OB/Peds Chapter 33 Adolescent
During a visit to the school nurse, an adolescent confides in recently having homosexual feelings. How should the nurse best respond to the adolescent?
"Would you like to talk about these feelings?" Explanation: The task of forming an identity is for adolescents to decide who they are and what kind of person they will be. One of the challenges of identity is to accept their changed body image. During adolescence, individuals begin to explore their sexual preferences and may question their gender identity. Encourage an open dialogue with adolescents to assist them to process their feelings and establish their own identity. The nurse should not be judgmental. Because the adolescent has had feelings does not mean the the adolescent is homosexual, nor does it imply there is something wrong that needs to be "fixed."
Parents ask the nurse how they will know when their daughter has reached puberty. Which is the best response by the nurse?
"By age 14, many girls have the physical appearance of a young woman." Explanation: Puberty is the period of human development during which physical growth and sexual maturation occurs. By age 14, many girls have the physical appearance of young women. Few grow in height after age 14. A rapid growth spurt marks adolescence, not puberty, by the end of which individuals achieve adult height. Hormonal changes control growth and many other physical aspects. Increased glandular activity causes an increase in sweat and contributes to the development of body odors. Mood swings occurs during adolescence, not puberty, as teenagers are pulling away from childhood in a quest for self reliance.
While conducting a health assessment of a 13-year-old girl, the mother tells the nurse that her daughter has difficulty falling asleep at night. Which type of questioning should the nurse initially pursue?
"What are the occasions when this occurs? Is there a pattern?" Explanation: The most common sleep disturbances can be traced to several origins. The first response would be to open a dialog that would help identify a pattern as to when the girl has difficulty falling asleep. The nurse should ask open-ended questions and avoid questions that require a yes or no response. The information that most sleep disturbances resolve on their own and have a limited duration is true, but does not address the mother's concerns.
The school nurse is assessing a 15-year-old female client. The client states, "I just want to be pretty and to look like everyone else." Which response by the nurse is appropriate?
"You seem concerned. Let's talk about your feelings." Explanation: Body image is closely related to self-esteem. Seeing one's body as attractive and functional contributes to a positive sense of self-esteem. During adolescence, the desire not to be different can extend to feelings about one's body and can cause adolescents to feel that their bodies are inadequate even though they are actually healthy and attractive. The nurse would acknowledge the client's concern and discuss the client's feelings. Stating the client is beautiful as is does not address the client's concern. Closed statements which require no response do not offer any insight for the nurse. The nurse would also avoid yes/no questions.
A school nurse is assisting in Sports Physical Day with a 15-year-old teen who has a pierced naval. Which of the following statements by the nurse would be the best for health promotion?
"You will need to clean the navel several times a day." Explanation: The best health promotion would be to educate the teen on prevention of infection and complications. Educating the teen on proper cleaning and its importance promotes health. Warning the teen about possible disease and skin or blood infections should be done before the procedure takes place.
The nurse will monitor which adolescent client most closely for the risk of suicide?
A homosexual client requesting the nurse have the client's necklace and whose parents divorced last month Explanation: Homosexuality, giving away valued possessions, and a disorganized family are all risk factors for suicide in adolescents. Other risk factors include: current substance abuse, having no close friends/being a loner, poor school performance, and mental health illness or changes. Refusing to take medication or have visitors are not risk factors.
An adolescent with a new piercing comes to the health center at the school. The client reports feeling hot. Which action will the nurse complete first?
Assess the client for signs of infection Explanation: The nurse will first assess the client for signs of infection. The client reports feeling hot, which could indicate a fever. The nurse would assess the client's temperature and for other signs and symptoms of infection, such as redness, swelling, warmness, drainage, discomfort. The nurse would ask when the client started feeling hot and about the technique used for the piercing to gain additional history and insight. However, these questions are not priority over assessing the client. Determining if the client has additional piercing is not necessary, as this will not provide information about the client's current situation.
A 15-year-old adolescent shows a pattern of gaining weight, not a large amount but a little more each visit. The adolescent is not active in any sports and eats out frequently with parents. What is the best way for the nurse to assess the adolescent's eating pattern?
Have the adolescent keep a food diary for 1 week. Explanation: Having the adolescent keep a food diary over 1 week allows the nurse as well as the client to examine what the client eats and when the client is eating it. Keeping a food journal allows a discussion of the choices made and the substitutes that the client could possibly make. The times that the client eats may also lead to weight gain. Asking for recall of 3 days' intake would be difficult, and most information would be inaccurate due to forgetting some item of food intake or when the food was eaten. Most people have no idea how many calories are in a food item unless they are specifically counting calories for dieting or health reasons. An adolescent would have a difficult time demonstrating a healthy portion size unless it has been demonstrated first.
The school nurse is teaching a health class on nutrition with some adolescents. Which comment by a student should the nurse prioritize and provide more teaching?
