Ch 33: Nursing Care of a Family with an Adolescent

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a) Tattooing carries risks such as infection, disease, and nerve damage

Pg. 898

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 tattoos.
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Terms in this set (43)
a) Tattooing carries risks such as infection, disease, and nerve damage

Pg. 898

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 tattoos.
1. 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?

a) Tattooing carries risks such as infection, disease, and nerve damage
b) It is not recommended to get the tattoo from your friend in his garage
c) Review the safety rules for those who do the tattooing
d) Complications are more likely when you tattoo yourself
b) Take her to the teen lounge so she can meet and interact with other teens

Pg. 911

Adolescents need access to their peers so they can keep up social contacts. Meeting other teens in the facility is one way to accomplish that. The client most likely also has an electronic device which will enable her to stay in contact with family and friends back home but meeting others can also help meet social needs. 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.
2. 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?

a) Ask her caregivers to bring her siblings and friends to visit
b) Take her to the teen lounge so she can meet and interact with other teens
c) Call the hospital's mental health unit to see if she can get some counseling
d) Suggest that she read books and magazines from the hospital bookmobile
a) History of previous suicide attempt
b) Family disorganization
e) Substance use disorder
f) Mental health changes

Pg. 906

Suicide is the third leading cause of death in adolescents 15 to 19 years of age. Risk factors for suicide include mental health changes, history of previous suicide attempt, family disorganization, and substance use disorder. Other risk factors include poor school performance, crowded conditions/housing, low socioeconomic status, limited parental supervision, single-parent families/both parents in workforce, access to guns or cars, drug or alcohol use disorder, low self-esteem, racism, peer or gang pressure, and aggression.
3. The school nurse is teaching parents risk factors for suicide in adolescents. What would the nurse discuss? Select all that apply.

a) History of previous suicide attempt
b) Family disorganization
c) Greatly improved school performance
d) Higher socioeconomic status
e) Substance use disorder
f) Mental health changes
b) A sense of trust and identity

Pg. 892

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.
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) An understanding of socialization and of isolation
b) A sense of trust and identity
c) A willingness to take initiative
d) An ability to be autonomous
b) Let them choose their hairstyle, even though it may not look the best for them

Pg. 891

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.
5. 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?

a) Leave pamphlets about topics such as drugs and alcohol in their room so they can read them
b) Let them choose their hairstyle, even though it may not look the best for them
c) Discourage spending too much time with school friends since we know they can be a negative influence
d) Our house rules are stricter than their friends but everyone follows the same rules in our home
b) "Drinking sodas is not related to my blood pressure"

Pg. 896

Hypertension is present if the blood pressure is above the 95th percentile, or 127/81 mm Hg for 16-year-old girls and 131/81 mm Hg for 16-year-old boys for two consecutive readings. Adolescents who are obese, who are black, who eat a diet high in salt, or who have a family history of hypertension are most susceptible to developing the condition. Drinking soda regularly increases the amount of sodium intake daily, thus having an impact on the blood pressure.
6. A black adolescent male has been diagnosed with hypertension. Which statement made by the adolescent indicates to the nurse that additional teaching is needed?

a) "My blood pressure should remain less than 130/90 mm Hg"
b) "Drinking sodas is not related to my blood pressure"
c) "My dad has hypertension, so I have to be careful"
d) "Playing baseball is good exercise for me"
a) The individual's sex no longer decides which career options are available

Pg. 891

Sex role stereotypes have been shattered in most careers and professions. More women are becoming lawyers, physicians, plumbers, and carpenters; more men are entering nursing or choosing to become stay-at-home fathers while their wives earn the primary family income. The adolescent should consider what the parents are saying, but the final choice is theirs. With the use of the Internet, travel to other areas, and a variety of school options, there are ways for the students to go to a school in a different area. There are also numerous resources that will help the student seek higher education. It just may mean they have to work a little harder to achieve their goal. There are many career choices for the adolescent to choose from.
7. The school nurse is preparing for a career fair at the local high school. Which factor should the nurse point out when presenting various medical career options to the students?

a) The individual's sex no longer decides which career options are available
b) Many individuals have already chosen what they want to do
c) The adolescent should seriously consider the parents' choice for the best career
d) The career choices may be limited after high school depending on location
a) Describe a normal serving size

