Chapter 29 Growth and Development of the Adolescent

A teacher refers a student to the school nurse because the student is frequently falling asleep during class. After talking with the student, the nurse is most concerned by which statement by the student? "My mom keeps telling me to turn off my television when I go to bed." "I just can't seem to stay awake during that class because it's boring." "I get 7 hours of sleep every night so I don't know why I am so tired." "I guess I need to be more careful about my curfew on school nights."

"I get 7 hours of sleep every night so I don't know why I am so tired." The average number of hours of sleep that teens require per night is 8.5 to 9.5 due to rapid growth that occurs during these years. Following a curfew and limiting distractions at bedtime can help provide the student with adequate hours of sleep each night.

The nurse is collecting data from an adolescent being seen for a well-child check-up. During the interview, the adolescent reports sleeping about 6 hours per night during the week but is able to sleep 8 to 9 hours per night on the weekend. What response by the nurse is most appropriate? "You would benefit by trying to sleep a little less on the weekends." "I am glad to see you are getting the amount of rest you need." "Let's talk about ways to increase the amount of rest you get during the week." "Sleeping during the weekend to catch up on missed rest is a good thing to do."

"Let's talk about ways to increase the amount of rest you get during the week." It is recommended that adolescents get 8 to 9.5 hours of sleep per night. Adolescents who do not get adequate rest during the week often sleep more hours on the weekend. The best practice would be to determine ways to improve daily rest patterns.

A 15-year-old adolescent tells the nurse about a desire to get a tattoo. What response by the nurse is most appropriate? "Tattoos are invasive and there is the potential for disease with their application." "If you are determined to get a tattoo you need to get a small one so you can hide it if you want." "You are too young to have a tattoo." "You need to remember that a tattoo will be with you forever."

"Tattoos are invasive and there is the potential for disease with their application." Piercings and tattoos are becoming increasingly common in teens. It is important to ensure that the teen and family understand the potential risk for disease with the application of the tattoo. The teen is young, but that does not change the fact he wants to get a tattoo. Reminding the teen that it is a permanent alteration in the skin is important but not the most important response by the nurse.

The parent of a Black adolescent voices concern to the nurse because the child, "has gotten her period before all of her friends." How should the nurse respond? "How old are most of her friends? Maybe that's the issue instead of it being a sign of something abnormal." "Some girls just get their period earlier than others." "That must be difficult, but on average Black girls start their period earlier than other ethnicities." "I will be sure to let the health care provider know this. We don't want to miss something that may be wrong

"That must be difficult, but on average Black girls start their period earlier than other ethnicities." Menarche, the first menstrual period, usually begins between the ages of 9 and 15 years (average 12.8 years), but on average Black girls reach menarche earlier than girls of other ethnic groups.

Ways to Improve Communication with Teens

-Allow sufficient time for conversation. -Speak respectfully as you would to a colleague. -Talk face to face; be aware of body language (yours and the teen's). -Ask open-ended questions to clarify and promote understanding. -Reflect back what you think you heard so that he or she feels heard. -Choose words carefully so that message and intent are clear. -Be honest; don't be afraid to say you don't know. -Be liberal with praise; acknowledge effort -Solicit the teen's input in decision making as often as possible. -Clearly state expectations and set limits fairly.

Developmental Concerns for the Adolescent

-Changes in body image -Peer groups -Violence -Suicide -Homicide -Substance use

Risk Factors for Suicide in Adolescents

-Depression or other mental health illness -Personal or family history of previous suicide attempt -Poor school performance -Dysfunctional or disorganized family -Substance abuse -Difficulties with sexual identity -Socially isolated (loner, victim of bullying) -Marked changes in behavior (giving away valued possessions) -Incarceration

Promoting Proper Hygiene for Adolescents

-Encourage frequent bathing and deodorant use. -Encourage washing face two to three times a day. -Discourage squeezing acne lesions and vigorous scrubbing of face. -Encourage frequent shampooing of hair. -Teach hygienic care for body piercings and tattoos. -Encourage sunscreen use; discourage artificial sun-tanning (tanning salons, chemical tans).

Risks of Being Involved in an Unhealthy Romantic Relationship

-Imbalance of power in the relationship to the detriment of one of the partners. -Unsafe sexual activity (STIs). -Unwanted pregnancy. -Dating violence.

