NUR410 PrepU PEDS Chapter 19 Care of the Adolescent

Which question would be most important for a nurse to ask when taking a history from a client who is suspected of having amenorrhea?

"Are you sexually active?" Explanation: Amenorrhea strongly suggests pregnancy in an adolescent and is the priority in a client with this diagnosis. Strenuous exercise can be a causative factor, but it is not the priority. Diet and medical visit history do not affect this current diagnosis.

A 16-year-old diagnosed with trichomoniasis states, "This is not going to stop me from having sex." What information is essential for the nurse to provide?

"Condoms should be used until treatment of you and your partner is complete." Explanation: The use of condoms may prevent reinfection. The other answers dismiss the statement by the teen that abstaining from sex is not an option.

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.

"I only tan before going on spring break to get a base tan so I won't burn." "My favorite time of day to be outside is the middle of the day, around noon." "The more exposure and burns I get now will toughen my skin so I won't get skin cancer when I'm older." Explanation: 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 14-year-old boy has come to his primary care physician's office for a routine well-child visit with his parent. Which statement by the parent should the nurse prioritize for further investigation after noting the father has a history of alcohol use disorder?

"Our next door neighbor is older than my son, and he drinks when they hang out together." Explanation: Some diseases and conditions are seen across families, and this is important in prevention as well as detection for the child. The caregiver can usually provide information regarding family health history. The nurse should use this information to do preventive teaching with the child and family. Early adolescence is a time when experimental use of substances, especially alcohol and tobacco, might be seen. It would be important to assess the use of substances and follow up regarding the behaviors of the adolescent.

When obtaining information from a teen concerning the reason for seeking health care, which question would be most important?

"What health concerns are you having?" Explanation: When obtaining data from a client, using the appropriate questions is important. Questions should be open-ended to yield the most information. Making questions direct will further refine the information made available. It is important that when interviewing the teen the nurse not promote a condition. Assuming the teen is ill is not appropriate.

The nurse is assessing a 14-year-old male client when the client's parent jokes about the changes in the client's voice and the hair under his armpits. Which response by the nurse to the client's parent is most appropriate?

"Your child can become modest and self-conscious and teasing may cause embarrassment." Explanation: It is never appropriate to discuss what is happening with a client in a way that is demeaning and hurtful. A 14-year-old adolescent is experiencing many bodily changes and is very self conscious. The nurse can share experiences with the client and the family, but it should not be in a way that the adolescent is embarrassed. Parents can share their experiences with the child, but they have to be open to this discussion or it can lead to an awkward experience for the adolescent. Reminding the parent of how the child is feeling and the possible feelings that can come from their interactions will bring the parent's attention to a delicate situation and is most appropriate. Simply stating these are expected findings does not address the joking manner of the parent.

A 17-year-old female is meeting with the nurse for an annual well-visit and is asking the nurse questions about how to know when one is in love. The nurse should point out which factor to help decide if both individuals have reached a mutual agreement and are ready for an intimate relationship?

A sense of trust and identity Explanation: In order to be intimate or to share one's deepest feelings with another person, it 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 nurse is explaining cognitive development in children to a client, with the help of Piaget's theory of cognitive development. What would be the best explanation by the nurse about the formal operations level of cognitive development?

After age 12 children can think in the abstract, including complex problem solving. Explanation: The nurse should explain that there are four levels of cognitive development in Piaget's theory. The sensorimotor level is up to age 2 where children learn by touching, tasting, and feeling. They learn to control body movement. Preoperational level is children from ages 2 to 7 years who investigate and explore the environment and look at things from their own point of view. At the concrete operations level from ages 7 to 11 years, children internalize actions and can perform them in the mind. At the formal operations after the age 12 children can think in the abstract. Complex problem solving is included in this category.

A chronically ill adolescent is readmitted to the hospital with an infected wound requiring long-term dressing changes. What is the best way the nurse can encourage independence for this client?