"I am feeling so fat. I think I need to exercise a few extra hours today." Explanation: Even after the body has become emaciated, the adolescent may believe that he or she is still fat and, therefore, unattractive. This condition is called anorexia nervosa and is a serious health concern related to adolescents and their nutritional status. Even if the adolescent doesn't eat with the family, he or she can still consume needed nutrients. Although carbohydrate-loading is a concern, this statement does not indicate the adolescent girl was following this eating pattern. Skim milk has adequate nutrients.
The nurse is promoting nutrition to a 13-year-old child who is overweight. Which instruction should the nurse include?
"Keep a food diary." Explanation: Having the child keep a detailed food diary for 1 week will determine current patterns of eating. This can then be used to show the child how to make small changes with results, especially if eating is done before periods of inactivity such as before going to bed or when bored. Speaking and thinking in terms of diet or eliminating sugar are negative and can lead to poor body image. The child could too easily choose the wrong sport or do poorly. It is best to offer solutions with more variety.
An adolescent's parent states not knowing what to do with the adolescent. The parent reports the teenager is taking two or three showers a day when not that long ago the parent could barely get the teen to take a shower at all. What should the nurse's reply be to the parent?
"Reinforce the family rules but also allow the adolescent to develop one's own routine." Explanation: Adolescents find that frequent baths and deodorants are important due to the apocrine sweat gland secretion activity. The increases in sex hormones and steroids cause the skin to be oily. This leads to more showers or baths daily. This is a time when the adolescent is defining what type of personal hygiene products are preferred. Hygiene and personal care can become a source of family arguments as the young person develops a style of personal care. Parents need to be mindful of the adolescent yet maintain family rules and boundaries regarding aspects of personal care. It is important for teenagers to feel that they have some ability to develop their own personal care standards and daily patterns.
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, thus allowing the nurse to 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.
An adolescent who is depressed states, "Nothing ever seems to be right in my life." Which would be the most appropriate response by the nurse?
"You are feeling sad right now. It's a hard time." Explanation: Some degree of depression is present in most adolescents because they are not only losing their parents while they grow apart from them but also their carefree childhood. When using therapeutic communication, it is important for the nurse to accept the client's verbalization as real. Support should be real. Telling the adolescent that things will be better in college provides false reassurance. Telling the adolescent to "look on the bright side of things" or that "being a teen is hard work" offer platitudes and interrupt the client's interactions.
The school nurse is meeting with a group of 11-year-old girls to discuss expected puberty changes in their bodies. When one of the girls states, "I just feel like my whole body is changing and I don't know why" what should the nurse point out to this group?
"You have lots of hormone changes going on right now." Explanation: Preadolescents need information about their changing bodies and feelings. Sex education that includes information about the hormonal changes that are occurring or will occur is necessary to help them through this developmental stage. Although adjustments will occur as the child gets older and friends are important, these responses are not the most direct and appropriate.
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 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 is preparing a presentation for a local health fair depicting the differences in maturity between preadolescents. Which differing factor should the nurse prioritize in the presentation?
Boys grow at a slower, steadier rate than do girls. Explanation: Preadolescent boys grow generally at a slower, steadier rate than do girls. Girls grow more rapidly during preadolescence and then their growth rate slows dramatically after menarche.
The school nurse is planning to teach a segment on smoking during the freshman health classes. The nurse is aware that this needs to be a forum rather than a lecture. Which of the following techniques will also help deliver a "don't smoke" message?
Listening to all comments nonjudgmentally Explanation: It is very important to listen to the students' comments without judgment to avoid creating a resistance to information. Spouting too many facts too often and taking on an authoritative tone will show the audience that their opinions don't matter. Using personal experiences and admitting mistakes you have made can be helpful to communication.
The caregiver of a 17-year-old girl is concerned she is not getting enough nutrition since starting a lactovegetarian diet and asking for menu ideas. Which food items should the nurse point out the child is choosing not to eat based on this diet?
Meat, poultry, fish, and eggs Explanation: The lactovegetarian diet includes dairy products and excludes meat, fish, poultry, and eggs. The semivegetarian diet includes dairy products, eggs, and fish and excludes red meat and possibly poultry. The lacto-ovo-vegetarian diet includes eggs and dairy products but excludes meat, poultry, and fish. The vegan diet excludes all food of animal origin, including dairy products, eggs, fish, meat, and poultry.
The school nurse is teaching parents risk factors for suicide in adolescents. What would the nurse discuss? Select all that apply.
Mental health changes History of previous suicide attempt Family disorganization Substance use disorder Explanation: Suicide is the third leading cause of death in adolescents 15 to 19 years of age. Risk factors for suicide include mental health changes, history of previous suicide attempt, family disorganization, and substance use disorder. Other risk factors include poor school performance, crowded conditions/housing, low socioeconomic status, limited parental supervision, single-parent families/both parents in workforce, access to guns or cars, drug or alcohol use disorder, low self-esteem, racism, peer or gang pressure, and aggression.
A 15-year-old girl is in the hospital for surgery and is confined to bed. The nurse can tell that the client is nervous about being in the hospital. She tells the nurse that she feels "gross" and "on display" in her hospital gown. What should the nurse do to encourage a sense of autonomy and dignity related to the girl's body image?
