Chapter 16: Health Problems of School-Age Children and Adolescents

Turner syndrome is suspected in an adolescent girl with short stature. This is caused by which of the following? a. Absence of one of the X chromosomes b. Presence of an incomplete Y chromosome c. Precocious puberty in an otherwise healthy child d. Excess production of both androgens and estrogens

A. Absence of one of the X chromosomes Turner syndrome is caused by an absence of one of the X chromosomes. Most girls who have this disorder have one X chromosome missing from all cells.

Which of the following statements is true about smoking in adolescence? a. Smoking is related to other high-risk behaviors. b. Smoking will not continue unless peer pressure continues. c. Smoking is less common when the adolescent's parent(s) smokes. d. Smoking among adolescents is becoming more prevalent.

A. Smoking is related to other high-risk behaviors. Cigarettes are considered a gateway drug. Teenagers who smoke are 11.4 times more likely to use an illicit drug.

A 9-year-old child has just been diagnosed with recurrent abdominal pain (RAP). Which of the following should the nurse include in preparing the family for discharge? (Select all that apply.) a. "Your child should be on a high-fiber diet." b. "You may give your child a stimulant laxative once a week." c. "You should help your child with bowel training to establish regular bowel habits." d. "Your child may place ice packs on the abdomen when pain occurs."

ANS: A, C A high-fiber diet with possible addition of bulk laxatives is beneficial in children with RAP. Bowel training is recommended to assist the child in establishing regular bowel habits.

Which of the following is the usual presenting symptom for testicular cancer? a. Hard, painful mass b. Hard, painless mass c. Epididymis easily palpated d. Scrotal swelling and pain

B. Hard, painless mass The usual presenting symptom for testicular cancer is a heavy, hard, painless mass that is either smooth or nodular and palpated on the testes.

Smokeless tobacco is: a. not addicting. b. proven to be carcinogenic. c. easy to stop using. d. a safe alternative to cigarette smoking.

B. Proven to be carcinogenic Smokeless tobacco is a popular substitute for cigarettes and poses serious health hazards to children and adolescents. Smokeless tobacco is associated with cancer of the mouth and jaw.

An adolescent tells the school nurse that she is pregnant. Her last menstrual period was 4 months ago. She has not received any medical care. She smokes but denies any other substance use. The priority nursing action is which of the following? a. Notify her parents. b. Refer for prenatal care. c. Explain the importance of not smoking. d. Discuss dietary needs for adequate fetal growth.

B. Refer for prenatal care Teenage girls and their unborn children are at greater risk for complications during pregnancy and delivery. With improved therapies, the mortality for teenage pregnancy is decreasing, but the morbidity is high.

Which of the following abnormalities is a common sex chromosome defect? a. Down b. Turner c. Marfan d. Hemophilia

B. Turner Turner syndrome is caused by an absence of one of the X chromosomes.

Which of the following statements is correct regarding sports injuries during adolescence? a. The increase in strength and vigor during adolescence helps prevent injuries related to fatigue. b. Conditioning does not help prevent many sports injuries. c. More injuries occur during organized athletic competition than during recreational sports participation. d. Adolescents may not possess insight and judgment to recognize when a sports activity is beyond their capabilities.

D-Adolescents may not possess insight and judgment to recognize when a sports activity is beyond their capabilities. Injuries occur when the adolescent's body is not suited to the sport and/or when they lack the insight and judgment to recognize that an activity exceeds their physical abilities.

The nurse is teaching the parents of a child recently diagnosed with ADHD who has been prescribed methylphenidate (Ritalin). Which of the following should the nurse include in teaching about the side effects of methylphenidate? a. "Your child may experience a sense of nervousness." b. "You may see an increase in your child's appetite." c. "Your child may experience daytime sleepiness." d. "You may see a decrease in your child's blood pressure."

a. "Your child may experience a sense of nervousness." Nervousness is one of the common side effects of Ritalin.

An adolescent girl tells the nurse that she is very suicidal. The nurse asks her if she has a specific plan. Asking this should be considered which of the following? a. An appropriate part of the assessment b. Not a critical part of the assessment c. Suggesting that the adolescent needs a plan d. Encouraging the adolescent to devise a plan

a. An appropriate part of the assessment Routine health assessments of adolescents should include questions that assess the presence of suicidal ideation or intent. Questions such as "Have you ever developed a plan to hurt yourself or kill yourself" should be part of that assessment.

