Pediatrics Chapter 29

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

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

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

D The average number of hours of sleep that teens require per night is 8.5 to 9.5 due to rapid growth that occurs during these years. Following a curfew and limiting distractions at bedtime can help provide the student with adequate hours of sleep each night.

According to Erikson, the adolescent develops their own sense of being an independent person with individual thoughts and goals. This stage is referred to as: identity vs. role confusion. autonomy vs. doubt and shame. industry vs. inferiority. intimacy vs. isolation.

A 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.

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? How is his personal hygiene? Have his sleeping and eating habits changed? Does he exercise?

A 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.

The nurse is counseling an overweight, sedentary 15-year-old girl. The nurse is assisting her to make appropriate menu choices. Which statement indicates the adolescent understands how to make appropriate dietary selections? "I need to eat plenty of fruit each day." "I avoid all fat intake." "To lose weight my protein intake should be limited to 2 to 4 servings per day." "Because of my age, my dairy intake is unlimited."

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

The nurse is assisting a 15-year-old who has been diagnosed with anemia in making menu selections. Which selections for the upcoming day's meals indicate an understanding of what foods are high in iron? Select all that apply. liver brown rice kiwi fruit kale peanut butter sandwich

A D E Foods high in iron include liver and other meat products such as beef, chicken, and fish. Peanut butter, nuts, seeds, and leafy green vegetables are also sources of iron.

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? Determine when the client started feeling hot. Assess the client for signs of infection. Inquire about the piercing technique used. Ask the client if any other piercings are present.

B 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 any additional piercings is not necessary, as this will not provide information about the client's current situation.

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 anxious to move away from his parent's home. The teen is uncertain and frequently unable to make decisions. The teen is sexually promiscuous. The teen is distrustful of others.

B 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 reading a journal article about adolescents and major causes of injuries in this age group. The nurse demonstrates understanding of this information by identifying which situation as the major cause of adolescent injuries? suicide motor vehicle crashes drowning violence

B Although drowning, violence, and suicide are causes of adolescent injury, the largest number of adolescent injuries are due to motor vehicle crashes.

The nursing instructor is leading a class discussion on the various aspects of adolescents. The instructor determines the class is successful after the students correctly choose which milestone as the beginning of adolescence? The deciduous teeth falling out The fine motor skills fully developed The child becoming self-supported The beginning of puberty

D 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.

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." "Things will be better when you go off to college." "Being a teenager is hard work." "Try to look at the bright side of things."

A 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.

A 16-year-old girl has arrived for her sports physical with a new piercing in her navel. Which response by the nurse is best? "Be sure to clean the navel several times a day." "I hope for your sake the needle was clean." "This is a risk for hepatitis, tetanus, and AIDS." "This is a wound and can become infected."

A The best response is to describe the proper care using frequent cleansing with antibacterial soap. It is too late for warnings about the dangers of piercing such as skin- or blood-borne infections, or disease from unclean needles.

What activity would best foster the developmental task of an adolescent who uses a wheelchair to ambulate? Watching television on the set in the adolescent's room Allowing the adolescent to decide when to bathe Having a teacher bring school work to the adolescent Talking to another adolescent who has a similar situation

D A sense of identity is developed by "trying on" roles and discussing values and goals with others. A sense of trust develops when an adolescent is able to find out whom (and what ideas) to have faith in. The adolescent period is also a time where past stages of development are revisited. The sense of autonomy is where the adolescent seeks ways to express individuality. The stage of initiative is where the adolescent develops vision of what he or she might become. Talking with another adolescent who also uses a wheelchair to ambulate will help the adolescent see possibilities and reassurances. Making decisions or having assistance from someone else does not allow the adolescent to "try out" roles.

The nurse is educating a 17-year-old adolescent after a new diagnosis of diabetes. What does the nurse understand about teaching an adolescent? The siblings of the adolescent will need to be taught healthy cooking classes related to diabetes. The adolescent will likely have the greatest influence on one's own decisions. The adolescent will respond best to teaching about how to avoid future complications. The parents will need to be instructed separately from the adolescent.

B In late adolescence, the client likely has the greatest influence on his or her own decision making. While offering teaching to the parents and healthy cooking classes to the siblings are options, the adolescent will most benefit from being the one to make choices about care. Focusing on more recent concerns rather than the idea of future complications with the adolescent will gain more credibility.

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 will feel better about yourself as you get older." "You have lots of hormone changes going on right now." "Your other friends are feeling like this too." "You may feel like you are changing, but you still look the same."

B 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.