Offer to assist the girl in washing her hair and let her pick the shampoo. Explanation: Remember when caring for hospitalized adolescents, providing time for self-care, such as shampooing hair, is important to include in an adolescent's nursing care plan. Offering to assist the client in washing her hair and letting her pick the shampoo both encourages a sense of autonomy to the client and offers her dignity related to her body image. Brushing the girl's hair for her and assisting her with using the bed pan for urination do not encourage a sense of autonomy. If it is the hospital's policy to require clients to be dressed in a hospital gown while admitted, the nurse should not allow the girl to wear her own clothes.
The nurse teaches parents of adolescents that teenagers need the support of parents and nurses to facilitate healthy lifestyles. What should be a priority focus of this guidance?
Reducing risk-taking behavior Explanation: The adolescent experiences drastic changes in the physical, cognitive, psychosocial, and psychosexual areas. 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 and to reduce risk-taking behaviors. Promoting physical growth, maximizing learning potential, and teaching hygiene are secondary to reducing risky behavior.
The nurse is helping the parents and their underweight adolescent collaborate on planning a healthy menu. The nurse should be aware of which nutritional requirement of adolescents?
Teenagers have a need for increased calories, zinc, calcium, and iron for growth. Explanation: Teenagers have a need for increased calories, zinc, calcium, and iron for growth. However, the number of calories needed for adolescence depends on the teen's age and activity level as well as growth patterns. Teenage girls who are active require about 2,200 calories per day. Teenage boys who are active require between 2,500 and 3,000 calories per day. Adolescents require about 1,200 to 1,500 mg of calcium each day.
The school nurse is preparing for a career fair at the local high school. Which factor should the nurse point out when presenting various medical career options to the students?
The individual's sex no longer decides which career options are available. Explanation: Sex role stereotypes have been shattered in most careers and professions. More women are becoming lawyers, physicians, plumbers, and carpenters; more men are entering nursing or choosing to become stay-at-home fathers while their wives earn the primary family income. The adolescent should consider what the parents are saying, but the final choice is theirs. With the use of internet, travel to other areas, and a variety of school options, there are ways for the students to go to a school in a different area. There are also numerous resources which will help the student seek higher education. It just may mean they have to work a little harder to achieve their goal. There are many career choices for the adolescent to choose from.
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. Explanation: 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 mother of an adolescent has called to talk to the pediatric nurse over concern that her daughter is not getting proper nutrition now that she has started following a vegetarian diet. Which response should the nurse prioritize for this mother?
Vegetarian diets can be healthy; ensure she includes whole-grain products, legumes, nuts, seeds, and soy dairy substitutes. Explanation: If planned with care, vegetarian diets can provide all needed nutrients. All vegetarians should include whole-grain products, legumes, nuts, seeds, and fortified soy substitutes. If the individual is following the lactovegetarian approach then low-fat dairy products are also appropriate. The lacto-ovo-vegetarian diet includes eggs and dairy products but excludes meat, poultry, and fish. The vegetarian diet does not need to be supplemented with protein drinks and megavitamins if the food choices are carefully chosen to provide adequate nutrition.
True adolescence is said to begin when what occurs?
Sperm is produced in the male. Explanation: True adolescence begins with the onset of menstruation in the female and the production of sperm in the male. In early adolescence (10 to 13 years) the female experiences the first menstrual cycle and the male experiences growth of the testes. In middle adolescence (14 to 16 years) the female aerola and papilla separate from the contour of the breast to form a mound and the male testes and scrotum grow and the voice changes. In late adolescence (17 to 20 years) breast enlargement stops in the female and the male achieves adult size penis and scrotum. The growth spurt in the female adolescent ends about 2 to 2.5 years after menarche. For boys it occurs around age 14 years.
The father of a 15-year-old daughter is concerned she is not getting adequate nutrition to play high school basketball. Her games are on Friday nights. Which suggestion should the nurse point out will best suit the needs of this adolescent?
Three daily meals that include choices from each of the food groups; Friday's lunch eaten around 2 p.m. with a small amount of fat and a somewhat larger than usual portion of complex carbohydrates. Explanation: A meal that is low in fat and high in complex carbohydrates, eaten 3 to 4 hours before an event, is appropriate for the teen athlete. Carbohydrate-loading, which some practice during the week before an athletic event, increases the muscle glycogen level to 2 to 3 times normal and may hinder heart function. The other suggested menus would not provide the additional muscle glycogen needed for optimal functioning.
While assessing a 17-year-old client, the nurse notes the following: blood pressure 152/96 mm Hg, pulse 124 beats/minute, respirations 20 breaths/minute, temperature 98.8°F (37.1°C), dilated pupils, euphoric state, and pressured speech. Which prescription will the nurse anticipate first from the primary health care provider?
Urine drug screen Explanation: The nurse would anticipate the primary health care provider would first prescribe a urine drug screen as the client is exhibiting findings of drug use. Drugs such as cocaine and crack can cause hypertension, tachycardia, dilated pupils, euphoria, pressured speech, weight loss, insomnia, agitation, and increased motor activity. Further prescriptions will be based on the results of the drug screen. At this time, a MRI, low-sodium diet, or thiazide diuretic (hydrochlorothiazide) are not indicated.