Allow the adolescent to choose the time for the dressing change. Explanation: Achieving a sense of identity may be difficult for adolescents who have a chronic illness. Some of the nursing actions which encourage of identity in the chronically ill adolescent include: respecting food preferences; allowing the adolescent to choose the time for the dressing changes; teaching the name, actions and possible side effects of medication; and respecting modesty. The school can provide homework so the adolescent does not get further behind in school work, and the teen can go to the teen room each day. These provide a good emotional outlet, but they do not promote independence. Teaching the parents to do the dressing changes makes the adolescent dependent on the parents. If the dressings are at a location the adolescent can reach and dexterity is not limited, then the adolescent should be allowed self care.

A nurse is examining a 17-year-old adolescent in the emergency room who is being disruptive in the waiting area. On assessment, the nurse finds dilated pupils, and the teen is talking very fast. Which of the following drugs does the nurse suspect the teen may be abusing?

Amphetamines Explanation: Amphetamine drug abuse can result in euphoria, rapid talking, and dilated pupils. Opiates can cause a person to be drowsy with constricted pupils. Marijuana users are usually very relaxed. Barbiturates cause euphoria that is followed by depression.

The nurse in an emergency department is assessing a 17-year-old adolescent who is reporting a gap in memory for the previous night. The client reports feeling dizzy and disoriented after drinking only one drink. The client woke up in a friend's bed but has no recollection of getting there. What action should the nurse prioritize for this client?

Complete a rape kit to rule out possible sexual abuse while the client was blacked out. Explanation: In recent years the use of rohypnol, also known as the "date rape drug," has become a concern for the adolescent. Rohypnol is not sold legally in the United States but is brought in from countries where it is sold legally. The drug, especially in combination with alcohol, causes memory loss, blackouts, and an inability to resist sexual attacks. Often the drug is secretly slipped into a person's drink. The drug has no taste or odor, but within a few minutes after ingesting the drug, the person feels dizzy, disoriented, and nauseated, and then rapidly passes out. After several hours, the person awakens and has no memory of what happened while under the influence of the drug. Waking up in someone's bed should raise suspicions that the individual was raped. Completing a rape kit will provide the authorities with the evidence they will need to further pursue the case.

Which scenario does the nurse anticipate for the life of an adolescent with a chronic condition who has deteriorating function?

Decline in involvement with peer activities Explanation: Peers can be very supportive of the client with deteriorating function; however, at this stage of development, the adolescent is typically activity involved in sports and school activities. The adolescent with a chronic condition may not physically be able to be included in such activities, thus there is a decline in involvement. Special accommodations need to be made for the client but these typically do not make the client feel special. With a decrease in function, an independent adolescent may need assistance in medication administration. The adolescent with a chronic condition will focus on what he/she is able to do, which often includes focusing on schoolwork. Also, most conditions do not include a decrease in cognitive function.

The nurse is doing a presentation for a group of nursing students about the topic of menstrual disorders. After discussing the disorder secondary amenorrhea, the students make the following statements. Which statement made by the nursing students is the most accurate regarding the cause of secondary amenorrhea?

Emotional stress can be a cause of this disorder." Explanation: Secondary amenorrhea can be the result of discontinuing contraceptives, a sign of pregnancy, the result of physical or emotional stress, or a symptom of an underlying medical condition. A complete physical examination, including gynecologic screening, is necessary to help determine the cause. Primary amenorrhea occurs when a girl has had no previous menstruation. A spontaneous abortion does not cause secondary amenorrhea.

A high school football player comes to the clinic with malaise, fever, headache, and anorexia that have been present for the last few days. Upon physical examination, the nurse notes that the cervical lymph nodes are firm and tender. Tonsils are red and enlarged and appear to have a white covering. What should the nurse suspect the diagnosis to be for this patient?

Mononucleosis Explanation: Infectious mononucleosis occurs most commonly in adolescents and young adults. Beginning symptoms include chills, fever, headache, anorexia, and malaise. Children develop enlarged lymph nodes and a severe sore throat. The cervical lymph nodes feel tender and firm. The tonsils feel painful and are enlarged and erythematous. A thick, white membrane may cover the tonsils; often, petechiae appear on the palate. The spleen may enlarge, which places the child at risk for spontaneous rupture.

The nurse is providing a class for a group of girls. When discussing the changes surrounding puberty, what information should be included? Select all that apply.

