RNSG 2201 Care of Children and Family Evolve Ch 17

A student nurse compares the issues associated with sexuality in boys and girls through different stages of adolescence. What statement is accurate related to romantic relationships in adolescence?

"A feeling of 'being in love' is common in middle adolescence." (A feeling of "being in love" is common in middle adolescence. In early adolescence, there is self-exploration and limited dating and intimacy. In late adolescence, intimacy involves commitment rather than exploration and romanticism. Dating as a romantic pair is seen in late adolescence; in early adolescence, there is limited dating, and in middle adolescence, there are multiple plural relationships. Tentative establishment of relationships occurs in middle adolescence; early adolescence involves limited dating and intimacy, while late adolescence is characterized by stable relationships and attachment to another. Public identification as being gay, lesbian, or bisexual occurs in late adolescence; in middle adolescence, there is internal identification of heterosexual, homosexual, or bisexual attractions.)

A nurse is screening adolescents for possible mental health issues. What statement regarding mental health in the adolescent is accurate?

"Feeling down or blue for some time can mean that the adolescent has depression." (Most adolescents who are depressed respond affirmatively when asked whether they have been feeling down or blue lately. Even though adolescents with depression often report feeling "blue," "down," or "depressed," they may not necessarily look depressed. Being alone can be a method of coping with stress in adolescents; it may indicate an attempt to cope with depression as well, though it is not always so. Adolescents with a strong sense of invulnerability in their personal fable are more likely to engage in risky behaviors that can lead to injury, while the ones whose personal fable is focused on their uniqueness may be at higher risk for depression and suicidal ideation.)

What statement made by an adolescent indicates to the nurse that they are couch surfing?

"I stay at my friends' houses because my parents are always fighting and I don't want to stay with them." (Adolescents who live in homes where there is constant conflict may run away, sometimes to a friend's home. The term couch surfing is used in some circles to refer to the adolescent who spends time at different friends' houses sleeping on a couch or in an available spare room to "crash" temporarily. The nurse needs to assess problem use in adolescents and ask them about how often they get "high" or "wasted" and also about the use of tobacco, alcohol, marijuana, or other substances in relation to sexual activity, because this pattern of use can endanger them. However, this is unrelated to couch surfing. Adolescents often try to cope with stress by spending periods of time alone. This is a normal behavior and is unrelated to couch surfing. Snacking on empty calories is common among adolescents, especially during inactivity. This is not related to couch surfing.)

A student nurse compares the changes in reproductive hormones seen in females and males at the initiation of puberty. What statement made by the student nurse demonstrates understanding of this information?

"Skeletal growth in both boys and girls is stimulated at low levels of estrogen." (Skeletal growth in both boys and girls is stimulated at low levels of estrogen; at higher levels, it inhibits growth. Menarche is the first menstruation; at this time ova do not generally mature enough to be released. The production of a mature ovum tends to occur one year or more after menarche. In boys, the capacity to ejaculate appears approximately one year after initial testicular enlargement and the appearance of pubic hair. LH stimulates the production of progesterone, not estrogen, in females. However, FSH acting with LH does stimulate sperm production in males. FSH stimulates the production of estrogen in females; the maturation of testicles in men is stimulated by LH.)

A nurse discusses the Tanner stages of puberty development in females with student nurses. What statement made by a student nurse indicates effective learning?

"Stage 4 shows projection of areola and papilla to form a secondary mound." (Stage 4 of breast development at puberty shows projection of areola and papilla to form a secondary mound; however, this may not occur in all girls. Stage 1 shows elevation of papilla only; enlargement of areolar diameter is seen in stage 2. Stage 3 shows enlargement of breast and areola with no separation of their contours; stage 2 shows a small area of elevation around the papilla. Stage 5 shows mature configuration, which is characterized by projection of papilla only caused by recession of areola into general contour.)

A 14-year-old adolescent male tells a nurse, "My trunk seems so short compared to my legs. Do I have some kind of problem?" What is the appropriate response by the nurse?

