Chapter 29: Growth and Development of the Adolescent

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

"Are the guns in your home locked in a safe?" Rationale: Common causes of death in adolescents are homicide and self-harm. These are related to the easy accessibility of guns, especially when added to depression, binge drinking, and impulsivity. Gang violence and the desire to protect themselves are additional factors. Having the gun locked in a safe provides a way for limited access. Knowing how to use a gun and going hunting demonstrate expertise, but the safest way to prevent harm is to have the gun locked when not in use for these purposes. Telling the adolescent it is important not to use a gun provides no explanation why and comes across as a rule to be broken.

A male nurse is meeting with a group of 12-year-old boys to discuss expected bodily changes. After one of the boy's says, "My older brother told me my bed might be wet and that means I had a wet dream. Is that true?" What is the best response from the nurse?

"Having wet dreams indicates that your body is going through a process of maturing." Rationale: In boys, the appearance of nocturnal emissions ("wet dreams") is often used as the indication that the preadolescent period has ended and that the adolescent is maturing into an adult. Nocturnal emissions usually occur at about the age of 11 in boys. Wet dreams are not associated with urination. Boys at this age start thinking of relationships with people they find sexually attractive, but this is not the best response.

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?

"I get 7 hours of sleep every night so I don't know why I am so tired." Rationale: 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 counseling an overweight, sedentary 15-year-old girl. The nurse is assisting her to make appropriate menu choices. Which statement indicates the adolescent understands how to make appropriate dietary selections?

"I need to eat plenty of fruit each day." Rationale: The sedentary teen needs to consume approximately 1,600 calories each day. A balanced diet includes plenty of fresh fruit and a small amount of fat. To avoid all fat could place the child's health at risk. Protein intake is important for the development of tissue. The teen will need about 5 ounces of protein daily.

An adolescent asks the nurse what the term "puberty" means. What is the nurse's best response?

"It is the age at which one first becomes capable of sexual reproduction." Rationale: Adolescence is a period of rapid growth with dramatic changes in body size and proportions. It is the time between puberty and the end of physical growth. During this time, sexual characteristics develop and reproductive maturity occurs. Puberty is the point at which an individual becomes capable of sexual reproduction. Puberty starts at different ages for males and females. Puberty is defined as sexual maturity only. It does not describe emotional maturity.

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?

"My son must be sexually active or having overly sexual thoughts to have a nocturnal emission." Rationale: 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.

The parent of a Black adolescent voices concern to the nurse because the daughter, "has gotten her period before all of her friends." How should the nurse respond?

"On average Black girls start their period earlier than other ethnicities." Rationale: Menarche, the first menstrual period, usually begins between the ages of 9 and 15 years (average 12.8 years), but on average Black adolescents reach menarche earlier than adolescents of other ethnicitic backgrounds. This response addresses the parent's concern. The other responses do not address the parent's concern or may lead the parent to think this is an abnormal occurrence.

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

"Our adolescent is working toward achieving a sense of personal identity." Rationale: According to Erikson's theory of psychosocial development, the major challenge of adolescence is the achievement of identity. Achieving independence from parental domination is another task of adolescence, but not the ultimate one. Helping other adolescents achieve higher goals is not a part of Erikson's theory of psychosocial development. Developing trust occurs in infancy.

A 15-year-old client's parent comments on the fact that the adolescent seems to always choose the opposite of what everyone else wants and that mood swings are a common occurrence. What statement shows the nurse that the client's parent understands these changes?

"This is common for this age group and it will get better with time." Rationale: During middle adolescence, the adolescent spends more time ignoring adult authority and becomes more reliant on peer relationships. Adolescents might choose a stance directly opposite that of their parents and use peer support to back their ideas. Mood swings are a common occurrence during the adolescent period. They tend to smooth out and the adolescent will become more introspective. By late adolescence emotions become more consistent. Making statements such as "my adolescent will never find anyone to live with" or "we will have to learn to live with [my adolescent's temperament]" does not demonstrate the parent has a good idea of what is happening during the adolescent period.