Factors Contributing to Adolescent Violence

-Low self-esteem -History of victimization -Peer or gang pressure -Poor family functioning -Limited parental supervision/parents working extended hours outside of the home -Access to guns and cars -Drug or alcohol use -Less than optimal housing situation -Lower socioeconomic class -Racism -Aggression

Common Substances Abused by Children and Adolescents

-Marijuana (including synthetic marijuana). -Alcohol -Nicotine -Prescription opiates, sedatives, and analgesics -Prescription stimulants (Adderall, Concerta, Ritalin). -Prescription CNS depressants (barbituates, benzothiazides, sleeping aids). -Dextromethorphan (cough syrup). -Bath salts -Hallucinogens -Inhalants (inhaling fumes from aerosol household products). -Cocaine, crack -Heroin

Factors Influencing the Adolescent's Diet

-Peer pressure; growing wish for independence from family in food choices. -Low cost/convenience/easy access of fast foods. -Family culture relating to food and meal time rituals. -Lack of time/opportunities for family meals (busy schedules). -Growing wish for independence in food choices.

Influence of Peers During Adolescence

-Play essential role in identity of the adolescent. -Provide opportunities to learn negotiation of differences. -Provide recreation, companionship, and someone to share problems with. -Teach peer loyalty. -Create stability in times of stress or transition -Serve as credible sources of information and social reinforcement. -Can have positive or negative influences on each other.

Caring for the Hospitalized Adolescent

-Provide opportunities for adolescent to maintain independence. -Encourage adolescent to participate in decisions. -Encourage socialization with friends through phone, e-mail, and visits when possible. -Identify any knowledge self-care deficits and provide resources.

Topics for Discussion to Discourage Substance Abuse

-Short- and long-term effects of alcohol, tobacco, and drugs on health, relationships, and school performance. -Risk factors and implications for unintentional injuries and unsafe/unwanted sexual activity. -The how and why of chemical dependency. -Impact of substance abuse on society. -Importance of maintaining a healthy lifestyle. -Importance of resisting peer pressure to use drugs and alcohol. -Importance of having confidence in teen's own judgment.

Areas of Focus to Encourage Growth and Development in the Adolescent

-Sports and physical fitness -Learning and participation in school activities -Safety issues -Proper nutrition and healthy eating habits -Healthy sleep hygiene and adequate rest -Personal care -Healthy sexual life -Appropriate discipline -Mental health resources

Safety Concerns for Adolescents

-Unintentional injuries -Internet safety -Motor vehicle safety (as a driver and as a passenger) -Avoiding substance abuse -Firearm safety -Water safety

Other Physical Changes in Adolescence

-Voice deepens (most dramatic in males). -Limbs elongate disproportionately (may look "leggy"). -Growth plates at the end of long bones begin to close. -Apocrine glands (sweat glands) activate in axilla and genital areas. -Skin changes related to increased sebaceous gland secretions may lead to skin eruptions (acne). -Increase in body hair. -Hips widen in females, shoulders widen in males.

How many mg of calcium is recommended per day for adolescents?

1,300mg

Puberty begins in boys around

10-11yrs

What percent of diet should be protein?

10-30%

Peak height velocity occurs at about what age in girls?

12yrs

Peak height velocity occurs at about what age in boys?

14yrs

Teenage girls who are moderately active require about

2,000 calories per day.

Teenage boys who are moderately active require between

2,200 and 2,800 calories per day.

What percent of diet should be fat?

25-35%

What percent of diet should be carbs?

45%-65%

Protein requirements for adolescent girls, 14 to 18 years of age?

46g

Protein requirements for adolescent boys, 14 to 18 years of age?

52g

The average number of hours of sleep that teens require per night?

9-10hrs.

Puberty begins in girls around

9-10yrs

A 16-year-old female adolescent reports to the nurse that she is trying to improve her diet to loose weight. When assessing her dietary intake for adequacy which findings indicate the need for further education? (Select all that apply.) A. Consumes 8-10 mg of iron each day B. 1,000 mg calcium intake per day C. Protein comprises approximately 30% of the daily dietary intake D. Fat comprises about 40% of the daily intake E. Average caloric intake is 2,500 per day

A, B, E The recommended calcium intake for teens is 1,300 mg/day. The average caloric intake is approximately 2,000. An intake of 2,500 calories per day is likely excessive and should be reduced. Fat intake should compose 25% to 35% of the daily diet. Daily iron intake for teen girls should be approximately 15 mg per day.