"You are completely normal." (Growth in the length of the body in adolescent males follows a specific sequence. The extremities grow first, followed by the trunk. Thus, adolescent males have a gawky appearance, with long limbs and a short trunk. The person does not have any health-related problem; therefore the nurse should not recommend exercise as a remedy. The differences in the lengths of body parts are not abnormal in this situation, and the nurse need not ask the patient to take growth pills. Because the patient has normal growth, the nurse should not advise the patient to have testosterone levels checked.)

An 18-year-old tells the nurse, "My friend got a cool tattoo around the belly button. I'm planning to get one too." What is the appropriate response by the nurse?

"You should consider going to a professional who uses a sterile technique." (The nurse advises the teenager to get the tattoo done by a professional who uses a sterile technique so that there is no risk for infections or other side effects. Asking the teenager to get permission from the parents is inappropriate, because they may be against it, which may cause conflict. To say that tattooing is not cool and has many risks may make the teenager defiant; instead the nurse advises the teenager to have it done safely. Saying that tattooing will cause HIV is inappropriate. Instead the nurse says that it may cause HIV if a sterile technique is not used.)

A nurse is examining an adolescent male during a physical. The nurse notes that the penis is longer than what it had been in childhood, the scrotum is darker in color, and the pubic region has coarse, dark, curly hair. The hair is spread over the pubic area. It is further seen that the penis had enlarged in both length and breath. What Tanner stage does the nurse document for the assessment?

A nurse is examining an adolescent male during a physical. The nurse notes that the penis is longer than what it had been in childhood, the scrotum is darker in color, and the pubic region has coarse, dark, curly hair. The hair is spread over the pubic area. It is further seen that the penis had enlarged in both length and breath. What Tanner stage does the nurse document for the assessment? (The boy is in Tanner stage 4. The scrotal skin becomes darker for the first time in stage 4, and the penis increases in size with growth in diameter and development of glans. The boy is not in stage 2, because the penis does not enlarge at this stage; only the scrotum does. Also, there is sparse growth of long, straight, downy, and slightly pigmented hair at the base of penis, and not coarse, dark hair over the entire pubic region. The boy is not in stage 3, because this stage is categorized by initial enlargement of the penis, but the enlargement is of length and not breath. Development of the glans is not seen at this stage. The boy is not in stage 5, because at this point, the testes, scrotum, and penis all reach their adult size and shape. Also, pubic hair is adult in quantity and type; it spreads to the inner surface of thighs and is no longer restricted only to the pubic area.)

What is a recommended screening practice for sexually active adolescents?

Both males and females should have laboratory tests for gonorrhea. (All sexually active teenagers should be tested for sexually transmitted infections like gonorrhea. Both males and females, if sexually active, should be evaluated for HPV by visual inspection and should also be asked whether they have received the HPV vaccine series. Only sexually active females should receive a Pap test to detect HPV infection or other cervical dysplasia. Both males and females should have a serologic test for syphilis if they are sexually active; also, the test should be performed if they have had more than one sexual partner within the past 6 months.)

What nursing care guidelines would be used when the nurse is interviewing adolescents? Select all that apply.

Ensuring confidentiality and privacy. Maintaining objectivity and avoiding judgments. Offering a nonthreatening explanation for the questions asked. (When interviewing adolescents it is important for the nurse to ensure confidentiality and privacy. Offering a nonthreatening explanation for the questions asked, such as, "First I'd like to talk about your main concerns," is helpful. It is also important to maintain objectivity and avoid judgments. Slang should be avoided; instead, terms that both the nurse and the adolescent understand should be used. It is important to interview adolescents without their parents.)

According to Erikson, what is the stage of psychosocial development for the adolescent?

Identity versus identity confusion (According to Erikson the adolescent has the task of developing a sense of identity. The infant has the task of developing trust. The toddler has the task of developing autonomy. The school-age child has the task of developing initiative.)

A 13-year-old boy is concerned about bilateral breast enlargement. What is the basis of knowledge for the response by the nurse?