Pg. 900

Some adolescents may be unaware that their food intake is excessive because they have been told they need excess nutrients for healthy adolescent growth and everyone in their family eats large portions. Health teaching with these adolescents may need to begin with a discussion of "normal" weight and standard food portions. If adolescents eat a diet too low in protein for any length of time, they can develop a negative nitrogen balance, which can lead to impaired growth. Therefore, a diet of fewer than 1,400 to 1,600 calories a day can rarely be tolerated by adolescents. Teenage girls who are moderately active require about 2,000 calories per day and teenage boys who are moderately active require between 2,200 and 2,800 calories per day. Eating in excess can lead to obesity and should be avoided.
8. To help prevent obesity, which intervention would the nurse include in an adolescent's plan of care?

a) Describe a normal serving size
b) Plan a diet of 3,000 calories per day
c) Encourage sources of proteins with fat
d) Plan a diet of 1,500 calories per day
b) Banding together with other girls and dressing like them

Pg. 891

In early adolescence, girls tend to band together with girls. They dress identically with other members of their group: jeans and sweatshirts, special jackets, or whatever the fashion may be. On the surface, this makes adolescents appear to be losing their identities rather than finding them.
9. 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?

a) Hanging out primarily with boys her own age
b) Banding together with other girls and dressing like them
c) Banding together with boys and girls but maintaining her own unique style
d) Hanging out with girls but maintaining her own unique style
b) "What specifically have you been noticing?"

Pg. 900

It is best to find out what caused the teenager to make the comment, thus allowing the nurse to work with her about the issue. This is an assessment and must be done first. Launching into a lecture on diet and exercise will be of no value if the teenager wants to talk about dealing with snide comments from her peers. Telling the teenager she is statistically in the normal range for weight and height may close the conversation prematurely. The focus is on the teenager, not her parents. Obtaining that information would be important, but not at this time.
10. During a health maintenance visit, a 15-year-old girl mentions that she is not happy with being overweight. Which approach is best for the nurse to take?

