PrepU: Ch. 19 - Care of the Adolescent

The school nurse is conducting a health class with a group of high school students on the topic of sex and sexuality issues. The nurse determines the session is successful when the students correctly choose which aspect as most important?

"Adolescents need to know how to use condoms correctly to avoid sexually transmitted infections."

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?

"Adolescents who have attempted suicide once are at increased risk to try to commit suicide again."

What is one of the most commonly reported communicable diseases in the United States?

gonorrhea

A nurse is providing teaching to the mother of an adolescent girl about how to manage menstrual pain by nonpharmacologic methods. Which statement by the mother indicates a need for further teaching?

"I need to follow these instructions exactly for them to work properly."

A nurse in the teen clinic is using anticipatory guidance to educate parents about preventing violence in teens. Which response by a parent would show the nurse that the teaching on suicide was effective?

"I will check for signs of depression and a lack of peers."

A 14-year-old boy is far quieter than usual when he visits his physician's office. The nurse asks him if anything is wrong, and the boy replies that he did not make the cut for the football team. What would be most appropriate for the nurse to say?

"I'm really sorry; I know that must be a big disappointment."

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."

A single male caregiver of a 14-year-old girl accompanies his daughter to her pre-high school physical. In the course of discussion about how his daughter is developing, he remarks, "She's terrific most of the time. Of course when she gets her period, she's miserable and mean, but I tell her that's just what it's like to be a woman." What would be the most appropriate response by the nurse?

"There are nutritional and medical things she can do to lessen the symptoms; I'll give both of you information about some strategies and we'll track her for a few months."

A 15-year-old female is being seen for an annual physical examination. The teen asks the nurse if what they talk about will be kept private. What is the appropriate response by the nurse?

"There are some things I may need to share with your parents or physician."

A 12-year-old boy reports to the nurse that he is one of the shortest kids in his class. He asks the nurse if he will ever grow. What response by the nurse is most appropriate?

"There is no way to know how tall you will grow because you are still well within the window for growth."

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."

When obtaining information from a teen concerning the reason for seeking health care, which question would be most important?

"What health concerns are you having?"

A 16-year-old girl who has been confined to a wheelchair since early childhood has been acting rebellious and rude. Her parents ask the nurse, "Are all adolescents like this?" What is the nurse's best response?

"Your daughter's behavior seems to be typical adolescent behavior. Let's talk more about it."

A nurse is caring for an adolescent diagnosed with toxic shock syndrome. As part of the nursing care for this client, the nurse would anticipate which interventions? Select all that apply.

- Use of menstrual pads and avoidance of tampons - Iodine douching - Cervical and vaginal cultures

Jordan is coming back to the office for a follow-up visit. He is 15 years old and he keeps gaining weight at each visit. Although the amount is not large, it is a little more at each visit. Jordan says that he is not active in any sports and that he and his father eat out a lot. Which of the following would be most appropriate for the nurse to do to asses Jordan's eating pattern?

Have Jordan keep a food diary for one week.

The parents of a 16-year-old male are worried about recent changes in his behavior, ignoring his schoolwork and sports, and spending almost all of his free time interacting with his girlfriend. Which suggestion should the nurse point out would best address this situation?

He has developed his own identity by now; being able to establish close relationships with girls is important preparation for all of his adult relationships. They should honor his need to be with, or talk to, his girlfriend as long as he has completed his schoolwork for the day.

The nurse is promoting learning and school attendance for a 13-year-old girl. Which factor will affect the child's attitude most?

Peer group behaviors and attitudes

The nurse is obtaining a reproductive health history from a 17-year-old client. Which approach by the nurse would be most effective in obtaining accurate information?

asking the adolescent, in private, about sexual history using general questions and then more specific questions

Nurses should provide anticipatory guidance to males to prepare them for what particular pubertal change in middle-to-late adolescence?

nocturnal emissions

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."

A senior high school nurse is observing the developmental characteristics of the graduating students. Which student statement confirms that the student is meeting the appropriate developmental level?

"I am going to the university to study something in the health sciences."

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."

A 15-year-old is hospitalized for acute appendicitis. Which activities would the nurse include in the client's plan of care? Select all that apply.

- Arrange care to provide for extra rest and sleep. - Allow friends to visit during visiting hours. - Include the parents when educating the client.

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.

- "Can you tell me the reason you feel the need to cut your carbohydrates when your activity level is high?" - "Since you are so active, your carbohydrate intake should comprise 45% to 65% of your daily diet."

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.

- "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." - "I notice you have a new piercing. Be sure to clean it twice a day so you don't get an infection."

The school nurse is teaching parents risk factors for suicide in adolescents. What would the nurse discuss? Select all that apply.

- Mental health changes - History of previous suicide attempt - Family disorganization - Substance use disorder

A client diagnosed with dysmenorrhea has several medications prescribed. Which medication should the nurse question?

oxycodone

The school nurse is teaching a health class on nutrition with some adolescents. Which comment by a student should the nurse prioritize and provide more teaching?