Normal occurrence during puberty (Gynecomastia, or enlargement of the breast tissue, occurs during midpuberty in about one third of boys. In most boys the breast enlargement disappears within 2 years. Although overweight boys may have excess body weight in the breast area, in boys of normal body weight gynecomastia is a normal occurrence during puberty. If gynecomastia persists beyond 2 years, a hormonal cause may need to be investigated. Precocious puberty is the early onset of puberty, before age 9 years in boys, and is not related to the gynecomastia.)

The nursing instructor is teaching a group of students about sexual maturation in boys. What is included in the teaching? Select all that apply.

Pubescent changes occur between 9½ and 14 years of age. Sometimes there is temporary breast enlargement in midpuberty. Early puberty can be identified with the initial appearance of pubic hair. Increasing muscularity and voice changes are characteristics of puberty. (Pubescent changes in boys occur between 9½ and 14 years of age. There is testicular enlargement and thinning, reddening, and looseness of the scrotum during this period. The initial appearance of pubic hair, increasing muscularity, and voice changes also indicate pubescent changes. Temporary breast enlargement or tenderness called gynecomastia occurs in one third of the boys in midpuberty. Testicular enlargement is the first pubescent change in boys.)

A nurse is completing an annual physical exam of a teenage girl. The nurse notes that the girl has dark, coarse, and curly pubic hair that is spread sparsely over the entire pubis in the typical female triangle. She also has enlargement of breast and areola with no separation of their contours. What is the appropriate Tanner stage to document for this patient?

Stage 3 (Tanner stage 3 is characterized by dark, coarse, and curly pubic hair that is spread sparsely over the entire pubis in the typical female triangle. There is also some enlargement of breast and areola with no separation of their contours in this stage. The girl is not in stage 1, because stage 1 is characterized by no pubic hair and elevation of the papilla only. The girl is not in stage 2; stage 2 is characterized by sparse growth of long, straight, downy, and slightly pigmented hair extending along the labia. Between stages 2 and 3, hair begins to appear on the pubis. Stage 2 of breast development is characterized by small area of elevation around the papilla, as well as enlargement of areolar diameter. The girl is not in stage 4, which is characterized by pubic hair that is denser, curled, and adult in distribution but less abundant and restricted to the pubic area. In terms of breast development, stage 4 is characterized by projection of the areola and papilla to form a secondary mound.)

What assessment finding demonstrates the onset of puberty in an adolescent boy?

Testicular enlargement (Testicular enlargement is the first change that signals puberty in boys during Tanner stage 2 of sexual development. Voice changes occur between Tanner stages 3 and 4 of sexual development. Fine pubic hair may develop at the base of the penis early in puberty, but darker hair grows in during Tanner stage 3 of sexual development. The penis enlarges during Tanner stage 3 of sexual development.)

The primary health care provider asks a nurse to assess and document the Tanner stage of puberty development in an adolescent female. What would the nurse include in the assessment? Select all that apply.

The development of breasts. The distribution of pubic hair.

Following the assessment of a 15-year-old adolescent boy, the nurse documents a delay in puberty for this patient. What assessment finding has led the nurse to this conclusion?

The patient does not have an enlarged scrotum. (If a male has not developed a scrotum by the age of 13 to 14, the male is diagnosed with a delay in puberty. Body hair does not determine pubertal development in males. Therefore having less body hair does not indicate that the male has a delay in puberty. Lengthening and widening of the penis usually occurs in the late puberty phase. Therefore a small penis size does not indicate that the patient has a delay in puberty. Hoarsening or having a low-pitched voice is a manifestation of sexual development in males.)

Why do peer relationships play a significant role during adolescence?

To provide a source of social reinforcement. (The peer group serves as a credible source of information, role model for new social behaviors, a source of social reinforcement, and a bridge to alternative lifestyles. During adolescence the parent-child relationship changes from one of protection-dependency to one of mutual affection and equality. Parents continue to play an important role in personal and health-related decisions. The peer group forms the transitional world between dependence and autonomy.)

