Growth and Development final
The nurse is assessing a 14-year-old male client when the client's parent jokes about the changes in the client's voice and the hair under his armpits. Which response by the nurse to the client's parent is most appropriate?
"Your child can become modest and self-conscious and teasing may cause embarrassment." Explanation: It is never appropriate to discuss what is happening with a client in a way that is demeaning and hurtful. A 14-year-old adolescent is experiencing many bodily changes and is very self conscious. The nurse can share experiences with the client and the family, but it should not be in a way that the adolescent is embarrassed. Parents can share their experiences with the child, but they have to be open to this discussion or it can lead to an awkward experience for the adolescent. Reminding the parent of how the child is feeling and the possible feelings that can come from their interactions will bring the parent's attention to a delicate situation and is most appropriate. Simply stating these are expected findings does not address the joking manner of the parent.
Which initial indication of puberty in males is identified correctly by the nurse? 1. Testicular enlargement 2. Facial hair 3. Pubic hair 4. Increased size of penis
1
The nurse is caring for an adolescent who weighs 110 pounds (50 kilograms, kg). Which assessment findings should the nurse report as abnormal? Select all that apply. 1. Heart rate is 50 beats per minute. 2. Blood pressure is 130/60. 3. Daily fluid intake is 1,800 milliliters (mL). 4. Hourly urine output is 30 mL. 5. Cholesterol level is 150 mg/dL (3.88 mmol/L).
1, 2, 3,
The nurse is performing a sexuality assessment on a 16-year-old adolescent female. What safe sex practices should the nurse assess for? Select all that apply. 1. Sexually transmitted infections (STIs) 2. Birth control options 3. Abstinence 4. Number of partners 5. Pregnancy
1, 2, 3, 4
The nurse demonstrates understanding of which hormones levels are increased during puberty when an adolescent has which hormones tested? Select all that apply. 1. Estrogen 2. Adrenocorticotropic hormone (ACTH) 3. Antidiuretic Hormone (ADH) 4. Androgens 5. Progesterone
1, 4, 5
A 13-year-old girl has grown rapidly in height over the past 2 years and is taller than most of the boys in her class. She wonders when she will stop growing. What should the nurse tell her as a general guideline for the ages at which most girls stop growing?
16 to 17 years old Explanation: Growth stops with closure of the epiphyseal lines of long bones which occurs at about 16 or 17 years of age in females and about 18 to 20 years of age in males.
A school nurse notes that three females who are close friends each lost nearly 20 pounds recently. What is the priority nursing action in this situation? 1. Tell the girls that they will need to have their weights monitored weekly from now on 2. Interview and assess each of the girls privately and obtain a nutritional history 3. Notify each of the girl's pediatricians of the situation 4. Inform each of their parents of the situation
2
The nurse is assessing an adolescent who states, "I think I might be gay." The nurse knows that what is true of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youths in comparison to heterosexual youth? 1. They perform worse in school 2. They are more likely to experience psychiatric problems 3. They are less likely to fall in love in school 4. More likely to experience emergence of sexual feelings
2
What is an important concept for a school nurse to consider when planning a class on injury prevention for adolescents? 1. The topic should be general and brief because adolescents usually do not take a lot of risks. 2. Present the material in a way that allows the adolescent to imagine long-term consequences of not protecting oneself from injury. 3. Have the teens discuss the topic with their primary care provider 4. Have the teens watch an education video
2
Which age group is the most often screened for idiopathic scoliosis? 1. Ages 2 - 4 2. Ages 10 - 12 3. Ages 15 - 16 4. Ages 18 - 20
2
The nurse is seeing a 16-year-old female who says she is pregnant. The client expresses she wants to keep the child. How should the nurse respond? Select all that apply. 1. Educate the client about options, such as adoption and terminating the pregnancy. 2. Assist the client in finding an appropriate healthcare provider. 3. Encourage the attendance of parenting classes. 4. Assess feelings about the pregnancy. 5. Provide adoption agency information or a skilled provider specializing in abortion.
2, 3, 4,
An adolescent is seen in the outpatient clinic for an annual physical examination and is with her mother. Which questions should the nurse ask when the mother steps out of the room? Select all that apply. 1. "Do you like school?" 2. "Have you ever tried or used drugs?" 3. "Are you sexually active?" 4. "Do you play sports?" 5. "Have you ever tried alcohol?"
2, 3, 5
Which statements are true regarding the use of complimentary/alternative medicines (CAM) and adolescents? Select all that apply. 1. Teens do not use CAM therapies often. 2. CAM therapies may utilize in the adolescent and their families. 3. Preferences for specific kinds of CAM therapies may become apparent during the adolescent phase of life 4. CAM therapy is only used with adolescents with a chronic illness. 5. CAM therapy usage needs to be assessed with every patient during every admission.