Which of the following is the most commonly used method in completed suicides? a. Firearms b. Drug overdose c. Self-inflected laceration d. Carbon monoxide poisoning

a. Firearms Firearms are the most commonly used instruments in completed suicides among both males and females. For adolescent boys, firearms are followed by hanging and overdose. For adolescent females, overdose and strangulation are the next most common means of completed suicide.

Which of the following statements is correct about childhood obesity? a. Heredity is an important factor in the development of obesity. b. Childhood obesity in the United States is decreasing. c. Childhood obesity is the result of inactivity. d. Childhood obesity can be attributed to an underlying disease in most cases.

a. Heredity is an important factor in the development of obesity. Heredity is an important fact that contributes to obesity. Identical twins reared apart tend to resemble their biologic parents to a greater extent than their adoptive parents. It is difficult to distinguish between hereditary and environmental factors.

A mother calls the school nurse saying that her daughter has developed a school phobia. She has been out of school 3 days. The nurse's recommendations should include which of the following? a. Immediately return child to school. b. Explain to child that this is the last day she can stay home. c. Determine cause of phobia before returning child to school. d. Seek professional counseling before forcing child to return to school.

a. Immediately return child to school. The primary goal is to return the child to school. Parents must be convinced gently, but firmly, that immediate return is essential and that it is their responsibility to insist on school attendance.

The nurse is caring for an adolescent brought to the hospital with acute drug toxicity. Cocaine is believed to be the drug involved. Data collection should include which of the following? a. Mode of administration b. Drug's actual content c. Function the drug plays in the adolescent's life d. Adolescent's level of interest in rehabilitation

a. Mode of administration When the drug is questionable or unknown, every effort must be made to determine the type, amount of drug taken, the mode and time of administration, and factors relating to the onset of presenting symptoms.

What is the most significant factor in distinguishing those who commit suicide from those who make suicidal attempts or threats? a. Social isolation b. Level of stress c. Degree of depression d. Desire to punish others

a. Social isolation Social isolation is a significant factor in distinguishing adolescents who will kill themselves from those who will not. It is also more characteristic of those who complete suicide than of those who make attempts or threats.

A 14-year-old boy and his parents are concerned about bilateral breast enlargement. The nurse's discussion of this should be based on which of the following? a. This is usually benign and temporary. b. This is usually caused by Klinefelter syndrome. c. Administration of estrogen effectively reduces gynecomastia. d. Administration of testosterone effectively reduces gynecomastia.

a. This is usually benign and temporary. The male breast responds to hormonal changes. Some degree of bilateral or unilateral breast enlargement occurs frequently in boys during puberty.

A sexually active female adolescent asks the nurse about the contraceptive Depo-Provera. The nurse should explain that it: a. requires injections every 3 months. b. requires daily administration of medication by mouth. c. provides long-term continuous protection, up to 5 years. d. prevents pregnancy if given within 72 hours of unprotected sex.

a. requires injections every 3 months The contraceptive Depo-Provera is administered by injection every 3 months.

Which of the following statements is true concerning adolescent suicide? a. A sense of hopelessness and despair are a normal part of adolescence. b. Gay and lesbian adolescents are at a particularly high risk for suicide. c. Problem-solving skills are of limited value to the suicidal adolescent. d. Previous suicide attempts are not an indication of risk for completed suicides.

b. Gay and lesbian adolescents are at a particularly high risk for suicide. A significant number of teenage suicides occur among homosexual youths. Gay and lesbian adolescents who live in families or communities that do not accept homosexuality are likely to suffer low self-esteem, self-loathing, depression, and hopelessness as a result of a lack of acceptance from their family or community.

Correct terminology is necessary in understanding substance abuse. Physical dependence is which of the following? a. Problem that occurs in conjunction with addiction b. Involuntary physiologic response to drug c. Culturally defined use of drugs for purposes other than accepted medical purposes d. Voluntary behavior based on psychosocial needs

b. Involuntary physiologic response to drug Physical dependence is an involuntary response to the pharmacologic characteristics of drugs such as opioids or alcohol.

Which of the following is descriptive of attention deficit hyperactivity disorder (ADHD)? a. Manifestations exhibited are so bizarre that the diagnosis is fairly easy. b. Manifestations affect every aspect of the child's life but are most obvious in the classroom. c. Learning disabilities associated with ADHD eventually disappear when adulthood is reached. d. Diagnosis of ADHD requires that all manifestations of the disorder be present.

b. Manifestations affect every aspect of the child's life but are most obvious in the classroom. ADHD affects every aspect of the child's life, but the disruption is most obvious in the classroom.