Most girls begin menstruation between ages 12 and 13. Thelarche occurs as early as age 9 years. Balck girls experience menarche earlier than white girls. Explanation: Girls reach physical maturity before boys and menarche, the first menstrual period, usually begins between the ages of 9 and 15 years (average 12.8 years). Breast budding (thelarche) occurs at approximately age 9 to 11 years and is followed by the growth of pubic hair. Black girls on average reach menarche slightly earlier than white girls.

A nurse is conducting a presentation for a local high school about injury prevention. When describing the various risks, which of the following would the nurse include as the leading cause of death among adolescents?

Motor vehicle crashes Explanation: Although adolescents do experience head injury from sports, use steroids, and binge drink, the leading cause of death among adolescents continues to be motor vehicle collisions, and distracted driving appears to contribute to fatal crashes.

The nurse is assessing the level of pain in a 3-year-old who appears to be experiencing abdominal pain. The nurse lays out six photographs of children's faces representing "no hurt" to "biggest hurt you could ever have" and asks the child to point to the one that best shows what the child is feeling. The nurse will document the results stating which pain scale?

Oucher pain rating scale Explanation: The Oucher scale consists of six photographs of children's faces representing "no hurt" to "biggest hurt you could ever have." The Wong-Baker FACES pain rating scale consists of six cartoon-like faces ranging from smiling to tearful. The FLACC Pain Assessment Tool is a scale by which health care providers can rate a young child's pain when a child cannot give input, such as during circumcision. It incorporates five types of behaviors that can be used to rate pain: facial expression, leg movement, activity, cry, and consolability. The COMFORT behavior scale is a pain rating scale devised by nurses to rate pain in very young infants. On the first part of the scale, six different categories (alertness, calmness/agitation, crying, physical movement, muscle tone, and facial expression) are rated from 1 to 5.

The nurse is caring for a 16-year-old child with a diagnosis of acquired immunodeficiency syndrome (AIDS). What treatment goal has the highest priority for this child?

Preventing spread of infection Explanation: Major goals for the child include maintaining the highest level of wellness possible by preventing infection and the spread of the infection. Because the adolescent has the belief that nothing can hurt him or her, and because of the increasing rate of sexual activity in this age group often involving multiple partners, the highest priority is teaching and preventing the spread of the infection. Other goals include maintaining skin integrity, minimizing pain, improving nutrition, alleviating social isolation, and diminishing a feeling of hopelessness. The primary goal for the family is improving coping skills and helping the teen cope with the illness.

The nurse reviews the 2020 National Health Goals for sexual health prior to preparing a presentation for high school students. On what should the nurse focus when preparing this teaching for the students?

Prevention of sexually transmitted infections Explanation: The 2020 National Health Goals for sexual health focus on the prevention and early treatment of sexually transmitted infections. This is the topic in which the nurse should focus during the presentation with adolescent students. The 2020 National Health Goals for sexual health do not address communication with primary care physicians, immunizations, or creating a work-life balance.

The nurse is providing education to an adolescent prescribed oral tetracycline. What statement should the nurse include in this teaching?

Take the medication on an empty stomach. Explanation: In pustular and cystic acne, oral antibiotics can be helpful because they are effective against P acnes. Tetracycline is effective against the anerobic bacteria that break down sebum to form irritating acids. It should be started at 500 mg twice daily dose the first week and then tapered to 250 mg daily for maintenance. Food impairs the absorption of tetracycline, so it should be taken on an empty stomach. Improvement is generally not seen for 2 to 4 weeks. Sun exposure does not affect the drug.

The nurse is caring for a 13-year-old girl. As part of a routine health assessment the nurse needs to address areas relating to sexuality and substance use. Which statement or question should the nurse say first to encourage communication?

Tell me about some of your current activities at school. Explanation: The nurse should first begin with open-ended questions regarding work, hobbies, activities, and friendship in order to make the teen feel comfortable. Once a trusting rapport has been established, the nurse should move on to the more emotionally charged questions. While it is important to assure confidentiality, the nurse should first establish rapport.

The nurse instructs an adolescent on the hazards of body piercings and tattoos. Which outcome indicates that teaching has been effective?

The patient refuses to get eyebrow pierced with girlfriends. Explanation: Evidence that teaching about body piercings and tattoos has been effective is the patient refuses to get eyebrow pierced with girlfriends. Getting any type of tattoo or body piercing on a body location indicates that teaching has not been effective.