"I am feeling so fat. I think I need to exercise a few extra hours today."

The parent of a 16-year-old female states, "I know she's pregnant because she missed her period for the second time." What is the best response by the nurse?

"I hear your concerns about pregnancy. There may be some other causes we need to explore."

A 15-year-old male client diagnosed with gonorrhea states, "I can't tell my partner about this." What is the best response by the nurse?

"What concerns you about telling your partner?"

The nurse is conducting a routine wellness examination of a 13-year-old client. Which question would be best to ask first when opening a discussion on sexual behavior?

"What do you like to do on the weekend?"

Which intervention would probably be most effective in preventing an adolescent from attempting suicide with an overdose again?

Helping to learn better problem solving

The nurse is educating the parents of a 10-year-old girl in ways to help their child avoid tobacco. Which suggestion should be part of the nurse's advice?

"As parents, you need to be good role models."

The nurse is counseling an overweight, sedentary 15-year-old girl. The nurse is assisting her to make appropriate menu choices. Which statement indicates the adolescent understands how to make appropriate dietary selections?

"I need to eat plenty of fruit each day."

The parent of a 14-year-old adolescent states to the nurse that the adolescent is moody, shuts oneself in the bedroom, and fights with a younger sibling. Which comment is most helpful to support the parent?

"Calmly talk to your adolescent about your concerns."

A 16-year-old diagnosed with trichomoniasis states, "This is not going to stop me from having sex." What information is essential for the nurse to provide?

"Condoms should be used until treatment of you and your partner is complete."

The nurse is promoting safe sex to a 14-year-old boy who is frequently dating. Which of the following points is most likely to be made during the talk?

"Contraception is a shared responsibility."

The nurse ends the health assessment of a 13-year-old adolescent with an open-ended question of "Is there any area of your health that you are frustrated with?" The adolescent states, "I am having a hard time falling asleep at night." Which is the most appropriate question for the nurse to ask next?

"How often are you having difficulty falling asleep?"

A male nurse is meeting with a group of high school boys to discuss various health topics. After the session on testicular self-exam, the nurse determines the session is successful when one of the students responds with which comment?

"I am almost 15 now, so that means I could possibly get this disease."

The mother of a 13-year-old boy confides to the pediatric nurse practitioner that her son has recently had a nocturnal seminal emission. The mother is concerned, and the nurse explains "wet dreams" and the other male traits of puberty to the mother. Which response indicates a need for further discussion?

"My son must be sexually active or having overly sexual thoughts to have a nocturnal emission."

Billy's mother is with him at a visit for a sore throat. During the interview she states that she does not know what to do with him. "He's taking two or three showers a day and it was not that long ago that I could barely get him to take a bath at all." Which response by the nurse would be most appropriate?

"Reinforce the family rules but also allow him to develop his own routine."

An adolescent's parent states not knowing what to do with the adolescent. The parent reports the teenager is taking two or three showers a day when not that long ago the parent could barely get the teen to take a shower at all. What should the nurse's reply be to the parent?

"Reinforce the family rules but also allow the adolescent to develop one's own routine."

The nurse is taking the health history of a 15-year-old client. What would be an appropriate way for the nurse to ask about the client's drug use history?

"Some teens like to smoke. Have you tried this?"

The nurse is providing education on adolescent safety to a group of caregivers. Which statement by a caregiver indicates additional teaching is needed?

"Taking a course on driving safety is sufficient to teach safe driving skills."

The nurse is assessing a 16-year-old girl at an annual well-clinic visit and notes the girl started menses at 13 years of age and grew 1 inch (2.5 cm) over the past year. When questioned by the young lady if this is normal, which answer should the nurse prioritize?

"You're following expected patterns of growth."

During a health visit, an adolescent client tells the nurse, "Why am I having all this acne?" Which response by the nurse would be appropriate?

"Your body is producing hormones called androgens that are responsible for your acne."

A nurse is conducting an assessment of a 16-year-old's cognitive development. The nurse determines that the adolescent's cognitive development is within acceptable parameters for the adolescent's age based on which assessment finding? Select all that apply.

- uses scientific methods to solve verbal problems - demonstrates thinking that the adolescent is invincible - shows a beginning interest and concern with societal and political issues.

During a well-child visit, the parents of an adolescent ask the nurse about how much physical activity their adolescent should engage in each day. The nurse would instruct the parents to encourage how many minutes of physical activity each day?

60

The nurse is interviewing an adolescent. What should the nurse recognize as an important aspect of interviewing the adolescent?

Adolescents will share more about themselves in a private conversation.

A 12-year-old client comes to the clinic for an annual checkup. The nurse needs to take a health history and perform a physical exam. Which method would be the most appropriate when obtaining the client's health history?

