Peds Chapter 15

7. Which aspect of cognition develops during adolescence? a. Capability to use a future time perspective b. Ability to place things in a sensible and logical order c. Ability to see things from the point of view of another d. Progress from making judgments based on what they see to making judgments based on what they reason

ANS: A Adolescents are no longer restricted to the real and actual. They also are concerned with the possible; they think beyond the present. During concrete operations (between ages 7 and 11 years), children exhibit these characteristic thought processes.

6. A nurse is planning a teaching session for a group of adolescents. The nurse understands that by adolescence the individual is in which stage of cognitive development? a. Formal operations b. Concrete operations c. Conventional thought d. Postconventional thought

ANS: A Cognitive thinking culminates with capacity for abstract thinking. This stage, the period of formal operations, is Piaget's fourth and last stage. Concrete operations usually occur between ages 7 and 11 years. Conventional and postconventional thought refers to Kohlberg's stages of moral development.

14. A young adolescent boy tells the nurse he "feels gawky." How should the nurse explain why this occurs in adolescents? a. Growth of the extremities and neck precedes growth in other areas b. Growth is in the trunk and chest c. The hip and chest breadth increases d. The growth spurt occurs earlier in boys than it does in girls

ANS: A Growth in length of the extremities and neck precedes growth in other areas, and, because these parts are the first to reach adult length, the hands and feet appear larger than normal during adolescence. Increases in hip and chest breadth take place in a few months followed several months later by an increase in shoulder width. These changes are followed by increases in length of the trunk and depth of the chest. This sequence of changes is responsible for the characteristic long-legged, gawky appearance of early adolescent children. The growth spurt occurs earlier in girls than in boys.

11. A 14-year-old boy seems to be always eating, although his weight is appropriate for his height. What is the best explanation for this? a. This is normal because of increase in body mass. b. This is abnormal and suggestive of future obesity. c. His caloric intake would have to be excessive. d. He is substituting food for unfilled needs.

ANS: A In adolescence, nutritional needs are closely related to the increase in body mass. The peak requirements occur in the years of maximal growth. The caloric and protein requirements are higher than at almost any other time of life. Seemingly always eating describes the expected eating pattern for young adolescents; as long as weight and height are appropriate, obesity is not a concern.

18. A 14-year-old adolescent never had chickenpox as a child. What should the nurse expect the health care provider to recommend? a. One dose of the varicella vaccination b. Two doses of the varicella vaccination 4 weeks apart c. One dose of the varicella immune globulin d. No vaccinations—the child is past the age to receive it

ANS: B All adolescents should also be assessed for previous history of varicella infection or vaccination. Vaccination with the varicella vaccine is recommended for those with no previous history; for those with no previous infection or history, the varicella vaccine may be given in two doses 4 or more weeks apart to adolescents 13 years or older. The varicella immune globulin is given to immunosuppressed children exposed to chickenpox to boost immunity; it is only temporary. The varicella vaccination should be given to adolescents, no matter the age, who have not had chickenpox as a child.

12. Which predisposes the adolescent to feel an increased need for sleep? a. An inadequate diet b. Rapid physical growth c. Decreased activity that contributes to a feeling of fatigue d. The lack of ambition typical of this age group

ANS: B During growth spurts, the need for sleep increases. Rapid physical growth, the tendency toward overexertion, and the overall increased activity of this age contribute to fatigue.

17. A nurse is conducting parenting classes for parents of adolescents. Which parenting style should the nurse recommend? a. Laissez-faire b. Authoritative c. Disciplinarian d. Confrontational

ANS: B Parents should be guided toward an authoritative style of parenting in which authority is used to guide the adolescent while allowing developmentally appropriate levels of freedom and providing clear, consistent messages regarding expectations. The authoritative style of parenting has been shown to have both immediate and long-term protective effects toward adolescent risk reduction. The laissez-faire method would not give adolescents enough structure. The disciplinarian and confrontational styles would not allow any autonomy or independence.

2. A school nurse is teaching a group of preadolescent girls about puberty. Which is the mean age of menarche for girls in the United States? a. years b. years c. years d. 14 years

ANS: B The average age of menarche is 12 years 9.5 months in North American girls, with a normal range of to 15 years. Ages , , and 14 are within the normal range for menarche, but these are not the average ages.

5. According to Erikson, which psychosocial task is developing in adolescence? a. Intimacy b. Identity c. Initiative d. Independence

ANS: B Traditional psychosocial theory holds that the developmental crises of adolescence lead to the formation of a sense of identity. Intimacy is the developmental stage for early adulthood. Independence is not one of Erikson's developmental stages.

16. A nurse is caring for an adolescent hospitalized for cellulitis. The nurse notes that the adolescent experiences many "mood swings" throughout the day. How should the nurse interpret this behavior? a. Requires a referral to a mental health counselor b. Requires some further lab testing c. It is normal behavior d. Related to feelings of depression

ANS: C Adolescents vacillate in their emotional states between considerable maturity and childlike behavior. One minute they are exuberant and enthusiastic; the next minute they are depressed and withdrawn. Because of these mood swings, adolescents are frequently labeled as unstable, inconsistent, and unpredictable, but the behavior is normal. The behavior would not require a referral to a mental health counselor or further lab testing. The mood swings do not indicate depression.