To help prevent obesity, which intervention would the nurse include in an adolescent's plan of care?
Correct response: Describe a normal serving size. Explanation: Some adolescents may be unaware that their food intake is excessive because they have been told they need excess nutrients for healthy adolescent growth and everyone in their family eats large portions. Health teaching with these adolescents may need to begin with a discussion of "normal" weight and standard food portions. If adolescents eat a diet too low in protein for any length of time, they can develop a negative nitrogen balance, which can lead to seriously impaired growth. Therefore, a diet of fewer than 1,400 to 1,600 calories a day can rarely be tolerated by adolescents. They generally will do better and will stick closer to 1,800 calories per day. A diet of 2,000 calories a day will provide excess amounts of food and may lead to obesity.
A male nurse is meeting with a group of high school boys to discuss various health topics. After the session on testicular self-exam, the nurse determines the session is successful when one of the students responds with which comment?
"I am almost 15 now, so that means I could possibly get this disease." Explanation: Testicular cancer is one of the most common cancers in young men between the ages of 15 and 34. Teaching the boys how and when to perform testicular self-examination is an important health maintenance activity. It is easier to treat testicular cancer if it is caught early and the best way to catch it is routine self-exams. A family history of testicular cancer increases the chances of the younger family members developing the cancer. The self-exam should be continued on a routine basis at least until the individual is 35 years old.
A female client tells the nurse about noticing an increase in weight and fat deposits during the past year. The nurse reviews the client's chart and recognizes that the client is most likely going through puberty. Which nursing action is most appropriate at this time?
Provide reassurance that these are normal changes. Explanation: Increased fat deposits and weight and height changes are normal as girls begin hormonal changes of puberty. During adolescence, girls are very sensitive about their appearance and experience a constant need for reassurance. Puberty is a period when children are very self-conscious about their overall appearance. Reassurance needs to be provided that increased fat deposits and weight and height changes are normal. Dietary management is indicated if a true weight problem is present, but healthy eating should be encouraged rather than dieting. Adolescents should be encouraged to participate in appropriate exercise programs. Dieting issues such as anorexia and bulimia can threaten the health of adolescents.
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.
The nurse assesses the spirituality of an adolescent. What traits are uncharacteristic during this time frame? Select all that apply.
Adolescents will base their actions on the avoidance of punishment and the attainment of pleasure. Adolescents can understand the concepts of right and wrong and are developing a conscience. Adolescents are able to understand and incorporate into their behavior the concept of the "golden rule." Explanation: The nurse must understand normal traits to detect uncharacteristic traits in the adolescent period. It is during the adolescent years that teenagers develop their own set of values and morals at different rates. At the beginning of this stage, teenagers begin to question the status quo. The majority of their choices are based on emotions while they are questioning societal standards. Adolescents also begin to question their formal religious practices. As they progress through adolescence, teenagers become more interested in the spiritualism of their religion than in the actual practices of their religion. The toddler will base his or her actions on the avoidance of punishment and the attainment of pleasure. The preschool child can understand the concepts of right and wrong and is developing a conscience. The school-age child is able to understand and incorporate into his behavior the concept of the "golden rule."
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 15-year-old is hospitalized for acute appendicitis. Which activities would the nurse include in the client's plan of care? Select all that apply.
Allow friends to visit during visiting hours. Include the parents when educating the client. Arrange care to provide for extra rest and sleep. Explanation: Because protein synthesis occurs most readily during sleep, and adolescents are building so many new cells, this age group may need proportionately more sleep than any other age group. When adolescents are admitted to the hospital they may sleep as if exhausted. Adolescents are capable of total self-care and because of their body awareness, may even be overly conscientious about personal hygiene and appearance. When caring for hospitalized provide time for self-care, such as shampooing the hair. Confidentiality is of utmost important as adolescents do not like to feel different than their peers and do not want their information shared unless they share it. At the beginning of care, the adolescent and the parents need to decide how much involvement the parents will have in care (e.g., will they stay in the room, will the adolescent be able to have a role in decision making).
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.
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.
A 17-year-old adolescent chats excitedly with the nurse about plans for college and a career. The adolescent states having checked out every college in the region and determined which one is the best fit and would give the adolescent the best career options. The nurse recognizes which developmental aspect in this client?
Formal operational thought Explanation: The final stage of cognitive development, the stage of formal operational thought, begins at age 12 or 13 years and grows in depth over the adolescent years, though it may not be complete until about 25. This step involves the ability to think in abstract terms and use the scientific method (deductive reasoning) to arrive at conclusions. With the ability to use scientific reasoning, adolescents can plan their future. They can create a hypothesis (What if I go to college? What if I do not?) and think through the probable consequences (In the long run, I will earn more money; I could begin earning money immediately). This scenario does not pertain to socialization, role identification, or sensorimotor development.
