Adolescent

An adolescent has skeletal traction for a fractured femur. Which is the most appropriate nursing intervention for this client? Assess pin sites every shift and as needed. Ensure that the rope knots catch on the pulley. Put all the joints through range of motion every shift. Add and remove weights at the adolescent's request.

Assess pin sites every shift and as needed. Nursing care for a client in traction includes assessing pin sites every shift and as needed and ensuring that the knots in the rope don't catch on the pulley. The nurse should add and remove weights at the physician's order, not at the adolescent's request. All joints, except those immediately proximal and distal to the fracture, should be put through range of motion every shift.

Which child should the nurse identify as being most at risk for an episode of major depression? a 16-year-old male who has been struggling in school, making only Cs and Ds a 10-year-old male who has never liked school and has few friends a 14-year-old female who recently moved to a new school after her parents' divorce a 13-year-old female who was upset over not being chosen as a cheerleader

a 14-year-old female who recently moved to a new school after her parents' divorce Children who experience serious losses, especially multiple losses, such as old friends or a parent, are more at risk for depression. Girls also are at greater risk than boys during the adolescent years.

The charge nurse on the adolescent unit must decide which nurse should admit a new client. Based on the present client care assignments, who is the best candidate to admit the client? a nurse whose patient with asthma has decreasing oxygen saturation levels a nurse who is about to start a complicated wet-to-damp dressing change a nurse who was reassigned from another ward at the beginning of the shift a nurse caring for a client who is paralyzed and has no visiting family

a nurse who was reassigned from another ward at the beginning of the shift The nurse's work load would be low because she was reassigned to the ward at the beginning of the shift. The client with asthma requires constant monitoring by the nurse until the situation is resolved. Simple tasks and procedures are commonly more time-consuming when clients with paralysis are involved because these clients can't directly aid in their own care. Additional time must also be allotted for the nurse about to undertake a complicated procedure, such as a wet-to-damp dressing change.

A nurse is assessing the growth and development of a 14-year-old boy. The client reports that their 13-year-old sister is 2 inches (5 cm) taller than them. What information should the nurse provide about growth spurts in adolescent boys compared with growth spurts in adolescent girls? They occur: about 2 years earlier. about 2 years later. about 1 year earlier. at about the same time.

about 2 years later. adolescent boys lag about 2 years behind adolescent girls in growth. Most girls are 1 to 2 inches (3 to 5 cm) taller than boys at the beginning of adolescence but tend to stop growing approximately 2 to 3 years after menarche with the closure of the epiphyseal lines of the long bones.

A 15-year-old client with a BMI of 20 three months ago has lost 30 lb (13.6 kg) since then. What other finding is the nurse likely to assess? pharyngeal irritation dental carries knuckle abrasions amenorrhea

amenorrhea A significant weight loss in an adolescent who is not obese signals possible anorexia nervosa. Amenorrhea is a common finding in girls and women with anorexia nervosa. Researchers don't know whether the condition results from starvation or from an underlying metabolic disturbance. Dental carries, knuckle abrasions, pharyngeal irritation, and diarrhea are commonly associated with bulimia nervosa. An extreme and fast weight loss is more likely with anorexia than bulimia. People suffering from bulimia tend to have a normal weight.

After conducting a presentation to a group of adolescent parents on the topic of adolescent pregnancy, the nurse determines that one of the parents needs further instruction when the parent says that adolescents are at greater risk for which complication? cephalopelvic disproportion congenital anomalies low-birth-weight infant denial of the pregnancy

congenital anomalies Additional teaching is needed when the parent says that adolescents are at greater risk for congenital anomalies. Although adolescents are at greater risk for denial of the pregnancy, lack of prenatal care, low-birth-weight infant, cephalopelvic disproportion, anemia, and nutritional deficits — and have a higher maternal mortality rate — studies reveal that congenital anomalies are not more common in adolescent pregnancies.

The nurse plans discharge care with the parents of a 16-year-old boy who recently attempted suicide. The nurse should advise the parents to notify a heath care provider immediately for which client finding? deciding to try out for an extracurricular activity. giving away valued personal items. desiring to spend more time with friends. expressing a desire to date.

giving away valued personal items. Giving away personal items has consistently been shown to be an indicator of suicidal plans in the depressed and suicidal individual. The other behaviors indicate a return of interest in normal adolescent activities.

After 6 months of treatment with diet and exercise, an adolescent with type 2 diabetes still has a fasting blood glucose level of 140 mg/dL (7.8 mmol/L). The health care provider (HCP) has decided to begin metformin. The client asks how the medication works. The nurse should tell the client that the medicine decreases the glucose production and performs which other function? increases insulin sensitivity replaces natural insulin decreases carbohydrate adsorption helps the body make more insulin

increases insulin sensitivity Metformin is currently approved by the Food and Drug Administration and Health Canada to treat type 2 diabetes in children. The medication decreases glucogenesis in the liver and increases insulin sensitivity in the peripheral tissues. Only insulin can actually replace insulin. This treatment is reserved for clients with type 1 diabetes or those with type 2 who do not respond to diet, exercise, and an oral diabetic agent. Other oral medications used to treat diabetes augment insulin production or decrease carbohydrate absorption, but those medications are primarily used in adults.

A nurse is conducting a teaching session on complications of sickle cell anemia with the parents of an adolescent who was admitted with the disease. Which complication would be of most concern for the parents? swelling of the hands and feet hemangiomas petechiae leg ulcers

leg ulcers In sickle cell anemia, sickling of red blood cells leads to increased blood viscosity and impaired circulation. Diminished peripheral circulation makes the adolescent or adult with sickle cell anemia susceptible to chronic leg ulcers. In children younger than age 2 who have sickle cell anemia (not adolescents), swelling of the hands and feet (hand-foot syndrome) commonly occurs during a vaso-occlusive crisis as a result of infarction of short tubular bones. Petechiae aren't associated specifically with sickle cell anemia. Hemangiomas, benign tumors of dilated blood vessels, aren't linked to sickle cell anemia.

A female adolescent client refuses to allow male nurses to care for her while she's hospitalized. Which of these health care rights is this adolescent exerting? right to have an advance directive on file right to privacy right to confidentiality of her medical record right to competent care

right to privacy This adolescent is exhibiting her right to privacy when she requests that she doesn't want a male nurse to care for her. She also has a right to competent care, the right to have an advance directive on file, and a right to confidentiality. However, she isn't exercising these rights in this scenario.

The health care provider (HCP) prescribes pulse assessments through the night for a school- age child with rheumatic fever who has a daytime heart rate of 120 bpm. The nurse explains to the parent that this is to evaluate if the elevated heart rate is caused by which factor? normal variations in day and evening hours routine activity during waking hours a warmer daytime environment the morning digitalis dose

routine activity during waking hours An above-average pulse rate that is out of proportion to the degree of activity is an early sign of heart failure in a client with rheumatic fever. The sleeping pulse is used to determine whether the mild tachycardia persists during sleep (inactivity) or whether it is a result of daytime activities. The environmental temperature would need to be quite warmer before it could influence the heart rate. Digitalis lowers the heart rate, so the rate would be decreased during the daytime.

The nurse assesses a male adolescent with severe abdominal pain. Which assessment finding should alert the nurse to suspect appendicitis? The abdomen appears slightly rounded. Bowel sounds are heard twice in 2 minutes. All four abdominal quadrants reveal tympany. The client demonstrates a cremasteric reflex.

Bowel sounds are heard twice in 2 minutes. Manifestations of appendicitis include decreased or absent bowel sounds. Normally, bowel sounds are heard every 10 to 30 seconds. Therefore, bowel sounds heard twice in 2 minutes suggest appendicitis. Normally, the contour of the male adolescent abdomen is flat to slightly rounded, and tympany is typically heard when auscultating over most of the abdomen. A cremasteric reflex is normal for male adolescents.

A nurse is preparing a health promotion program for teenagers focusing on lifestyle choices. Which of the following methods used by the nurse will best ensure the success of the program? validating the current lifestyle choices of the teenagers disclosing and explaining personal lifestyle choices creating a safe environment for sharing information reviewing data about common teenage lifestyle choices

creating a safe environment for sharing information Creating an environment where the teenagers feel safe to share their information leads to therapeutic communication that is client focused. This helps to establish trust, which facilitates a more successful program. The other options block the ability of the teenagers to share their thoughts and feelings openly.

An adolescent with insulin-dependent diabetes is being taught the importance of rotating the sites of insulin injections. The nurse should judge that the teaching was successful when the adolescent identifies which complication that can result from using the same site? thickening of the subcutis and too-rapid insulin uptake destruction of the fat tissue and poor absorption development of resistance to insulin and need for increased amounts damage to nerves and painful neuritis

destruction of the fat tissue and poor absorption Repeated use of the same injection site can result in atrophy of the fat in the subcutaneous tissue and lead to poor insulin absorption. The neuritis that develops from diabetes is related to microvascular changes that occur. Subcutaneous tissue may thicken and harden, but this leads to decreased, not rapid, insulin absorption. Resistance to insulin is caused by an immune response to the insulin protein.

The nurse is caring for a 15-year-old adolescent mother after birth. The adolescent lives at home with her parents and has a boyfriend who is also 15 years old. Neither is currently working, and they both have plans for higher education. When addressing the psychosocial issues that may occur after the birth of the child, which of the following would be the most important for the nurse to include in client teaching? inability to achieve educational goals potential rejection by the boyfriend dependence on parents after birth increased stress for new mothers

increased stress for new mothers The increased psychological stress experienced by new mothers is the priority. A young adolescent mother is faced with the overwhelming situation of caring for a newborn. All other options are relevant, but are not the priority.

A nurse is caring for a 14-year-old adolescent who states, "No one understands me." Which statement by the nurse best demonstrates empathy? "It's difficult to be a teenager. Tell me more about your experiences." "Explain why you think no one understands you. How can adults help?" "Let's talk about your future plans and which courses you enjoy." "Tell me about a time you felt your parents were understanding."

"It's difficult to be a teenager. Tell me more about your experiences." Empathy is the ability to put oneself in another's place and experience a feeling as that person is experiencing it. The correct answer acknowledges the adolescent's feelings and conveys an understanding without intimidating the client. Asking how adults can help and reflecting on parental understanding or favorite coursework is helpful overall but does not demonstrate empathy for the client.