Ask the client if it's OK for the parent to be in the room.

The nurse is performing an admission assessment of an adolescent with the teen and the parents. During the assessment the nurse suspects that the teen may be pregnant. What is the best way for the nurse to address this situation?

Ask the parents to wait in the family lounge while finishing the assessment, then ask the teen during the assessment.

The doctor orders a vaginal examination for a 16-year-old female client who is complaining of severe lower abdominal pain and heavy vaginal bleeding. Which action should the nurse take first to prepare the adolescent for the procedure?

Assess previous experiences with pelvic examinations.

A client has confided in a nurse that her 13-year-old daughter has recently changed dramatically in her social interactions with others. What is a social behavior most likely to be exhibited by a girl at this age?

Banding together with other girls and dressing like them

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

During the admission process the nurse learns a 14-year-old female client has not experienced menarche yet. Which nursing action is appropriate?

Continue with the admission process.

When describing the various changes that occur in organ systems during adolescence, what would the nurse include?

Decrease in heart rate

To help prevent obesity, which intervention would the nurse include in an adolescent's plan of care?

Describe a normal serving size.

The nurse is discussing ways to promote discipline with parents who are becoming increasingly frustrated with their adolescent. What would the nurse suggest to the parents?

Develop consistent expectations and use consistent responses each time.

The nurse is caring for a 16-year-old client. The client confides in the nurse that they use of marijuana daily. Which action by the nurse is appropriate?

Discuss adverse side effects with the client.

The nurse is caring for a 12-year-old with cerebral palsy who is unable to communicate verbally. Which pain assessment tool is the most appropriate for the nurse to use when assessing pain in this client?

Face, leg, activity, cry, and consolability (FLACC) descriptors

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

Which of the following is accurately related to growth patterns in adolescent girls?

Growth slows after the beginning of menstruation.

When caring for an adolescent with a disability, it is best for the nurse to promote which of the following?

Have the child socialize with peers with and without disabilities.

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.

What anticipatory guidance can the nurse provide the girl who has noted the development of breast buds?

Menarche should follow in about 2 years.

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.

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?

Permit peers to visit during open visitation hours.

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.

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 and interact with other teens.

An adolescent female is experiencing dysmenorrhea. What should the nurse teach the client to help with this disorder?

Take over-the-counter ibuprofen.

The nurse is helping the parents and their underweight adolescent collaborate on planning a healthy menu. The nurse should be aware of which nutritional requirement of adolescents?

Teenagers have a need for increased calories, zinc, calcium, and iron for growth.

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."

The nurse is caring for an 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.

The physician has made a notation in the medical record of a 17-year-old that the teen is not demonstrating successful completion of Erikson's stages of development. What behavior would be consistent with this assessment?

The teen is uncertain and frequently unable to make decisions.

With summer approaching, the nurse discusses sun safety with a group of teen girls. Which suggestion is most likely to be followed?

Wear sunglasses.

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.

A nurse is caring for a teenager who is in the end stage of cancer. Which of the following nursing interventions provides self-esteem and self-worth to the teen?

allowing the teenager to completely participate in decisions

The nurse will monitor which adolescent client most closely for the risk of suicide?

an LGBT client requesting the nurse have the client's necklace and whose parents divorced last month

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

A young adult female is suspected of having gonorrhea. The nurse would anticipate additional testing for which sexually transmitted infection?

chlamydia

A 15-year-old girl has been experiencing dysmenorrhea for the past year. Over the past 6 months, she has been taking ibuprofen and oral contraceptives, with no improvement. What underlying condition should be assessed for in this client at this point?

endometriosis

The nurse anticipates that a 16-year-old girl with infectious mononucleosis will be instructed to avoid strenuous activities and contact sports to:

prevent splenic rupture.

A 14-year-old boy is aware that he is dying. Which action best meets the child's need for self-esteem and sense of worth?

providing full participation in decision making

A group of nursing students are preparing sample menus for the lacto-ovo-vegetarian diet. The instructor determines the presentation is successful after noting the students avoided the use of which foods in planning the menus?

red meat, poultry, and fish

The nurse is teaching a nutritional class to a group of adolescents who are lactose-intolerant. Which food should the nurse point out will help these adolescents consume the calcium they need for proper nutrition?

soybean curd

The nurse is caring for a 16-year-old adolescent who was arrested for driving while intoxicated. Which teaching method is most effective in changing the adolescent's behavior?

stressing that the driver's license can be lost if drinking continues

An 18-year-old client is planning to attend college in the fall. The health care nurse informs the adolescent that a visit with the primary care physician (PCP) will need to be scheduled before the start of college. What primary purpose does this PCP visit serve?

to update immunizations

An adolescent is concerned that although he has pubic hair, he has no facial hair yet. He wishes facial hair would grow to cover acne lesions. The nurse would advise him that facial hair:

usually follows pubic hair growth.