2, 3, 5
When examining an adolescent, which action by the nurse would be most appropriate? Select all that apply. 1. Allow child to participate in the examination 2. Respect the client's privacy at all times 3. Ask all questions directly to the parents 4. Speak with the adolescent directly 5. Ask the physician to accompany them while examining the adolescent
2, 4
The nurse is caring for an adolescent who has been hospitalized for an acute condition. What roles/boundaries should the nurse establish when caring for this client? Select all that apply. 1. Be a friend 2. Be respectful 3. Use judgment 4. Develop trust 5. Use humor
2, 4, 5
A 14-year-old female is seen in an outpatient clinic and asks about losing weight. The nurse assesses the client and notes that the client has progressively lost weight in the past six months and is now plotting on the 10th percentile on the weight by age growth chart. What is the nurse's best response to this client? 1. "You are already thin enough and do not need to lose any weight." 2. "Why do you want to lose weight?" 3. "Tell me more about how you are feeling about your body's appearance." 4. "You should speak with a psychologist about your obsession with losing weight."
3
A nurse is providing care to a 14-year-old adolescent post-operatively. What is most significant in planning care for this child? 1. A child this age will miss being in school the most 2. A child this age will only want to be with their parents while in hospital 3. A child this age will be concerned about privacy 4. A child this age is learning to be independent with activities
3
An adolescent female who has just started her menses is concerned about gaining weight now that she is a teenager. What is the best response by the nurse? 1. "You should avoid salty foods when you have your period. This will help you from gaining water weight." 2. "You should not worry about gaining weight. Teenagers don't eat enough food. You should eat what you want." 3. "Tell me more about what you are experiencing. What is leading you to feel like you are gaining weight?" 4. "You should talk to your mother about what worked for her when she was your age."
3
The nurse is admitting an adolescent to the hospital for an acute condition. What should the nurse do to optimize the environment of care? 1. Leave the equipment out for view, so the adolescent can feel like they are apart of their care. 2. Group the adolescent with adults to give them a sense of independency. 3. Allow the adolescents to leave the unit if their condition allows it. 4. Offer only board games or age-appropriate magazines so that the adolescent doesn't exhaust themselves.
3
A nurse is providing anticipatory guidance to a parent of an adolescent about injury prevention. Which statement, when made by the parent, indicates they understand the teaching? 1. "I will make sure that my teen sits in a booster seat in the car." 2. "I will keep all medications out of reach." 3. "I will make sure that my teen does not stay up past 10pm every night." 4. "I will have ongoing conversations with my teen about rules they will need to follow when they begin to drive."
4
According to Kohlberg's theory of moral development, the nurse knows that adolescents tend to engage in which behavior? 1. Depend on friends in times of crisis 2. Base their value system on that of their family 3. Socialize in co-ed cliques 4. Explore gender roles
4
An adolescent male states "I want to be a police officer just like my father." This adolescent is demonstrating which stage of development according to Erikson? 1. Autonomy vs. Shame 2. Industry vs. Isolation 3. Intimacy vs. Isolation 4. Identity vs. Role confusion.
4
The nurse demonstrates understanding of what a positive Russell's sign is by further assessing an adolescent for which condition(s)? 1. Neuromuscular problems 2. Developmental delay 3. Failure to thrive 4. Bulimia
4
The nurse is teaching a group of adolescents about nutrition. Which statement should the nurse include in the teaching? 1. "It is recommended that most adolescent girls and boys consume 2,800 calories per day." 2. "It is recommended that that dietary supplements are taken in addition to eating healthy to obtain the correct level of vitamins and minerals." 3. "Around 70% of obese adolescents will be obese as adults." 4. "Obesity in adolescence puts you at risk for hypertension and type II diabetes."
4
The nurse is using the CRAFFT screening tool. Which adolescent should the nurse assess with this tool? 1. One who vomits and fasts after overeating 2. A teenager who needs health promotion activities 3. A teenager who is being cyberbullied 4. One who drinks beer every other weekend
4
The nurse knows that developmental changes affect medication absorption, metabolism, and elimination. What should the nurse keep in mind when prescribing a medication to an adolescent? 1. The nurse can rely on symbols or phrases to warn adolescents of medicine-related risks. 2. After puberty, medication metabolism increases to adult levels. 3. Most medications are metabolized slower by a client in puberty. 4. The adolescent understands medication warnings best when informed verbally by the healthcare personnel.
4
When performing a physical assessment on a hospitalized adolescent, how should the nurse best protect their privacy? 1. Perform the physical assessment on the client over their clothes 2. Wait until there is no one else in the room to perform the physical assessment 3. Ask the physician to perform the physical assessment 4. Ask pertinent questions making sure to address the adolescent first, then, politely ask parents and visitors to step out of the room momentarily in order to complete the physical assessment
4
When performing the physical examination for an adolescent, the nurse must perform which of the following actions? 1. Address questions to the parent of the adolescent 2. Focus on the negative aspects of the individual because those are the most important to address during the visit 3. Use slang for reference to anatomical body parts 4. Inform the adolescent of your actions and explain the rationales
4
Which is considered one of the best strategies for preventing smoking in teenagers? 1. Provide long term consequences of smoking 2. Showing pictures of lungs in people who smoked for years 3. Involve the teen's parents in a discussion about not smoking 4. Provide social and peer related media about unhealthy consequences of smoking
4
Which of the following does the nurse correctly identify as the leading cause of mortality in adolescents? 1. Homicide 2. Suicide 3. Cardiac disease 4. Motor vehicle accidents
4
A 17-year-old female is meeting with the nurse for an annual well-visit and is asking the nurse questions about how to know when one is in love. The nurse should point out which factor to help decide if both individuals have reached a mutual agreement and are ready for an intimate relationship?