A nurse is performing a psychosocial assessment on a 14-year-old adolescent. Which response to the assessment questions is not typical during early adolescence? "I'm sorry for how I acted earlier. Let's finish these questions." "If I sit through this whole appointment, what do I get out of it?" "I just want to go back to bed. When will this be done?" "These questions are so stupid. When can I leave?"

"I'm sorry for how I acted earlier. Let's finish these questions." Moodiness may occur often during early adolescence. Moodiness occurs due to immature cognitive control and emotional development. Essentially, early adolescent clients (age 10-14) have difficulty coping with emotions. These emotions are affected by the hormonal and maturing issues that occur during this time period. Anger and combativeness are more typical of middle adolescence. Cooperativeness typically occurs during late adolescence. Indications of depression are taken seriously and are not attributed to moody behaviors or statements.

An adolescent is brought to the emergency department in a coma and is diagnosed with diabetic ketoacidosis. What is the correct action for the nurse to take? Assess for Chvostek sign. Monitor for elevated sodium levels. Monitor for respiratory acidosis. Infuse intravenous fluids as prescribed.

Infuse intravenous fluids as prescribed. Dehydration results from the osmotic diuresis associated with hyperglycemia and polyuria. The client is at risk for shock from dehydration. Chvostek sign is exhibited by clients with hypocalcemia. Calcium and sodium are not concerningly altered in the acute phase of diabetic ketoacidosis (DKA). People experiencing DKA have classic metabolic acidosis manifestations with a low bicarbonate level. Eventually, the body should try to shift toward respiratory alkalosis to compensate.

The nurse discovers that an adolescent client with anorexia nervosa is taking diet pills rather than complying with the diet. What should the nurse do first? Talk with the client about how weight loss worries the health care providers (HCPs). Inquire about worries of the client's family concerning the client's health. Listen to the client discuss fears of losing control of eating while being treated. Explain to the client how diet pills can jeopardize health.

Listen to the client discuss fears of losing control of eating while being treated. A client with anorexia nervosa commonly has an extreme fear of not being able to control weight. The nurse should address this fear. Explaining the dangers of diet pills or discussing the HCP or family concerns focuses on the effect of the client's weight loss on other people rather than the client. Unless the client is motivated to stop, the client will likely not be successful.

When caring for an adolescent who is at risk for injury related to intracranial pathology, which action by the nurse would maintain stable intracranial pressure (ICP)? Keep the head of the bed at a 45- to 90-degree angle. Perform tracheal and oropharyngeal suctioning frequently. Adjust the room temperature to keep the room warm. Maintain the adolescent's head in midline position.

Maintain the adolescent's head in midline position. Elevating the head of the bed to 15 degrees while keeping the client's head in midline position will facilitate venous drainage and avoid jugular compression. Excessive suctioning and raising the head of bed to greater than 30 degrees for prolonged periods could increase pressure in the head and should be avoided. A 30- to 45-degree head elevation is allowed for brief periods. While shivering due to fever must be avoided, hyperthermia due to an overly warm room can increase metabolic demand by up to 10% per degree and cause vasodilation, further increasing ICP.

The nurse is teaching an adolescent with celiac disease about dietary changes that will help maintain a healthy lifestyle. Which of the following foods can the nurse safely recommend as part of the adolescent's diet? Select all that apply. bagels pizza potatoes corn apples

potatoes corn apples Celiac disease is an intolerance to the gluten factor of protein found in grains. Specific grains to be removed from the diet include wheat, rye, oats, and barley. Clients with a diagnosis of celiac disease can tolerate corn, fruits, and vegetables.

An adolescent, age 14, is hospitalized for nutritional management and drug therapy after experiencing an acute episode of ulcerative colitis. Which nursing intervention is appropriate? providing high-fiber snacks administering antibiotics with meals as ordered administering digestive enzymes before meals as ordered providing small, frequent meals

providing small, frequent meals Clients with ulcerative colitis, an inflammatory bowel disorder (IBD), tolerate small, frequent meals better than a few large meals daily. Eating large amounts of food may exacerbate the abdominal distention, cramps, and nausea IBD typically causes. Frequent meals also provide the additional calories needed to restore nutritional balance. This adolescent doesn't lack digestive enzymes and therefore doesn't need enzyme supplementation. Antibiotics are contraindicated because they may interfere with the actions of other ordered drugs and because ulcerative colitis isn't caused by bacteria. High-fiber foods may irritate the bowel further.

The nurse assesses an adolescent client with lethargy, retractions of the intercostal spaces, a persistent expiratory wheeze, diminished breath sounds, tachycardia, and tachypnea. Arterial blood gas results are pH 7.10; PCO2 80 mm Hg (10.64 kPa); PO2 35 mm Hg (4.66 kPa), HCO3 29 mEq/l (29 mmol/l). What is the priority condition the nurse must address? change in mental status breathing pattern increased heart rate respiratory acidosis

respiratory acidosis Based on the results of the arterial blood gases, this client is in respiratory acidosis. The nurse must address this quickly because it could lead to respiratory failure. If the nurse addresses the respiratory acidosis quickly, which means also addressing the cause of the imbalance, the client may not experience respiratory failure. Additionally, assessment data, vital signs, and laboratory work will begin to normalize.

The nurse assesses a teenage girl's musculoskeletal system. According to the figure, the nurse should note that the girl which condition? scoliosis lordosis kyphosis spondylolisthesis

scoliosis The teenage girl has scoliosis, the lateral deviation of the spine. Kyphosis is noted by a forward curvature of the shoulders. Lordosis is an inward curvature of the lower back. Spondylolisthesis is a slipping of the vertebrae out of position. Pain is the main finding with this condition, not curvature of the spine.

An adolescent with ulcerative colitis who is taking corticosteroids is at risk for which complication? decreased bowel sounds delayed sexual maturation perianal lesions jaundice

delayed sexual maturation In children and adolescents with ulcerative colitis, frequent diarrhea and poor nutrient absorption from the bowel lead to malnutrition. Nausea, vomiting, and anorexia may further compromise nutritional status. Malnutrition, in turn, may cause growth restriction and delayed sexual maturation. Corticosteroid therapy, which is commonly used to treat ulcerative colitis, may also cause growth retardation and delayed sexual maturation. Jaundice isn't associated with ulcerative colitis. Because this disease causes increased bowel motility, bowel sounds may be hyperactive, not decreased. Perianal lesions are rare in clients with ulcerative colitis.

According to Erikson, the psychosocial task of adolescence is the development of a sense of identity. A nurse can best promote the development of a hospitalized adolescent by: arranging for tutoring in school work. emphasizing the need to follow the facility regimen. encouraging peer visitation. allowing parents and siblings to visit frequently.

encouraging peer visitation. Peer visitation gives the adolescent an opportunity to continue along the path toward independence and identity. Knowledge of the facility regimen prepares the adolescent for upcoming procedures but doesn't affect development. To achieve a sense of identity, the adolescent must gain independence from family. Tutoring may help maintain a positive self-image relative to schoolwork but doesn't affect development.

An adolescent is diagnosed with iron deficiency anemia. After emphasizing the importance of consuming dietary iron, the nurse asks the client to select iron-rich breakfast items from a sample menu. Which selection demonstrates knowledge of dietary iron sources? grapefruit and white toast bagel and cream cheese ham and eggs pancakes and a banana

ham and eggs Good sources of dietary iron include red meat, egg yolks, whole wheat breads, seafood, nuts, legumes, iron-fortified cereals, and green, leafy vegetables. Fresh fruits and milk products contain only small amounts of iron. White bread isn't a good iron source.

A 14-year-old brought to the emergency department with right lower quadrant pain is tentatively diagnosed with acute appendicitis. The nurse should further assess the client for which sign or symptom? low-grade fever costovertebral angle tenderness gross hematuria widening pulse pressure

low-grade fever The most common manifestations of appendicitis include right lower quadrant pain, localized tenderness, and a low-grade fever. Other signs of inflammation, including increased pulse and respiratory rates, may be present. Costovertebral angle tenderness and gross hematuria are associated with urologic problems. Widening pulse pressure is seen in increased intracranial pressure.

The nurse is caring for an adolescent who has been admitted several times with uncontrolled type 1 diabetes. The child is now stabilized and is preparing for discharge. What should be the priority focus for the nurse when conducting discharge teaching? risk for injury and readmission relocating closer to the hospital management of the therapeutic regimen coping with a chronic disease

management of the therapeutic regimen The priority immediately after recovery is therapy management, including reviewing that the interruption of insulin administration may result in diabetic ketoacidosis. The multiple admissions suggest that the adolescent either does not understand the consequences of the disease or is making choices that are not consistent with the health teaching. This is an opportunity to review those choices.

An adolescent client scheduled for an emergency appendectomy is to be transferred directly from the emergency department to the operating room. Which statement by the client should the nurse interpret as most significant? "I feel like I am going to throw up." "It hurts when you press on my stomach." "All of a sudden, it does not hurt at all." "The pain is centered around my navel."

"All of a sudden, it does not hurt at all." Sudden relief of pain in a client with appendicitis may indicate that the appendix has ruptured. Rupture relieves the pressure within the appendix but spreads the infection to the peritoneal cavity. Periumbilical pain (pain centered around the navel), vomiting, and abdominal tenderness on palpation are common findings associated with appendicitis.

A 15-year-old adolescent confides in the nurse that the adolescent has been contemplating suicide. The adolescent has developed a specific plan to carry it out and pleads with the nurse not to tell anyone. What is the nurse's best response? "I will need to notify the local authorities of your intentions." "We can keep this between you and me, but promise me you won't try anything." "For your protection, I can't keep this secret. After I notify the physician, we will need to involve your family. We want you to be safe." "I need to protect you. I will tell your physician, but we don't need to involve your parents. We want you to be safe."

"For your protection, I can't keep this secret. After I notify the physician, we will need to involve your family. We want you to be safe." In situations in which a client is a threat to self, the nurse can't honor confidentiality. Because this adolescent has a specific plan to commit suicide, the nurse must take immediate action to ensure the adolescent's safety. The physician and mental health professionals should be notified as well as the client's family. The nurse should inform the adolescent that this is necessary, while at the same time conveying a sense of caring and understanding. The local authorities needn't be notified in this situation.

A 13-year-old girl is being evaluated for possible Crohn's disease. She is about to undergo a colonoscopy with biopsy. While teaching about the diagnosis, the nurse is asked whether the client's delayed puberty is a result of the disease process. Which is the nurse's best response? "Yes, Crohn's disease often causes delayed puberty." "No definitive diagnosis has been made yet; it's best to wait until testing is complete." "You'll have to ask the doctor." "She is too young to be diagnosed with delayed puberty."