a) "Tell me about your parents. Are they overweight?"
b) "What specifically have you been noticing?"
c) "Good observation. Let's talk about diet and exercise"
d) "Don't worry; you are within the weight and height guidelines"
c) "Would you like to talk about these feelings?" Pg. 901 The task of forming an identity is for adolescents to decide who they are and what kind of person they will be. One of the challenges of identity is to accept their changed body image. During adolescence, individuals begin to explore their sexual preferences and may question their gender identity. Encourage an open dialogue with adolescents to assist them to process their feelings and establish their own identity. The nurse should not be judgmental. Because the adolescent has had feelings does not mean the adolescent is gay, nor does it imply there is something wrong that needs to be "fixed."11. During a visit to the school nurse, an adolescent confides in recently having feelings of attraction to a member of the same gender. How should the nurse best respond to the adolescent? a) "These feelings are normal for your age" b) "Do these feelings make you feel bad about yourself?" c) "Would you like to talk about these feelings?" d) "How long have you been having these feelings?"a) Assess the client for signs of infection Pg. 898 The nurse will first assess the client for signs of infection. The client reports feeling hot, which could indicate a fever. The nurse would assess the client's temperature and for other signs and symptoms of infection, such as redness, swelling, warmness, drainage, discomfort. The nurse would ask when the client started feeling hot and about the technique used for the piercing to gain additional history and insight. However, these questions are not priority over assessing the client. Determining if the client has any additional piercings is not necessary, as this will not provide information about the client's current situation.12. An adolescent with a new piercing comes to the health center at the school. The client reports feeling hot. Which action will the nurse complete first? a) Assess the client for signs of infection b) Ask the client if any other piercings are present c) Determine when the client started feeling hot d) Inquire about the piercing technique useda) Permit peers to visit during open visitation hours Pg. 891 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 and to explain medical concepts/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.13. 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? a) Permit peers to visit during open visitation hours b) Explain medical concepts by providing handouts and brochures c) Allow the client to touch equipment before procedures d) Provide video games for the client to playb) "You seem concerned. Let's talk about your feelings" Pg. 891 Body image is closely related to self-esteem. Seeing one's body as attractive and functional contributes to a positive sense of self-esteem. During adolescence, the desire not to be different can extend to feelings about one's body and can cause adolescents to feel that their bodies are inadequate even though they are actually healthy and attractive. The nurse would acknowledge the client's concern and discuss the client's feelings. Stating the client is beautiful as is does not address the client's concern. Closed statements which require no response do not offer any insight for the nurse. The nurse would also avoid yes/no questions.14. The school nurse is assessing a 15-year-old female client. The client states, "I just want to be pretty and to look like everyone else." Which response by the nurse is appropriate? a) "Do you not think you are pretty now?" b) "You seem concerned. Let's talk about your feelings" c) "I think you are beautiful just as you are" d) "Looking like everyone else is not what makes someone pretty"d) Sit down with her and openly discuss her concerns and questions in an honest, straightforward manner Pg. 892 Discussions about human sexuality need to be open, honest and straightforward with adolescents. Parents and health care providers must remain nonjudgmental if they want adolescents to come to them with questions. Sitting down with the student and addressing her questions is the best way to establish a trusting relationship with her. Recommending that she talk with her parents will not help her since they are apparently not open to discussing the topic. Brochures cannot answer her specific questions and may result in more confusion on her part. Referring her to the health department is passing the nurse's responsibility to someone else, and there is no indication that any pregnancy prevention is needed.15. When interviewed by the school nurse, a 13-year-old adolescent female states she has a boyfriend and that her parents do not talk about sex with her. She says she is confused about the facts and wants to know the truth. Which approach would best address this adolescent's concerns? a) Offer to provide her some brochures to help her better understand how her body works b) Refer the adolescent to a local health department for sexual counseling and pregnancy prevention c) Explain that a discussion about sex is best handled by her parents and she should go home and ask them d) Sit down with her and openly discuss her concerns and questions in an honest, straightforward mannerc) Listening to all comments nonjudgmentally Pg. 903 It is very important to listen to the students' comments without casting judgment to avoid creating resistance to information. Spouting too many facts too often and taking on an authoritative tone will show the audience that their opinions don't matter. Using personal experiences and admitting mistakes you have made can be helpful to communication.16. The school nurse is planning to teach a segment on smoking during the freshman health classes. The nurse is aware that this needs to be a forum rather than a lecture. Which technique will also help deliver a "don't smoke" message? a) Showing a command of the facts on smoking b) Keeping your personal experiences out of it c) Listening