger cues. c. regular physical activity. d. appetite-suppressant drugs

c. regular physical activity. sibutramine is an appetite supressant ok for >16y.o. no dietary restriction, improving nutritional quality instead

Amanda comes to the school nurse's office early in the morning, visibly upset. She tells the nurse that she and her boyfriend were having sexual relations last night and the condom broke. Amanda asks the nurse about a new pill she has read about that will keep her from becoming pregnant. She wants the nurse to give her more information about this pill. Which of the following statements made to Amanda provides the best information about levonorgestrel? a. "It is available without a prescription and must be taken within 24 hours of the unprotected sexual intercourse." b. "It is very effective but has side effects, so you will need to be out of school at least 1 day." c. "It contains estrogen, so you will need to have a pregnancy test before it can be administered." d. "It is available to women over the counter. It must be taken within 120 hours of the unprotected sexual intercourse."

d. "It is available to women over the counter. It must be taken within 120 hours of the unprotected sexual intercourse." low AE profile, no prego test required , no prescription needed

Rape victims display a variety of manifestations. Which of the following might the nurse see in 16-year-old Sally as she arrives at the emergency department for treatment after being raped? a. Hysterical crying or giggling b. Calm and controlled behavior c. Anger and rage alternating with helplessness and agitation d. All of the above

d. All of the above let victim know she/he is alright and not blamed for the situation clear account of the circumstances without forcing victim to relieve painful experience do not let shower/bathe before evaluation

Ana, age 16, has not had a period for the past 3 months, and her pregnancy test is positive. Which of the following is not an appropriate action for the nurse to take at this time? a. Inform Ana privately that her test is positive. b. Review with Ana facts about the pregnancy, including the duration of pregnancy and anticipated due date. c. Understand that Ana's reaction may be one of ambivalence, shock, fear, or apathy. d. Arrange for Ana's parents to be present when Ana is given the news.

d. Arrange for Ana's parents to be present when Ana is given the news. ask her beforehand who she is planning on telling offer to tell parents for her or to be present when news is given

Nancy, age 16 years, comes to see the nurse because of acne on her face and shoulders. After talking with Nancy, the nurse makes a nursing diagnosis of Knowledge Deficit related to proper skin care. Which one of the following would the nurse include in the instruction plan for Nancy? a. Wash the areas vigorously with antibacterial soaps. b. Brush the hair down on the forehead to conceal the acne areas. c. Avoid the use of all cosmetics. d. Gently wash the areas with a mild soap once or twice daily.

d. Gently wash the areas with a mild soap once or twice daily. antibacterial soaps ineffective and may be drying hair/scalp hygiene is related; brush hair away cosmetics with lanolin, petralatum, veggie oils, lauryl alcohol contributes to acne

Karen is suspected of being bulimic. The nurse recognizes which of the following as clinically characteristic of this disease? a. Bulimia often begins with decreased dietary intake associated with poor relationships with family members. b. Once started, the bingeing decreases in frequency to only about once per day. c. Insulin production is decreased because of excessive self-induced vomiting. d. Impulse control and satiety regulation are problems in bulimic adolescents.

d. Impulse control and satiety regulation are problems in bulimic adolescents. more common in older girls/young women avg or slightly above avg wt one binge/wk x3mo bingeing increases and control loss follows insulin production stimulated

James has kept a diet history for the nurse, and the nurse has carefully reviewed this eating diary. Which one of the following suggestions would best promote healthy eating habits in James? a. Limit fast-food consumption to no more than three times a week. b. Take second helpings of meat and vegetables only. c. Do not skip meals. d. Include more low-fat foods.

d. Include more low-fat foods.

Cindy, age 16, has been sent to the school nurse because her gym teacher has noticed a marked decrease in Cindy's weight since vacation. Which one of the following does the nurse recognize as a common finding in an adolescent girl with anorexia nervosa? a. Wears form-fitting clothes like tank tops and jeans b. Has strong peer relationships with classmates and several best friends c. Has poor schoolwork performance because of little interest in school d. Is present at meals, selects foods, and appears to family and friends to be eating appropriately

d. Is present at meals, selects foods, and appears to family and friends to be eating appropriately eat small amounts or play with food withdraw from peer relationships, self-imposed isolation overachievers and school is important secondary amenorrhea, low HR/temp/BP, cold intolerance, brittle nails

In discussing prevention of STIs, the nurse tells the adolescent that which one of the following is most effective? a. Birth control pills b. Natural skin condoms with nonoxynol-9 c. Spermicides d. Latex condoms

d. Latex condoms

Therapeutic management for chlamydia includes: a. doxycycline 100 mg twice daily for 7 days in the pregnant adolescent and her partner. b. intramuscular injection of ceftriaxone (Rocephrin) 125 mg for the patient and partner. c. intramuscular injection of penicillin 2.4 million international units for the patient and partner. d. azithromycin 1 g orally in a single dose for the patient and partner.

