Ch 29: Growth and Development of the Adolescent

In discussing the psychosocial development of the adolescent, it is important to understand that in order for adolescents to be in intimate relationships in which feelings are mutually shared, both persons must have: A) A willingness to take initiative B) An ability to be autonomous C) An understanding of socialization and of isolation D) A sense of trust and identity

D) A sense of trust and identity In order to be intimate or to share one's deepest feelings with another person, is impossible unless both persons have established a sense of trust and a sense of identity. Being autonomous or taking initiative are not aspects that lead toward intimate relationships. Socialization and isolation are not relevant to the establishment of intimate relationships.

A 16-year-old adolescent is talking with the nurse at a local health clinic about skin care. Which comments by the teen does the nurse determine require additional conversation? Select all that apply. A) "I only tan before going on spring break to get a base tan so I won't burn." B) "Our coach makes us wear sun-protective clothes when we practice outside on the weekends." C) "My mom had melanoma so she always makes me wear a sunscreen with an SPF of 30." D) "My favorite time of day to be outside is the middle of the day, around noon." E) "The more exposure and burns I get now will toughen my skin so I won't get skin cancer when I'm older."

A) "I only tan before going on spring break to get a base tan so I won't burn." D) "My favorite time of day to be outside is the middle of the day, around noon." E) "The more exposure and burns I get now will toughen my skin so I won't get skin cancer when I'm older." The nurse should further discuss comments that demonstrate incorrect information about sun exposure. Any exposure to tanning beds should be avoided to prevent skin cancer risks. Other risks for skin cancer include being in the sun between the times of 10:00 am and 4:00 pm, and sun exposure and burns during childhood and adolescence. A minimum SPF of 15 should be used, so SPF 30 is good practice, as is wearing sun-protective clothing when outside during the day.

A 16-year-old client has been hospitalized 100 miles from home for a week. She is recovering from surgery to repair a broken kneecap, an injury incurred while skateboarding. She was cheerful and chatty when she first arrived, but the nurse notes in recent days she has become increasingly quiet and seems lonely. Which nursing intervention would be most appropriate for this client? A) Show her where the teen lounge in the hospital is so she can meet other teens, use a phone, and check her e-mail. B) Call the hospital's mental health unit to see if she can get some counseling. C) Ask her caregivers to bring her siblings and friends to visit. D) Suggest that she read books and magazines from the hospital bookmobile.

A) Show her where the teen lounge in the hospital is so she can meet other teens, use a phone, and check her e-mail. Adolescents need access to their peers so they can keep up social contacts. Access to a phone, computer, and e-mail will help the teen stay connected. Recreation areas are important. In settings specifically designed for adolescents, recreation rooms can provide an area where teens can gather to do schoolwork, play games and cards, and socialize. Because she is 100 miles from home, a visit from friends might be difficult.

During the annual physical examination, a teenage client tells the nurse that she is anxious as well as frustrated because of the acne on her face. Which is the best response for the nurse? A) "It could be serious; seek consultation when your primary care physician examines you." B) "This is one of the most common physical changes during adolescence." C) "Most of us get acne during adolescence. Even some adults do. Don't worry." D) "You must be eating fried foods or sweets in large quantities."

B) "This is one of the most common physical changes during adolescence." It is important for the nurse to inform the client that acne is one of the physical changes that characterizes adolescence as a result of increased glandular activity. The client need not seek consultation with the primary care provider, because the condition is not serious. The client should not be reprimanded; the condition should be explained as a natural phase. The client's worries should not be trivialized or ignored either.

A 15-year-old is seen at a health care facility for facial acne. When counseling him, you would teach him that the basic cause of his acne is: A) vitamin deficiency from an inadequate diet. B) activation of androgen hormones. C) thyroid-gland secretions increasing with adolescence. D) lack of showering adequately after gym class.

B) activation of androgen hormones. As androgen rises with puberty, sebaceous glands are activated to increase production of sebum, which leads to plugging of ducts (comedones).

Computer use at home and at school has increased adolescents' comfort in gaining access to and using the Internet. This has expanded their exposure to risks. What potential risks are there for an adolescent to be exposed to? A) Teens are at risk for identity theft from sharing personal information with others whom they do not know. B) Teens can become addicted to the online gaming and role-playing that is popular with their peers. C) Teens can be exposed to inappropriate materials, harassment, threats, and potential for molestation. D) Computer use can contribute to adolescent obesity due to decreased activity and increased consumption of snacks.