The psychologic effects of being obese during adolescence include which of the following? a. Sexual promiscuity b. Poor body image c. Feelings of contempt for thin peers d. Accurate body image but self-deprecating attitude

b. Poor body image Common emotional consequences of obesity include poor body image, low self-esteem, social isolation, and feelings of depression and isolation.

Which of the following is descriptive of central nervous system stimulants? a. They produce strong physical dependence. b. They can result in strong psychologic dependence. c. Withdrawal symptoms are life threatening. d. Acute intoxication can lead to coma.

b. They can result in strong psychologic dependence. Central nervous system stimulants such as amphetamines and cocaine produce a strong psychologic dependence.

Which of the following is a characteristic of children with depression? a. Increased range of affective response b. Preoccupation with need to perform well in school c. Change in appetite, resulting in weight loss or gain d. Tendency to prefer play instead of schoolwork

c. Change in appetite, resulting in weight loss or gain Physiologic characteristics of children with depression include change in appetite resulting in weight loss or gain, nonspecific complaints of not feeling well, alterations in sleeping pattern, insomnia or hypersomnia, and constipation.

Brian, age 12 years, has short stature because of a constitutional growth delay. The nurse should be the most concerned about which of the following? a. Proper administration of thyroid hormone b. Proper administration of human growth hormones c. Child's self-esteem and sense of competence d. Helping child understand that his height is most likely caused by chronic illness and is not his fault

c. Child's self-esteem and sense of competence Most cases of constitutional growth delay are caused by simple constitutional delay of puberty, and the child can be assured that normal development will eventually take place. Listening to distressed adolescents and conveying interest and concern are important interventions for these children and adolescents. They should be encouraged to focus on the positives aspects of their bodies and personalities.

Which of the following statements regarding chlamydial infections is correct? a. Treatment of choice is oral penicillin. b. Treatment of choice is nystatin or miconazole. c. Clinical manifestations include dysuria and urethral itching in males. d. Clinical manifestations include small, painful vesicles on genital areas.

c. Clinical manifestations include dysuria and urethral itching in males. Symptoms of chlamydial infection in males include meatal erythema, tenderness, itching, dysuria, and urethral discharge. Some infected males have no symptoms.

Young people with anorexia nervosa are often described as being which of the following? a. Independent b. Disruptive c. Conforming d. Low achieving

c. Conforming Individuals with anorexia nervosa are described as perfectionist, academically high achievers, conforming, and conscientious.

Which of the following is an important consideration when the nurse is discussing enuresis with the parents of a young child? a. Enuresis is more common in girls than in boys. b. Enuresis is neither inherited nor has a familial tendency. c. Organic causes that may be related to enuresis should be considered first. d. Psychogenic factors that cause enuresis persist into adulthood.

c. Organic causes that may be related to enuresis should be considered first. Organic causes that may be related to enuresis should be ruled out before psychogenic factors are considered.

The school nurse is discussing testicular self-examination with adolescent boys. Why is this important? a. Epididymitis is common during adolescence. b. Asymptomatic sexually transmitted diseases may be present. c. Testicular tumors during adolescence are generally malignant. d. Testicular tumors, although usually benign, are common during adolescence.

c. Testicular tumors during adolescence are generally malignant. Tumors of the testes are not common, but when manifested in adolescence, they are generally malignant and demand immediate evaluation.

Prevention of pelvic inflammatory disease (PID) in adolescents is important because it: a. is easily prevented by proper personal hygiene. b. is easily prevented by compliance with any form of contraception. c. can have devastating effects on the reproductive tract of affected adolescents. d. can cause life-threatening and serious defects in the future children of affected adolescents.

c. can have devastating effects on the reproductive tract of affected adolescents. PID is a major concern because of its devastating effects on the reproductive tract. Short-term complications include abscess formation in the fallopian tubes, whereas long-term complications include ectopic pregnancy, infertility, and dyspareunia.

Adolescents with bulimia may experience which of the following complications as a result of the frequent vomiting? a. Diarrhea b. Amenorrhea c. Cold intolerance d. Erosion of tooth enamel

d. Erosion of tooth enamel Some of the signs of bulimia include erosion of tooth enamel, increased dental caries from vomited gastric acid, throat complaints, fluid and electrolyte disturbances, and abdominal complaints from laxative abuse.