"No definitive diagnosis has been made yet; it's best to wait until testing is complete." Although Crohn's disease may cause growth failure or delayed puberty, the client has not actually been diagnosed with anything yet; therefore, it cannot be said definitively that Crohn's is the culprit, if indeed puberty is delayed. Median age for menarche in the United States is 10.4 years; secondary sex characteristics should precede or follow within a few months. If Crohn's is diagnosed, other appropriate testing can follow if indicated.

The nurses discusses the onset of pubescence with parents. The nurse should explain that pubescence occurs at what time? 1 to 2 years earlier in boys than in girls same age for both boys and girls 1 to 2 years earlier in girls than in boys 3 to 4 years later in boys than in girls

1 to 2 years earlier in girls than in boys Girls experience the onset of puberty about 1 to 2 years earlier than boys. The reason for this is not understood.

An adolescent sustains a head injury and develops diabetes insipidus. The healthcare provider orders desmopressin, 10 mcg subcutaneously. When does the nurse assess the client to determine the need for an additional dose? 15 to 30 minutes 4 to 7 hours 2 to 4 hours 30 minutes to 2 hours

4 to 7 hours The minimum required dose is given to avoid water retention and hyponatremia. Control of polyuria and electrolytes is the goal. Another dose is not administered until the client has another episode of brisk polyuria and diuresis, indicating the initial dose is no longer effective. The drug's half life via this route is 3 hours, indicating the drug will stop working in about 6 hours.

Client is a 13-year-old who presented to the emergency department after suffering a sports related injury. Client's left forearm is significantly larger than left due to swelling and tissue damage. Bone is protruding through skin with bleeding. Capillary refill: 1 second in affected extremity. Client rates pain as a 10 (1 = no pain, 10 = worst pain). Which nursing interventions are appropriate for this client? Select all that apply. Elevate affected limb Apply a sterile wound dressing Administer fluid replacement Prepare for aspirin therapy to prevent clotting Apply splint below suspected fracture Apply cold pack to affected area Apply direct pressure to wound Educate on possible need for tetanus prophylaxis Administer analgesics

Administer analgesics Elevate affected limb Apply direct pressure to wound Administer fluid replacement Apply a sterile wound dressing Educate on possible need for tetanus prophylaxis The nurse will need to know the appropriate nursing interventions for the client experiencing an open fracture. Since the client rated pain as 10 out of a 10, it is appropriate to administer analgesics for pain (limit opioid use). The affected limb should be elevated to assist with pain, bleeding, and swelling. Direct pressure should be applied to the wound to aid in controlling bleeding. Fluid replacement should be administered as ordered to prevent hypovolemic shock from bleeding. Apply a sterile wound dressing as ordered to cover open fracture. The client and the client's parents should be educated on the possible need for tetanus prophylaxis due to open fracture. It is appropriate to apply a cold pack to the affected area if the fracture is closed; however, with an open fracture you should not as it could decrease needed blood flow to the affected area. Aspirin therapy would be contraindicated due to the client's open wound and bleeding. There is a low risk of thrombus formation, therefore, anticoagulants are not required. The splint should be applied above and below the affected area, not just below.

Which suggestion should the nurse give to an adolescent athlete with Osgood-Schlatter disease of the left knee? Stop playing until healing has occurred. Apply ice on the knee after playing. Use crutches until healing has occurred. Make an appointment with a physical therapist.

Apply ice on the knee after playing. Most adolescents with Osgood-Schlatter disease are able to continue to exercise and use ice afterward. Ibuprofen also may be prescribed. Because Osgood-Schlatter disease is self-limited, crutches or physical therapy are usually unnecessary, and the adolescent usually does not need to stop playing sports. Only in severe cases would the adolescent have to stop playing sports.

A 17-year-old client confides in the school nurse an interest in understanding safe sex practices. In instructing the client on how to correctly use a condom, which information would be stressed? Select all that apply. Condoms should be stored in a cool, dry place to prevent damage. The condom should be applied on an erect penis. Never reuse a condom. A condom only needs to be placed on the penis immediately before ejaculation. Leave a 1/2-inch space at the tip of the condom. SUBMIT ANSWER

Condoms should be stored in a cool, dry place to prevent damage. Leave a 1/2-inch space at the tip of the condom. Never reuse a condom. The condom should be applied on an erect penis. With proper instruction and use, condoms can be a reliable method of birth control and STI prevention. Condoms should be stored in a cool, dry place to prevent heat damage. A 1/2-inch space should be left at the tip of the condom to allow for collection of the ejaculate and to prevent tearing of the condom. A condom is applied after the penis is erect but before insertion into the partner. A condom should not be reused.

The parents of a 15-year-old state that their child is moody and rude. What should the nurse advise the parents to do? Obtain family counseling. Restrict their child's activities. Talk to other parents of adolescents. Discuss their feelings with their child.

Discuss their feelings with their child. Parents need to discuss with their adolescent how they perceive their behavior and how they feel about it. Moodiness is characteristic of adolescents. The adolescent may have a reason for or not be aware of their behavior. Restricting the adolescent's activities will not change their mood or the way they respond to others. It may increase their unacceptable responses. Counseling may not be needed at this time if the parents are open to communicating and listening to the adolescent. Talking to other parents may be of some help, but what is helpful to others may not be helpful to their child.

The nurse is caring for an adolescent with cancer who is well informed about the medical condition and treatment. The adolescent refused the morning medications and states intentions of refusing all future medications. What is the best action by the nurse? Persuade the adolescent to take the medication as ordered. Document the adolescent's choice and offer to discuss feelings about the medication. Ask the adolescent's parents to encourage the adolescent to take the medication. Ensure that the adolescent understands the rationale for taking the medication.

Document the adolescent's choice and offer to discuss feelings about the medication. The client has the right to choose whether to take the medication. The nurse should try to determine the reason for the adolescent not wanting the medication other than choice (e.g., side effects, fear of falling asleep and not waking). The other options do not support the autonomy of the adolescent to make an informed decision.

An adolescent in the terminal stage of leukemia cries out for more pain medicine. What is the best action for a nurse to take in caring for this dying adolescent? Withhold medication because the adolescent has a low pain threshold. Withhold pain medication because the adolescent may become addicted to it. Maintain a strict medication administration schedule. Give the adolescent more pain medication to control pain and suffering.

Give the adolescent more pain medication to control pain and suffering. The adolescent is in severe pain and requires more pain medication. The goal of treatment at this stage of terminal cancer is to make the adolescent as comfortable as possible. Increased tolerance and addiction potential aren't concerns. Strict timing of medication administration doesn't always coincide with an individual's fluctuating pain. The nurse should give the medication even if the adolescent's need for it doesn't match the administration schedule. Pain is what a client says it is; a nurse shouldn't withhold medication or make judgments about a client's pain threshold.

An adolescent female arrives in the emergency department after a physical assault. How could the male nurse best protect the client's rights during the physical examination? Leave the door open. Have a female health care worker present. Keep the suspected attacker away from the examination room. Keep the client's friends (who are waiting in the lounge area) informed of her medical condition.

Have a female health care worker present. A female health care provider should be present to observe an examination performed by a male health care provider. Leaving the door open and informing the client's friends about her condition violates her right to privacy and confidentiality. Although the suspected attacker should be kept away from the examination room, having a female health care worker present during the examination best protects the girl's rights.

A 15-year-old with acute lymphocytic leukemia has been caught hiding her oral chemotherapy each morning. Which nursing intervention will improve compliance? Have the child meet teenage survivors of cancer who were compliant with treatment. Notify the physician to talk to the teenager and the family about compliance. Give written and internet resources of information about the disease process and implications of noncompliance. Discuss the noncompliance with the parents, child, and physician, setting limits and taking away privileges until the child complies.

Have the child meet teenage survivors of cancer who were compliant with treatment. Have the teenager talk to other teenagers who are going through similar experiences. Talking to age-appropriate peers will make a bigger impact than trying to force the teenager to conform.

The parents of teenagers express concerns about the types and large quantities of food their children eat and their refusal to eat foods served at family meals. Which suggestion would be most helpful for the parents? Inform the adolescents about the adverse effects of fad diets. Incorporate the adolescents' preferences into meal planning. Give the adolescents responsibility for grocery shopping for 1 month. Carefully evaluate the adolescents' nutritional intake.

Incorporate the adolescents' preferences into meal planning. Preventing food intake from becoming the center of an independence-dependence struggle is important. Nursing responsibilities include helping parents realize that adolescents require a high caloric intake and they need to make individual decisions. Adolescents are subject to peer pressure that commonly supersedes family pressure for a healthy diet.The parents have already evaluated their adolescents' diet, as evidenced by their concerns.Although the adolescents should be informed about the adverse effects of fad diets, doing so does not ensure the adolescents' adequate nutritional intake.Responsibility for grocery shopping for a month may encourage independence but does not ensure adequate nutritional status.

The nurse is teaching an adolescent how to self-administer insulin. Which of the following is a priority for the nurse to emphasize about insulin administration? Insulin injections are administered in subcutaneous tissue. Meal sizes are not usually considered when determining insulin needs. Activity levels rarely determine insulin requirements. The need for insulin always decreases when strenuous sports are played.

Insulin injections are administered in subcutaneous tissue. The goal of the session is self-administration, so the information related to actually administering insulin is prioritized (i.e., information that insulin is always self-administered subcutaneously). Too much information at one session will confuse the client. A separate session should be dedicated to insulin dosing concerns, which are the other three choices.

An adolescent presents with a large round ring with a swollen border on the left arm. The adolescent often plays ball games in a field behind the school. What condition does the nurse suspect? actinic keratosis cellulitis Lyme disease impetigo

Lyme disease Lyme disease, which results from a tick bite, is characterized by a large round ring with a raised swollen border at the site of the bite. Treatment at this stage can prevent systemic involvement that could lead to cardiac, neurologic, and musculoskeletal symptoms. Impetigo is a clustering of vesicles that ooze and form a crust on the skin. Cellulitis is caused by a microorganism entering through broken skin, resulting in red, painful, swollen skin that is hot and tender. Actinic keratosis appears on sun-exposed surfaces like the arms and neck and causes thick, scaly, and discolored skin that is sometimes red or pink.

An adolescent tells the nurse that they would like to use tampons during their period. What should the nurse do first? Assess the client's usual menstrual flow pattern. Provide information about preventing toxic shock syndrome. Determine whether the client is sexually active. Refer the client to a specialist in adolescent gynecology.