The physician has made a notation in the medical record of a 17-year-old that the teen is not demonstrating successful completion of Erikson's stages of development. What behavior would be consistent with this assessment?

The teen is uncertain and frequently unable to make decisions. Explanation: According to Erikson'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 one's self as in 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.

A nurse is assessing a teenager with a chronic condition in preparation for transition to adult services. Which of the following would the nurse identify as a factor to promote successful transitioning?

The teen talks about functioning as an adult. Explanation: The following factors have been identified as some of the components for successful transitioning: "1) the family, young adult, and provider have a future orientation; 2) transition is started early; 3) family members and health care providers foster personal and medical independence; 4) planning occurs for the future; 5) the young adult verbalizes the desire to function in the adult medical world; and 6) reimbursement for services is not interrupted" (Reiss & Gibson, 2002, p. 1312).

A 15-year-old client tells the nurse he has been having wet dreams and is ashamed and afraid he will get into trouble because he believes his parents think he is too young to understand or know about sex. To which statement would be the most appropriate for the nurse to respond?

Wet dreams are not the result of anything you are doing but are simply the body's way of ridding itself of excess semen." Explanation: Boys who are unprepared for nocturnal emissions may feel guilty, believing that they have caused these "wet dreams" by sexual fantasies or masturbation. They need to understand that this is a normal occurrence and is simply the body's method of getting rid of surplus semen. The other suggestions do not address the situation in a professional manner.

An adolescent comes to the emergency center with symptoms of acute shortness of breath, chest pain worsening with deep breaths, diaphoresis and anxiety. While providing the history the client states he took methylphenidate this morning, plays on the football team and is a type 1 diabetic. Prioritize the assessment data the nurse will collect. Use all options.

When did the symptoms start? What was his or her behavior prior to dyspnea? Is there a history of chronic disease? What medications does the adolescent take? Explanation: The nurse would first want to know when the symptoms started and what adolescent's behavior was prior to developing symptoms. Knowing the adolescent's medical history would be contributory to the data needed. A urine and blood screen would be done to determine substances in the body. One drug, methylphenidate, can cause pulmonary emboli. Methylphenidate is a stimulant. It produces a feeling of giddiness and extreme well-being. Knowing the behavior prior to the symptoms could lead to the diagnosis of methylphenidate ingestion. When methylphenidate is crushed and injected intravenously it does not dissolve completely. Small particles remaining in the bloodstream can result in complications such as pulmonary embolus or emphysema.

Teachers are in a class on drug use taught by the school nurse. The nurse instructs the teachers to observe for which physical symptoms from misuse of cough medications with codeine? Select all that apply.

lack of coordination excessive itching confusion Explanation: Adolescents who misuse cough medications with codeine can have a drunken appearance, a lack of coordination, confusion, and excessive itching. They may also be found with empty bottles of cough medications. Enlarged pupils would be seen with marijuana use. Excessive giggling and silliness can be seen with stimulant ingestion.

The nurse is caring for a 17-year-old child who was sprained her ankle. The physician has prescribed ibuprofen to manage the pain. What statement by the teen indicates the need for further instruction?

"This medication should be taken on an empty stomach." Explanation: Ibuprofen belongs to a group of medications referred to as non steroidal anti-inflammatory drugs. Side effects of this medication may include nausea, vomiting, bleeding gums and bruising. Taking this medication with foods may help to lessen gastrointestinal upset.

The nurse is teaching the parents of a 12-year-old boy about common approaches when raising an adolescent. Which instruction is most important?

"Try to be open to his views." Explanation: It is most important to be open to the child's views. This will encourage the child to consider parental concerns and promote communication. Being judgmental about his friends will make the child defensive about his choice of friends. Rules need to be flexible so they can apply to new situations. Avoid condescension. The child will appreciate being treated like a young man.

Which order would the nurse expect to see when caring for an adolescent diagnosed with pelvic inflammatory disease (PID)?

Culture of vaginal discharge Explanation: A culture will allow identification of the infective agent. Although restricting movement may ease pain, complete bedrest is not needed. Feminine hygiene sprays may contribute to the infectious process, and a pregnancy test does not treat PID.