15. A nurse is reviewing hormone changes that occur during adolescence. What is the hormone responsible for the growth of beard, mustache, and body hair in the male? a. Estrogen b. Pituitary c. Androgen d. Progesterone

ANS: C Beard, mustache, and body hair on the chest, upward along the linea alba, and sometimes on other areas (e.g., back and shoulders) appears in males and is androgen dependent. Estrogen and progesterone are produced by the ovaries in the female and do not contribute to body hair appearance in the male. The pituitary hormone does not have any relationship to body hair appearance in the male.

3. A school nurse is teaching a group of preadolescent boys about puberty. By which age should concerns about pubertal delay be considered? a. 12 years b. 13 years c. 14 years d. 15 years

ANS: C Concerns about pubertal delay should be considered for boys who exhibit no enlargement of the testes or scrotal changes from to 14 years. Ages 12 to years is too young for initial concern.

10. The school nurse tells adolescents in the clinic that confidentiality and privacy will be maintained unless a life-threatening situation arises. How should this practice be interpreted? a. Not appropriate in a school setting b. Never appropriate because adolescents are minors c. Important in establishing trusting relationships d. Suggestive that the nurse is meeting his or her own needs

ANS: C Health professionals who work with adolescents should consider adolescents' increasing independence and responsibility while maintaining privacy and ensuring confidentiality. However, in some circumstances, such as self-destructive behavior or maltreatment by others, they are not able to maintain confidentiality. Confidentiality and privacy are necessary to build trust with this age group. The nurse must be aware of the limits placed on confidentiality by local jurisdiction.

8. Parents are concerned about the number of hours their teenage daughter spends with peers. The nurse explains that peer relationships are important during adolescence for which reason? a. Adolescents dislike their parents. b. Adolescents no longer need parental control. c. They provide adolescents with a feeling of belonging. d. They promote a sense of individuality in adolescents.

ANS: C The peer group serves as a strong support to teenagers, providing them with a sense of belonging and a sense of strength and power. During adolescence, the parent-child relationship changes from one of protection-dependency to one of mutual affection and quality. Parents continue to play an important role in the personal and health-related decisions. The peer group forms the transitional world between dependence and autonomy.

13. What is the most common cause of death in the adolescent age group? a. Drownings b. Firearms c. Drug overdoses d. Motor vehicles

ANS: D Forty percent of all adolescent deaths in the United States are the result of motor vehicle accidents. Drownings, firearms, and drug overdoses are major concerns in adolescence but are not the most common cause of death.

1. What is the initial indication of puberty in girls? a. Menarche b. Growth spurt c. Growth of pubic hair d. Breast development

ANS: D In most girls, the initial indication of puberty is the appearance of breast buds, an event known as thelarche. The usual sequence of secondary sex characteristic development in girls is breast changes, rapid increase in height and weight, growth of pubic hair, appearance of axillary hair, menstruation, and abrupt deceleration of linear growth.

4. A 14-year-old male mentions that he now has to use deodorant but never had to before. The nurse's response should be based on knowledge that which occurs during puberty? a. Eccrine sweat glands in the axillae become fully functional during puberty. b. Sebaceous glands become extremely active during puberty. c. New deposits of fatty tissue insulate the body and cause increased sweat production. d. Apocrine sweat glands reach secretory capacity during puberty.

ANS: D The apocrine sweat glands, nonfunctional in children, reach secretory capacity during puberty. They secrete a thick substance as a result of emotional stimulation that, when acted on by surface bacteria, becomes highly odoriferous. They are limited in distribution and grow in conjunction with hair follicles, in the axilla, genital, anal, and other areas. Eccrine sweat glands are present almost everywhere on the skin and become fully functional and respond to emotional and thermal stimulation. Sebaceous glands become extremely active at this time, especially those on the genitalia and the "flush" areas of the body such as face, neck, shoulders, upper back, and chest. This increased activity is important in the development of acne. New deposits of fatty tissue is not the etiology of apocrine sweat gland activity.

9. An adolescent boy tells the nurse that he has recently had homosexual feelings. What knowledge should the nurse's response be based on? a. This indicates the adolescent is homosexual. b. This indicates the adolescent will become homosexual as an adult. c. The adolescent should be referred for psychotherapy. d. The adolescent should be encouraged to share his feelings and experiences.

ANS: D These adolescents are at increased risk for health-damaging behaviors, not because of the sexual behavior itself, but because of society's reaction to the behavior. The nurse's first priority is to give the young man permission to discuss his feelings about this topic, knowing that the nurse will maintain confidentiality, appreciate his feelings, and remain sensitive to his need to talk about the topic. In recent studies among self-identified gay, lesbian, and bisexual adolescents, many of the adolescents report changing self-labels one or more times during their adolescence. An assessment must be made about any risks to himself or others. If these do not exist, the adolescent needs a supportive person to talk with.