Provide information about preventing toxic shock syndrome. The nurse should provide the adolescent with information about toxic shock syndrome because of the identified relationship between tampon use and the syndrome's development. Additionally, about 95% of cases of toxic shock syndrome occur during menses. Most adolescent females can use tampons safely if they change them frequently. Using tampons is not related to menstrual flow or sexual activity. There is no need to refer the girl to a gynecologist; a nurse can provide health teaching about tampon use.

A 15-year-old adolescent is admitted to the telemetry unit because of suspected cardiac arrhythmia. A nurse applies five electrodes to the client's chest and then attaches the lead wires. Identify the area where the nurse should place the chest lead (V1).

The nurse should place the V1 lead in the fourth intercostal space to the right of the sternum.

The nurse is preparing a presentation on nutrition to a group of pregnant adolescents. Which information would be important for the nurse to include in the teaching plan? Two to four servings of whole-grain products is recommended. Three or more servings of dairy products meet the calcium requirement. Vitamin A supplements may be necessary for clients who are vegetarian. Spinach is an excellent source of calcium in the diet.

Three or more servings of dairy products meet the calcium requirement. Three or more servings of dairy products meet the calcium requirement. These can be obtained through milk, cheese, yogurt, and foods such as tofu.Spinach contains oxalates, which decrease the availability of calcium. Six to eleven servings of whole grains are recommended.Vitamin A supplements are not necessary in vegetarian diets because most vegetarian diets are rich in vitamin A. Vitamin A supplements can lead to anorexia, irritability, hair loss, and damage to the fetus.

A nurse is assessing a severely depressed adolescent. Which finding indicates the highest risk of suicide? refusal to interact with others altered speech excessive sleepiness a preoccupation with death

a preoccupation with death An adolescent who demonstrates a preoccupation with death (such as by talking frequently about death) should be considered at high risk for suicide. Although excessive sleepiness, altered speech, and voluntary seclusion may occur in suicidal adolescents, they also occur in adolescents who aren't suicidal. Verbal and emotional withdrawal and slowed speech are signs of possible depression; however, a focus on death is most concerning.

A nurse is preparing to administer the first dose of tobramycin to an adolescent with cystic fibrosis. The order is for 3 mg/kg I.V. daily in three divided doses. The client weighs 95 lb (43.2 kg). How many milligrams should the nurse administer per dose? Record your answer using one decimal place.

43.2 To perform this dosage calculation, the nurse should calculate the client's daily dose using this formula:43.2 kg × 3 mg/kg = 129.6 mgLastly, the nurse should calculate the divided dose:129.6 mg ÷3 doses = 43.2 mg/dose

An adolescent with pneumonia shares fears of having contracted human immunodeficiency virus (HIV). The adolescent wants to be tested but does not want parental involvement. What should the nurse say? "The healthcare provider will run the test confidentially." "Tell me why you think you may have contracted HIV." "You're very young to have HIV." "You'll have to talk with the hospital's nurse ethicist."

"The healthcare provider will run the test confidentially." Federal laws state that adolescents may be tested for sexually transmitted diseases without their parents' permission. The rules of confidentiality apply to this adolescent. The adolescent doesn't have to speak with anyone before the test. HIV can be contracted at any age, even during infancy and childhood. Asking why the client thinks HIV is possible may exhibit therapeutic communication, but it does not address the client's concern.

Family members and friends stage an intervention for an alcoholic adolescent. The intervention is successful when the adolescent: is motivated to enter an alcohol rehabilitation program. breaks down and cries. is willing to talk with the friends. says, "I'm sorry. I'll never drink again."

is motivated to enter an alcohol rehabilitation program. Willingness to enter a rehabilitation program indicates that the adolescent is motivated to change. An intervention is an emotionally charged meeting; crying may be an indication of manipulation, rather than a sign that the intervention has succeeded. Relapses are common among alcoholics who simply stop drinking; success in overcoming alcoholism is more likely when a structured program is part of the rehabilitation process. Talking with friends doesn't indicate a successful intervention.

The nurse counsels an obese adolescent. The nurse should advise the client that which complication is the most common? gastrointestinal problems orthopedic problems lifelong obesity psychosocial problems

lifelong obesity The most common complication of adolescent obesity is its persistence into adulthood. The incidence of gastrointestinal and orthopedic problems, such as Legg-Calvé-Perthes disease and genu valgum (knock knees), is greater for obese adolescents; however, they are not the most common complication. Although psychosocial problems do occur, they are not the most common complication.

An adolescent is admitted for treatment of bulimia nervosa. When developing the care plan, the nurse anticipates including interventions that address which metabolic disorder? hypoglycemia hyperkalemia metabolic acidosis metabolic alkalosis

metabolic alkalosis In a client with bulimia nervosa, metabolic alkalosis may occur secondary to hydrogen loss caused by frequent, self-induced vomiting. Typically, the blood glucose level is within normal limits, making hypoglycemia unlikely. In bulimia nervosa, hypokalemia is more common than hyperkalemia and typically results from potassium loss related to frequent vomiting.

A nurse is caring for a 16-year-old male client who needs an appendectomy. His parents are not present at the hospital. Prior to the surgery, the nurse needs to ensure that informed consent is obtained. Which situations allows the healthcare provider to obtain an informed consent from an adolescent? The adolescent has declared himself emancipated. The adolescent is under the protection of a court guardian. The adolescent has a power-of-attorney document. The adolescent is the appropriate age to sign an informed consent.

The adolescent has declared himself emancipated. Individuals under the age of 18 need a parent or guardian to provide an informed consent, unless the individual is an "emancipated minor," an adolescent who is legally recognized as an adult. Otherwise, an adolescent is considered a minor until his 18th birthday. The power-of-attorney document allows another individual who is over the age of 18 to make decisions.

An adolescent with type 1 diabetes is experiencing a growth spurt. Which treatment approach would be most effective? substituting an oral antidiabetic agent for insulin administering insulin once per day limiting dietary fat intake administering multiple doses of insulin

administering multiple doses of insulin During an adolescent growth spurt, a regimen of multiple insulin doses achieves better control of the blood glucose level because it more closely simulates endogenous insulin release. A single daily dose of insulin wouldn't control the blood glucose level as effectively. Limiting dietary fat intake wouldn't help the body use glucose at the cellular level. An adolescent with type 1 diabetes doesn't produce insulin and therefore can't receive an oral antidiabetic agent instead of insulin.

An adolescent who is immobilized in a cast to stabilize a recent fractured femur suddenly develops chest pain, dyspnea, diaphoresis, and tachycardia. The nurse should further assess the client for what condition? atelectasis pulmonary emboli pneumonia pulmonary edema

pulmonary emboli Chest pain and dyspnea in an immobilized adolescent with a large bone fracture suggest a fat embolus. With this condition, fat droplets, rather than a thrombus, are transferred from the marrow into the general blood stream by the venous-arterial route, possibly reaching the lung or brain. Atelectasis may develop; however, the onset of signs and symptoms is usually more gradual and subtler. Pneumonia can occur; however, the signs and symptoms usually do not develop suddenly. Pulmonary edema should not be a problem in a healthy adolescent who has sustained a fracture.

When assessing a 17-year-old client with depression for suicide risk, which question would be best? "Are you thinking about killing yourself?" "Has anyone in your family ever committed suicide?" "What movies about death have you watched lately?" "Can you tell me what you think about suicide?"

"Are you thinking about killing yourself?" Asking whether the client is thinking about killing herself is the most direct and therefore the best way to assess suicide risk. Knowing whether the client has recently watched movies on suicide and death, what the client thinks about suicide, or about previous suicides of family members will not tell the nurse whether the client herself is thinking about committing suicide right now.

The nurse cares for an adolescent who has just returned to their room after an open appendectomy. What would the nurse expect as a normal response from an adolescent? "I do not want to have any pain." "What will my friends say about the scar?" "I am worried about the size of my scar." "I will need plastic surgery for this scar."

"I am worried about the size of my scar." Adolescents are concerned about the immediate state and functioning of their bodies. The adolescent needs to know whether any changes (e.g., illness, trauma, surgery) will alter their lifestyle or interfere with their quest for physical perfection. Having a scar may be devastating to the adolescent. The need for plastic surgery cannot be determined at this point. The adolescent has just returned from surgery and has yet to see the scar. Healing has yet to occur. Typically, scars become smaller and fade over time. The desire for no pain is unrealistic. Although adolescents are worried about pain and how they will respond, they typically are discharged within 24 hours after an appendectomy with pain well controlled by oral analgesics. The immediate concern of adolescents is the state and functioning of their bodies. After concerns about themselves, then adolescents are concerned about their peer group and their responses. Although friends' responses will matter, this concern would be more common later in the course of the adolescent's recovery.

An athletic teenager who is diagnosed with infectious mononucleosis is told to avoid contact sports for 3 to 4 weeks. The teenager protests to the nurse and demands to know why sports must be avoided for so long. What is the best response by the nurse? "Your spleen is enlarged from your illness and could easily rupture with an injury." "This helps prevent transmission of the infection to your teammates." "Your illness causes fatigue and it's best for you to rest while recovering." "Vigorous activity can further weaken your immune system."

"Your spleen is enlarged from your illness and could easily rupture with an injury." In a client with infectious mononucleosis, the spleen enlarges, and the individual is at risk for a spontaneous rupture with any trauma to the area. The client is placed on bed rest during the acute phase of illness, which usually lasts about 7 to 10 days, and should avoid contact sports for 3 to 4 weeks to prevent this complication.

A school nurse is planning a program for parents on "Drugs Commonly Abused by Teenagers". Which information should be included about inhalants? Select all that apply. The basic groups of inhalants are hydrocarbon solvents such as glue, aerosol propellants from spray cans, and anesthetics/gases. Use of inhalants by teens is on the decline. Brain damage is unlikely with the use of inhalants. Deaths from inhalants occur from asphyxiation, suffocation, and aspiration of vomit. Monitor for paper bags and rags that may have been used for breathing inhalants. Inhalants usually cause depression of the central nervous system.

Monitor for paper bags and rags that may have been used for breathing inhalants. Deaths from inhalants occur from asphyxiation, suffocation, and aspiration of vomit. Inhalants usually cause depression of the central nervous system. The basic groups of inhalants are hydrocarbon solvents such as glue, aerosol propellants from spray cans, and anesthetics/gases. The nurse should instruct the parents to monitor their children for use of paper bags or rags. The nurse should present information about brain damage from inhalants including damage to the frontal lobe, cerebellum, and hippocampus, and that death is possible. Rather than use being on the decline, teenagers are experimenting even more with many types of inhalants, such as Freon, ground-up candy disks, and spray cleaners for computer and TV screens.