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

-development of a trusting relationship -compliance with existing laws -an environment where adolescents can be truthful Rationale: Adolescents may seek a health care appointment for an unrelated health concern as a reason to discuss a sexual health question with a health care professional. Reassurance should be given to the adolescent that all questions and concerns will be addressed and will be kept confidential. This is the basis for the nurse-client relationship. All questions and concerns do not involve treatment and, therefore, do not involve parental consent. Parents may voice concerns because they are responsible for the insurance and billing. The nurse should act as a client advocate and work with the parents to develop a mutual understanding of the situation.

The parent of an adolescent diagnosed with iron-deficient anemia asks the nurse for help with incorporating more iron into the adolescent's diet when packing lunches and snacks for school. Which foods would be good sources of iron that could be easily incorporated into the diet when taking lunches and snacks to school? Select all that apply.

-peanut butter -strawberries -eggs -nuts Rationale: Good sources of iron that may work well in a teen's diet include peanut butter, eggs, strawberries, and nuts. Oranges are a good source of vitamin C but not iron.

Which nursing action will best assist a 15-year-old client accomplish the developmental task according to Erikson?

Allow the client's friends to visit while the client is hospitalized Rationale: The developmental task of adolescence is to develop a sense of identity, or deciding who and what kind of person one is. Friends and peers are important to facilitating the adolescent in determining one's identity. Permitting the client to make decisions assists in developing autonomy, which is a toddler task. Praising facilitates initiative, which is a preschool task. Independently performing tasks assists in developing industry, which is a school-age task.

A client has confided in a nurse that her 13-year-old daughter has recently changed dramatically in her social interactions with others. What is a social behavior most likely to be exhibited by a girl at this age?

Banding together with other girls and dressing like them Rationale: In early adolescence, girls tend to band together with girls. They dress identically with other members of their group: jeans and sweatshirts, special jackets, or whatever the fashion may be. On the surface, this makes adolescents appear to be losing their identities rather than finding them.

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?

Black Rationale: Black girls on average reach menarche slightly earlier than White, Hispanic, and South Asian girls.

The nurse is talking with parents of a depressed 16-year-old boy. Which question is of the most importance?

Is there a gun in your home? Rationale: He may be at risk for suicide. Firearm-related suicides have been responsible for a large number of the suicide deaths in 15- to 19-year-olds nationwide. All the other questions assess for depression and do not protect against suicide.

A 16-year-old client has been hospitalized 100 miles from home for 1 week to repair a fractured patella suffered in a skateboarding accident. 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 should the nurse prioritize for this client?

Take her to the teen lounge so she can meet and interact with other teens. Rationale: Adolescents need access to their peers so they can keep up social contacts. Meeting other teens in the facility is one way to accomplish that. The client most likely also has an electronic device which will enable her to stay in contact with family and friends back home but meeting others can also help meet social needs. 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.

An 18-year-old adolescent reveals the presence of nipple ring and is looking to get a tattoo in the next few months. What is the most important thing that the nurse can teach the adolescent at this time?

Tattooing carries risks such as infection, disease, and nerve damage. Rationale: The nurse needs to emphasize that tattoos and body piercing can be painful, and carry risks of complications such as infection, blood-borne diseases, keloids and granulomas, allergic reactions, excessive bleeding, nerve damage, or damage to the piercing site. Complications are more likely if a person tattoos oneself or has the tattoo done by a friend. The nurse needs to encourage the adolescent to seek the expertise of a trained technician, doctor, or nurse to have the piercing, tattooing, or branding done. There are developed safety rules for those who do piercing and tattoos.

The nurse is preparing to participate in a community discussion on the needs of the adolescents in the local school. The nurse should point out which goal is the primary concern for these young individuals as the committee makes plans?

Teens are busy developing their own personal identity. Rationale: According to Erikson, the central task of adolescence is to develop unique personality and identity. The developmental task for the school-age child is to develop a sense of industry, and completing activities builds that feeling of confidence. Erikson's psychosocial developmental task for toddlers is to achieve autonomy (independence) and do things on their own. Learning to speak and to understand and respond to discipline are not developmental tasks, according to Erikson.

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 Rationale: All options should be included in the presentation, but 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 middle-to-late adolescence?

nocturnal emissions Rationale: Involuntary ejaculation during the night can be disturbing to the adolescent male who has little or no understanding of what is happening in the body. Lengthening of the penis begins to occur in early adolescence as does reddening of the scrotum and emergence of pubic hair.