A sense of trust and identity Explanation: In order to be intimate or to share one's deepest feelings with another person, it is impossible unless both persons have established a sense of trust and a sense of identity. Being autonomous or taking initiative are not aspects that lead toward intimate relationships. Socialization and isolation are not relevant to the establishment of intimate relationships.
__________ is the intentional infliction of physical or emotional discomfort or the deprivation of basic needs necessary for comfort or survival.
Abuse
The school nurse is monitoring a student athlete who experienced a concussion 2 weeks ago during a soccer game. The student reports having difficulty in a course in which the child previously performed well. Which action should the nurse's take first?
Ask the student to describe the issues he is having in the class Explanation: Talking with the teacher and performing a neurological assessment are actions that may be necessary, but the nurse must first determine if the student is following the recommended level of cognitive activity; this can be accomplished by asking the child to describe the issues he is having in class. Contacting the parents immediately would not be warranted until sufficient information is collected.
A teenage boy tells the nurse that his parents embarrass him in front of his friends when they kiss him goodbye. The nurse is aware that this teenager is revisiting which stage of development identified by Erikson?
Autonomy Explanation: In revisiting the stage of autonomy, the adolescent is seeking out ways to express his or her individuality in an effective manner. The adolescent would avoid behaviors that would "shame" or ridicule him or her in front of his or her peers. The sense of industry is again encountered as the adolescent makes his or her choice to participate in different activities at school, in the community, at church, and in the workforce. Initiative is revisited as the adolescent develops his or her vision for what he or she might become. Generativity largely involves establishment of career and work.
The nurse is preparing a presentation for a local health fair depicting the differences in maturity between preadolescents. Which differing factor should the nurse prioritize in the presentation?
Boys grow at a slower, steadier rate than do girls. Explanation: Preadolescent boys grow generally at a slower, steadier rate than do girls. Girls grow more rapidly during preadolescence and then their growth rate slows dramatically after menarche.
Nurses' knowledge of sexuality in the older adult population should include: 1.Chronic illness may affect the ability to participate in sexual activity. 2.Sexual response time is unchanged. 3.Ability to achieve orgasm declines. 4.Dryness of the vaginal walls is associated with pelvic inflammatory disease.
Chronic illness may affect the ability to participate in sexual activity.
A nurse is attending to a group of boys at a school. The nurse is required to document the sexual development in boys on a regular basis. The nurse would anticipate which clients having the highest incidence of nocturnal emissions?
Clients who are showing pubertal changes Explanation: The nurse should know that boys who are undergoing pubertal changes are more likely to experience nocturnal emissions. The first sign of pubertal changes and sex maturation is testosterone secretion. As this increased so does the penis and scrotum enlargement. This is a time when nocturnal emissions occur. In late adolescence, which lasts from age 18 to 20, the transition into adulthood is completed. The nurse should also know that boys in the age group of age 12 to 20 experience various chemical and physical changes taking place within their body. A strong, muscular appearance does not indicate the presence of nocturnal emissions.
Which age-related changes predispose the elderly patient to drug toxicity and extended duration of action of drugs? (Select all that apply.) 1.Decreased body water 2.Increased ratio of muscle to fat 3.Low serum albumin 4.Reduced blood flow to liver
Decreased body water, Low serum albumin, Reduced blood flow to liver
What should the nurse include in the teaching plan for self-medication practices of older adults? 1.Eliminate unnecessary medications. 2.Substitute herbal preparations for certain prescribed medications. 3.Develop a drug reminder system and schedule. 4.Pharmacy shop for the cheapest medications.
Develop a drug reminder system and schedule.
A nurse is admitting a 16-year-old male to the floor for an appendectomy. How can the nurse prepare this client for hospitalization? Select all that apply.
Encourage him to keep his cell phone nearby to communicate with his friends. Interview the adolescent separately from the parent to allow expression of information that he may not be comfortable sharing in front of the parent. Provide privacy when client is changing into the hospital gown or going to the bathroom.
The nurse is assessing a teenage client and notes his lower front teeth are slightly crossed over. The nurse points out to his caregiver that he should see an orthodontist about this to prevent which potential situation?
Even slight malocclusions make chewing and jaw function less efficient. Explanation: Dental malocclusion (improper alignment of the teeth) is a common condition that affects the way the teeth and jaws function. Correction of the malocclusion with dental braces improves chewing ability and appearance. Crooked teeth do not lead to more cavities, nor do they lead to infection and tooth loss. While appearance and acceptance in society is important to the adolescent, that is not the most important reason for orthodontic care for the adolescent.
The nurse is performing a health surveillance visit with a 12-year-old boy. Which characteristic suggests the boy has entered adolescence?
Experiences frequent mood changes Explanation: If the boy has just entered adolescence, he is likely to exhibit frequent mood changes. A growing interest in attracting girls' attention and understanding that actions have consequences are typical of the middle stage of adolescence. Feeling secure with his body image does not occur until late adolescence.
The nurse is talking to a 13-year-old boy about choosing friends. Which function do peer groups provide that can have a negative result?