An adolescent is being seen in the clinic for abdominal pain with a fever. In what order should the nurse assess the abdomen? All options must be used.

inspect auscultate percuss palpate The nurse should first inspect the abdomen for abnormalities. Auscultation should be done before percussion and palpation as vigorous touching may disturb the intestines. Percussion is next. Palpation is the last step as it is most likely to cause pain.

The nurse is providing an education program to a group of adolescents on the importance of testicular self-examinations. One of the participants asks the nurse, "when is the best time to do the examination?" What is the best response by the nurse? in the evening prior to going to bed prior to urinating in the morning when you first arise in the morning when you are in the shower or immediately after

when you are in the shower or immediately after Testicular cancer occurs most frequently between the ages of 15 and 34; therefore, boys should begin doing testicular self-examinations at age 12, which will help them become familiar with the normal contours and consistency of their genital structures. The nurse should inform the group that the best time to perform a testicular self-examination is in the shower or immediately afterward because the scrotum is relaxed. When the male first rises in the morning, in the evening, or prior to urinating, the scrotum is not in the optimal condition for the examination.

Which statement by an adolescent receiving gentamicin should the nurse interpret as indicating drug toxicity? "I urinate a lot now." "I haven't moved my bowels in 3 days." "I'm feeling dizzy." "I have no appetite."

"I'm feeling dizzy." Gentamicin sulfate is a broad-spectrum aminoglycoside antibiotic that can cause nephrotoxicity and ototoxicity. Manifestations of ototoxicity include hearing problems and vestibular disturbances, such as dizziness.Anorexia may occur; however, it is not indicative of gentamicin toxicity.Frequent urination is more commonly associated with diuretic therapy. If nephrotoxicity were occurring, the client probably would report a decrease in urination.No bowel movement in 3 days suggests constipation, which is more commonly related to the use of opioid analgesics.

A 12-year-old client says, "Give me my pajamas. I'm not putting your silly gown on." What is the most appropriate response by the nurse? "You're upset because you feel awkward and embarrassed in these gowns." "You're upset because you think we're unreasonable." "I know they're funny, but everyone here wears them." "You don't mean that, now. A big guy like you knows how hospitals are."

"You're upset because you feel awkward and embarrassed in these gowns." The nurse uses active listening in which the client's feelings are reflected back to the client. Telling the client that everyone wears the gown does not consider the client's feelings. Telling the client that what he said is not what he meant discounts the validity of his statement. Interpreting the client's statement as meaning that the client thinks the rule is unreasonable does not take into account how wearing the gown affects the client personally.

An adolescent becomes increasingly withdrawn, is irritable with family members, and has been getting lower grades in school. After giving away a stereo and some favorite clothes, the adolescent is brought to the community mental health agency for evaluation. Which aspect of the adolescent's behavior is most suggestive of suicide? The adolescent is exhibiting a suicide gesture. The adolescent has expressed a suicidal threat. The adolescent is expressing suicidal ideations. The adolescent has a suicide plan.

The adolescent has a suicide plan. Changes in academic performance and familial communications, social withdrawal, and giving away treasured possessions suggest that this adolescent is contemplating suicide; thus, a plan has been developed. There is no evidence that a suicide gesture (e.g., cutting), ideation, or threat has been expressed.

An adolescent client is admitted to the hospital with the diagnosis of acute lymphocytic leukemia. Which finding requires the most urgent nursing intervention? enlarged liver and spleen fatigue and anorexia swollen neck lymph glands and lethargy fever and petechiae

fever and petechiae Fever and petechiae associated with acute lymphocytic leukemia indicate suppression of normal white blood cells and thrombocytes by the bone marrow and put the client at risk for other infections and bleeding. The nurse should initiate infection control and safety precautions to reduce these risks. Fatigue is a common symptom of leukemia due to red blood cell suppression. Although the client should be told about the need for rest and meal planning, such teaching is not the priority intervention. Swollen glands and lethargy may be uncomfortable, but they do not require immediate intervention. An enlarged liver and spleen require safety precautions that prevent injury to the abdomen; however, these precautions are not the priority.

A nurse interviews the parent of a middle school student who is exhibiting behavioral problems, including substance abuse, following a sibling's suicide. The parent says, "I'm a single parent who has to work hard to support my family, and now I've lost my only son, and my daughter is acting out and making me crazy! I just can't take all this stress!" Which issue is the priority? the adolescent's anger potential suicidal thoughts/plans of both family members the parent's ability to emotionally support the adolescent in this crisis the parent's frustration

potential suicidal thoughts/plans of both family members The parent's expression of stress and grief and the adolescent's behavior and drug use could be preludes to suicide, especially since another member of the family succeeded in suicide. Suicide attempts are more likely in families in which there has been a previous suicide attempt or suicide death, especially for young people.The parent's ability to emotionally support the adolescent in this crisis has been compromised, but the safety of both supersedes this concern.Assuring the client's and parent's safety is more important than dealing with anger or frustration at this point.Though the emotional states of both the parent and the child are important, one is not more important than the other.

Several high-school seniors are referred to the nurse because of suspected alcohol misuse. When the nurse assesses the situation, what would be most important to determine? the type of alcohol they usually drink what they know about the legal implications of drinking the reasons they choose to use alcohol when and with whom they use alcohol

the reasons they choose to use alcohol Information about why adolescents choose to use alcohol or other drugs can be used to determine whether they are becoming responsible users or problem users. The senior students likely know the legal implications of drinking, and the nurse will establish a more effective relationship with the students by understanding their motivations for use. The type of alcohol and when and with whom they are using it are not the first data to obtain when assessing the situation.

A 15-year-old girl visits the neighborhood clinic seeking information on "how to keep from getting pregnant." What should the nurse say in response to her request? "What would you like to know?" "Can you tell me if you've told your parents you're having sex?" "Can you tell me about the precautions you're taking now?" "Let's discuss what your friends are doing to keep from getting pregnant."

"Can you tell me about the precautions you're taking now?" An attitude that requests only the information the girl is willing to give is nonthreatening and nonjudgmental. This may enhance the girl's willingness to talk about her experiences, thus enabling the nurse to better assess her needs. Asking what the girl would like to know assumes the girl knows what information she needs. The precautions her friends are taking are irrelevant at this time. Referencing the girl's parents may make her defensive and fearful.

The parents of a pregnant adolescent are outraged that they are being refused medical information about their daughter's condition. What is the best response by the nurse to address their anger? "Your daughter's medical information is confidential." "Your daughter is not ready to share her health information." "I understand your concerns, but she is responsible for her own health." "If we obtain permission from her, we can include you in our discussions."

"If we obtain permission from her, we can include you in our discussions." The reality of this situation is that the parents may be included in the exchange of medical information but only with the daughter's consent. Sharing that fact with the parents clearly identifies that the decision is the daughter's to make and that she is entitled to make it. The nurse must support the client's right to privacy and confidentiality. The client is responsible for her own health, and her information is confidential, but stating these facts does not adequately address the parents' concern. The client may not be ready to share any information, but this does not help the parents understand what is occurring. It is best to simply explain that the client's permission is necessary in order to include the parents in the sharing of medical information.

When developing the teaching plan for an adolescent with insulin-dependent diabetes, the nurse should include what information about the relationship between exercise, diet, and insulin? "You'll need to take extra insulin before you go running." "Don't eat your snack before running because you'll get a stomachache." "Before running, inject your insulin into the leg muscle for quicker absorption." "If your blood glucose is 240 mg/dL (13.3 mmol/L) or above, do not run."

"If your blood glucose is 240 mg/dL (13.3 mmol/L) or above, do not run." Strenuous exercise, such as running, should be avoided if the adolescent's blood glucose level is 240 mg/dL (13.3 mmol/L) or above because it places the client at risk for hypoglycemia. When insulin levels are not adequate, the cells cannot receive glucose, even though the blood glucose level is high. With low insulin levels, glucagons act to increase hepatic glucose production, thus raising the blood glucose level, which cannot be used at the muscle site. Taking extra insulin prior to strenuous exercise also increases the risk of hypoglycemia. Vigorous muscle contraction increases local blood flow and absorption of insulin injected into that area. Because exercise decreases blood glucose levels, snacks should be given before strenuous exercise to prevent hypoglycemia. If the adolescent cannot tolerate the extra needed food, insulin dosage may have to be reduced.

An adolescent client who has been taking an antidepressant for 6 weeks has returned to the clinic for a medication check. When the nurse talks with the client and her parent, the mother reports that she has to remind the client to take her antidepressant every day. The client says, "Yeah, I'm pretty bad about remembering to take my meds, but I never miss a dose because Mom always bugs me about taking it." Which response would be effective for the nurse to make to the client? "It's a good thing your mom takes care of you by reminding you to take your meds." "It seems there are some difficulties with being responsible for your medications that we need to address". "You'll never be able to handle your medication administration at college next year if you are so dependent on her." "I'm surprised your mother allows you to be so irresponsible."

"It seems there are some difficulties with being responsible for your medications that we need to address". The client and mother need to address the issue of responsibility for medication administration. Reinforcing the mother's over involvement in medication taking or making negative comments about the client and mother are unlikely to engage them in problem solving about the matter.

A new client has just been admitted to an adolescent psychiatric inpatient unit. The charge nurse and an unlicensed assistive personnel (UAP) are discussing the client's needs. The UAP says, "She is just showing off to try and get our sympathy. There is no need for her to cut herself. Why would adolescents want to do such a thing to themselves?" What response by the charge nurse would most help the UAP understand the client and her illness? "It's hard to see a young person harm herself as she does, but she has serious family issues and doesn't know better ways to handle them, so we have to help her with that." "She's not doing the cutting for attention since she always wears clothing that covers up her injuries, and further, she's not willing to talk about it." "You don't understand her problems and don't take them seriously, so you shouldn't be allowed to work with her during her hospitalization." "Perhaps you should transfer to another unit where you are able to have empathy for clients."