An adolescent is diagnosed as having gonorrhea. The nurse can anticipate that her management will include:

identification of sexual contacts. Explanation: Gonorrhea is a reportable contagious disease. Individuals diagnosed with the disease will be asked to identify their sexual contacts so they can receive therapy also.

A nurse is conducting a class for high school-aged girls about reproductive health. During the class, one of the girls asks, "When should a girl have a pelvic examination?" Which response by the nurse would be most appropriate?

"If you are not sexually active and have no problems, typically it occurs around the age of 18." Explanation: For the adolescent girl, the pelvic examination becomes part of routine health care at approximately age 18 to 20 years if she is not sexually active and is not having problems. This may be earlier if the girl is sexually active.

A nurse is employing the use of guided imagery for a child experiencing pain. Which of the following demonstrates the correct use of this technique?

After achieving a relaxed state, the nurse begins a guided imagery of walking down a sandy beach and collecting seashells, a favorite activity of the 13-year-old female patient Explanation: Imagery begins with achieving a relaxed state. Guide the child to choose a favorite place. When using guided imagery, do not lead the child; let the child become immersed in their personal image and take command of the experience. Guided imagery is not appropriate for preschoolers and toddlers.

Jenny is a 15-year-old who is being seen today in the clinic accompanied by her mother. The mother states, "She ignores what we tell her and looks to her friends for answers and support. What should we do?" After talking with Jenny's mother, which statement by her mother indicates understanding of the basis for Jenny's behavior?

"Adolescents her age all do this and it will get better with time." Explanation: During the middle adolescence the teenager spends more time ignoring adult authority and becomes more reliant on peer relationships. The adolescent 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 and they tend to smooth out and the teen will become more introspective. By late adolescence emotions become more consistent.

A nurse is educating a 15-year-old obese teen who is not very active about nutrition. The nurse educates the teen about menu choices so that the teen can make his/her own choices. The nurse knows the teaching is effective by which of the teen's responses?

"I need to choose 2 servings of fruit each day of the week." Explanation: Because the teen is not active, the calorie intake should be approximately 1,600 calories a day. Dietary recommendations for fruit intake are 2 servings per day. All balanced diets should contain a small amount of fat. Protein is important for tissue development and should be approximately 5 ounces per day.

What is an appropriate method of assessing for menorrhagia?

Ask how long it takes to saturate a tampon or a sanitary napkin Explanation: Menorrhagia refers to abnormally heavy menstrual periods. The other methods would not glean the information needed.

The nurse is working with a 15-year-old hospitalized with a chronic illness. Which action by the nurse might help the chronically ill teen thrive while hospitalized?

Encourage the teen to talk to friends on the phone and connect with friends on the computer by email. Explanation: The chronically ill child of any age should be encouraged to participate in age-appropriate activities. Contact with peers and friends are an important aspect of normal adolescent growth and development.

The student nurse is preparing a short oral report for post clinical discussion on adolescent stages of growth and development. Based on the information that adolescence can be divided into stages, what would be the best explanation of the main characteristics of middle adolescence stage?

Fluctuations in self assurance Explanation: Desire for goal attainment occurs during the later school aged period when the child works on a project through completion. A middle adolescence main characteristic is fluctuations in self assurance and the main characteristics of late adolescence is grappling with every day issues and career choices.

The nurse is caring for an adolescent diagnosed with syphilis. The drug of choice for treating syphilis is:

Penicillin Explanation: Syphilis responds to one intramuscular injection of penicillin G benzathine; if the child is sensitive to penicillin, oral doxycycline, tetracycline, or erythromycin can be administered as alternative treatment.

Which educational topic is often overlooked when teaching an adolescent about living with a chronic condition?

Sexuality Explanation: All aspects of an adolescent's development must be addressed when instructing on living with a chronic condition. Health care providers are comfortable with topics of smoking, drinking alcohol, and drugs but uncomfortable with talking about sex.

The nurse is reviewing the causative organisms noted on laboratory reports. Which organism is transmitted solely by sexual contact?

Trichomonas Explanation: The organism transmitted solely by sexual contact is Trichomonas. The other organisms are causes of various infections and acquired in various ways.