Following role models Explanation: Peers serve as role models for social behaviors, so their impact on an adolescent can be negative if the group is using drugs, or the group leader is in trouble. Sharing problems with peers helps the adolescent work through conflicts with parents. The desire to be part of the group teaches the child to negotiate differences and develop loyalties.
A 17-year-old adolescent chats excitedly with the nurse about plans for college and a career. The adolescent states having checked out every college in the region and determined which one is the best fit and would give the adolescent the best career options. The nurse recognizes which developmental aspect in this client?
Formal operational thought Explanation: The final stage of cognitive development, the stage of formal operational thought, begins at age 12 or 13 years and grows in depth over the adolescent years, though it may not be complete until about age 25. This step involves the ability to think in abstract terms and use the scientific method (deductive reasoning) to arrive at conclusions. With the ability to use scientific reasoning, adolescents can plan their future. They can create a hypothesis (What if I go to college? What if I do not?) and think through the probable consequences (In the long run, I will earn more money; I could begin earning money immediately). This scenario does not pertain to socialization, role identification, or sensorimotor development.
Which mental change is associated with aging? 1.Confusion 2.Gradual decline in cognitive skills 3.Depression 4.Inappropriate behavior
Gradual decline in cognitive skills
A patient in the middle stage of Alzheimer's disease (AD) may exhibit which characteristic or behavior? 1.Mild depression 2.Hallucinations 3.Weight loss 4.Impaired mobility
Hallucinations
A 15-year-old adolescent shows a pattern of gaining weight, not a large amount but a little more each visit. The adolescent is not active in any sports and eats out frequently with parents. What is the best way for the nurse to assess the adolescent's eating pattern?
Have the adolescent keep a food diary for 1 week. Explanation: Having the adolescent keep a food diary over 1 week allows the nurse as well as the client to examine what the client eats and when the client is eating it. Keeping a food journal allows a discussion of the choices made and the substitutes that the client could possibly make. The times that the client eats may also lead to weight gain. Asking for recall of 3 days' intake would be difficult, and most information would be inaccurate due to forgetting some item of food intake or when the food was eaten. Most people have no idea how many calories are in a food item unless they are specifically counting calories for dieting or health reasons. An adolescent would have a difficult time demonstrating a healthy portion size unless it has been demonstrated first.
Which intervention would probably be most effective in preventing an adolescent from attempting suicide with an overdose again?
Helping to learn better problem solving Explanation: Suicide is a solution when there does not appear to be any other solution. It is the leading cause of death in 10- to 24-year olds. Some of the risk factors for suicide include a history of a previous suicide attempt, substance use disorder, depression, poor school performance, and family disorganization. Helping an adolescent learn better problem solving can help prevent a second attempt. Keeping medications locked may be a good safety practice but it does not solve the adolescent's depression and the underlying reason the adolescent feels the need to commit suicide. The financial level is not indicative of a need to commit suicide. Suicide can occur in all socioeconomic levels. The adolescent who is alone and has no close friends at school is at higher risk for suicide. Helping the adolescent find a friend would be a positive action but it is not as important as helping the teen to make better choices and have better problem-solving skills.
Which statement is true regarding falls in the elderly? 1.Most falls occur in the garage. 2.Hip fractures resulting from falls are a leading cause of placement in long-term care facilities. 3.Fall risk decreases with addition of medications 4.Sedatives reduce the risk of falls
Hip fractures resulting from falls are a leading cause of placement in long-term care facilities.
A teacher refers a student to the school nurse because the student is frequently falling asleep during class. After talking with the student, the nurse is most concerned by which statement by the student?
I get 7 hours of sleep every night so I don't know why I am so tired." Explanation: The average number of hours of sleep that teens require per night is 8.5 to 9.5 due to rapid growth that occurs during these years. Following a curfew and limiting distractions at bedtime can help provide the student with adequate hours of sleep each night.
The nurse is talking with parents of a depressed 16-year-old boy. Which question is of the mostimportance?
Is there a gun in your home? Explanation: He may be at risk for suicide. Firearm-related suicides have been responsible for a large number of the suicide deaths in 15- to 19-year-olds nationwide. All the other questions assess for depression and do not protect against suicide.Is there a gun in your home?
The nurse is meeting with a group of caregivers of adolescents. Which example should the nurse point out is most effective for the caregiver to support the adolescent?
Let them choose their hairstyle, even though it may not look the best for them. Explanation: The adolescent whose family caregivers make it difficult to conform are adding another stress to an already emotion-laden period. By allowing the adolescent to follow trends and fads in clothing choices, hairstyles, and music, the caregiver decreases the stress for the child. Information about drugs and alcohol is important to share, but these topics would be better discussed with the child. It is important the adolescent spend time with peers.
What anticipatory guidance can the nurse provide the girl who has noted the development of breast buds?
Menarche should follow in about 2 years. Explanation: Menarche usually follows within 2 years of the first signs of breast development. Peak height velocity (PVH) in girls occurs 6 to 12 months following menarche. It does not follow immediately. Breast development progresses through several stages and will not be complete until late puberty. Adult height is not reached at the time of menarche but about 6 to 12 months following menarche.