A 17-year-old adolescent on the high school swim team tells the nurse diet changes during swim season that involve cutting the carbohydrates in the diet to 30% to improve swim times. What responses by the nurse are appropriate? (Select all that apply.) A. "Since you are so active, your carbohydrate intake should comprise 45% to 65% of your daily diet." B. "Twenty-five to thirty-five percent of your diet should be carbohydrates so you fall into the acceptable range." C. "Can you tell me the reason you feel the need to cut your carbohydrates when your activity level is high?" D. "As long as you are taking in around 2,500 calories per day you should be just fine." E. "Cutting carbohydrates is a good way to keep your weight down during swim season."

A,C Adolescents who are moderately active require between 2,200 and 2,800 calories per day and 45% to 65% should come from carbohydrates. Carbohydrates should not be cut, especially during an athletic season when energy use is increased. Asking the student why he or she are cutting carbohydrates is appropriate in order to help the nurse address the issue effectively.

The nurse is planning to talk to a 12½-year-old boy who says, "I am too short! Girls are taller than I am. Guess I won't be playing basketball." What points of information will the nurse share? (Select all that apply.) A. "Girls begin to grow rapidly at a younger age than boys do. Boys start later and grow longer." B. "If you know how tall you were at age 3, you can double that and predict fairly well how tall you will get." C. "There are a lot of size differences in your age group now because everyone enters puberty and grows at slightly different times than others." D. "You could add as much as 12 in to your height before you stop growing." E. "You are at the age now when most boys begin their growth spurt and grow very rapidly." F. "You can't control when and how much you will grow. Basketball can use some really fast guards."

A,C,D The information about girls growing faster than boys, about differences in size within his age group, and about his growth potential is accurate and addresses concerns implied in his comments to the nurse. Most boys' growth spurts begin near 14 years, not 12½. Height should be doubled at 2 years to predict adult size. The growth control and basketball remarks minimize his concerns and provide no information

The school nurse is preparing a presentation for a group of teachers about teen suicide. When discussing risk factors for this occurrence which should be included? (Select all that apply.) A. History of mental illness B. Sexual promiscuity C. Substance use disorder D. Family history of depression E. Homosexuality

A,C,E Suicide is the third leading cause of death in teens and young adults. There are identifiable risk factors that place a teen at an increased risk for suicide. These risk factors include substance use disorder, a history of mental illness, and homosexuality. A history of depression in the teen, not in family members, is considered a risk factor for suicide. Sexual promiscuity is not considered an increased risk for suicide.

Female 17-20 (Physical Changes Related to Puberty)

Adult like pubic hair and breasts.

Male 17-20 (Physical Changes Related to Puberty)

Adult like pubic hair, scrotum, testes, penis, breast tissue disappears, facial hair more coarse and wide spread.

The parent of a 15-year-old child expresses sadness to the nurse that the child is "much more connected to friends than family." What understanding would benefit this parent? (Select all that apply.) A. Peers provide opportunity to learn and practice social roles. B. Adolescents need parental support and guidance as they move toward greater peer involvement. C. Adolescents learn about negotiating differences by spending time with peers. D. Peers can be positive or negative influences. E. Peers are needed for emotional security while stepping away from family.

All.

The school nurse has just completed a presentation about normal adolescent physical growth to a group of adolescent students. Which comments by the adolescents indicate understanding of the nurse's presentation? (Select all that apply.) A. "Since I just had my first period and I am 14 years old, I probably haven't reached my peak height yet." B. "It doesn't seem fair that girls typically have more fat than boys." C. "Our hormones are sure going to cause us to change a lot over our teenage years." D. "Since I'm a 15-year-old guy, I still have a chance to get taller over the next couple of years." E. "It's strange how girls start getting taller before boys start getting taller."

All. All of these statements demonstrate understanding of normal physical growth during adolescence. The rapid growth during adolescence is secondary only to that of the infant years and is a direct result of the hormonal changes of puberty. Boys' growth spurt occurs later than girls' and usually begins between the ages of 10½ and 16 years and ends sometime between the ages of 13½ and 17½ years. Peak height velocity occurs at approximately 12 years of age in girls or at about 6 to 12 months after menarche. Muscle mass increases in boys and fat deposits increase in girls.

