Nurse 140 Ch. 20

A 13-year-old boy states, The girls in my class tower over me. What would be the nurses most informative response? a. It may seem that way because girls have a growth spurt 2 years earlier than boys. b. Perhaps your parents are not exceptionally tall. c. Boys usually experience a growth spurt 1 year earlier than girls. d. You may feel short, but you are actually average height for your age.

a. It may seem that way because girls have a growth spurt 2 years earlier than boys. REF: Page 463

At what stage is the adolescent considered to be, according to Freuds theory? a. Conceptual b. Genital c. Glandular d. Pubertal

b. Genital Freud describes the adolescent period as genital. REF: Page 460

An adolescents parent comments, My son seems so preoccupied with his appearance these days. Is this normal? What is the nurses best response? a. It is his attempt to express his individualism. b. His preoccupation with his looks is quite normal. c. He is probably troubled with his physical changes. d. This shows that he has a positive self-image.

b. His preoccupation with his looks is quite normal. Preoccupation with self-image is normal and accounts for the constant primping of adolescents REF: Page 462

The school nurse is planning a program for girls about the physical changes of puberty. Toward what age girl should this program be directed? a. 10 years b. 12 years c. 14 years d. 16 years

a. 10 years Because puberty can occur in girls as early as age 10 years, instruction must be given by that age. REF: Page 460

The nurse considers what rites of passage valued by the adolescent in American society? (Select all that apply.) a. Attaining legal drinking age b. Selection of a career c. Religious affiliation d. Obtaining a drivers license e. High school graduation

a. Attaining legal drinking age d. Obtaining a drivers license e. High school graduation Rites of passage are socially recognized milestones that signify adulthood. Legal drinking age, drivers license, and matriculation through high school are such signals. Religious affiliation and selection of a career path do not necessarily signal adulthood. REF: Page 473

Which is considered a sign of depression in the adolescent? a. Change in school performance b. Experimenting with members of the same sex c. Becoming secretive about activities with peer groups d. Decrease in appetite during the school day

a. Change in school performance Adolescents may experience with members of the opposite sex while identifying their role. Adolescents may also become secretive with peer groups, but it would be concerning if they started withdrawing from peer groups. Adolescents typically have decreased appetites during the day because of their level of activity. REF: p. 475

The school nurse is discussing challenges of the adolescent years with a group of high school students in health class. What challenges toward adolescent development will the nurse include? a. Developing intimacy b. Maintaining dependence on parents c. Searching for identity d. Adjusting to body changes e. Establishing future goals

a. Developing intimacy c. Searching for identity d. Adjusting to body changes e. Establishing future goals Adolescents face the challenges of developing intimacy, searching for identity, adjusting to body changes and establishing goals for the future. Adolescents are striving for independence from parents. REF: Page 459

One of the tasks of adolescence as defined by Erikson is: 1. finding an identity 2. sexual latency 3. heterosexuality 4. concrete operations

1. finding an identity The major tasks of adolescence include establishing an identity, separating from family, initiating intimacy, and developing career choices for economic independence. Erikson identifies the major task of this group as identity versus role confusion. Emancipation is a critical element in the establishment of identity. REF: General characteristics; Box 20-1

Puberty can most accurately be defined as the period of life characterized by the: 1. occurrence of sexual maturity and appearance of secondary sex characteristics. 2. substitution of adult interests and value systems for child interests. 3. most rapid rate of physical and mental growth and development. 4. awakening of sexual feelings and the initiation of sexual experience.

1. occurrence of sexual maturity and appearance of secondary sex characteristics. Puberty is the stage in which the reproductive organs become functional and secondary sex characteristics develop. REF: Growth and development

Which action is most important when planning nutrition management for the adolescent? 1. Planning a low-calorie diet 2. Incorporating favorite or fad foods into the diet 3. Encouraging a positive attitude toward obesity 4. Skipping a meal to reduce caloric intake

2. Incorporating favorite or fad foods into the diet Foods for the adolescent should be selected from the basic food pyramid. Foods and eating fads are often a conflict between adolescents and their parents. Incorporating favorite or fad foods into the diet will increase the chances of compliance. Adolescents grow rapidly and expend large amounts of energy. The nurse attempts to involve the adolescent in selecting foods that are nutritious and appetizing. This may be done by reviewing choices made on the daily menu. REF: Sports and nutrition