"It's hard to see a young person harm herself as she does, but she has serious family issues and doesn't know better ways to handle them, so we have to help her with that." The UAP is concerned about the behavior of the client and confused about why it is occurring, so the nurse needs to explain a bit about the issues involved as well as demonstrate empathy for the aide. It is appropriate to explain that the client is not cutting for attention, but the nurse's response does not address the reason for the teen's behavior and is therefore inadequate. It could also appear that the nurse is denigrating the UAP, which will not encourage the aide to listen to what she has to say. The comments that the UAP cannot work with the client or that she should transfer are punitive and do nothing to help the UAP understand self-mutilation.

An adolescent child is admitted to the nursing unit after an attempted suicide. The nurse is discussing the attempted suicide with the parents. Which of the following statements by the parents indicate to the nurse that the parents need more teaching? Select all that apply. "Our child would not do this again." "Our child is just trying to get attention." "Our child needs to learn new coping skills." "Our child will be fine in a couple of days." "Our child doesn't understand how this affects the family."

"Our child would not do this again." "Our child is just trying to get attention." "Our child will be fine in a couple of days." Suicide should not be seen just as attention-seeking behavior. It has very serious consequences and should never be minimized. To believe that such an attempt might not happen again or that the adolescent will have resolved the problems that led to the attempt in a couple of days shows a lack of understanding of the seriousness of the situation. Observations that the child has needs for coping skills and is likely unaware of how the suicide attempt affects other family members demonstrate some understanding of teaching about suicide.

A school nurse is teaching an adolescent client about acne. Which of the following statements by the adolescent indicate to the nurse that the teaching has been understood? Select all that apply. "Some cosmetics may cause an increase in lesion formation." "Excessive face washing is not necessary to prevent acne." "There's no relationship between stress and acne formation." "Diet plays a significant role in acne production." "Picking or squeezing acne lesions may increase symptoms."

"Picking or squeezing acne lesions may increase symptoms." "Excessive face washing is not necessary to prevent acne." "Some cosmetics may cause an increase in lesion formation." Adolescents should be taught that picking or squeezing acne lesions can worsen the condition. Excessive face washing is not necessary and may actually cause more damage to the skin. Cosmetics may clog pores and trigger the formation of acne lesions. 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. Stress may worsen acne by triggering an increase in oil production.

The parents of an adolescent client newly diagnosed with anorexia nervosa are meeting with the nurse during the admission process. Which remarks should the nurse interpret as typical for parents of a client with anorexia nervosa? "We've given her everything, and look how she repays us!" "She's had behavior problems for the past year both at home and at school." "She's been a model child. We've never had any problems with her." "We have five children, all normal kids with some problems at times."

"She's been a model child. We've never had any problems with her." Parents commonly describe their child as a model child who is a high achiever and compliant. These adolescents are typically well liked by teachers and peers. It is not typical for behavior problems to be reported. The description about having given the child everything and being repaid is more likely to describe an adolescent who is exhibiting behavior problems.

An adolescent client is sent to the school clinic with dizziness and nausea. While assessing the girl, who denies any health problems, the nurse smells alcohol on her breath. Which response by the nurse is most appropriate? "Tell me everything that you have had to eat and drink yesterday and today." "I know that high school is stressful, but drinking alcohol is not the best way to handle it." "Don't tell me that you have been drinking alcohol before you came to school this morning!" "What is the real reason that you are feeling sick this morning?"

"Tell me everything that you have had to eat and drink yesterday and today." Asking the client to report everything that she has had to eat and drink yesterday and today is the least judgmental approach and also provides helpful information. Confronting the client about drinking alcohol or asking her to admit the real reason for feeling sick can put the client on the defensive and block further communication. The nurse should avoid putting the client on the defensive to facilitate communication that may eventually enable the nurse to get the truth and identify interventions.

A nurse is caring for an adolescent after surgery. Which post-operative teaching statement is best to use for the adolescent? "It is important that you follow these instructions to prevent future complications." "Do everything just as instructed to avoid problems with your parents." "Just believe me that you need to do each thing exactly as I instruct you." "The instructions that I give you will help you get back to your regular activities quickly."

"The instructions that I give you will help you get back to your regular activities quickly." Postoperative teaching must be age specific and developmentally appropriate. The adolescent client needs instructions that are immediately relevant to his or her daily activities to understand the importance of instructions given. Having the client avoid problems with parents addresses the need of an adolescent to reach a sense of independence and identity. During this time, conflicts are heightened, not resolved. Adolescents rarely finalize plans for the future; this normally happens later in adulthood. Therefore, telling the client the teaching will avoid future complications does not mean as much and reduces the chances of compliance.

A member of a nurse-led group for depressed adolescents tells the group that she is not coming back because she is taking medication and no longer needs to talk about her problems. Which response by the nurse is most appropriate? "You don't have to stay in the group if you don't want to, but if you choose to leave, then you won't be able to change your mind later and return to the group." "The purpose of the group is to provide each of you with a place to discuss the problems of being a teenager with depression with others who also are experiencing a similar situation." "I think that it's important to let everyone respond to what you said, so let's go around the group and let everyone give their thoughts about what you've decided." "I'm glad that you're taking your medication, but how can we know that you will continue to take it? After all, you haven't been on it for very long, and you might decide to stop taking it."

"The purpose of the group is to provide each of you with a place to discuss the problems of being a teenager with depression with others who also are experiencing a similar situation." Focusing on the purpose of the group is the best response. Adolescents are greatly influenced by their peers. Medication alone is not typically the most successful treatment strategy. Questioning whether the client will continue the medication is negative and is not the reason for her to stay in the group. Asking the rest of the group to respond may or may not give the nurse support for the teenager remaining in the group. Groups commonly have rules regarding movement of members in and out of the group, but this does not address the reasons for the client to remain in the group.

A nurse is providing health teaching to a group of adolescent girls. The focus is on urinary tract infections. One of the girls tells the nurse that she wants to know more about cystitis. Which statement by the nurse is the most appropriate response? "This condition can result from irritation and inflammation from sexual activity." "This is a serious condition that occurs after intercourse or vaginal cleanses." "This condition happens frequently in young women and is not harmful." "This is a minor bacterial infection of the bladder that can occur at anytime."

"This condition can result from irritation and inflammation from sexual activity." Cystitis is a lower urinary tract infection. One cause seen in young adolescent women is after their first sexual intercourse. The urinary tract infections occur because of inflammation and local irritation caused by sexual activity. Bladder infections can lead to complications, and therefore are not minor or harmless. A bladder or urethral infection is not the result of vaginal cleanses such as douches.

A hospitalized adolescent diagnosed with anorexia nervosa refuses to comply with her daily before-breakfast weigh-in. She states that she just drank a glass of water, which she feels will unfairly increase her weight. What is the nurse's best response to the client? "Don't drink or eat for 2 hours, and then I'll weigh you." "You must weigh in every day at this time. Please step on the scale." "If you don't get on the scale, I'll be forced to call your health care provider." "You're here to gain weight so that will work in your favor."

"You must weigh in every day at this time. Please step on the scale." In responding to the client, the nurse must be nonjudgmental and matter of fact. Telling her that weight gain is in her favor ignores the client's extreme fear of gaining weight. Putting off the weigh-in for 2 hours allows the client to manipulate the nurse and interferes with the need to weigh the client at the same time each day. Threatening to call the health care provider is not likely to build rapport or a working relationship with the client.

A nurse is reviewing discharge instructions with the parents of an adolescent who sustained a head injury to the frontal lobe of the brain. When discussing possible consequences of the injury, which of the following is the most important information to give the parents? "Your child may mention unusual numbness and tingling." "Your child may exhibit drastic personality changes." "Your child will gradually lose the ability to hear." "Your child may develop sudden problems with vision."

"Your child may exhibit drastic personality changes." The frontal lobe regulates personality and judgment. The occipital lobe regulates vision, the temporal lobe regulates hearing, and the parietal lobe regulates sensation.

A 19-year-old nulligravid client visiting the clinic for a routine examination asks the nurse about cervical mucus changes that occur during the menstrual cycle. Which information would the nurse expect to include in the client's teaching plan? Cervical mucus disappears immediately after ovulation, resuming with menses. About midway through the menstrual cycle, cervical mucus is thick and sticky. During ovulation, cervical mucus is decreased and cloudy. As ovulation approaches, cervical mucus becomes clear and stretchy.

As ovulation approaches, cervical mucus becomes clear and stretchy. As ovulation approaches, cervical mucus is abundant, clear, and stretchy, resembling raw egg white. Ovulation generally occurs 14 days (± 2 days) before the beginning of menses. During the luteal phase of the cycle, which occurs after ovulation, the cervical mucus is thick and sticky, making it difficult for sperm to pass. Changes in the cervical mucus are related to the influences of estrogen and progesterone. Cervical mucus is always present.

The nurse is providing nutrition counseling for an obese adolescent. What is the most effective way for the nurse to obtain a nutrition history from this client? Telephone the parent, and ask what the client ate yesterday. Tell the client to list what they plan to eat for the next 24 hours. Ask the client what they know about good nutrition. Ask the client what they ate yesterday if it was a typical day.

Ask the client what they ate yesterday if it was a typical day. A 24-hour recall history is the best method to obtain a dietary history from an adolescent. Open-ended questions tend not to provide sufficient details for a nutrition history. Asking what the client plans to eat in the future gives the client an opportunity to report the "right" answer. The nurse obtains the information directly from the client; asking the parent has the potential to undermine trust.

Two months after an adolescent's thoracic spinal cord injury, the client has a pounding headache. The nurse notes that the client's arms and face are flushed and they are diaphoretic. What should the nurse do next? Check the patency of the urinary catheter. Lower the adolescent's head below their knees. Place the adolescent flat on their back. Prepare to administer epinephrine subcutaneously.

Check the patency of the urinary catheter. The adolescent is exhibiting signs of autonomic dysreflexia, a generalized sympathetic response usually caused by bladder or bowel distention. Immediate treatment involves eliminating the cause. Because bladder distention is a common cause of this problem, the nurse should immediately determine the patency of the indwelling (Foley) catheter. Lowering the head below the knees would increase the blood pressure and is contraindicated because of the spinal cord injury. Lying flat will not decrease blood pressure. Epinephrine is contraindicated because it elevates blood pressure and therefore can exacerbate the problem.

An adolescent is at risk for injury related to intracranial pathology following a motor vehicle collision. Which nursing action is the priority? Monitor oxygenation and temperature. Monitor intracranial pressure. Maintain the head in a neutral position. Maintain normoglycemia and normotension.