While caring for a 16-year-old client expected to be hospitalized for several months, the nurse will perform which action to assist the client in meeting the current stage of psychosocial development?
Permit peers to visit during open visitation hours Explanation: In each stage of development, a significant person or group exerts a lasting influence on the ongoing development of the child. An adolescent striving for self-identity and increased independence spends more time with peers than with family. It is important for the hospitalized adolescent to still be able to visit with peers. Video games may be enjoyed by the adolescent and limit boredom; however, this action would not facilitate psychosocial development. Allowing the client to touch equipment to explain medical concepts and procedures are methods used to teach toddlers and preschoolers. Providing handouts and brochures are not effective methods to explain medical concepts; the nurse would verbally explain using models, pictures, and diagrams. Handouts and brochures can be used as supplements to teaching.
The mother of a 15-year-old boy confides in the nurse that she is concerned because her son is about to turn 16 and is pressuring her and her husband to buy him a motorcycle. Her husband is okay with the idea, but she is concerned about his safety. What information should the nurse mention to the mother regarding motorcycle safety? Select all that apply.
Require the son to wear a helmet. Require the son to wear long pants. Require the son to wear full body covering. Require the son to learn all relevant safety rules. Explanation: Equally dangerous as cars for adolescents are motorcycles, motorbikes, and motor scooters, which are appealing because of their low cost and convenience in parking. Both drivers and riders should wear safety helmets to prevent head injury; long pants to prevent leg burns from exhaust pipes; and full body covering to prevent abrasions in case of an accident. Advise adolescents who choose these forms of transportation to be as familiar with safety rules as automobile drivers and to wait until they are emotionally mature enough to use sound driving judgment. In the interest of an adolescent's safety and that of others, parents need to have the courage to insist on emotional maturity rather than age as the qualification for obtaining a driver's license. Motorcycles do not have seat belts.
When interviewed by the school nurse, a 13-year-old adolescent female states she has a boyfriend and that her parents do not talk about sex with her. She says is confused about the facts and wants to know the truth. Which approach would best address this adolescent's concerns?
Sit down with her and openly discuss her concerns and questions in an honest, straightforward manner. Explanation: Discussions about human sexuality need to be open, honest and straightforward with adolescents. Parents and health care providers must remain nonjudgmental if they want adolescents to come to them with questions. Sitting down with the student and addressing her questions is the best way to establish a trusting relationship with her. Recommending that she talk with her parents will not help her since they are apparently not open to discussing the topic. Brochures cannot answer her specific questions and may result in more confusion on her part. Referring her to the health department is passing the nurse's responsibility to someone else, and there is no indication that any pregnancy prevention is needed.
A runaway female adolescent has come to the community clinic because she is pregnant. When developing a plan of care, the nurse should identify which priority goal for this client?
safe housing Explanation: Because many adolescents who run away are not good problem solvers, setting goals with them may be difficult. As the adolescent has no money for food, telling her to eat a nutritious diet is not attainable. If the adolescent does not have a means of transportation, she may be unable to return to the health care facility for frequent follow-up visits. The nurse should ask the adolescent if she wants to return home and if possible, ascertain if the parents will allow the adolescent back home. While food and antenatal visits are necessary, safety is the priority for the mother and the baby.
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.
During a health check-up without the parents present, a 17-year-old adolescent tells the nurse about being gay. Which statement from the nurse is best?
"Tell me what makes you think you are gay." Explanation: The nurse needs to get more information from the adolescent (assessment) before making any comment and then proceed in a sensitive and caring way. Comments about being at risk or needing to know about safe sex are negative and should be replaced with health promotion comments. Denying the statement shows the adolescent that the nurse is not an ally.
The school nurse is presenting information to a group of high school students who are asking about vegetarian diets? Which foods will the nurse point out are not eaten when following the vegan diet?
Dairy products, meat, poultry, fish, and eggs Explanation: The vegan excludes all food of animal origin, including dairy products, eggs, fish, meat, and poultry. The semi-vegetarian includes dairy products, eggs, and fish and excludes red meat and possibly poultry. The lacto-ovo-vegetarian includes eggs and dairy products but excludes meat, poultry, and fish. The lactovegetarian includes dairy products and excludes meat, fish, poultry, and eggs.
When describing the various changes that occur in organ systems during adolescence, what would the nurse include?
Decrease in heart rate Explanation: During adolescence, the heart rate decreases while the systolic blood pressure increases. Brain growth continues, but the size of the brain does not increase significantly. Ossification is more advanced in girls and occurs at an earlier age. Sebaceous gland activity increases during adolescence.
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. Explanation: 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.
According to Erikson, the adolescent develops his or her own sense of being an independent person with individual thoughts and goals. This stage is referred to as:
identity vs. role confusion. Explanation: Adolescents must develop their own personal identity—a sense of being independent people with unique ideals and goals. This is the period Erikson calls identity versus role confusion. Erikson believes during this time the adolescent goes back through all previous developmental periods to achieve this identity. The stage of autonomy versus shame and doubt occurs between 18 months and 3 years. Industry versus inferiority occurs between 5 to 12 years. Intimacy versus isolation occurs in adulthood between the ages of 19 to 40 years.