For what reasons do nurses work to prevent tobacco use by teens? (Select all that apply.) A. Smokeless tobacco damages gums and teeth. B. Smoking is associated with fighting and unprotected sex. C. Teens who smoke are more likely to use alcohol and drugs. D. Smoking damages the respiratory system. E. Tobacco use is addicting (nicotine).

All. All the options are true and represent reasons nurses work to help teens resist tobacco use.

The school nurse is monitoring a student athlete that experienced a concussion 2 weeks ago during a soccer game. The student reports having academic issues in a course in which the student previously had no difficulty. Which action should the nurse's take first? Perform a neurologic assessment on the student to see if there are any changes in neurologic status. Immediately notify the student's parents that their child should see the healthcare provider. Ask the student to describe the academic issues the student is having in the class. Ask the student's teacher if the student is following the recommendations given to him or her for cognitive activity.

Ask the student to describe the academic issues the student is having in the class. Talking with the teacher and performing a neurologic assessment are actions that may be necessary, but the nurse must first determine if the student is following the recommended level of cognitive activity; this can be accomplished by asking the child to describe the issues he or she is having. Contacting the parents immediately would not be warranted until sufficient information is collected.

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

B,C,E 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.

For reasons of anticipatory guidance, nurses should be aware that menarche appears earlier in some ethnic groups than others. In which ethnic group is menarche likely to appear first? Mexican Americans Indian Americans Black Americans White Americans

Black Americans. Black girls on average reach menarche slightly earlier than White, Mexican American, and Indian American girls.

thelarche

Breast budding, occurs at approximately age 9 to 11 years and is followed by the growth of pubic hair.

A 17-year-old child needs to increase iron intake but is concerned about weight gain. The nurse will suggest which foods? Chicken, whole-wheat bread, watermelon. Raspberry yogurt, granola, apple. Cottage cheese, crackers, oranges. Egg white omelet, broccoli, pear.

Chicken, whole-wheat bread, watermelon. Chicken, whole-wheat bread, and watermelon are all foods high in iron. The calorie content will not promote weight gain. All the other options do not include good sources of iron but are nutritious foods. Calorie content is also acceptable.

Female 14-16 (Physical Changes Related to Puberty)

Coarser pubic hair, broader distribution of pubic hair beyond mons, areola more prominent.

Male 14-16 (Physical Changes Related to Puberty)

Coarser pubic hair, growth in scrotum, testes, penis widens, glans penis develops, may see breast development, soft facial hair.

Secretion of _______ in girls and ______ in boys stimulates physical sexual changes.

Estrogen, testosterone.

Low _______ levels tend to stimulate skeletal growth, while higher levels inhibit growth.

Estrogen.

Piaget adolescence

Formal operational

GI system maturation (Adolescent)

Full set of permanent teeth; liver, spleen, kidneys, and digestive tract enlarge.

Rapid physical growth in body size and proportions second only to?

Growth in infancy.

Neurologic system maturation (Adolescent)

Growth of myelin sheath enables faster neural processing; cognitive growth increases.

Male Adolescent growth

Growth spurt occurs later than girls' and usually begins between the ages of 101⁄2 and 16 years and ends sometime between the ages of 131⁄2 and 171⁄2 years. On average, those between the 50th and 95th percentile will gain 10 to 30 cm (4 to 12 in) in height and 7 to 30 kg (15 to 65 lb) in weight.

Female Adolescent growth

Height increases rapidly before menarche and usually ceases 2 to 21⁄2 years after menarche. On average, those between the 50th and 95th percentile will gain 5 to 20 cm (2 to 8 in) in height and 7 to 25 kg (15 to 55 lb).

Dropout rates are highest among _______ students.

Hispanic

________ is the third leading cause of death in children between 10 and 24 years old, with the majority of victims being male and killed by firearms

Homicide.

Erickson adolescence

Identity vs role confusion

Sexuality

Includes the thoughts, feelings, and behaviors related to the adolescent's sexual identity.

Respiratory system maturation (Adolescent)

Increase in diameter and length of the lungs; respiratory volume and vital capacity increase.

The nurse is talking with parents of a depressed 16-year-old child. Which question is of the most importance? Have your child's sleeping and eating habits changed? Does your child exercise? Is there a gun in your home? How is your child's personal hygiene?

Is there a gun in your home? The child 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. All the other questions assess for depression and do not protect against suicide.

Tooth avulsion

Knocked out teeth.