d. azithromycin 1 g orally in a single dose for the patient and partner. - also doxycycline but req.s more than one dose chlamydia assoc.d with increased risk of ectopic prego and tubal factor infertility RF: <25y.o., no barrier contraceptive, new/multiple partners often asymptomatic, bleeding

Gail, age 14, comes to the health provider's office for a yearly physical. Gail has always been overweight but has gained 50 lb since her last visit and now fits the criteria of obesity. The diagnostic evaluation of Gail should include all of the following except: a. history regarding the development of obesity. b. physical examination to differentiate simple obesity from increased fat that results from organic disease. c. family history, especially regarding obesity, diabetes, heart disease, and dyslipidemia. d. laboratory studies for anemia

d. laboratory studies for anemia

Herpes simplex virus (HSV): a. presents with a less severe clinical course in men than women. b. is treated with acyclovir, famciclovir, and valacyclovir for cure of the disease. c. is treated with ointments containing cortisone to help inflammation. d. requires cesarean birth within 4 hours after labor begins or membranes rupture, if visible lesions are present.

d. requires cesarean birth within 4 hours after labor begins or membranes rupture, if visible lesions are present. painful, recurrent ulcers (chronic recurring disease, no cure; triggered by stressors); fever, severe dysuria, vulvar edema to the point that it's difficult to sit RF: 15-34y.o., multiple partners primary infections during 1/3 associated with increased miscarriage - cleaning lesion bid w/ NaCl prevents secondary infection AVOID CORTISONE/nonantivirals; lidocaine spray for pain NO SEX from onset of prodrome (genital tingling) to lesion healing

The pelvic examination in the adolescent: a. should be performed on all females who are sexually active. b. should only be conducted when there is a suspicion of a sexually transmitted disease. c. is always conducted with a parent or guardian in the room. d. should allow for the opportunity to discuss safe sex practices, prevention of sexually transmitted diseases, and postponement of sexual involvement.

d. should allow for the opportunity to discuss safe sex practices, prevention of sexually transmitted diseases, and postponement of sexual involvement. should always be part of physical should always be given choice of gown/own clothing mirror on hand if she wants to see

Pain during or shortly before menstruation

dysmenorrhea - common in first 3 years after menarche - more common in obese/smokers

Inflammation that is a result of infection, local trauma, or chemical irritant

epididymitis - slow onset of unilateral scrotal pain/redness/swelling - NO GI involvement like torsion

Characterized by unilateral scrotal pain, redness, and swelling; may include urethral discharge, dysuria, fever, and pyuria; treated with antibiotics

epididymitis - DOES NOT involve GI upset like testicular torsion

Populations at risk for rape?

females, adolescents, survivors of childhood sex/phys abuse, sex workers, poor/homeless, prisoners, areas of military conflict

What is the SCOFF Questionnaire?

food disorder screening tool, each "yes" gets 1pt; >1pt may indicate eating disorder do you make yourself SICK b/c you are so full? worry of CONTROL loss? lost more than 14lbs in 3mo? think yourself FAT, other say thin? FOOD dominates life?

Benign and temporary disease that occurs in about 50% of adolescent boys

gynecomastia - usually lasts <1yr

Breast enlargement that occurs during puberty

gynecomastia - usually lasts <1yr

What does the federal law state about abortion for minors?

have the right to obtain 1/3 abortion w/o parental consent, unless otherwise specified by state law

Name two STIs for which there is a vaccine.

hep B and HPVs 6, 11, 16, and 18 for girls 9-26y.o.

The nurse is conducting an educational session with Cindy and her parents on medications used for acne. Which of the following is correct information? i. Benzoyl peroxide gel has a bleaching effect on bed coverings and towels. ii. Topical clindamycin is applied only to the individual lesions. iii. Oral contraceptive medications contain estrogen, which will increase acne formation and should be avoided. iv. Tretinoin requires that Cindy protect herself from sun exposure. v. Oral antibiotics are intended for short-term therapy and are not considered safe for long-term treatment. vi. Minocycline is more expensive but less likely to cause gastrointestinal side effects and is effective against severe inflammatory acne. vii. Results are better if systemic antibiotics are combined with topical antibiotic creams. viii. Resistance to amoxicillin and tetracycline usually develops. a. i, iv, and vi b. i, ii, iii, and iv c. ii, iv, v, vi, and vii d. i, v, and viii

i. Benzoyl peroxide gel has a bleaching effect on bed coverings and towels. - antibacterial agent, less likely to produce resistant strains - no skin bleaching ii. Topical clindamycin is applied only to the individual lesions. - side effects decreased when used every other day iv. Tretinoin requires that Cindy protect herself from sun exposure. v. Oral antibiotics are intended for short-term therapy and are not considered safe for long-term treatment. vi. Minocycline is more expensive but less likely to cause gastrointestinal side effects and is effective against severe inflammatory acne. best if topical and systemic antibiotics not combined oral contraception decreases acne