to all comments nonjudgmentally d) Speaking with a tone of authorityd) Being honest and straightforward with teenagers will encourage them to ask about subjects like sexuality Pg. 901 The most important aspect of discussions about sexuality with adolescents is giving honest, straightforward answers in an atmosphere of caring concern. Children whose need for information is not met through family, school, or community programs will get the information—often inaccurately—from peers, movies, television, or other media.17. The nurse is meeting with a group of caregivers of adolescents and discussing sex and sexuality, including how to discuss these issues with their children. Which comment should the nurse prioritize with this group of caregivers? a) Teenagers spend so much time with their peers, and that is usually how they find out about sex b) Internet resources, movies, and television have the most accurate and current information for your adolescent to learn about sexuality issues c) Most schools have excellent programs to teach adolescents about sex and sexuality d) Being honest and straightforward with teenagers will encourage them to ask about subjects like sexualityb) Complete a rape kit to rule out possible sexual abuse while the client was blacked out Pg. 901 In recent years the use of rohypnol, also known as the "date rape drug," has become a concern for the adolescent. Rohypnol is not sold legally in the United States but is brought in from countries where it is sold legally. The drug, especially in combination with alcohol, causes memory loss, blackouts, and an inability to resist sexual attacks. Often the drug is secretly slipped into a person's drink. The drug has no taste or odor, but within a few minutes after ingesting the drug, the person feels dizzy, disoriented, and nauseated, and then rapidly passes out. After several hours, the person awakens and has no memory of what happened while under the influence of the drug. Waking up in someone's bed should raise suspicions that the individual was raped. Completing a rape kit will provide the authorities with the evidence they will need to further pursue the case.18. The nurse in an emergency department is assessing an 18-year-old who is reporting a gap in memory for the previous night. The client reports feeling dizzy and disoriented after drinking only one drink. The client woke up in a friend's bed but has no recollection of getting there. What action should the nurse prioritize for this client? a) Have the client call a caregiver to get permission to treat and counsel the client b) Complete a rape kit to rule out possible sexual abuse while the client was blacked out c) Call social services to counsel the client about blackouts related to alcohol use disorder d) Call the neurology department so they can see the client to rule out a neurological impairmentc) Allow the adolescent to participate in decisions Pg. 888-890 Erikson describes the developmental task of adolescence as "identity versus role confusion." Adolescents must develop their own personal identities—a sense of being independent people with unique ideals and goals.19. The nurse teaches a 14-year-old client's mother about the adolescent developmental task of identity versus role confusion. What is the best way for the mother to help her adolescent complete this task? a) Set limits and offer concrete choices b) Allow the adolescent to set his/her own limits c) Allow the adolescent to participate in decisions d) Set limits according to what other adolescents are allowed to doa) Peer group behaviors and attitudes Pg. 891 In this age group, children have a strong desire to conform to their peer group and to be accepted. It is important to know the peer group's attitude about school and learning. Early adolescence marks the beginning of separation from the family, including its values and desires. Physiologic changes and sexual attraction would not have significant or lasting influence in this matter.20. The nurse is promoting learning and school attendance for a 13-year-old girl. Which factor will affect the child's attitude most? a) Peer group behaviors and attitudes b) Her parents' values and desires c) Desire for attention from boys d) The dramatic changes to her bodya) Allow the adolescent to choose the time for the dressing change Pg. 911 Achieving a sense of identity may be difficult for adolescents who have a chronic illness. Some of the nursing actions which encourage identity in the chronically ill adolescent include the following: respecting food preferences; allowing the adolescent to choose the time for the dressing changes; teaching the name, actions, and possible side effects of medication; and respecting modesty. The school can provide homework so the adolescent does not get further behind in school work, and the teen can go to the teen room each day. These provide a good emotional outlet, but they do not promote independence. Teaching the parents to do the dressing changes makes the adolescent dependent on the parents. If the dressings are at a location the adolescent can reach and dexterity is not limited, then the adolescent should be allowed self-care.21. A chronically ill adolescent is readmitted to the hospital with an infected wound requiring long-term dressing changes. What is the best way the nurse can encourage independence for this client? a) Allow the adolescent to choose the time for the dressing change b) Have the school provide homework c) Teach the parents to perform dressing changes at home d) Have the adolescent go to the teen room every daya) "Try to be open to his views" Pg. 892 It is most important to be open to the child's views. This will encourage the child to consider parental concerns and promote communication. Being judgmental about his friends will make the child defensive about his choice of friends. Rules need to be flexible so they can apply to new situations. Avoid condescending the child. The child will appreciate being treated like a young man.22. The nurse is teaching the parents of a 12-year-old boy about common approaches when raising an