A student nurse compares the issues associated with identity in boys and girls through different stages of adolescence. What statement indicates the student understands the role identity?

"An early adolescent meticulously conforms to group norms." (An early adolescent thoroughly conforms to group norms; a middle adolescent is self-centered and narcissistic, and a late adolescent has defined and articulated social roles. Late adolescence is the phase of consolidation of identity; the late adolescent has defined social and gender identity, whereas an early adolescent tries out various roles. Self-esteem decreases in early adolescence; late adolescence sees an increase in self-esteem. Middle adolescents modify their body image; a late adolescent is comfortable with physical growth.)

A nurse is conducting a health screening interview with an adolescent. What questions would the nurse ask to give the adolescent an opportunity to talk about strengths and deficits that the adolescent might be experiencing within the school environment? Select all that apply.

"Are you on any club or team at school?" "Do you feel that your teachers at school are interested in your success?" (Questions about feeling cared for and connected to teachers, counselors, students, and others at school, along with questions about involvement in school-related activities, give teenagers an opportunity to talk about strengths and deficits they experience within their school environments. Asking whether the adolescent is a member of a club or team at school may help the nurse understand how involved the adolescent is in school-related activities and how connected the adolescent might be to other students. Asking what the adolescent feels about the teachers' attitudes in relation to the adolescent can help the nurse understand if the adolescent feels connected to and cared for by the teachers. Asking who the adolescent can talk to at home regarding problems at school helps to give the nurse a general sense of the adolescent's family relationships. Questions about future plans related to education and employment or career choices may give older youths the chance to talk about significant sources of stress. Questions pertaining to adolescents' feelings about their rate of development compared with their peers may allow young adolescents to discuss issues related to physical development.)

Arrange in order the events that take place at the initiation of puberty for all adolescents.

1. GnRH is released by the hypothalamus. 2. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are produced and secreted. 3. The sex steroids are produced. 4. Gonadotropin-releasing hormone (GnRH) secretion is decreased. 5. GnRH secretion increases again when serum sex hormone levels decrease. (Puberty begins as some not completely understood cluster of events triggers the production of gonadotropin-releasing hormone (GnRH) by the hypothalamus. GnRH travels through a network of capillaries to the anterior pituitary gland. There, it stimulates the production and secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). As the levels of FSH and LH in the blood increase, gonadal response is stimulated. The gonads release the sex steroids like estrogen, progesterone, testosterone, and other androgens. Increasing serum levels of sex steroids provide feedback to the hypothalamus, causing decreases in GnRH secretion. When serum sex hormone levels decrease, the hypothalamus is stimulated to increase GnRH secretion, again initiating the sequence that produces the appropriate gonadal responses.)

Arrange in order the events that take place during the menstrual cycle.

1. One ovarian follicle becomes dominant. 2. Increasing amounts of estrogen are produced during the follicular phase. 3. An ovum is released around day 14 of the menstrual cycle. 4. Estrogen production decreases as the follicle involutes. 5. Production of follicle-stimulating hormone (FSH) is increased. (During each menstrual cycle, one ovarian follicle becomes dominant. This follicle produces increasing amounts of estrogen during the early-cycle, follicular phase. The follicle then releases an ovum around day 14 of the menstrual cycle. After ovulation, the follicle involutes and its estrogen production decreases. This leads to a drop in serum estrogen and progesterone. The pituitary gland responds to the drop in these hormone levels with increased production of FSH, initiating the start of a new menstrual cycle.)

The nurse is assessing the health status of an adolescent. What guidelines for adolescent health does the nurse take into consideration during the assessment? Select all that apply.

Avoid assumptions, judgments, and lectures. Use language that the adolescent understands. Show concern for the adolescent's perspective. Offer a nonthreatening explanation for the questions. (The nurse shows concern for the adolescent's perspective to build trust. The nurse offers a nonthreatening explanation for the questions that are asked so that the adolescent is not anxious and understands the purpose of the interview. The nurse avoids assumptions, judgments, and lectures to maintain objectivity. The nurse uses language that the adolescent understands to reduce confusion and obtain concise answers. The nurse interviews the adolescent without the parents to ensure confidentiality and privacy.)