The nurse is discussing PID with a group of sexually active adolescent females. Which of the following is correct information? i. C. trachomatis is estimated to cause half of all cases. ii. Using IUDs for birth control with more than one sexual partner increases the risk of developing PID. iii. Pain is not always found in patients presenting with PID. iv. After a single episode of PID, infertility occurs because of tubal scarring. v. After a single episode of PID, the risk for ectopic pregnancy increases. vi. All pregnant women with PID should be hospitalized and treated with parenteral antibiotics. a. i, ii, iii, and vi b. ii, v, and vi c. i, ii, v, and vi d. ii, iv, v, and vi

i. C. trachomatis is estimated to cause half of all cases. ii. Using IUDs for birth control with more than one sexual partner increases the risk of developing PID. v. After a single episode of PID, the risk for ectopic pregnancy increases. * by sevenfold vi. All pregnant women with PID should be hospitalized and treated with parenteral antibiotics. no sex until treatment completed if acute, should be in a semi-Fowler's position; restricted activity during recovery phase

Physical inactivity has been linked with overweight children. Which of the following explain this decrease in childhood activity? i. Decrease in physical activity in secondary and elementary schools ii. Parental obesity and low levels of physical activity at home iii. Increased time spent with television, video games, computers, and the Internet iv. Lack of sidewalks, parks, and bike paths in low-income communities a. i, ii, and iii b. ii and iii c. i and iv d. i, ii, iii, and iv

i. Decrease in physical activity in secondary and elementary schools ii. Parental obesity and low levels of physical activity at home iii. Increased time spent with television, video games, computers, and the Internet iv. Lack of sidewalks, parks, and bike paths in low-income communities

The proper use of isotretinoin 12-cis-retinoic acid (Accutane) for adolescents includes: i. reserving its use for severe, cystic acne that has not responded to other treatments. ii. limiting treatment to 20 weeks. iii. watching for side effects, including mood changes, depression, and suicidal ideation. iv. watching for detrimental effects on bone mineralization. v. recognizing that it is contraindicated in pregnancy and in sexually active females not using an effective contraceptive method. vi. monitoring for elevated cholesterol and triglyceride levels before and during treatment. a. i, ii, iv, and v b. i, iii, and v c. i, ii, iii, v, and vi d. i, ii, iii, iv, v, and vi

i. reserving its use for severe, cystic acne that has not responded to other treatments. ii. limiting treatment to 20 weeks. iii. watching for side effects, including mood changes, depression, and suicidal ideation. - also dry skin/eyes, photosensitivity, HA iv. watching for detrimental effects on bone mineralization. v. recognizing that it is contraindicated in pregnancy and in sexually active females not using an effective contraceptive method. vi. monitoring for elevated cholesterol and triglyceride levels before and during treatment.

Increased obesity among children is related to: a. high birth weight. b. underlying disease. c. enzyme abnormalities and metabolic defects. d. overeating.

increased cholesterol/BP, asthma, orthopedic cond.s, DM II, fatty liver disease, cholelithiasis

What is the ketogenic diet?

it is a protein-sparing modified fast, hypocaloric diet designed to provide enough protein to minimize loss of lean body mass during wt loss K, Ca, and calorie-free beverages can reduce complications

Age- and gender-specific BMI at or above the 95th percentile

obesity excess accumulation of fat in relation to lean body mass

Produce signals that increase appetite

orexigenic substances

Refers to state of weighing more than average for height and body build

overweight BMI at 85-94%

Tight foreskin of the penis that cannot be retracted

paraphimosis - may cause gangrene

Infection of the upper genital tract (endometrium, fallopian tubes, and ovaries), most commonly caused by sexually transmitted bacteria, such as Neisseria gonorrhoeae, Chlamydia trachomatis, and a variety of other anaerobic bacteria

pelvic inflammatory disease (PID) @ increased risk for extopic prego, infertility, and chronic pelvic pain

Rupture of the corpus cavernosum as a result of trauma to the erect penis

penile fracture

Condition that has more than 150 associated physical, psychologic, and behavioral symptoms beginning in the luteal phase of the menstrual cycle

premenstrual syndrome - affects 30-80% - 20-30s most frequently reported PMDD is more severe form

A 6-month or more cessation of menses in a previous menstruating female

secondary amenorrhea

Bulimia nervosa is characterized by:

secretive binge/purging, excessive exercise, self-deprecating thoughts, depressed mood, awareness of abnormal eating pattern - more common in F

The most common treatable cause of male-related impaired fertility

varicocele

Wormlike mass that is palpated above the testicle and becomes smaller when the adolescent lies down

varicocele - dilation of testile veins - most common cause of preventable male infertility