adolescent. Which instruction is most important? a) "Try to be open to his views" b) "Maintain a firm set of rules" c) "Remind him that he is still your little boy" d) "Find out if his friends are worthy of him"d) "Give her some options; it's important to find something she enjoys" Pg. 888 With the onset of puberty and accompanying changes in physique and coordination, sports must be matched to the physical and emotional development of the child. It is important to give the girl some options and find something that she enjoys doing. Making a suggestion for activities without the girl's input is unhelpful. Reminding the girl that she needs regular physical activity does not address the mother's concern and is not constructive. Making a statement that organized sports are just a complement to other physical activity is accurate but does not teach or offer solutions.23. The nurse is caring for an 11-year-old girl. The girl's mother reports that the girl does not want to play team sports like soccer or volleyball anymore. Her daughter insists she does not enjoy them. The mother is concerned that her daughter will not get enough physical activity and asks the nurse for guidance. How should the nurse respond? a) "Remind her of the importance of regular physical activity for good health" b) "Why don't you sign her up for an aerobics or dance class?" c) "Organized sports are just a complementary activity to other physical activities" d) "Give her some options; it's important to find something she enjoys"c) Offer to assist the girl in washing her hair and let her pick the shampoo Pg. 895 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.24. 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? a) Allow the girl to wear her own clothes, despite hospital policy b) Brush the girl's hair for her c) Offer to assist the girl in washing her hair and let her pick the shampoo d) Assist the girl with using the bed pan to urinatec) "You are feeling sad right now. It's a hard time" Pg. 906 Some degree of depression is present in most adolescents because they are not only losing their parents while they grow apart from them but also their carefree childhood. When using therapeutic communication, it is important for the nurse to accept the client's verbalization as real. Support should be real. Telling the adolescent that things will be better in college provides false reassurance. Telling the adolescent to "look on the bright side of things" or that "being a teen is hard work" offer platitudes and interrupt the client's interactions.25. An adolescent who is depressed states, "Nothing ever seems to be right in my life." Which would be the most appropriate response by the nurse? a) "Try to look at the bright side of things" b) "Things will be better when you go off to college" c) "You are feeling sad right now. It's a hard time" d) "Being a teenager is hard work"a) Vegetarian diets can be healthy; ensure she includes whole-grain products, legumes, nuts, seeds, and soy dairy substitutes Pg. 895 If planned with care, vegetarian diets can provide all needed nutrients. All vegetarians should include whole-grain products, legumes, nuts, seeds, and fortified soy substitutes. If the individual is following the lactovegetarian approach, then low-fat dairy products are also appropriate. The lacto-ovo vegetarian diet includes eggs and dairy products but excludes meat, poultry, and fish. The vegetarian diet does not need to be supplemented with protein drinks and megavitamins if the food choices are carefully chosen to provide adequate nutrition.26. The parent of an adolescent has called to talk to the pediatric nurse over concern that her daughter is not getting proper nutrition now that she has started following a vegetarian diet. Which response should the nurse prioritize for this parent? a) Vegetarian diets can be healthy; ensure she includes whole-grain products, legumes, nuts, seeds, and soy dairy substitutes b) Vegetarian diets can be healthy for teens but should be supplemented with protein drinks and megavitamins c) Lacto-ovo vegetarian diets are acceptable for teens but, until the body's growth cycle is complete, she needs some egg and dairy products for good health d) A vegetarian diet is unhealthy for growing bodies, and teens are too immature to make a healthy decisiond) To update immunizations Pg. 897 The primary purpose of the PCP visit is to ensure that the adolescent has received recommended immunizations and administer any missing vaccines so that the adolescent is ready for communal living. The other answers may or may not be discussed during the visit, but they are not the primary purpose.27. 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? a) To obtain birth control b) To assess for health problems c) To discuss diet d) To update immunizationsd) 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 Pg. 892 When identity has been established, generally between the ages of 16 and 18 years, adolescents seek intimate relationships, usually with members of the opposite sex. Intimacy, which is mutual sharing of one's deepest feelings with another person, is impossible unless both persons have established a sense of trust and a sense of identity. Intimate relationships are a preparation for long-term relationships, and people who fail to achieve intimacy may develop feelings of isolation and experience chronic difficulty in communicating with others.28. 