Monitor intracranial pressure. Increased intracranial pressure contributes to increasingly severe pathology, including potential for brain stem herniation, so monitoring and maintaining stable intracranial pressure is priority. Systemic parameters and intracranial parameters are both essential, though. The nurse takes actions to keep the intracranial pressure low by controlling factors that can cause elevated ICP such as monitoring for changes in oxygenation, temperature, glucose, blood pressure, and heart rhythm and rate. Maintaining the head in a neutral position is essential to keeping ICP within the desired limits.

An adolescent client is hospitalized with bacterial meningitis. At 1730, the client's mother reports her child is "burning up." The nurse is reviewing the client's medication administration records in the medical record. The health care provider (HCP) has prescribed ibuprofen 325 mg every 3 to 4 hours for temperature over 99°F (37.2°C). The child's temperature at 1730 is 102.5°F (39.1°C). What should the nurse do first? Initiate tepid sponge bath. Institute seizure precautions. Administer another dose of ibuprofen. Notify the HCP.

Notify the HCP. Because the client's temperature continues to rise in spite of recently administering ibuprofen, the nurse notifies the HCP. After notifying the HCP, the nurse can bathe the client with tepid water. If the temperature cannot be lowered quickly, the client is also at risk for seizures; the nurse pads side rails and observes for seizure activity. The nurse cannot administer another dose of ibuprofen without the HCP's orders.

An obese adolescent tells the nurse that he would like to lose weight and asks the nurse's opinion on how to accomplish his goal. Which suggestion would be most appropriate? Participate in an adolescent weight-reduction program. Strictly limit calorie intake. Exercise more often. Cut down on sweets and other snacks.

Participate in an adolescent weight-reduction program. Weight loss treatment modalities that include peer involvement have been proven to be the most successful approach with obese adolescents. This is because peer support is critical to adolescents, especially with an all-encompassing problem such as obesity.Increasing the amount of exercise is helpful, but this is just one aspect of a weight-reduction program.Strict calorie restriction is not recommended because it can result in use of muscle protein as well as fat for energy.Although decreased ingestion of nonnutritive snacks is helpful in dietary control, weight loss needs to be about long term behavior changes that also include physical activity.

An adolescent client is admitted with a diagnosis of rheumatic fever and is on bed rest. The client has a sore throat. Their joints are painful and swollen. They have a red rash on their trunk and are experiencing aimless movements of their extremities. Use the chart below to determine what the nurse should do first. Splint the joints to relieve the pain. Apply lotion to the rash. Request a prescription to treat the elevated temperature. Report the heart rate to the health care provider (HCP).

Report the heart rate to the health care provider (HCP). The child's heart rate of 150 bpm is significantly above its rate at the time of their admission. The nurse must notify the HCP. The increase in heart rate may indicate carditis, a possible complication of rheumatic fever that can cause serious and lifelong effects on the heart. The HCP will intervene with medication and cardiac monitoring. While lotion may provide comfort, the most important action for the nurse is to notify the HCP of the increased heart rate. Splinting will not help the inflammation that is causing the painful joints. The joint pain will migrate and subside with time. The temperature is not elevated at this time and does not require intervention.

A 16-year-old client is admitted to the emergency department following an accident. The client sustained a head injury, is unconscious, and has compound fractures of the right tibia and fibula. No family members accompanied the client and none can be reached by phone. The surgeon instructs the nurse to take the client to the operating room immediately. Which of the following actions should the nurse take regarding informed consent? Call the nursing supervisor and ask that the hospital lawyer be contacted. Take the client to the operating room for surgery without informed consent. Contact the hospital chaplain to sign the consent on the client's behalf. Keep the client in the emergency department until the family is contacted.

Take the client to the operating room for surgery without informed consent. The surgeon can take responsibility for consent in this situation because the condition is life (and limb) threatening and delaying the surgical treatment would have a negative impact on the client. The other options would delay the life-saving surgery and would result in negative outcomes for the client. The hospital chaplain has no authority to sign a consent form on behalf of the client.

The nurse is assessing an adolescent 1 hour after admission for a head injury. The nurse identifies that there have been changes since the baseline assessment, including apnea, bradycardia, and a widening pulse pressure. What is the primary reason for the nurse to notify the healthcare provider? The changes suggest that the client's intracranial pressure is increasing. The healthcare provider should be notified of significant condition changes. The healthcare provider will want to change fluids and narcotics prescribed. The client may require additional diagnostic testing and imaging.

The changes suggest that the client's intracranial pressure is increasing. Cushing's triad (apnea, bradycardia, and widening pulse pressure) is a hallmark of increasing intracranial pressure, which indicates that the adolescent's condition is deteriorating. It is correct that the healthcare provider must be alerted to significant changes and may need to change orders. The client may need additional testing. However, the primary reason to notify the healthcare provider is so the obvious increase in intracranial pressure can be managed using a holistic and emergent approach.

An adolescent is brought to the emergency department (ED) after accidentally taking an overdose of heroin. The adolescent is semiconscious, unable to respond appropriately to questions, slurs words, and has constricted pupils; the client's vital signs are blood pressure 60/50 mm Hg, pulse 50 beats/min, and respirations 8 breaths/min. Naloxone is administered to temporarily reverse the effects of the heroin. Which finding would first indicate that the naloxone administration has been effective? The client's memory and attention become normal. The client's respirations improve to 12/min. The client's blood opiate level drops to a nontoxic level. The client becomes talkative and physically active.

The client's respirations improve to 12/min. Decreased respirations and coma are the two most dangerous effects of heroin overdose, so an increase in respirations after administration of the naloxone demonstrates initial effectiveness of the medication. Changes in cognition and psychomotor activity will take more time to become apparent. The client's blood opioid level may not drop to a nontoxic level for a few days.

The nurse is invited to attend a meeting with several parents who express frustration with the amount of time their adolescents spend in front of the mirror and the length of time it takes them to get dressed. What does the nurse explain that this behavior indicates? a method of procrastination an abnormal narcissism a way of testing the parents' limit-setting a result of developing self-concept

a result of developing self-concept An adolescent's body is undergoing rapid changes. Adolescence is a time of integrating these rapidly occurring physical changes into the self-concept to achieve the developmental task of a positive self-identity. Thus, most adolescents spend much time worrying about their personal appearance. This behavior is not abnormal narcissism, a method of procrastination, or a way of testing the parents' limits.

Which adolescent would the nurse determine needs further evaluation? a young adolescent boy who restricts his food and fluid intake to be able to box in a lower weight class a young adolescent girl who reads "dark" novels and questions why God allows innocent people to be harmed a young adolescent boy who coughs for 5 minutes after trying his first marijuana cigarette and declares he does not want to do it again a young adolescent girl whose mood changes when upset with her parents, though she has never been in trouble in school or the community

a young adolescent boy who restricts his food and fluid intake to be able to box in a lower weight class Restricting intake to lose weight is a first step toward an eating disorder for males as well as females, so this behavior should be investigated further, especially since males of this age are usually unconcerned about their weight. Quick mood changes are common in young adolescents, particularly girls. Such mood changes should not be considered problematic if the adolescent is not experiencing trouble in major areas of his/her life. Experimenting with alcohol or other substances is fairly common in the teen years, but one or two uses do not generally lead to addiction. The negative effect of the coughing may be a deterrent to further use. Religious questioning and exploration of "dark" subjects is common among teens and is part of the development of mature thinking. In the absence of other signs of depression, it does not warrant further evaluation.

The nurse on the adolescent unit delegates a task to the nursing assistant. After delegating the task, the nurse should: keep asking the nursing assistant if the task has been completed. allow adequate time for the nursing assistant to complete the task, then follow-up with the nursing assistant. assume the nursing assistant has completed the task to the nurse's satisfaction. document in the chart that the task has been completed.

allow adequate time for the nursing assistant to complete the task, then follow-up with the nursing assistant. The nurse remains accountable for all of the client's care, including tasks that have been delegated to the nursing assistant. The nurse should allow the nursing assistant ample time to complete the task, then follow up to make sure the nursing assistant has completed the task. Documentation occurs after the task has been completed satisfactorily. When a task is delegated, it's important to allow team members the authority to complete the assigned task. However, the nurse should follow up to make sure the nursing assistant has completed the task satisfactorily; the nurse can't assume that has been done.

Acetaminophen was given to an adolescent for headache. Which of the following parameters would indicate the effectiveness of the medication? change in behavior intermittent sleeping no change in behavior no change in vital signs

change in behavior Positive changes in behavior and vital signs are indicators of an effective response to pain medication. Sleeping isn't a reliable indicator of pain relief because the teen may use sleep as a coping mechanism. Vital signs may or may not change.

An adolescent diagnosed with thalassemia major (Cooley's anemia) is at risk for which condition? chronic hypoxia and iron overload hypertrophy of the thyroid polycythemia vera and thrombosis hypertrophy of the thymus

chronic hypoxia and iron overload Thalassemia major increases destruction of red blood cells (RBCs), shortens the life span of RBCs, and causes anemia. The body responds by increasing RBC production, but it can't produce adequate numbers of mature cells. This process results in chronic hypoxia. In addition, children with thalassemia major require multiple transfusions of packed RBCs. The combination of excessive RBC destruction and multiple transfusions deposits excess iron that damages organs and tissues. Thalassemia major doesn't place the adolescent at risk for hypertrophy of the thymus or thyroid or polycythemia vera, which involves excessive RBC production that can lead to thrombosis.

A 13-year-old client is being evaluated for possible Crohn's disease. The nurse expects to prepare the client for which diagnostic study? colonoscopy with biopsy myelography genetic testing cystoscopy

colonoscopy with biopsy Crohn's disease is an inflammatory bowel disorder characterized by inflammation, ulceration, and edema of the bowel wall (typically involving the terminal ileum). Colonoscopy with biopsy are the primary procedures used to establish the diagnosis; a barium enema also may be indicated. Although genetics may play a role in Crohn's disease, genetic testing isn't part of the diagnostic workup. Cystoscopy visualizes the bladder and urinary tract and isn't indicated for this client. Myelography is a radiographic procedure used to evaluate the spinal cord.

A nurse is caring for an adolescent involved in a motor vehicle crash. The adolescent has a chest tube in place. If the chest tube is accidentally removed, the nurse should immediately: clean the wound with povidone-iodine and apply a gauze dressing. reintroduce the tube and attach it to water seal drainage. call a physician and obtain a chest tray. cover the opening with petroleum gauze.

cover the opening with petroleum gauze. If a chest tube is accidentally removed, the nurse should cover the insertion site with sterile petroleum gauze. The nurse should then observe the client for respiratory distress because tension pneumothorax may develop. If tension pneumothorax does develop, the nurse should remove the gauze to allow air to escape. The nurse shouldn't reintroduce the tube. Rather, the nurse should have another staff member call a physician so another tube can be introduced by the physician under sterile conditions.