The nurse is caring for an adolescent athlete who is being seen for a fractured arm. The parent reports that this is the third sports injury in the past 2 years. The parent asks the nurse why the adolescent—who is healthy overall— continues to have injuries. How should the nurse respond? The bones, joints, and tendons of adolescents are vulnerable to injury due to their rapid state of growth. These are accidents and random in occurrence. Some adolescents are accident-prone. There may be some underlying problems that your adolescent should be evaluated for.

A Rapidly growing bones, muscles, joints, and tendons are more vulnerable to unusual strains and fractures. While some people may seem to be accident-prone, this adolescent's injuries are most likely the result of the stage of physical growth. There is no evidence the adolescent has any underlying medical conditions.

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. Improvement should be seen in 1 week. Limit the amount of sun exposure. Take the prescribed 500 mg throughout treatment.

A 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 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.

Nurses should provide anticipatory guidance to males to prepare them for what particular pubertal change in middle-to-late adolescence? pubic hair growth lengthening of the penis nocturnal emissions reddening of the scrotum

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

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? "Do you and your dad hunt?" "Have you been taught how to use a gun?" "Do you understand that it is important for you not to handle a gun?" "Are the guns in your home locked in a safe?"

D 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 male nurse is meeting with a group of 12-year-old boys to discuss expected bodily changes. After one of the boy's says, "My older brother told me my bed might be wet and that means I had a wet dream. Is that true?" What is the best response from the nurse? "Having wet dreams indicates that your body is going through a process of maturing." "When you are thinking about people you find sexually attractive or dating those people you might have a wet dream." "It will be several years before you will start having wet dreams." "It is not common to wet the bed or urinate when you have a wet dream."

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

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." "Remind her of the importance of regular physical activity for good health." "Organized sports are just a complementary activity to other physical activities." "Why don't you sign her up for an aerobics or dance class?"

A 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 15-year-old adolescent is seen at a health care facility for facial acne. When counseling the teen, the nurse would teach that the basic cause of acne is: vitamin deficiency from an inadequate diet. activation of androgen hormones. lack of showering adequately after gym class. thyroid-gland secretions increasing with adolescence.

B Acne occurs in adolescence as the result of hormone influence. With increased androgen production the sebaceous glands become more active. With increased testosterone production (in both boys and girls) increased sebum is produced. These increased hormone productions lead to the development of acne. Showering will certainly lead to cleaner skin and the removal of oils but the lack of showering does not cause acne. Diet and thyroid hormones do not play a role in the development of acne.

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. "My mom had melanoma so she always makes me wear a sunscreen with an SPF of 30." "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." "Our coach makes us wear sun-protective clothes when we practice outside on the weekends." "I only tan before going on spring break to get a base tan so I won't burn."

B C E The nurse should further discuss comments that demonstrate incorrect information about sun exposure. Any exposure to tanning beds should be avoided to prevent skin cancer risks. Other risks for skin cancer include being in the sun between the times of 10:00 am and 4:00 pm, and sun exposure and burns during childhood and adolescence. A minimum SPF of 15 should be used, so SPF 30 is good practice, as is wearing sun-protective clothing when outside during the day.

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? Hanging out primarily with boys her own age Hanging out with girls but maintaining her own unique style Banding together with other girls and dressing like them Banding together with boys and girls but maintaining her own unique style

C 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.

Which nursing action will best assist a 15-year-old client accomplish the developmental task according to Erikson? Praise the client for correctly performing self-care Provide the client with crafts and puzzles to complete independently Allow the client's friends to visit while the client is hospitalized Permit the client to make decision regarding one's care

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

The nurse is promoting nutrition to a teen who is going through a growth spurt. Which food should the nurse recommended for its high iron content? fat-free milk organic carrots whole grain bread fresh orange juice

C Whole grain bread contains high amounts of iron and is a type of food the child would not have an aversion to. Milk is a good source of vitamin D. Carrots are high in vitamin A. Orange juice is a good source for vitamin C.

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

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

The 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? Leave pamphlets about topics such as drugs and alcohol in their room so they can read them. Discourage spending too much time with school friends since we know they can be a negative influence. Our house rules are stricter than their friends but everyone follows the same rules in our home. Let them choose their hairstyle, even though it may not look the best for them.

D 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.

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." "I remember that time in my life, it was so awkward and uncomfortable." "Based on your child's age, changes in hair distribution and voice pitch are expected." "It would be helpful to discuss with your child your trials with puberty and the changes you experienced.

A 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.

Computer use at home and at school has increased adolescents' comfort in gaining access to and using the Internet. This has expanded their exposure to risks. What potential risks are there for an adolescent to be exposed to? Teens can be exposed to inappropriate materials, harassment, threats, and potential for molestation. Teens can become addicted to the online gaming and role-playing that is popular with their peers. Computer use can contribute to adolescent obesity due to decreased activity and increased consumption of snacks. Teens are at risk for identity theft from sharing personal information with others whom they do not know.