An adolescent female with anemia has been prescribed a diet high in iron. Selection of which meal indicates to the nurse that the client understands the prescribed diet?
meatloaf, steamed cauliflower with cheese, and milk Explanation: Iron is necessary to meet expanding blood volume requirements. Females require a high iron intake not only because of this increasing blood volume but also because iron begins to be lost with menstruation. Foods high in iron include meats and green leafy vegetables. Cauliflower is the same specifies of plant as green leafy vegetables and as such is included in this category. Carrots, squash, and corn contain very limited amounts of iron.
The school nurse is conducting a health class with a group of high school students on the topic of sex and sexuality issues. The nurse determines the session is successful when the students correctly choose which aspect as most important?
"Adolescents need to know how to use condoms correctly to avoid sexually transmitted infections." Explanation: The priority is to prevent STIs. Adolescents need to understand that STIs can be acquired via oral sex as well as vaginal sex. They also need to understand that using contraceptive pills will not prevent STIs. They need contraceptive information to prevent pregnancy but more importantly they need straightforward information about using condoms to protect them against HIV and other infections. Both male and female adolescents need this information, and girls should be advised to carry their own condoms if they believe there is any possibility of having sexual intercourse.
A 13-year-old girl has grown rapidly in height over the past 2 years and is taller than most of the boys in her class. She wonders when she will stop growing. What should the nurse tell her as a general guideline for the ages at which most girls stop growing?
16 to 17 years old Explanation: Growth stops with closure of the epiphyseal lines of long bones which occurs at about 16 or 17 years of age in females and about 18 to 20 years of age in males.
In observing a group of young adolescents playing basketball, it is noted that many of the adolescents appear to be uncoordinated and drop the ball often. The most common reason this occurs is because:
large muscles grow before small muscles grow. Explanation: Because the hands and feet increase in size first, when fine motor skills such as the use of the fingers are needed, the actions of the adolescent appear to lack coordination. These fine motor skills are well-developed by this age.
The nurse is assessing a 16-year-old girl at an annual well-clinic visit and notes the girl started menses at 13 years of age and grew 1 inch (2.5 cm) over the past year. When questioned by the young lady if this is normal, which answer should the nurse prioritize?
"You're following expected patterns of growth." Explanation: Girls grow about 3 inches (7.6 cm) each year until menarche, after which growth slows considerably. This height increase would be within expected patterns of growth. Height is not dependent on weight.
Which of the following is accurately related to growth patterns in adolescent girls?
Growth slows after the beginning of menstruation. Explanation: Girls grow about 3 in (7.6 cm) each year until menarche (the beginning of menstruation), after which growth slows considerably.
A nurse in the teen clinic is using anticipatory guidance to educate parents about preventing violence in teens. Which of the following responses by a parent would show the nurse that the teaching on suicide was effective?
"I will check for signs of depression and a lack of peers." Explanation: Assessing for signs and symptoms of depression or lack of friends would be the most effective way to prevent suicide. All other choices are for preventing violence towards others.
A mother calls the school nurse and is concerned because her 13-year-old daughter's friends wear heavy makeup and black clothes. Which is the best advice for the mother?
"Teen appearance might not accurately reflect their actual values." Explanation: The nurse should inform the mother that the statements adolescents make with their dress and grooming may not indicate what their actual values are. Mentioning piercings and tattoos will only worry the mother more. Minimizing the situation as experimentation is of no value to the mother. Telling the mother to choose her daughter's friends for her will destroy trust between mother and daughter.
The nutritionist is presenting information about vegetarian diets with a group of nursing students. The nutritionist determines the session is successful when the students correctly choose which factor concerning the semi-vegetarian diet?
"The diet excludes red meat and possibly poultry." Explanation: The semi-vegetarian diet includes dairy products, eggs, and fish and excludes red meat and possibly poultry. The lacto-ovo-vegetarian diet includes eggs and dairy products but excludes meat, poultry, and fish. The lactovegetarian diet includes dairy products and excludes meat, fish, poultry, and eggs. The vegan diet excludes all food of animal origin, including dairy products, eggs, fish, meat, and poultry.
A nurse is admitting a 16-year-old male to the floor for an appendectomy. How can the nurse prepare this client for hospitalization? Select all that apply.
Encourage him to keep his cell phone nearby to communicate with his friends. Interview the adolescent separately from the parent to allow expression of information that he may not be comfortable sharing in front of the parent. Provide privacy when client is changing into the hospital gown or going to the bathroom. Explanation: In order for an adolescent to adapt well to hospitalization, the nurse needs to provide him privacy and allow him control over his surroundings and care when possible. Keeping in contact with peers is very important to an adolescent, as is being discreet in regard to sharing personal information that typically is elicited in an admission interview.
Based on Erikson's developmental theory, what is the major developmental task of the adolescent?