Which of the following symptoms would the nurse expect to observe during the physical assessment of an adolescent girl with severe weight loss and disrupted metabolism associated with anorexia nervosa? a. Dysmenorrhea and oliguria b. Tachycardia and tachypnea c. Heat intolerance and increased blood pressure d. Lowered body temperature and brittle nails

d. Lowered body temperature and brittle nails Symptoms of anorexia nervosa include lower body temperature, severe weight loss, decreased blood pressure, dry skin, brittle nails, altered metabolic activity, and presence of lanugo hair.

An adolescent girl asks the school nurse for advice because she has dysmenorrhea. She says that a friend recommended she try an over-the-counter nonsteroidal antiinflammatory drug (NSAID). The nurse's response should be based on which of the following? a. Aspirin is the drug of choice for the treatment of dysmenorrhea. b. Over-the-counter NSAIDs are rarely strong enough to provide adequate pain relief. c. NSAIDs are effective because of their analgesic effect. d. NSAIDs are effective because they inhibit prostaglandins, leading to reduction in uterine activity.

d. NSAIDs are effective because they inhibit prostaglandins, leading to reduction in uterine activity. First-line therapy for adolescents with dysmenorrhea is NSAIDs. This group of drugs blocks the formation of prostaglandins.

The nurse is assisting the family of a child with a history of encopresis. Which one of the following should be included in the nurse's discussion with this family? a. Instruct the parents to sit the child on the toilet at twice-daily routine intervals. b. Instruct the parents that the child will probably need to have daily enemas. c. Suggest the use of stimulant cathartics weekly. d. Reassure the family that most problems are resolved successfully, with some relapses during periods of stress.

d. Reassure the family that most problems are resolved successfully, with some relapses during periods of stress. Children may be unaware of a prior sensation and unable to control the urge once it begins. They may be so accustomed to bowel accidents that they are unable to smell or feel it. Family counseling is directed toward reassurance that most problems resolve successfully, although relapses during periods of stress are possible.

Anorexia nervosa may best be described as which of the following? a. Occurs most frequently in adolescent males b. Occurs most frequently in adolescents from lower socioeconomic groups c. Results from a posterior pituitary disorder d. Results in severe weight loss in the absence of obvious physical causes

d. Results in severe weight loss in the absence of obvious physical causes The etiology of anorexia remains unclear, but a distinct psychologic component is present. The diagnosis is based primarily on psychologic and behavioral criteria.

An adolescent asks the nurse what causes primary dysmenorrhea. The nurse's response should be based on which of the following? a. It is an inherited problem. b. Excessive estrogen production causes uterine pain. c. There is no physiologic cause; it is a psychologic reaction. d. There is a relation between prostaglandins and uterine contractility.

d. There is a relation between prostaglandins and uterine contractility. The exact etiology of primary dysmenorrhea is debated. Overproduction of uterine prostaglandins has been implicated, as has overproduction of vasopressin.

The weight loss of anorexia nervosa is usually triggered by which of the following? a. Sexual abuse b. School failure c. Independence from family d. Traumatic interpersonal conflict

d. Traumatic interpersonal conflict Weight loss may be triggered by a typical adolescent crisis such as the onset of menstruation or a traumatic interpersonal incident; situations of severe family stress, such as parental separation or divorce; or circumstances in which the young person lacks personal control, such as being teased, changing schools, or entering college.

Which of the following statements is true about gonorrhea? a. It is caused by Treponema pallidum. b. Treatment is by multidose administration of penicillin. c. Treatment is by topical applications to lesions. d. Treatment of all sexual contacts is an essential part of treatment.

d. Treatment of all sexual contacts is an essential part of treatment. The treatment plan should include finding and treating all sexual partners.

Which of the following is descriptive of bulimia during adolescence? a. Strong sense of control over eating behavior b. Feelings of elation after the binge-purge cycle c. Profound lack of awareness that the eating pattern is abnormal d. Weight that can be normal, slightly above normal, or below normal

d. Weight that can be normal, slightly above normal, or below normal Individuals with bulimia are of normal or more commonly slightly above normal weight. Those who also restrict their intake can become severely underweight.

An adolescent girl calls the nurse at the clinic because she had unprotected sex the night before and does not want to be pregnant. The nurse should explain that: a. it is too late to prevent an unwanted pregnancy. b. an abortion may be the best option if she is pregnant. c. Norplant can be administered to prevent pregnancy for up to 5 years. d. postcoital contraception is available to prevent implantation and therefore pregnancy.

d. postcoital contraception is available to prevent implantation and therefore pregnancy. Several emergency methods of contraception are available.