The parents of a 16-year-old are fearful that their child may be using illegal drugs. They report to the nurse that they have noticed recently that their child seems much more focused when doing homework or chores, is losing weight, displays a high level of energy, and becomes agitated easily. The nurse is aware that the teen is displaying symptoms of which type of drug use?
Methamphetamine Explanation: Euphoria, increased energy and alertness, agitation, weight loss, insomnia, tachycardia, and hypertension are symptoms of methamphetamine use. Stimulants have similar effects as alcohol but the high only lasts a few minutes and includes slurred speech, lack of coordination, euphoria, and dizziness. Opiates produce feelings of relaxation and euphoria. CNS depressants cause euphoria followed by depression or hostility, impaired judgment, decreased inhibitions, slurred speech, and incoordination.
The school nurse is preparing health promotion presentations regarding unintentional injuries for a high school health fair. On which topic should the nurse place as the priority when preparing the presentation?
Motor vehicle safety Explanation: All options should be included in the presentation, but motor vehicle safety has the highest priority because motor vehicle accidents are the leading cause of injury and death followed by poisoning, which includes prescription drug overdose.
Nurses should provide anticipatory guidance to males to prepare them for what particular pubertal change in late adolescence?
Nocturnal emissions Explanation: This involuntary ejaculation during the night can be disturbing to the adolescent male who has little or no understanding of what is happening in his body. Lengthening of the penis begins to occur in early adolescence as does reddening of the scrotum. Breast enlargement occurs in some males in middle adolescence and resolves in late adolescence.
What is the initial nursing intervention in preventing polypharmacy? 1.Obtain a thorough medication history. 2.Discontinue all herbal preparations. 3.Refer the patient to a geriatric practitioner. 4.Consult a pharmacist to review all medications.
Obtain a thorough medication history.
A 15-year-old girl is in the hospital for surgery and is confined to bed. The nurse can tell that the client is nervous about being in the hospital. She tells the nurse that she feels "gross" and "on display" in her hospital gown. What should the nurse do to encourage a sense of autonomy and dignity related to the girl's body image?
Offer to assist the girl in washing her hair and let her pick the shampoo. Explanation: When caring for hospitalized adolescents, providing time for self-care, such as shampooing hair, is important to include in an adolescent's nursing care plan. Offering to assist the client in washing her hair and letting her pick the shampoo both encourages a sense of autonomy to the client and offers her dignity related to her body image. Brushing the girl's hair for her and assisting her with using the bed pan for urination do not encourage a sense of autonomy. If it is the hospital's policy to require clients to be dressed in a hospital gown while admitted, the nurse should not allow the girl to wear her own clothes.
A patient is taking a psychotropic medication for agitation associated with dementia. What is a common side effect of psychotropics? 1.Accelerated hypertension 2.Orthostatic hypotension 3.Diarrhea 4.Chest pain
Orthostatic hypotension
While caring for a 16-year-old client expected to be hospitalized for several months, the nurse will perform which action to assist the client in meeting the current stage of psychosocial development? You Selected:
Permit peers to visit during open visitation hours Explanation: In each stage of development, a significant person or group exerts a lasting influence on the ongoing development of the child. An adolescent striving for self-identity and increased independence spends more time with peers than with family. It is important for the hospitalized adolescent to still be able to visit with peers. Video games may be enjoyed by the adolescent and limit boredom; however, this action would not facilitate psychosocial development. Allowing the client to touch equipment to explain medical concepts and procedures are methods used to teach toddlers and preschoolers. Providing handouts and brochures are not effective methods to explain medical concepts; the nurse would verbally explain using models, pictures, and diagrams. Handouts and brochures can be used as supplements to teaching.
A female client tells the nurse about noticing an increase in weight and fat deposits during the past year. The nurse reviews the client's chart and recognizes that the client is most likely going through puberty. Which nursing action is most appropriate at this time?
Provide reassurance that these are normal changes. Explanation: Increased fat deposits and weight and height changes are normal as girls begin hormonal changes of puberty. During adolescence, girls are very sensitive about their appearance and experience a constant need for reassurance. Puberty is a period when children are very self-conscious about their overall appearance. Reassurance needs to be provided that increased fat deposits and weight and height changes are normal. Dietary management is indicated if a true weight problem is present, but healthy eating should be encouraged rather than dieting. Adolescents should be encouraged to participate in appropriate exercise programs. Dieting issues such as anorexia and bulimia can threaten the health of adolescents.
The mother of a 15-year-old boy confides in the nurse that she is concerned because her son is about to turn 16 and is pressuring her and her husband to buy him a motorcycle. Her husband is okay with the idea, but she is concerned about his safety. What information should the nurse mention to the mother regarding motorcycle safety? Select all that apply.
Require the son to wear a helmet. Require the son to wear long pants. Require the son to wear full body covering. Require the son to learn all relevant safety rules. Explanation: Equally dangerous as cars for adolescents are motorcycles, motorbikes, and motor scooters, which are appealing because of their low cost and convenience in parking. Both drivers and riders should wear safety helmets to prevent head injury; long pants to prevent leg burns from exhaust pipes; and full body covering to prevent abrasions in case of an accident. Advise adolescents who choose these forms of transportation to be as familiar with safety rules as automobile drivers and to wait until they are emotionally mature enough to use sound driving judgment. In the interest of an adolescent's safety and that of others, parents need to have the courage to insist on emotional maturity rather than age as the qualification for obtaining a driver's license. Motorcycles do not have seat belts.