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? a) He is not developmentally mature enough to have an intimate relationship with one girl; they should encourage him to spend time with groups of friends rather than time alone with his girlfriend b) He is not developmentally mature enough to make healthy choices about the ways in which he spends his time, so it would be helpful if they would make a schedule for him that includes about a half-hour per day to talk with his girlfriend c) He has chosen a girl who is overly dependent on him. They should talk to him about making sure he meets his own needs, including doing the schoolwork he enjoys, in any relationship d) 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 dayb) "Teen appearance might not accurately reflect their actual values" Pg. 891 The nurse should inform the mother that the statements adolescents make with their dress and grooming may not indicate what their actual values are. Mentioning piercings and tattoos will only worry the mother more. Minimizing the situation as experimentation is of no value to the mother. Telling the mother to choose her daughter's friends for her will destroy trust between mother and daughter.29. A mother calls the school nurse and is concerned because her 13-year-old daughter's friends wear heavy makeup and black clothes. Which is the best advice for the mother? a) "The teen years are a time for experimenting" b) "Teen appearance might not accurately reflect their actual values" c) "Encourage her to socialize with the kids at church" d) "This can lead to piercings and tattoos"c) Reducing risk-taking behavior Pg. 891 The adolescent experiences drastic changes in the physical, cognitive, psychosocial, and psychosexual areas. With this rapid growth during adolescence, the development of secondary sexual characteristics, and interest in the opposite sex, the adolescent needs the support and guidance of parents and nurses to facilitate healthy lifestyles and to reduce risk-taking behaviors. Promoting physical growth, maximizing learning potential, and teaching hygiene are secondary to reducing risky behavior.30. The nurse teaches parents of adolescents that teenagers need the support of parents and nurses to facilitate healthy lifestyles. What should be a priority focus of this guidance? a) Promoting adequate physical growth b) Maximizing learning potential c) Reducing risk-taking behavior d) Teaching personal hygiene routinesa) After age 12 children can think in the abstract, including complex problem solving Pg. 893 The nurse should explain that there are four levels of cognitive development in Piaget's theory. The sensorimotor level is up to age 2 where children learn by touching, tasting, and feeling. They learn to control body movement. Preoperational level takes place in children ages 2 to 7 years who investigate and explore the environment and look at things from their own point of view. At the concrete operations level, from ages 7 to 11 years, children internalize actions and can perform them in the mind. At the formal operations, after age 12, children can think in the abstract. Complex problem solving is included in this category.31. A nurse is explaining cognitive development in children to a client, with the help of Piaget's theory of cognitive development. What would be the best explanation by the nurse about the formal operations level of cognitive development? a) After age 12 children can think in the abstract, including complex problem solving b) Children from ages 2 to 7 years investigate and explore the environment and look at things from their own point of view c) From ages 7 to 11 years, children internalize actions and can perform them in the mind d) Up to age 2, children learn by touching, tasting, and feeling. They learn to control body movementc) Dairy products, meat, poultry, fish, and eggs Pg. 895 The vegan diet excludes all food of animal origin, including dairy products, eggs, fish, meat, and poultry. The semi-vegetarian diet includes dairy products, eggs, and fish and excludes red meat and possibly poultry. The lacto-ovo-vegetarian diet includes eggs and dairy products but excludes meat, poultry, and fish. The lacto-vegetarian diet includes dairy products and excludes meat, fish, poultry, and eggs.32. The school nurse is presenting information to a group of high school students who are asking about vegetarian diets. The nurse determines that the group needs more information when they identify which foods as being included in a vegan diet? a) Red meat and possibly poultry b) Red meat, poultry, and fish c) Dairy products, meat, poultry, fish, and eggs d) Meat, poultry, fish, and eggsc) Teenagers have a need for increased calories, zinc, calcium, and iron for growth Pg. 895 Teenagers have a need for increased calories, zinc, calcium, and iron for growth. However, the number of calories needed for adolescence depends on the teen's age and activity level as well as growth patterns. Teenage girls who are active require about 2,200 calories per day. Teenage boys who are active require between 2,500 and 3,000 calories per day. Adolescents require about 1,200 to 1,500 mg of calcium each day.33. 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? a) Adolescents require about 1,000 to 1,200 mg of calcium each day b) Teenage girls who are active require about 1,800 calories per day c) Teenagers have a need for increased calories, zinc, calcium, and iron for growth d) Teenage boys who are active require between 2,000 and 2,500 calories per dayb) Finding an identity Pg. 888 According to Erikson, it is during adolescence that teenagers achieve a sense of identity. The toddler developed a sense of trust in infancy and is ready to give up dependence and to assert his or her sense of control and autonomy. The psychosocial task of the preschool years is establishing a sense of initiative versus guilt by mastering skills. In the school-age years the child develops concrete operations and is able to assimilate and coordinate information about the world from different dimensions.34. Based on Erikson's developmental theory, what is the major developmental task of the adolescent? a) Gaining independence b) Finding an identity c) Coordinating information d) Mastering motor skillsd) "What specifically have you been noticing?" Pg. 900 It is best to find out what caused the teenager to make the comment, thus allowing the nurse to work with her about the issue. This is an assessment and must be done first. Launching into a lecture on diet and exercise will be of no value if the teenager wants to talk about dealing with snide comments from her peers. Telling the teenager she is statistically in the normal range for weight and height may close the conversation prematurely. The focus is on the teenager, not her parents. Obtaining that information would be important, but not at this time.35. During a health maintenance visit, a 15-year-old girl mentions that she is not happy with being overweight. Which approach is best for the nurse to take? a) "Don't worry; you are within the weight and height guidelines" b) "Tell me about your parents. Are they overweight?" c) "Good observation. Let's talk about diet and exercise" d) "What specifically have you been noticing?"a) Boys grow at a slower, steadier rate than do girls Pg. 887 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.36. 