During the administration of medications, a 17-year-old patient tells the nurse that he has never had that particular pill before. The best nursing action would be: a. check the patient's ID band again. b. assure the patient that the medication packet has his name on it. c. ask the patient to take the medication since the ID band and the medication administration record match. d. check the health care provider's written orders to confirm if this medication is newly prescribed. 1. a and b 2. c only 3. a and d 4. all of the above

3. a and d Adolescent is capable of knowing and understanding the care he is given and communication with an adolescent should be treated with respect. It is a nursing responsibility to assure the right medication is given to the right patient, therefore the medication administration record must be reassessed. REF: The Nursing approach to adolescence

A 16-year-old adolescent towers over her companions, which bothers her. She confides in the nurse, saying, "I just hate school - everyone is always staring at me." The nurse's best response would be: 1. "Don't pay any attention to it." 2. "You just don't know how lucky you are to be tall." 3. "This will resolve itself in time. Don't worry." 4. "Tell me more about how this embarrasses you."

4. "Tell me more about how this embarrasses you." The nurse must open the lines of communication and share with adolescents to enable them to feel at ease before initiating care or teaching. Open-ended questions concerning common problems of adolescence may encourage the discussion of a topic that adolescents may not initiate by themselves. REF: Health promotion and guidance

When communicating with an adolescent about safety concerns, which concept of adolescent behavior should be considered? 1. The typical adolescent understands teaching and respects and usually follows the advice of adults. 2. Growth and development are complete in the adolescent, and muscle coordination and skills lessen the risks for injury. 3. Safety concerns at this age mostly focus on sports injuries. 4. Adolescents are risk takers and tend to experiment with potentially dangerous outcomes.

4. Adolescents are risk takers and tend to experiment with potentially dangerous outcomes. The nurse must open the lines of communication and share with adolescents to enable them to feel at ease before initiating care or teaching. Open-ended questions concerning common problems of adolescence may encourage the discussion of a topic that adolescents may not initiate by themselves. REF: Health promotion and guidance

To what is the restlessness seen in the adolescent considered to be attributed? (Select all that apply.) a. Drive to be accepted by society as an individual b. Urge for independence c. Establishment of a personal identity d. Intense libido e. Slowing of body changes

a. Drive to be accepted by society as an individual b. Urge for independence c. Establishment of a personal identity d. Intense libido All the options listed are sources of stress to the adolescent and are stimulants to restlessness except option E: body changes are rapid. REF: Page 459

A girl tells the nurse that she and her best friend belong to the popular clique. She states, I love Katy Perry, and I want to be a singer. The nurse recognizes the girls statement as characteristic of what time period? a. Early adolescence b. Middle adolescence c. Late adolescence d. The entire adolescent period

a. Early adolescence Cliques of unisex friends, having a best friend, and hero worship are characteristics of the early adolescent. REF: Page 462

What is the best food choice for the nurse to recommend an adolescent eat before an important exam? a. Fish and rice b. Eggs and bacon c. Pancake and sausage d. A peanut butter sandwich with grapefruit

a. Fish and rice For an adolescent scheduled to take an important school examination, the nurse can offer nutritional guidance as part of the examination preparation. Fish, soy, peanuts, and rice increase choline and acetylcholine in the brain, which results in increased memory. REF: p. 473

A mother confides in the school nurse that she witnessed her son kissing another boy. Which concepts should guide the nurse to base a reply? (Select all that apply.) a. Homosexual behavior in adolescents is not uncommon. b. Homosexuality is a mental disorder. c. Adolescents often desire to explore alternative lifestyles. d. Homosexual tendencies should be addressed with counseling. e. Parents should seek a support group for parents of gays.

a. Homosexual behavior in adolescents is not uncommon. c. Adolescents often desire to explore alternative lifestyles. Adolescents may experiment with an alternate sexual expression as part of their self-discovery. Homosexual activities are not uncommon in adolescence. REF: Page 469

The nurse suggests the use of I messages to communicate a parents feeling to an adolescent. What is the most appropriate example of an I message? a. I feel frightened when you stay out past your curfew. b. I am your mother, and I insist that you observe your curfew. c. I am sick and tired of your staying out late. d. I expect you to show me proper respect

a. I feel frightened when you stay out past your curfew. This is the only statement that associates the parents feelings about the adolescent behavior that is not aggressive or accusatory REF: Page 471