A 17-year-old male adolescent on the high school swim team tells the nurse that during swim season he cuts the carbohydrates in his diet to 30% to help his swim times. What responses by the nurse are appropriate? Select all that apply.
Since you are so active, your carbohydrate intake should comprise 45% to 65% of your daily diet." "Can you tell me the reason you feel the need to cut your carbohydrates when your activity level is high?"
The school nurse is preparing a presentation for a group of teachers about teen suicide. When discussing risk factors for this occurrence which should be included? Select all that apply.
Substance use disorder History of mental illness Homosexuality
A 16-year-old client has been hospitalized 100 miles from home for 1 week to repair a fractured patella suffered in a skateboarding accident. She was cheerful and chatty when she first arrived, but the nurse notes in recent days she has become increasingly quiet and seems lonely. Which nursing intervention should the nurse prioritize for this client?
Take her to the teen lounge so she can meet other teens, use a phone, and check her email. Explanation: Adolescents need access to their peers so they can keep up social contacts. Access to a phone, computer, and email will help the teen stay connected. Recreation areas are important. In settings specifically designed for adolescents, recreation rooms can provide an area where teens can gather to do schoolwork, play games and cards, and socialize. Because she is 100 miles from home, a visit from friends might be difficult.
An 18-year-old adolescent reveals the presence of nipple ring and is looking to get a tattoo in the next few months. What is the most important thing that the nurse can teach the adolescent at this time?
Tattooing carries risks such as infection, disease, and nerve damage. Explanation: The nurse needs to emphasize that tattoos and body piercing can be painful, and carry risks of complications such as infection, blood-borne diseases, keloids and granulomas, allergic reactions, excessive bleeding, nerve damage, or damage to the piercing site. Complications are more likely if a person tattoos oneself or has the tattoo done by a friend. The nurse needs to encourage the adolescent to seek the expertise of a trained technician, doctor, or nurse to have the piercing, tattooing, or branding done. There are developed safety rules for those who do piercing and
The nurse is preparing to participate in a community discussion on the needs of the adolescents in the local school. The nurse should point out which goal is the primary concern for these young individuals as the committee makes plans?
Teens are busy developing their own personal identity. Explanation: According to Erikson, the central task of adolescence is to develop unique personality and identity. The developmental task for the school-age child is to develop a sense of industry, and completing activities builds that feeling of confidence. Erikson's psychosocial developmental task for toddlers is to achieve autonomy (independence) and do things on their own. Learning to speak and to understand and respond to discipline are not developmental tasks, according to Erikson.
Computer use at home and at school has increased adolescents' comfort in gaining access to and using the Internet. This has expanded their exposure to risks. What potential risks are there for an adolescent to be exposed to?
Teens can be exposed to inappropriate materials, harassment, threats, and potential for molestation.
The nurse is providing anticipatory guidance to the parents of a 15-year-old who voice concerns with their teenager's sleep habits. They state, "Left to her own devices, I'm sure she'd stay up until 3:00 in the morning on the weekends and sleep until after lunchtime." Which should the nurse explain to the parents?
That must be hard for you to manage. Perhaps we can explore some strategies with her to establish more predictable sleep patterns." Explanation: It is common for adolescents to adopt habits of going to bed late and awakening late, especially on weekends. Despite the fact that this is common, it is not ideal; the nurse should explore strategies for changing the adolescent's behavior in a collaborative and inclusive manner. Simply communicating that it is unacceptable is unlikely to bring about change.
hat is the best explanation of Erikson's theory of psychosocial development during adolescence?
The adolescent faces many different decisions during the teen years concerning the future and the adult world. Explanation: The main point of Erikson's theory on which the nurse should focus is that the adolescent faces many different decisions during the teen years concerning the future and the adult world. Piaget states that cognitive development is cumulative; that is, what is learned is based on what has been known before. It is true that the adolescent develops many skills during the teen years, which help adolescents make educational and career choices, and that the adolescent thinks in the abstract and develops skills to participate in complex problem solving. These aspects, however, are not central to Erikson's theory.
The nurse is assessing the psychosocial development of an adolescent. The nurse determines that the client is in the middle post-conventional phase with which observation?
The adolescent tells the nurse, "I'm starting to think that some of my friends care a lot more about what other people think of them than what I do." Explanation: According to Kohlberg, the middle post-conventional phase is characterized by the adolescent developing their own set of morals by evaluating individual morals in relation to peer, family, and societal morals. This is demonstrated when the adolescent stated. "I'm starting to think that some of my friends care a lot more about what other people think of them than what I do." The early post-conventional phase is characterized by asking broad, usually unanswerable questions about life such as the question about God. During the late post-conventional phase the adolescent internalizes their own morals and values, and continue to compare own morals and values to those of society. During this phase the adolescent also evaluates morals of others. The statements regarding the rich in society and work ethic demonstrate this late phase.
The nurse is caring for adolescent athlete who is being seen for a fractured arm. The parent reports that this is the third sports injury in the past 2 years. The parent asks the nurse why the adolescent who is healthy overall continues to have injuries. How should the nurse respond?