A Teens are exposed to a great deal of inappropriate materials, harassments from other online users, and potential threats of molestation or solicitation of sexual favors. Teens are at risk for identity theft, but it is not as big of a concern for them because they do not use their Social Security information or credit card information. Computer use can contribute to obesity, but the risks of inappropriate materials, threats, and sexual exploitation are a greater threat. It is possible for teens to become addicted but the other risks are of more concern to parents.

The nurse is meeting with a group of caregivers of adolescents and discussing sex and sexuality, including how to discuss these issues with their children. Which comment should the nurse prioritize with this group of caregivers? Teenagers spend so much time with their peers, and that is usually how they find out about sex. Most schools have excellent programs to teach adolescents about sex and sexuality. Being honest and straightforward with teenagers will encourage them to ask about subjects like sexuality. Internet resources, movies, and television have the most accurate and current information for your adolescent to learn about sexuality issues.

C The most important aspect of discussions about sexuality with adolescents is giving honest, straightforward answers in an atmosphere of caring concern. Children whose need for information is not met through family, school, or community programs will get the information—often inaccurately—from peers, movies, television, or other media.

The mother of a 13-year-old boy confides to the pediatric nurse practitioner that her son has recently had a nocturnal seminal emission. The mother is concerned, and the nurse explains "wet dreams" and the other male traits of puberty to the mother. Which response indicates a need for further discussion? "My son is developing normally and the traits of puberty vary from child to child." "My son's spontaneous erections and nocturnal emissions are very normal." "My son is not doing anything to cause the nocturnal emissions; they occur spontaneously." "My son must be sexually active or having overly sexual thoughts to have a nocturnal emission."

D Spontaneous erections and nocturnal seminal emissions do not mean that the child is sexually active or having overactive sexual thoughts. Parents need to be instructed that these occurrences are spontaneous and that the child is not doing anything to cause them.

The 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? Serve fruits and vegetables in the cafeteria. Include both parents and children in the wellness program. Eliminate sweetened, carbonated beverages in the cafeteria. Incorporate activity in parts of the daily schedule.

B Every campaign to support good nutrition and daily physical activity must include parents and their children as active members of the learning community. Although 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 implemented without a family-centered approach often fail when the child's home life and school life are disconnected.

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? "Looking like everyone else is not what makes someone pretty." "Do you not think you are pretty now?" "You seem concerned. Let's talk about your feelings." "I think you are beautiful just as you are."

C 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.

The nurse is talking to a 13-year-old boy about choosing friends. Which function do peer groups provide that can have a negative result? developing stability sharing problems following role models negotiating differences

C Peers serve as role models for social behaviors, so their impact on an adolescent can be negative if the group is using drugs, or the group leader is in trouble. Sharing problems with peers helps the adolescent work through conflicts with parents. The desire to be part of the group teaches the child to negotiate differences and develop loyalties and stability.

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? An ability to be autonomous An understanding of socialization and of isolation A willingness to take initiative A sense of trust and identity

D 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.

The nurse is caring for a 13-year-old adolescent. The adolescent has been identified as overweight with no underlying psychologic or secondary causes. The nurse is reviewing the adolescent's weight-loss progress and nutrition at a follow-up visit. What statement by the parent indicates a need for further discussion and teaching? "My adolescent is helping us plan our family's weekly menu." "My adolescent's goal is to be a size smaller by our vacation in 2 weeks." "Our whole family has changed our eating habits." "My adolescent has begun to eat slowly, putting down the fork between bites."

B The parent 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 parent 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.

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 cocaine?" "Do you take anabolic steroids?" "Do you take amphetamines?" "Do you take human growth hormone?"

B 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.

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? It is not recommended to get the tattoo from your friend in his garage. Tattooing carries risks such as infection, disease, and nerve damage. Review the safety rules for those who do the tattooing. Complications are more likely when you tattoo yourself.

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

The nurse is preparing to participate in a community discussion on the needs of the adolescents in the local school. The nurse should point out which goal is the primary concern for these young individuals as the committee makes plans? Each child is learning to do things on his or her own. They understand and respond to discipline. Teens are busy developing their own personal identity. They want to successfully complete activities.

C 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.

To help prevent obesity, which intervention would the nurse include in an adolescent's plan of care? Plan a diet of 3,000 calories per day. Describe a normal serving size. Encourage sources of proteins with fat. Plan a diet of 1,500 calories per day.

B 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 impaired growth. Therefore, a diet of fewer than 1,400 to 1,600 calories a day can rarely be tolerated by adolescents. Teenage girls who are moderately active require about 2,000 calories per day and teenage boys who are moderately active require between 2,200 and 2,800 calories per day. Eating in excess can lead to obesity and should be avoided.