What statement made by a parent indicates an understanding about helping a 13-year-old manage his allowance? a. I set amounts he can earn for particular chores. b. I give him a certain amount of money for each day. c. I put money into his bank account each month. d. I told him to ask me when he needs money.

a. I set amounts he can earn for particular chores. If money is simply handed out as requested, it is difficult to develop responsibility for finances and money management. The older adolescent is able to get a job. The younger adolescent can earn money by doing particular chores. REF: Page 467

The nurse is documenting the pediatricians assessment of a female patient. When assessing Tanners stages of breast development there is elevation of papilla only. What stage of development will the nurse document? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4

a. Stage 1 According to Tanners Stages of Sexual Maturity, Stage 1 (Preadolescent) is elevation of papilla only Page 463

The nurse is planning a safety program for high school students. To what will the nurse relay that most accidental deaths in adolescence are related? a. Firearms b. Automobiles c. Drowning d. Diving injuries

b. Automobiles The chief safety hazard for the adolescent is automobiles REF: Page 473

The school nurse is educating high school students about guidelines to be followed when participating in sports. Which statement by a student alerts the nurse of the need for further information? a. I will eat carbohydrates before practice. b. I drink large amounts of fluid when working out. c. I wear protective gear every time I play sports. d. I avoid caffeine when participating in sport

b. I drink large amounts of fluid when working out. Fluids lost by sweat must be replaced by drinking small amounts of fluid during a workout. Thirst is one guide for intake. Caffeine and alcohol deplete body water and are to be avoided. Carbohydrates that provide both energy and other nutrients are best for athletes. Protective gear should be worn by all team players in any contact sport. REF: Page 472

Which stage of adolescent development is considered the time of greatest turmoil for most families? a. Early adolescence b. Middle adolescence

b. Middle adolescence Middle adolescence appears to be the time of greatest turmoil for most families. REF: p. 459

What does adolescent acne result from? a. Ineffective sweat glands b. Oily skin c. Inadequate hygiene d. A poor diet

b. Oily skin Adolescent acne is the result of overactive sweat glands and oily skin. REF: Page 460

A physical exam of an adolescent female reveals projection of the areola and papilla to form a secondary mound on the breast. According to Tanner, which stage of sexual maturity is this considered? a. 2 b. 3 c. 4 d. 5

c. 4 The papilla and areola project during stage 4. REF: p. 463

The nurse is planning care of an adolescent. What psychosocial task does the nurse understand is important for the adolescent to develop? a. A sense of initiative b. A sense of industry c. A sense of identity d. A sense of involvement

c. A sense of identity Psychosocial milestones that must be accomplished during adolescence include the five Isimage of self, identity, independence, interpersonal relationships, and intellectual maturity. REF: Page 459

A 13-year-old girl tells the nurse she is concerned because she has not had her first menstrual period. What is the best initial response from the nurse? a. Your hormone levels may be irregular. b. Could you be pregnant? c. Age of first menstrual cycle varies. d. Do not worry about it.

c. Age of first menstrual cycle varies. Puberty is easily recognized in girls by the onset of menstruation. The first menstrual period is called the menarche. It commonly occurs about age 12 or 13 years, but this varies. It may occur as early as age 10 years or as late as age 15 years REF: Page 464

The nurse is assessing a 13-year-old boy. With what do physical changes in the pubertal male begin? a. Development of axillary and facial hair b. Enlargement of penis c. Enlargement of testicles d. Pigmentation of the scrotum

c. Enlargement of testicles In boys, pubertal changes begin with enlargement of the testicles and internal structures. REF: Page 462

The nurse is leading a discussion group with parents of adolescents. One parent comments, My son cant do anything without checking with his friends first. My opinion doesn't count anymore. What knowledge in regard to this behavior would the nurse formulate as a response? a. It is unusual for adolescent boys. b. It is often more apparent in boys than girls. c. It is a normal phenomenon during adolescence. d. It is suggestive of feelings of low self-worth.

c. It is a normal phenomenon during adolescence. Parents may need help understanding that the adolescents exaggerated conformity is necessary for moving away from dependence and obtaining approval from persons outside the nuclear family. REF: Page 466