A teenager comes to the clinic with fever, muscle pain, and a macular rash on the palms and soles of the feet. Based on these findings, what diagnosis would the nurse anticipate for this client?

toxic shock syndrome Explanation: Fever, severe muscle pain, and a sunburn-like rash on the palms and soles of the hands and feet are consistent with the diagnosis of toxic shock syndrome. Polycystic ovary syndrome, ammenorrhea, and premenstrual dysmorphic disroder are not consistent with these symptoms.

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 have 4 servings of fruit each day." Explanation: The sedentary teen needs to consume approximately 1,600 calories each day. The recommended number of daily servings of fruit is four. A balanced diet includes 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.

During a health maintenance visit, a 15-year-old girl mentions that she is not happy with being overweight. Which approach is best for the nurse to take?

"What specifically have you been noticing?" Explanation: It is best to find out what caused the teenager to make the comment so that you can work with her about the issue. This is an assessment and must be done first. Launching into a lecture on diet and exercise will be of no value if the teenager wants to talk about dealing with snide comments from her peers. Telling the teenager she is statistically in the normal range for weight and height may close the conversation prematurely. The focus is on the teenager, not her parents. Obtaining that information would be important, but not at this time.

A nurse is attending to a group of boys at a school. The nurse is required to document the sexual development in boys on a regular basis. The nurse would anticipate which clients having the highest incidence of nocturnal emissions?

Clients who are showing pubertal changes Explanation: The nurse should know that boys who are undergoing pubertal changes are more likely to experience nocturnal emissions. The first sign of pubertal changes and sex maturation is testosterone secretion. As this increased so does the penis and scrotum enlargement. This is a time when noctournal emissions occur. In late adolescence, which lasts from age 18 to 20, the transition into adulthood is completed. The nurse should also know that boys in the age group of age 12 to 20 experience various chemical and physical changes taking place within their body. A strong, muscular appearance does not indicate the presence of nocturnal emissions.

A 15-year-old girl has been experiencing dysmenorrhea for the past year. Over the past 6 months, she has been taking ibuprofen and oral contraceptives, with no improvement. What underlying condition should be assessed for in this client at this point?

Endometriosis Explanation: If dysmenorrhea does not improve within 6 months with the use of NSAIDs and COCs, a laparoscopy is indicated to look for endometriosis, the most common reason for secondary dysmenorrhea. The other conditions listed are not associated with dysmenorrhea.

The nurse is providing discharge teaching to an adolescent who has been treated for pelvic inflammatory disease (PID). What would the nurse include as a preventive measure?

Insisting that sexual partners use condoms Explanation: PID is a sexually transmitted infection; use of condoms prevents PID. Using a vaginal douche routinely leads to bacterial overgrowth and increases the risk for PID. Sexual partners should also receive treatment with antibiotics. Oral contraceptives prevent pregnancy, not PID.

The nurse is caring for a family with a chronically ill adolescent. The parents are frustrated that the adolescent will not complete the treatment plan during the school day. Which approach by the nurse will be most appropriate?

Explaining to the parents that the adolescent may be struggling to fit in with his peers Explanation: The adolescent with a chronic illness may try to minimize their differences from their peers by being "normal" and avoiding their medical treatments. Encouraging the parents to understand the reason will therefore help them in planning an approach appropriate for their child. Treating the adolescent like a child by instructing them to do the treatment, and telling them to obey their parent will further isolate the adolescent and complicate their treatment plan. Encouraging the parents to let go is contraindicated because the child needs the treatments.

The nurse is promoting learning and school attendance to a 13-year-old girl. Which factor will affect the child's attitude most?

Peer group behaviors and attitudes Explanation: In this age group, children have a strong desire to conform to their peer group and to be accepted. It is important to know the peer group's attitude about school and learning. Early adolescence marks the beginning of separation from the family, including its values and desires. Physiologic changes and sexual attraction would not have significant or lasting influence in this matter.

The nurse knows that barriers to the adolescent's health and successful achievement of the tasks of adolescence exist. What is the major barrier to health for this population?

Socioeconomic Explanation: The major barrier to the adolescent's health and successful achievement of the tasks of adolescence is socioeconomic status. Adolescents at a lower socioeconomic level are at higher risk for developing health care problems and risk-taking behaviors; this may be due to their inability to access health care and to obtain needed services. In caring for adolescents, the nurse should also recognize the influence of their culture, ethnicity, and race upon them.