Musculoskeletal system maturation (Adolescent)

Linear growth is not complete until late adolescence in boys and occurs earlier in girls; growth plates (which promote linear growth) begin to close at puberty. Adult height is attained when growth plates have closed in late adolescence.

How many mg of iron is recommended per day for adolescents?

Males- 11mg Females- 15mg

Most commonly used drug?

Marijuana.

Foods high in protein

Meats, fish, poultry, beans, and dairy products.

What anticipatory guidance can the nurse provide the girl who has noted the development of breast buds? The growth spurt will begin immediately with menarche. Adult height will be reached at the time of menarche. Menarche should follow in about 2 years. Breast development will be complete with 12 months.

Menarche should follow in about 2 years. Menarche usually follows within 2 years of the first signs of breast development. Peak height velocity (PVH) in girls occurs 6 to 12 months following menarche. It does not follow immediately. Breast development progresses through several stages and will not be complete until late puberty. Adult height is not reached at the time of menarche but about 6 to 12 months following menarche.

The school nurse is preparing health promotion presentations regarding unintentional injuries for a high school health fair. On which topic should the nurse place as the priority when preparing the presentation? Motor vehicle safety Drug and alcohol use prevention Poison prevention Water sports injuries

Motor vehicle safety Motor vehicle safety has the highest priority because motor vehicle accidents are the leading cause of injury and death followed by poisoning, which includes prescription drug overdose.

Nurses should provide anticipatory guidance to males to prepare them for what particular pubertal change in late adolescence? Lengthening of the penis Breast enlargement Nocturnal emissions Reddening of the scrotum

Nocturnal emissions. This involuntary ejaculation during the night can be disturbing to the adolescent male who has little or no understanding of what is happening in his body. Lengthening of the penis begins to occur in early adolescence as does reddening of the scrotum. Breast enlargement occurs in some males in middle adolescence and resolves in late adolescence.

What exercise recommendation should nurses give to adolescents? Engage in aerobic exercise for 30 minutes 3 days per week. Participate in 60 minutes of moderate to vigorous physical activity each day. Engage in at least one competitive sport during the school year. Participate in physical activities that cause sweating and hard breathing weekly.

Participate in 60 minutes of moderate to vigorous physical activity each day. The U.S. Department of Health and Human Services recommends that adolescents participate in 60 minutes of moderate to vigorous physical activity each day. Aerobic exercise for 30 minutes three times weekly is not the recommended amount of exercise. The other recommendations lack adequate activity or specificity.

60 minutes per day is recommended for what?

Physical activity.

Kohlberg adolescence

Postconventional level 3

Male 10-13yrs (Physical Changes Related to Puberty)

Pubic hair begins and spreads laterally, scrotum and testes enlarge, scrotum begins to darken.

Parents comment that their child seemed more coordinated on the basketball floor at 12 years than now at 14. The nurse can include what information in the response? This may be a reaction to adult authority. Rapid and uneven growth of early adolescence (11 to 14 years) can interfere with coordination. It is more difficult to keep focused at 14 years than at 12. Hand--eye coordination is affected negatively by puberty.

Rapid and uneven growth of early adolescence (11 to 14 years) can interfere with coordination. Uneven growth of soft tissues and bones during growth spurts can cause decreased coordination for boys. The age of 14 years is usually the time of peak height velocity (PHV). Mental focus and reaction to adult authority are not causes of poor coordination. Gains in hand—eye coordination are made during puberty and become precise by late adolescence.

Cardiovascular system maturation (Adolescent)

Size and strength of heart increases; systolic blood pressure increases and heart rate decreases.

Integumentary system maturation (Adolescent)

Skin is thick and tough; sebaceous glands are more active; sweat glands function at adult level.

_______ remains the leading preventable cause of death in the United States

Smoking.

Female 10-13yrs (Physical Changes Related to Puberty)

Soft pubic hair begins on mons, breast buds appear, menses begin, increased pigmentation on genitalia.

Adolescence

Spans the years of transition from childhood to adulthood, which is usually between the ages of 11 and 20 years.

Risk-taking behaviors

Such as drinking, drug use, sexual activity, and participating in reckless behavior or dangerous activities. With this rapid growth during adolescence, the development of secondary sexual characteristics, and interest in the opposite sex, the adolescent needs the support and guidance of parents and nurses to facilitate healthy lifestyles.