An adolescent with well-controlled type 1 diabetes has assumed complete management of the disease and wants to participate in gymnastics after school. To ensure safe participation, the nurse should instruct the client to adjust the therapeutic regimen by: eating a snack before each gymnastics practice. increasing morning dosage of intermediate-acting insulin. measuring blood glucose level after each gymnastics practice. measuring urine glucose level before each gymnastics practice.

eating a snack before each gymnastics practice. Because exercise decreases the blood glucose level, the nurse should instruct the client to eat a snack before engaging in physical activity to prevent a hypoglycemic episode. Measuring urine glucose level before each gymnastics practice is incorrect because the urine glucose level doesn't reflect the current blood glucose level. To prevent hypoglycemia, the blood glucose level should be measured before the activity, not after the activity. Increasing the morning dosage of intermediate-acting insulin may lead to hypoglycemia during gymnastics practice; to avoid this condition, the adolescent may need to decrease, not increase, the morning dosage of intermediate-acting insulin.

A nurse is assigned to an adolescent. Which nursing diagnosis is most appropriate for a hospitalized adolescent? anxiety related to separation from parents ineffective coping related to activity restrictions fear related to altered body image fear related to the unknown

fear related to altered body image Fear related to altered body image is the most appropriate nursing diagnosis for a hospitalized adolescent because of the adolescent's developmental level and concern for physical appearance. An adolescent may fear disfigurement resulting from procedures and treatments. Separation is rarely a major stressor for the adolescent. Adolescents may have Fear related to the unknown, but they typically ask questions if they want information. A diagnosis of Ineffective coping related to activity restrictions may be appropriate for a toddler who has difficulty tolerating activity restrictions but is an unlikely nursing diagnosis for an adolescent.

The nurse is instructing a client with cancer who is receiving chemotherapy about reporting signs of infection. Which is the most reliable early indicator of infection in a client who is neutropenic? fever chills dyspnea tachycardia

fever Fever is an early sign requiring clinical intervention to identify potential causes. Chills and dyspnea may or may not be observed. Tachycardia can be an indicator in a variety of clinical situations when associated with infection; it usually occurs in response to an elevated temperature or change in cardiac function.

A 14-year-old client in skeletal traction for treatment of a fractured femur is expected to be hospitalized for several weeks. When planning care, the nurse should take into account the client's need to achieve what developmental milestone? industry autonomy identity initiative

identity According to Erikson's theory of personal development, the adolescent is in the stage of identity versus role confusion. During this stage, the body is changing as secondary sex characteristics emerge. The adolescent is trying to develop a sense of identity, and peer groups take on more importance. The hospitalized adolescent is separated from the peer group and the adolescent's body image may be altered. This alteration in body image may interfere with the ongoing development of the adolescent's identity. Toddlers are in the developmental stage of autonomy versus shame and doubt. Preschool children are in the stage of initiative versus guilt. School-age children are in the stage of industry versus inferiority.

The nurse cares for an adolescent after an appendectomy. Which client action would the nurse judge to be a healthy coping behavior? refusing to fill out the menu and allowing the nurse to do so not taking telephone calls from friends so they can rest avoiding interactions with other adolescents on the nursing unit insisting on wearing a T-shirt and gym shorts rather than pajamas

insisting on wearing a T-shirt and gym shorts rather than pajamas Adolescents struggle for independence and identity, needing to feel in control of situations and conform to peers. Control and conformity are often manifested in appearance, including clothing, and this carries over into the hospital experience. An adolescent feels best when they are able to look and act as they normally do, for example, wearing a T-shirt and gym shorts. Adolescents normally want to interact with peers and commonly seek every opportunity to do so. Avoiding other adolescents on the nursing unit or not taking phone calls from friends might suggest ineffective coping behavior. Refusing to fill out the menu and allowing the nurse to do so demonstrate dependent behavior, not a healthy coping mechanism.

A 17-year-old adolescent with acute lymphocytic leukemia is discharged with written information about chemotherapy administration and an outpatient appointment schedule. The client now is in the maintenance phase of chemotherapy but has missed clinic appointments for blood work and admits to omitting some chemotherapy doses. To improve the client's compliance, the nurse should include which intervention in the care plan? reprimanding the adolescent for failing to comply with treatment emphasizing the long-term consequences of noncompliance letting the adolescent participate in planning and scheduling of treatments threatening to discontinue care if the client doesn't comply

letting the adolescent participate in planning and scheduling of treatments Because the adolescent is striving for independence, healthcare providers should promote self-reliance whenever possible, such as by letting the client participate in planning and scheduling treatments. The client can help establish realistic goals and evaluation outcomes as well as help schedule procedures and chemotherapy doses to minimize lifestyle disruptions. Adolescents are oriented in the present and have relatively little concern for the long-term consequences of their behavior. Reprimanding the client or threatening to discontinue care isn't likely to improve compliance and isn't in the client's best interest.

An adolescent is admitted to the adolescent unit with pain caused by sickle cell crisis. Who should be consulted first about this adolescent's care? nutritionist physical therapist pediatric pain specialist case manager

pediatric pain specialist Children and adolescents hospitalized with sickle cell crisis are commonly in excruciating pain. Therefore, the pediatric pain specialist should be consulted first to help relieve the adolescent's pain. The adolescent also requires hydration with I.V. fluids, but consulting a nutritionist isn't important at this time. Bed rest is commonly ordered to minimize energy expenditure and oxygen demand; therefore, consulting a physical therapist isn't necessary at this time. It isn't necessary to consult the case manager first; pain relief is most important at this time.

An adolescent is a heavy user of marijuana and alcohol. When the nurse confronts the client about his drug and alcohol use, he admits previous heavy use in order to feel more comfortable around peers and achieve social acceptance. He says he has been trying to stay clean since his parents found out and had him seek treatment. When the nurse develops a plan of care with the client, what should be the highest priority to help him maintain sobriety? peer recognition that does not involve substance use the threat of legal charges if caught drinking or smoking marijuana support and guidance from his parents a strict no-drug policy at his high school

peer recognition that does not involve substance use Peer acceptance and recognition is a very powerful force in the lives of adolescents, leading to positive or negative behavior depending on the child's peers. While the influence of parents remains strong, peer acceptance combined with the adolescent's desire for independence can lead to disobeying the parents. The sanctions provided at school and in the community by law enforcement will support those teens that have other support in their lives, but are generally not sufficient to prevent substance use in adolescents lacking support at home and with peers.

Which substance should the nurse include in the teaching plan for a teenager with acne who has requested information about cleansing the affected skin? soap and water witch hazel hydrogen peroxide baby lotion

soap and water Acne is a disorder of the pilosebaceous follicles (hair follicles and sebaceous gland complex). During adolescence, the secretions of the sebaceous glands increase, altering the follicular lining and causing occlusion of the ducts with accumulated sebum. Bacteria in the follicle then cause an infection. Frequent washing of affected areas with soap and water is recommended to act as a mild peeling agent and reduce secondary infection.Witch hazel is an astringent that can be used after thoroughly cleansing the skin.Hydrogen peroxide is a poor cleansing agent for skin with acne.Lotions and creams aggravate the condition by adding more oily substances to the already oily skin.

While in the emergency department, an adolescent who was in a motorcycle accident less than 1 hour earlier remains conscious but is agitated and anxious. The nurse observes that his pulse and respirations are increasing and his blood pressure is decreasing. The nurse should initiate interventions to manage which complication? spinal shock autonomic dysreflexia metabolic alkalosis increased intracranial pressure

spinal shock Spinal shock occurs 30 to 60 minutes after a spinal cord injury owing to the sudden disruption of central and autonomic pathways. This disruption causes flaccid paralysis, loss of reflexes, vasodilation, hypotension, and increased pulse and respiratory rates.Autonomic dysreflexia occurs only after the return of spinal reflexes and is characterized by hypertension.Increased intracranial pressure is associated with widened pulse pressure and decreased pulse and respiratory rates.Metabolic alkalosis, manifested by vomiting, elevated plasma and urine pH, and elevated plasma bicarbonate levels, does not occur with spinal shock. Rather, hydrogen ion loss leading to metabolic alkalosis would occur with pyloric stenosis, diuretic therapy, and potassium depletion.

When assessing a 13-year-old adolescent, what is an expected finding? primarily one friend Tanner stage I of development subjective judgments of right and wrong decision about a career

subjective judgments of right and wrong For the adolescent, moral development occurs as abstract reasoning develops. Moral issues are seen to differ based on opinions.Many adolescents at age 13 have reached at least Tanner stage II, an assessment of the development of secondary sex characteristics.Many adolescents at this age do not have a career choice in mind yet.Typically, adolescents have more than one friend.

An adolescent with a history of surgical repair for an undescended testis comes to the clinic for a sports physical. Which anticipatory guidance for the parents and adolescent is most important? need for a lot of psychological support the adolescent's future plans the adolescent's sterility technique for monthly testicular self-examinations

technique for monthly testicular self-examinations Because the incidence of testicular cancer is increased in adulthood among children who have had undescended testes, it is extremely important to teach the adolescent how to perform the testicular self-examination monthly. The undescended testicle is removed to reduce the risk for cancer in that testicle. Removal of a testis would not necessarily make the adolescent sterile because the other testicle remains. Although discussing the adolescent's future plans is important, it is not the priority at this time. Because the adolescent has been dealing with the situation for a long time, the need for a sports physical at this time should not be a cause of emotional distress requiring a lot of psychological support.

An overweight adolescent client has lost 12 lb (5.4 kg) in 8 weeks using diet strategies. The client reaches a weight loss plateau and is discouraged. The nurse instructs the client to keep a food diary for what purpose? to help the client stay busy and more focused on losing weight to help the client analyze how much food is consumed and when to provide a written record of caloric intake for the nurse to help the nurse determine whether the diet is being followed

to help the client analyze how much food is consumed and when Keeping a food diary allows the adolescent client to use the cognitive level of formal operations to help identify and evaluate eating behaviors of which he may not be aware. It is primarily a tool to assist in self-correction and behavior modification. The client does not need to be preoccupied with weight loss. The nurse can provide insights based on the diary entries, but this device is not for the nurse.