Finding an identity Explanation: According to Erikson, it is during adolescence that teenagers achieve a sense of identity. The toddler developed a sense of trust in infancy and is ready to give up dependence and to assert his or her sense of control and autonomy. The psychosocial task of the preschool years is establishing a sense of initiative versus guilt by mastering skills. In the school-age years the child develops concrete operations and is able to assimilate and coordinate information about the world from different dimensions.
An 18-year-old client is planning to attend college in the fall. The health care nurse informs the adolescent that a visit with the primary care physician (PCP) will need to be scheduled before the start of college. What primary purpose does this PCP visit serve?
To update immunizations Explanation: The primary purpose of the PCP visit is to ensure that the adolescent has received recommended immunizations and administer any missing vaccines so that the adolescent is ready for communal living. The other answers may or may not be discussed during the visit, but they are not the primary purpose.
The parents of a 16-year-old male are worried about recent changes in his behavior, ignoring his schoolwork and sports, and spending almost all of his free time interacting with his girlfriend. Which suggestion should the nurse point out would best address this situation?
He has developed his own identity by now; being able to establish close relationships with girls is important preparation for all of his adult relationships. They should honor his need to be with, or talk to, his girlfriend as long as he has completed his schoolwork for the day. Explanation: When identity has been established, generally between the ages of 16 and 18 years, adolescents seek intimate relationships, usually with members of the opposite sex. Intimacy, which is mutual sharing of one's deepest feelings with another person, is impossible unless both persons have established a sense of trust and a sense of identity. Intimate relationships are a preparation for long-term relationships, and people who fail to achieve intimacy may develop feelings of isolation and experience chronic difficulty in communicating with others.
The school nurse is developing a school wellness program to promote healthy eating habits and regular physical activity. What is the most important element to emphasize to maximize compliance, healthy habits, and long-term change?
Include both parents and children in the wellness program. Explanation: Every campaign to support good nutrition and daily physical activity must include parents and their children as active members of the learning community. Altough the other actions can accomplish in-school enhancements to health, long-term change tends to be more likely when the programs implemented involve the family. Programs implemetned without a family-centered approach often fail when the child's home life and school life are disconnected.
A 13-year-old girl has recently begun menstruating. She is active in sports at school. Increased intake of which of the following nutrients should the nurse recommend to the girl to prevent anemia associated with menstruation?
Iron Explanation: Females require a high iron intake not only because of this increasing blood volume but also because iron begins to be lost with menstruation. Girls with a heavy menstrual flow (menorrhagia), especially those who participate in strenuous athletics, may need to take an additional iron supplement to prevent iron-deficiency anemia. Increased calcium and vitamin D plus physical exercise are necessary for rapid skeletal growth as well as to "stockpile" calcium to prevent osteoporosis later in life. Zinc is necessary for sexual maturation and final body growth
The nurse is promoting learning and school attendance for 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 is teaching a nutritional class to a group of adolescents who are lactose-intolerant. Which food should the nurse point out will help these adolescents consume the calcium they need for proper nutrition?
Soybean curd Explanation: For lactose-intolerant client, the nurse can recommend other products high in calcium, such as tofu (soybean curd), soybeans, and greens to increase calcium intake. Chocolate pudding, nonfat milk, and cottage cheese are all high in lactose.
The nursing instructor is leading a class discussion on the various aspects of adolescents. The instructors determines the class is successful after the students correctly choose which milestone as the beginning of adolescence?
The beginning of puberty Explanation: Early adolescence (preadolescence, pubescence) begins with a dramatic growth spurt that signals the advent of puberty or reproductive maturity. The deciduous teeth are all out around the age of 10 or 11. Children usually are not self-supported. Fine motor skills continue to develop through adolescence.
A nurse is educating a middle school class of male adolescents about sex education. The topic of multiple partners is discussed. Which of the following statements from the nurse would be the most effective?
"Contraception is a responsibility of both parties involved." Explanation: The nurse should educate the teens that most methods of contraception are designed for females, but that it is a shared responsibility. This age group often feels invulnerable to warnings and statistics. A male teen may feel a false security if he believes female teens are more vulnerable to STIs, so stating this would not be appropriate.
The nurse is caring for a 13-year-old girl. The child has been identified as overweight with no underlying psychological or secondary causes. The nurse is reviewing the child's weight-loss progress and nutrition at a follow-up visit. What finding indicates a need for further discussion and teaching?
"Her goal is to be a size smaller by our vacation in two weeks." Explanation: The mother must be reminded that a successful weight loss program emphasizes long-term permanent changes, not rapid weight loss or short-term diets to meet a short-term goal.
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?" Explanation: 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 high-school athlete comes to the emergency department with hypertension, aggressiveness, and psychosis. What question would be important for the nurse to ask the client?
"Do you take anabolic steroids?" Explanation: Anabolic steroids are used by adolescents who play sports. They are used to enhance the adolescent's athletic ability. They produce euphoria and lessened fatigue. Unfortunately, steroid use can also lead to early closure of the epiphyseal plate, acne, elevated triglyceride levels, hypertension, aggressiveness, and possibly psychosis. Human growth hormone is also used to enhance athletic performance. The side effects of it are joint pain and swelling and the development of diabetes. Amphetamines provide a sense of well-being, alertness, and self-esteem. They can produce paranoia and extreme restlessness. Cocaine produces increased pulse and respirations, increased temperature, and blood pressure and decreased appetite.