The parent of a 14-year-old girl voices concerns that the child is likely to be not getting enough nutrients. How many calories should be ingested by the child daily? The adolescent should not consume more than 2,500 calories per day. The range for caloric intake for an adolescent girl is 1,700--2,000 per day. At least 1,800 calories per day is recommended for an adolescent girl. The adolescent girl who is active should consume about 2,000 calories per day.

The adolescent girl who is active should consume about 2,000 calories per day. Adolescent girls who are moderately active require about 2,000 calories per day.

The healthcare provider has made a notation in the medical record of a 17-year-old adolescent that the client is not demonstrating successful completion of the Erikson stage of development. What behavior would be consistent with this assessment? The adolescent is anxious to move away from the parent's home. The adolescent is sexually promiscuous. The adolescent is distrustful of others. The adolescent is uncertain and frequently unable to make decisions.

The adolescent is uncertain and frequently unable to make decisions. According to Erickson's stages of development the teen develops a sense of identity. Failure to successfully complete this stage will result in a lack of self-confidence and an inability to see oneself as an independent being. The establishment of the ability to trust is completed in an earlier stage of psychosocial development. A desire to move away from the parental home is not uncommon and is not a sign of impaired navigation of this level of psychosocial development.

The nurse is caring for an adolescent athlete who is being seen for a fractured arm. The adolescent's parent reports that this is the third sports injury in the past 2 years. The parent asks the nurse why the child who seems so healthy seems to continue to have injuries. What information should be included in the nurse's response? There may be some underlying problems that the child should be evaluated for. Some children are accident prone. These are accidents and random in occurrence. The bones, joints and tendons of teens are vulnerable to injury due to their rapid state of growth.

The bones, joints and tendons of teens are vulnerable to injury due to their rapid state of growth. Rapidly growing bones, muscles, joints, and tendons are more vulnerable to unusual strains and fractures. While some people may seem to be accident prone, this is most likely the result of the stage of physical growth experienced during adolescence. There is no evidence the child has any underlying medical conditions.

True/False Males are more likely than females to die of any type of injury.

True

True/False By late adolescence, language skills are comparable to those of adults?

True.

Is the following statement true or false? Suicide is the second leading cause of death in youths 10 to 24 years of age.

True. Suicide is the second leading cause of death in youth 10 to 24 years of age. Rationale: In a nationwide CDC study, 16% of adolescents surveyed reported that they had seriously considered suicide within the past 12 months, with 13% creating a plan and 8% attempting to take their own life (CDC, 2017b).

Is the following statement true or false? The nurse caring for an adolescent should educate the parents about the importance of monitoring their adolescent's interaction with peer groups.

True. The nurse caring for an adolescent should educate the parents about the importance of monitoring their adolescent's interaction with peer groups. Rationale: Adolescents who do not have parental or adult supervision and opportunities for conversation with adults may be more susceptible to peer influences and at higher risk for poor peer selections.

With summer approaching, the nurse discusses sun safety with a group of adolescents. Which suggestion is most likely to be followed? Do not attempt to get a tan. Limit sun exposure between 10:00 AM and 2:00 PM. Wear a hat when in the sun. Wear sunglasses.

Wear sunglasses. Sunglasses can be a fashion statement and are likely to be accepted. The other pieces of advice are less appealing to adolescents who link a tan body to beauty. Unfortunately sun exposure is cumulative over a lifetime, and much of it occurs in youth, making protecting young skin important.

The nurse is assessing the cognitive development of an adolescent. Which of the following statements accurately represents a normal finding at this stage? a. The adolescent progresses from an abstract to a concreteframework of thinking b. The adolescent develops the ability to think outside the present c. All adolescents achieve formal operational reasoning at the same time d. Adolescent thinking starts out very introspective and then becomes egocentric

b. The adolescent develops the ability to think outside the present. Rationale: According to Piaget, the adolescent progresses from a concrete framework of thinking to an abstract one. During this period, the adolescent develops the ability to think outside of the present; that is, he or she can incorporate into thinking concepts that do exist as well as concepts that might exist. Not all adolescents achieve formal operational reasoning at the same time. Adolescent thinking starts out egocentric and then becomes very introspective and idealistic.

Foods High in Iron

• Beef, chicken, seafood, liver • Tofu • Nuts and seeds • Lentils and legumes • Eggs • Dark leafy vegetables such as spinach • Iron fortified cereals, whole-grain breads, and pastas