What statement is true about the developmental stages of secondary sexual characteristics and genital development in boys?

Slightly pigmented hair forms at the base of the penis at Tanner stage 2. (During the Tanner stage 2 or the puberty stage, sparse growth of long, straight, downy, and slightly pigmented hair occurs at the base of the penis. Initial enlargement of the penis, mainly in length, occurs at Tanner stage 3; at stage 4, the penis increases further in length and also grows in diameter. Initial enlargement of scrotum and testes occurs at Tanner stage 2, or the puberty stage; during stage 3, testes and scrotum are further enlarged. Pubic hair growth remains restricted to the pubic area until Tanner stage 4; during stage 5, the pubic hair spreads to inner surface of thighs.)

What statement is true regarding the changes that start with puberty in females?

The involution of the follicle leads to increased production of follicle-stimulating hormone (FSH). (The follicle involutes after ovulation, and its estrogen production decreases. The resultant drop in serum estrogen and progesterone leads the pituitary gland to respond with increased production of FSH. This starts a new menstrual cycle. Menarche or the first menstruation occurs when the endometrial lining of the uterus, caused by high estrogen levels, breaks down. However, the ova are generally not mature enough to be released at menarche. These start releasing as puberty progresses. The primary sexual characteristic in girls is the development and release of an egg, or ovum, from the ovaries approximately every 28 days. Breast development is a secondary sexual characteristic. During the early-cycle follicular phase, one ovarian follicle becomes dominant during each menstrual cycle and produces increasing amounts of estrogen.)

Sexual maturation in girls occurs in a particular sequence. Arrange the maturational changes in the correct sequence.

1. Breast changes 2. Growth of pubic hair 3. Appearance of axillary hair 4. Menstruation (The initial indication of puberty in girls is the appearance of breast buds, which is called thelarche. It occurs between 8 and 13 years of age. This is followed in 2 to 6 months by growth of pubic hair. This process is called adrenarche. It is followed by the appearance of axillary hair and menstruation. Menstruation occurs 2 years after the first pubescent changes.)

How long after the appearance of the first pubescent changes does menarche, or the first menstruation, occur?

2 years (Initial menstruation, or menarche, occurs about 2 years after the appearance of the first pubescent changes. Three years is too long, and 15 or 18 months is not long enough.)

The nurse is assessing the social factors that influence an adolescent. What factors would the nurse include in the assessment? Select all that apply.

Interests and activities. Relationships with peers. Relationships with parents. (The relationship of adolescents with their parents changes to mutual affection and equality during adolescence. There may be conflicts between parents and adolescents, because adolescents want to be free of parental restraints. Peer groups have intense influence on adolescents' behavior and also influence their decision making. Leisure time activities also help in the development of social, physical, and cognitive skills of the adolescent. Gender is not a social factor. Self-concept and body image are not social factors but are more related to how the adolescent feels about the new changes that have taken place in the body.)

A nurse is conducting an assessment of a teenage girl. Upon assessing the girl's external genitalia the nurse notes a clear to white discharge. What condition is this girl experiencing?

Leukorrhea (Leukorrhea is the term used to describe a clear to white discharge; it may be caused by physical, chemical, or infectious agents. This discharge is not linked to cancer. Dysmenorrhea is the term used to describe discomfort during the first day or two of menstrual flow. Leukorrhea is a normal finding that occurs with hormonal changes in puberty.)

While caring for hospitalized adolescents, the nurse observes that sometimes teenagers are skeptical of their parents' religious beliefs and practices. What would the nurse recognize as about this behavior?

Normal spiritual development for age (Adolescents reexamine and reevaluate many of the beliefs and values of their childhood. Adolescents try to determine which of their parents' standards and beliefs to incorporate into their own. The behavior described is not abnormal, nor is it applicable only during times of crisis. The behavior described is not related to the parents' inability to explain their beliefs and practices.)