The nurse is caring for an 11-year-old girl. The girl's mother reports that the girl does not want to play team sports like soccer or volleyball anymore. Her daughter insists she does not enjoy them. The mother is concerned that her daughter will not get enough physical activity and asks the nurse for guidance. How should the nurse respond?
"Give her some options; it's important to find something she enjoys." Explanation: With the onset of puberty and accompanying changes in physique and coordination, sports must be matched to the physical and emotional development of the child. It is important to give the girl some options and find something that she enjoys doing. Making a suggestion for activities without the girl's input is unhelpful. Reminding the girl that she needs regular physical activity does not address the mother's concern and is not constructive. Making a statement that organized sports are just a complement to other physical activity is accurate but does not teach or offer solutions.
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.
The parents are concerned their 14-year-old child is always eating. The child weighs 54 kg and is 65 inches (165 cm) tall. What is the best explanation the nurse can give the parents?
"The calories help his body increase muscle mass." Explanation: Adolescents grow rapidly and mature dramatically during the period from ages 13 to 20 years. An adolescent needs an increased number of calories to support the rapid body growth that occurs. Foods must come from a variety of sources to supply the necessary amounts of carbohydrates, vitamins, protein, and minerals. Boys typically gain about 15 to 55 pounds (7 to 25 kg) during their teenage years. The calorie intake will not predispose him to future obesity unless it is continuously excessive. The majority of adolescents eat as part of their development, not as an emotional need.
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 condescending the child. The child will appreciate being treated like a young man.
The nurse teaches a 14-year-old client's mother about the adolescent developmental task of identity versus role confusion. What is the best way for the mother to help her adolescent complete this task?
Allow the adolescent to participate in decisions. Explanation: Erikson describes the developmental task of adolescence as "identity versus role confusion." Adolescents must develop their own personal identities—a sense of being independent people with unique ideals and goals.
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 Explanation: 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.
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.
A school health nurse is supporting a 15-year-old young woman with acne. What is a common myth related to acne in adolescent populations?
Diet plays a significant role in acne production. Explanation: Diet does not actually influence the development of acne lesions; rather, acne is caused by the changes in puberty, specifically the rapid increase in androgen secretion, which causes the sebaceous glands to become active.
The nurse is performing an assessment of the reproductive system of a 17-year-old girl. What would alert the nurse to a developmental delay in this girl?
Lack of occurrence of first menstrual period Explanation: The first menstrual period usually begins between the ages of 9 and 15 years (average 12.8 years). Breast budding (thelarche) occurs at approximately ages 9 to 11 years and is followed by the growth of pubic hair.
The nurse is meeting with a group of caregivers of adolescents. Which example should the nurse point out is most effective for the caregiver to support the adolescent?
Let them choose their hairstyle, even though it may not look the best for them. Explanation: The adolescent whose family caregivers make it difficult to conform are adding another stress to an already emotion-laden period. By allowing the adolescent to follow trends and fads in clothing choices, hairstyles, and music, the caregiver decreases the stress for the child. Information about drugs and alcohol is important to share, but these topics would be better discussed with the child. It is important the adolescent spend time with peers.
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 other teens, use a phone, and check her e-mail. Explanation: Adolescents need access to their peers so they can keep up social contacts. Access to a phone, computer, and e-mail will help the teen stay connected. Recreation areas are important. In settings specifically designed for adolescents, recreation rooms can provide an area where teens can gather to do schoolwork, play games and cards, and socialize. Because she is 100 miles from home, a visit from friends might be difficult.
Glycogen loading is practiced regularly by the local high school football team. What is most important for the nurse to monitor in these students?
the amount of carbohydrates the student is eating Explanation: Glycogen loading is a procedure used to ensure there is adequate glycogen to sustain energy through an athletic event. Several days before a sports event, athletes lower their carbohydrate intake and exercise heavily to deplete muscle glycogen stores. They then switch to a diet high in carbohydrate. With the renewed carbohydrate intake, muscle glycogen is stored at 2 to 3 times the usual level, which supplies them with up to 2 times the glucose needed for sustained energy. Athletes need more energy from carbohydrates than protein. Participating in this practice would cause a negative nitrogen balance, not a positive.
A black adolescent male has been diagnosed with hypertension. Which statement made by the adolescent indicates to the nurse that additional teaching is needed?
"Drinking sodas is not related to my blood pressure." Explanation: Hypertension is present if the blood pressure is above the 95th percentile, or 127/81 mm Hg for 16-year-old girls and 131/81 mm Hg for 16-year-old boys for two consecutive readings. Adolescents who are obese, who are black, who eat a diet high in salt, or who have a family history of hypertension are most susceptible to developing the condition. Drinking soda regularly increases the amount of sodium intake daily, thus having an impact on the blood pressure.
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? Explanation: 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.