The bones, joints and tendons of adolescents are vulnerable to injury due to their rapid state of growth. Explanation: Rapidly growing bones, muscles, joints, and tendons are more vulnerable to unusual strains and fractures. While some people may seem to be accident prone, this adolescent's injuries are most likely the result of the stage of physical growth. There is no evidence the adolescent has any underlying medical conditions.
The nurse is admitting a 15-year-old to the pediatric unit. Which of the following does the nurse recognize as a priority for this child?
The child's need for privacy should be respected
Jenny is a 15-year-old who is being seen today in the clinic and her mom comments on the fact that Jenny seems to always choose the opposite of what everyone else wants and that her mood swings are a common occurrence. What statement below shows the nurse that Jenny's mom understands these changes?
This is common for this age group and it will get better with time."
The father of a 15-year-old daughter is concerned she is not getting adequate nutrition to play high school basketball. Her games are on Friday nights. Which suggestion should the nurse point out will best suit the needs of this adolescent?
Three daily meals that include choices from each of the food groups; Friday's lunch eaten around 2 p.m. with a small amount of fat and a somewhat larger than usual portion of complex carbohydrates. Explanation: A meal that is low in fat and high in complex carbohydrates, eaten 3 to 4 hours before an event, is appropriate for the teen athlete. Carbohydrate-loading, which some practice during the week before an athletic event, increases the muscle glycogen level to 2 to 3 times normal and may hinder heart function. The other suggested menus would not provide the additional muscle glycogen needed for optimal functioning.
The nurse is promoting nutrition to a teen who is going through a growth spurt. Which food should the nurse recommended for its high iron content?
Whole grain bread Explanation: Whole grain bread contains high amounts of iron and is a type of food the child would not have an aversion to. Milk is a good source of vitamin D. Carrots are high in vitamin A. Orange juice is a good source for vitamin C.
A 15-year-old adolescent is seen at a health care facility for facial acne. When counseling the teen, the nurse would teach that the basic cause of acne is:
activation of androgen hormones. Explanation: Acne occurs in adolescence as the result of hormone influence. With increased androgen production the sebaceous glands become more active. With increased testosterone production (in both boys and girls) increased sebum is produced. These increased hormone productions lead to the development of acne. Showering will certainly lead to cleaner skin and the removal of oils but the lack of showering does not cause acne. Diet and thyroid hormones do not play a role in the development of acne.
A patient with depression may be prescribed a(n): 1.phenytoin (Dilantin). 2.lorazepam (Ativan). 3.quetiapine (Seroquel). 4.amitriptyline hydrochloride (Elavil).
amitriptyline hydrochloride (Elavil).
A patient with dysphagia is: 1.fed only for pleasure. 2.at low risk for nutritional deficits. 3.at higher risk for pneumonia 4.able to drink thin liquids.
at higher risk for pneumonia
An elderly patient has acute confusion after undergoing abdominal surgery. The patient most likely has: 1.delirium. 2.anxiety. 3.dementia. 4.depression.
delirium.
A nursing intervention for a patient with constipation is to: 1.avoid the urge to defecate. 2.limit fluid intake. 3.give prune juice with a noncarbonated drink. 4.encourage bran cereal or whole-grain breads.
encourage bran cereal or whole-grain breads.
Appropriate nursing care for a patient with urinary incontinence is to: 1.insert an indwelling Foley catheter. 2.order oxybutynin chloride (Ditropan). 3.encourage fluids to decrease the urine concentration so it is less irritating. 4.recommend herbal approaches to reduce incontinence.
encourage fluids to decrease the urine concentration so it is less irritating.
According to Erikson, the adolescent develops his or her own sense of being an independent person with individual thoughts and goals. This stage is referred to as:
identity vs. role confusion. Adolescents must develop their own personal identity—a sense of being independent people with unique ideals and goals. This is the period Erikson calls identity versus role confusion. Erikson believes during this time the adolescent goes back through all previous developmental periods to achieve this identity. The stage of autonomy versus shame and doubt occurs between 18 months and 3 years. Industry versus inferiority occurs between 5 to 12 years. Intimacy versus isolation occurs in adulthood between the ages of 19 to 40 years.
The nurse takes into consideration that of all the physical changes that the elderly experience, the most common cause of most problems is that of: 1.visual disturbance. 2.hearing deficit. 3.loss of muscle mass 4.impaired mobility.
impaired mobility.
Medications taken early in Alzheimer's disease to improve memory and alertness work by: 1.increasing dopamine in the frontal lobe. 2.decreasing dopamine in the frontal lobe. 3.increasing acetylcholine in the cerebral cortex. 4.decreasing acetylcholine in the cerebral cortex.
increasing acetylcholine in the cerebral cortex.
Age-related eye changes may include: 1.increased visual accommodation. 2.macular degeneration. 3.non-preventable blindness as a result of glaucoma. 4.decreased ability of pupil to respond to light changes.
macular degeneration.
A patient with dementia wanders throughout the skilled nursing facility. A nursing intervention for wandering may include: 1.administering a sedative 2.maintaining a regular activity program. 3.locking the patient's room from the outside. 4.keeping a staff member with the patient when wandering.
maintaining a regular activity program.