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? a) Boys grow at a slower, steadier rate than do girls b) Boys grow at a rapid, sporadic rate c) Boys and girls grow at the same rate d) Girls grow at a slower, steadier rate than do boysc) Have the adolescent keep a food diary for 1 week Pg. 894 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.37. 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? a) Ask the adolescent to show the nurse what a healthy portion looks like b) Have the adolescent guess the calorie intake in a 24-hour period c) Have the adolescent keep a food diary for 1 week d) Ask the adolescent to recall what was eaten in the last 3 daysa) "Contraception is a responsibility of both parties involved" Pg. 901 The nurse should educate the teens that most methods of contraception are designed for females, but that it is a shared responsibility. This age group often feels invulnerable to warnings and statistics. A male teen may feel a false security if he believes female teens are more vulnerable to STIs, so stating this would not be appropriate.38. A nurse is educating a middle school class of male adolescents about sex education. The topic of multiple partners is discussed. Which of the following statements from the nurse would be the most effective? a) "Contraception is a responsibility of both parties involved" b) "Be careful, or you will end up being a teen parent" c) "Teens account for 25% of all sexually transmitted infections (STI) in the population" d) "Compared with male teens, female teens are more susceptible to STIs"d) "Tell me what makes you think you are gay" Pg. 901 The nurse needs to get more information from the adolescent (assessment) before making any comment and then proceeding in a sensitive and caring way. Comments about being at risk or needing to know about safe sex are negative and should be replaced with health promotion comments. Denying the statement shows the adolescent that the nurse is not an ally.39. During a health check-up without the parents present, a 17-year-old adolescent tells the nurse about being gay. Which statement from the nurse is best? a) "You are not gay; you are confused" b) "We need to talk about safe sex" c) "This puts you in an at-risk category" d) "Tell me what makes you think you are gay"a) Chicken, whole-wheat bread, watermelon Pg. 894 Chicken, whole-wheat bread, and watermelon are all foods high in iron. The calorie content will not promote weight gain. All the other options do not include good sources of iron but are nutritious foods. The calorie content is also acceptable.40. The nurse is educating an adolescent female who needs to increase dietary iron but has expressed concern about weight gain. What dietary choices would the nurse recommend? a) Chicken, whole-wheat bread, watermelon b) Cottage cheese, crackers, oranges c) Raspberry yogurt, granola, apple d) Pasta, broccoli, pearb) "Adolescents need to know how to use condoms correctly to avoid sexually transmitted infections" Pg. 901 The priority is to prevent STIs. Adolescents need to understand that STIs can be acquired via oral sex as well as vaginal sex. They also need to understand that using contraceptive pills will not prevent STIs. They need contraceptive information to prevent pregnancy but more importantly, they need straightforward information about using condoms to protect them against HIV and other infections. Both male and female adolescents need this information, and girls should be advised to carry their own condoms if they believe there is any possibility of having sexual intercourse.41. 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? a) "Males, as well as their partners, are responsible for avoiding an unwanted pregnancy" b) "Adolescents need to know how to use condoms correctly to avoid sexually transmitted infections" c) "Girls should carry their own condoms and use them to avoid pregnancy" d) "It is important for adolescents to abstain from sexual activity"d) "Calmly talk to your adolescent about your concerns" Pg. 896 Families and parents of adolescents experience changes that require adjustments and the understanding of adolescent development. The adolescent is striving for self-identity and increased independence. Thus, getting the parent and adolescent talking and sharing information is the most helpful advice. Telling the parent that this is normal does nothing for the family situation. Setting rules will likely alienate the adolescent, and taking away privileges will likely cause conflict between the parent and adolescent.42. 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? a) "Take away all of the adolescent's privileges until your adolescent starts acting better" b) "Set some rules for family etiquette" c) "This is normal for the age" d) "Calmly talk to your adolescent about your concerns"a) 68 in (172.72 cm) Pg. 887 Preadolescence begins in the female between the ages of 9 and 11 years and is marked by a growth spurt that lasts for about 18 months. Girls grow about 3 inches each year until menarche, after which growth slows considerably. The four years between age 9 and 13 would mean the girl should have grown approximately 12 inches, making her now 68 in (172.72 cm) tall (56 + 12 = 68 in).43. The nurse is measuring the height of a 13-year-old girl who was 56 in (142.24 cm) tall at age 9. The nurse predicts the girl will be approximately how tall if following the normal pattern of growth? a) 68 in (172.72 cm) b) 58 in (147.32 cm) c) 76 in (193.04 cm) d) 62 in (157.48 cm)