C) Teens can be exposed to inappropriate materials, harassment, threats, and potential for molestation. Teens are exposed to a great deal of inappropriate materials, harassments from other online users, and potential threats of molestation or solicitation of sexual favors. Teens are at risk for identity theft, but it is not as big of a concern for them because they do not use their Social Security information or credit card information. Computer use can contribute to obesity, but the risks of inappropriate materials, threats, and sexual exploitation are a greater threat. It is possible for teens to become addicted but the other risks are of more concern to parents.

The nursing student is discussing the effects on hormone production for an 11-year-old boy who has been admitted with a brain injury. Which statements by the nursing student are accurate? Select all that apply. A) "Sperm production could be impacted because follicle-stimulating hormone (FSH) and luteinizing hormone (LH) stimulate its production." B) "Since the hormones that produce changes seen in puberty occur mostly in the reproductive organs, his brain injury shouldn't affect these hormones." C) "Maturation of the testicles is directly impacted by luteinizing hormome (LH). Having a brain injury at this age could cause problems with this stage of puberty." D) "The production and secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) could be affected by his brain injury." E) "Gonadotropin-releasing hormone (GnRH) is produced by the hypothalamus. Since this child has a brain injury, this could be a concern for normal production of other hormones."

A) "Sperm production could be impacted because follicle-stimulating hormone (FSH) and luteinizing hormone (LH) stimulate its production." C) "Maturation of the testicles is directly impacted by luteinizing hormone (LH). Have a brain injury at this age could cause problems with this stage of puberty." D) "The production and secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) could be affected by his brain injury." E) "Gonadotropin-releasing hormone (GnRH) is produced by the hypothalamus. Since this child has a brain injury, this could be a concern for normal production of other hormones." Gonadotropin-releasing hormone (GnRH), produced by the hypothalamus, travels to the anterior pituitary gland to stimulate the production and secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The increased levels of FSH and LH stimulate the gonadal response. LH stimulates acts on testicular Leydig cells in boys, prompting maturation of the testicles and testosterone production. FSH with LH stimulates sperm production. Since production of these hormones are stimulated by the hypothalamus and the pituitary glands, a brain injury at this age could the onset or continuation of changes seen with puberty.

A client tells the nurse that she has noticed an increase in her weight and fat deposits during the last 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? A) Review dietary measures to assist in controlling weight gain. B) Provide reassurance that these are normal changes. C) Encourage increased exercise to control weight gain. D) Share what foods can be eaten on a low fat diet to prevent fat deposits.

B) Provide reassurance that there are normal changes. 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 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. Teenagers should be encouraged to participate in appropriate exercise programs. Dieting issues such as anorexia and bulimia can threaten the health of adolescents.

The nurse is caring for an 11-year-old girl. The girl's mother reports that the girl does not want to play team sports like soccer or volleyball anymore. Her daughter insists she does not enjoy them. The mother is concerned that her daughter will not get enough physical activity and asks the nurse for guidance. How should the nurse respond? A) "Remind her of the importance of regular physical activity for good health." B) "Organized sports are just a complementary activity to other physical activities." C) "Give her some options; it's important to find something she enjoys." D) "Why don't you sign her up for an aerobics or dance class?"

C) "Give her some options; it's important to find something she enjoys." With the onset of puberty and accompanying changes in physique and coordination, sports must be matched to the physical and emotional development of the child. It is important to give the girl some options and find something that she enjoys doing. Making a suggestion for activities without the girl's input is unhelpful. Reminding the girl that she needs regular physical activity does not address the mother's concern and is not constructive. Making a statement that organized sports are just a complement to other physical activity is accurate but does not teach or offer solutions.

The mother of a 13-year-old boy confides to the pediatric nurse practitioner that her son has recently had a nocturnal seminal emission. The mother is concerned, and the nurse explains "wet dreams" and the other male traits of puberty to the mother. Which response indicates a need for further discussion? A) "My son's spontaneous erections and nocturnal emissions are very normal." B) "My son is developing normally and the traits of puberty vary from child to child." C) "My son must be sexually active or having overly sexual thoughts to have a nocturnal emission." D) "My son is not doing anything to cause the nocturnal emissions; they occur spontaneously."

C) "My son must be sexually active or having overly sexual thoughts to have a nocturnal emission." Spontaneous erections and nocturnal seminal emissions do not mean that the child is sexually active or having overactive sexual thoughts. Parents need to be instructed that these occurrences are spontaneous and that the child is not doing anything to cause them.