An elderly patient is too weak to walk independently after surgery. Based on the services available on the rehabilitation unit, the nurse should work collaboratively with a(n): 1.exercise physiologist. 2.nutritionist. 3.physical therapist. 4.occupational therapist
physical therapist.
________ is the use of multiple medications, often inappropriately and excessively, at the same time.
polypharmacy
Alzheimer's disease may be suggested in its early stages by: 1.magnetic resonance imaging (MRI). 2.computed tomography (CT). 3.positron emission tomography (PET). 4.autopsy.
positron emission tomography (PET), autopsy
Alcoholism is often overlooked in the elderly. Cues to alcoholism include: (Select all that apply.) 1.delirium. 2.self-neglect. 3.frequent falls. 4.mental confusion.
self-neglect, frequent falls, mental confusion
The mother of a 9-year-old female voices concern to the nurse about her daughter developing breasts "at such a young age." How should the nurse respond?
understand your concern, but girls typically enter puberty around the age of 9 or 10." Explanation: Voicing empathy regarding the mother's concern conveys support, and letting her know that this is normal growth and development helps ease her concerns. The other responses don't address her concerns or show genuine empathy.
A 16-year-old girl has arrived for her sports physical with a new piercing in her navel. Which response by the nurse is best?
"Be sure to clean the navel several times a day." Explanation: The best response is to describe the proper care using frequent cleansing with antibacterial soap. It is too late for warnings about the dangers of piercing such as skin- or blood-borne infections, or disease from unclean needles.
The nurse is instructing a 12½-year-old boy who says, "I am too short! Girls are taller than I am. Guess I won't be playing basketball." What instructions are best included in the plan of care? Select all that apply.
"Girls begin to grow rapidly at a younger age than boys do. Boys start later and grow longer." "There are a lot of size differences in your age group now because everyone enters puberty and grows at slightly different times than others." "You could add as much as 12 inches to your height before you stop growing."
During the assessment of a 15-year-old female, the nurse notes a new body piercing in the navel. Which statements by the nurse would be appropriate in regard to this new piercing? Select all that apply.
"I notice you have a new piercing. Be sure to clean it twice a day so you don't get an infection." "Did they tell you when you got your piercing how important cleaning it is? Infections can take up to a year to heal in a naval piercing."
A 16-year-old adolescent is talking with the nurse at a local health clinic about skin care. Which comments by the teen does the nurse determine require additional conversation? Select all that apply.
"I only tan before going on spring break to get a base tan so I won't burn." "My favorite time of day to be outside is the middle of the day, around noon." "The more exposure and burns I get now will toughen my skin so I won't get skin cancer when I'm older." Explanation: The nurse should further discuss comments that demonstrate incorrect information about sun exposure. Any exposure to tanning beds should be avoided to prevent skin cancer risks. Other risks for skin cancer include being in the sun between the times of 10:00 am and 4:00 pm, and sun exposure and burns during childhood and adolescence. A minimum SPF of 15 should be used, so SPF 30 is good practice, as is wearing sun-protective clothing when outside during the day.
An adolescent asks the nurse what the term "puberty" means. What is the nurse's best response?
"It is the age at which one first becomes capable of sexual reproduction." Explanation: Adolescence is a period of rapid growth with dramatic changes in body size and proportions. It is the time between puberty and the end of physical growth. During this time, sexual characteristics develop and reproductive maturity occurs. Puberty is the point at which an individual becomes capable of sexual reproduction. Puberty starts at different ages for males and females. Puberty is defined as sexual maturity only. It does not describe emotional maturity.
The nurse has provided an education conference for a group of teachers about suicide risks for adolescents. Which statement by a teacher indicates a correct understanding of the nurse's teaching?
"Teens who have attempted suicide once are at increased risk to try to commit suicide again." Explanation: Teens who have attempted suicide are at an increased risk for attempting to take their own lives again. Homosexual teens are at an elevated risk for suicide. Risk factors for suicide include a multitude of mental health disorders and is not limited to depression.
The nurse is providing anticipatory guidance to the parents of a 15-year-old who voice concerns with their teenager's sleep habits. They state, "Left to her own devices, I'm sure she'd stay up until 3:00 in the morning on the weekends and sleep until after lunchtime." Which should the nurse explain to the parents?
"That must be hard for you to manage. Perhaps we can explore some strategies with her to establish more predictable sleep patterns." Explanation: It is common for adolescents to adopt habits of going to bed late and awakening late, especially on weekends. Despite the fact that this is common, it is not ideal; the nurse should explore strategies for changing the adolescent's behavior in a collaborative and inclusive manner. Simply communicating that it is unacceptable is unlikely to bring about change.
A 15-year-old client tells the nurse he has been having wet dreams and is ashamed and afraid he will get into trouble because he believes his parents think he is too young to understand or know about sex. To which statement would be the most appropriate for the nurse to respond?
"Wet dreams are not the result of anything you are doing but are simply the body's way of ridding itself of excess semen." Explanation: Boys who are unprepared for nocturnal emissions may feel guilty, believing that they have caused these "wet dreams" by sexual fantasies or masturbation. They need to understand that this is a normal occurrence and is simply the body's method of getting rid of surplus semen. The other suggestions do not address the situation in a professional manner.