The mother of a 9-year-old female voices concern to the nurse about her daughter developing breasts "at such a young age." How should the nurse respond? "This is rather young to be developing breasts. I will be sure to let the doctor know." "I understand your concern, but girls typically enter puberty around the age of 9 or 10." "I am sure you are concerned but children develop at different rates." "Do the females in your family typically develop at an early age?"

B Voicing empathy regarding the mother's concern conveys support, and letting her know that this is normal growth and development helps ease her concerns. The other responses don't address her concerns or show genuine empathy.

A 15-year-old client's parent comments on the fact that the adolescent seems to always choose the opposite of what everyone else wants and that mood swings are a common occurrence. What statement shows the nurse that the client's parent understands these changes? "This is common for this age group and it will get better with time." "This is my adolescent's temperament, and we will have to learn how to deal with it." "I know that my adolescent is doing this because of all the hormones." "My adolescent will never find anyone to live with if the adolescent acts like this."

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

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? Explain medical concepts by providing handouts and brochures. Permit peers to visit during open visitation hours. Provide video games for the client to play. Allow the client to touch equipment before procedures.

B 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 and to explain medical concepts/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.

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? Share what foods can be eaten on a low-fat diet to prevent fat deposits. Provide reassurance that these are normal changes. Review dietary measures to assist in controlling weight gain. Encourage increased exercise to control weight gain.

B 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.

The nurse is admitting a 15-year-old adolescent to the hospital pediatric unit. What does the nurse recognize as a priority for this adolescent? The adolescent's need for parental support should be discussed. The adolescent's need for privacy should be respected. The adolescent should be encouraged to call friends often. The adolescent should be given freedom to participate in unit activities as desired.

B When an adolescent is ill or injured, it affects the body and body image. A hospitalized adolescent's primary concerns are pain and the loss of privacy. The adolescent is also anxious about being separated from friends and losing control of one's life. When an adolescent is hospitalized, it is very important the adolescent be given privacy. The adolescent needs individualized attention, confidentiality, and the right to participate in decisions about one's own health care. The adolescent should have contact with friends and be allowed in unit activities. Because the adolescent is under the age of 18, the parents should be involved and informed of the care. The nurse can talk with the adolescent and parents about care decisions and the adolescent's need for support from family.

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

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

The school nurse is monitoring a student athlete who experienced a concussion 2 weeks ago during a soccer game. The student reports having difficulty in a course in which the child previously performed well. Which action should the nurse take first? Notify the student's parents that their child should see the family health care provider. Perform a neurologic assessment on the student to see if there are any changes in neurologic status. Ask the student to describe the issues he is having in the class. Ask the student's teacher if the child is achieving the recommended level of cognitive activity

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

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? "Reevaluate the adolescent's ability to perform hygiene care since showering is so frequent." "Do not encourage multiple baths; it can be very drying to the skin." "Remind the adolescent about needing to be on a schedule so as to not disrupt the family." "Reinforce the family rules but also allow the adolescent to develop one's own routine."

D 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.

The nurse is providing anticipatory guidance to the parents of a 15-year-old who voice concerns with their teenager's sleep habits. They state, "Left to her own devices, I'm sure she'd stay up until 3:00 in the morning on the weekends and sleep until after lunchtime." Which should the nurse explain to the parents? "It's very important that you communicate to your daughter that this is unacceptable because it can have a negative effect on her health." "This is expected at this stage of development. Are there any ways that you could adjust your family routines to accommodate this?" "I can hear that this is exasperating for you, but know that children do grow out of this in time, with no ill effects." "That must be hard for you to manage. Perhaps we can explore some strategies with her to establish more predictable sleep patterns."

D It is common for adolescents to adopt habits of going to bed late and awakening late, especially on weekends. Despite the fact that this is common, it is not ideal; the nurse should explore strategies for changing the adolescent's behavior in a collaborative and inclusive manner. Simply communicating that it is unacceptable is unlikely to bring about change.

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? Sensorimotor Identification of identity Socialization Formal operational thought

D 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 age 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.

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? Assist the girl with using the bed pan to urinate. Allow the girl to wear her own clothes, despite hospital policy. Brush the girl's hair for her. Offer to assist the girl in washing her hair and let her pick the shampoo.

D 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 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 is not developmentally mature enough to have an intimate relationship with one girl; they should encourage him to spend time with groups of friends rather than time alone with his girlfriend. He is not developmentally mature enough to make healthy choices about the ways in which he spends his time, so it would be helpful if they would make a schedule for him that includes about a half-hour per day to talk with his girlfriend. He has chosen a girl who is overly dependent on him. They should talk to him about making sure he meets his own needs, including doing the schoolwork he enjoys, in any relationship. 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.

D 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.