What can the nurse suggests as a good dietary source of zinc for an adolescent who is a vegetarian? a. Green, leafy vegetables b. Citrus fruits c. Nuts d. Enriched breads

c. Nuts Zinc is essential for growth and sexual maturation in adolescence. Good vegetable sources include nuts, legumes, and wheat germ. REF: Page 472

. A 13-year-old girl tells the school nurse that she is getting fat, especially in her hips and legs. What understanding by the nurse would best guide the response? a. Many adolescents are unaware of proper nutrition. b. Adolescents of this age become less active and should eat fewer calories. c. Puberty is often preceded by fat deposits in these areas. d. As soon as menarche occurs, she will lose this excess weight.

c. Puberty is often preceded by fat deposits in these areas. Secondary sexual characteristics become apparent before menarche. Fat is deposited in the hips, thighs, and breasts, causing them to enlarge. REF: Page 464

What foods would be a healthy choice for an adolescent who just finished playing in a strenuous sports game? a. A cheeseburger and soda b. A hot fudge sundae c. Two sausage and egg breakfast sandwiches and orange juice d. A bagel and skim milk

d. A bagel and skim milk A bagel provides a rapid supply of carbohydrates to the muscles, and skim milk provides a slow release of carbohydrates to the muscles. REF: Page 472

A 16-year-old excitedly tells his parents that he was offered a part-time job. Which response represents an effective problem-solving approach for his parents? a. Your studies are too important for you to have a part-time job. b. When we went to high school, academics were the adolescents priority. c. We want you to put your earnings in a savings account. d. How do you think you will manage your school work and a job?

d. How do you think you will manage your school work and a job? An effective approach to help adolescents learn to solve problems is for parents to guide them in exploring alternatives. REF: Page 471

The nurse using the PACE interview guide for persons at risk for substance abuse arrives at a score of 2 for an adolescent patient. How would the nurse interpret this score? a. Nonindicative of potential substance abuse b. Normal experimentation of the adolescent c. Need to schedule another PACE interview in 3 months d. Indication for referral for counseling

d. Indication for referral for counseling The PACE guide recommends that a score of 2 or higher would suggest the need for a referral for counseling about substance abuse. REF: Page 474

What does an adolescents peer group serve as related to development? a. Social outlet b. Association to blur personal identity c. Platform for group think d. Initial separation from family

d. Initial separation from family Being a member of a peer group and communicating with and seeking approval from this group are hallmarks of the first separation from the family REF: Page 462

A parent comments that her adolescent daughter seems to be daydreaming a lot. What does the nurse understand this behavior to indicate regarding their daughter? a. She is bored. b. She is not getting enough rest. c. She is trying to block out stress and anxiety. d. She is mentally preparing for real situations.

d. She is mentally preparing for real situations. Daydreaming allows adolescents to act out in their imaginations what will be said or done in certain situations. This helps them to prepare for and cope with interactions with others. REF: Page 468

When planning to answer a 16-year-old girls questions about menstruation, the nurse must consider cognitive development. What is developed during adolescence according to Piaget? a. The ability to view a situation from multiple perspectives b. The ability to focus more on the past than present situations c. The ability to exercise concrete reasoning d. The ability to consider hypothetical situations

d. The ability to consider hypothetical situations According to Piaget, in the formal operations stage adolescents have the ability to think abstractly REF: Page 460

The mother of a 15-year-old girl states that her daughter always believes people are looking at her. What is the best education the nurse can provide at this time? a. This is unusual behavior and may require counseling. b. This may begin to interfere with the girl's development. c. This is behavior that should be discussed with the physician. d. This is normal behavior for an adolescent.

d. This is normal behavior for an adolescent. Adolescents create what has been termed an imaginary audience, which means they believe everyone is looking at them. This preoccupation with self is normal and accounts for the constant hair combing and makeup repairing often observed in a group of adolescents. REF: p. 466

What are the best breakfast choices for the nurse to point out prior to a big exam, to provide high levels of alertness and increased memory? (Select all that apply.) a. Pancakes and syrup b. Coffee and chocolate-covered donuts c. Bacon and fried eggs d. Whole grain cereal and yogurt e. Oatmeal and sliced apples

d. Whole grain cereal and yogurt e. Oatmeal and sliced apples Meals high in protein will break down into norepinephrine and increase alertness. Meals with a high sugar content result in a soothing sleepy response. Meals high in fats digest slowly and draw blood from the brain during the lengthy digestive process. REF: Page 472