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Flashcards in Chapter 16 Deck (17):

While caring for hospitalized adolescents, the nurse observes that sometimes they are skeptical of their parents' religious beliefs and practices. The nurse should recognize that this is
a. normal in spiritual development.
b. abnormal in spiritual development.
c. related to illness and occurs only at times of crisis.
d. related to the parents' inability to adequately explain their beliefs and practices.

Ans: A
The behavior described occurs in stage 4 in spiritual development. Adolescents attempt to determine which of their parents' standards and beliefs to incorporate into their own.
The behavior described is not abnormal.
The behavior described is not applicable only during times of crisis.
The behavior described is not related to the parents' inability to explain their beliefs and practices.


How does the onset of the pubertal growth spurt compare in girls and boys?
a. In girls, it occurs about 2 years before it appears in boys.
b. In girls, it occurs about 3 years before it appears in boys.
c. In boys, it occurs about 1 year before it appears in girls.
d. It is about the same in both boys and girls.

Ans: A
The average age of onset for puberty is 12 years in girls and 14 years in boys.
Although this may be true for an individual, the average difference is approximately 2 years.
Usually, girls begin puberty and their growth spurt earlier than boys.
Usually, girls begin puberty and their growth spurt earlier than boys.


Girls experience an increase in weight and fat deposition during puberty. Nursing considerations related to this include
a. giving reassurance that these changes are normal
b. suggesting dietary measures to control weight gain
c. recommending increased exercise to control weight gain
d. encouraging a low-fat diet to prevent fat deposition

Ans: A
A certain amount of fat is increased along with lean body mass to fill the characteristic contours of the child's gender. A healthy balance must be achieved between expected healthy weight gain and obesity as related to these normal and expected physical changes.
This should not be done unless weight gain is excessive. Eating disorders can develop in this group, and diet management should be considered only under a health care practitioner's care.
Exercise is an important component in weight management but should never be done or encouraged in increased amounts or in excess to control weight gain that occurs normally during puberty.
Some fat deposition is essential for normal hormonal regulation. Menarche is delayed in girls with body fat contents that are too low; therefore, a low-fat diet is not a recommended intervention.


The onset of puberty in boys is characterized by
a. voice changes.
b. testicular enlargement.
c. growth of dark pubic hair.
d. increased size of the penis.

Ans: B
This is the first change that signals puberty in boys during Tanner stage 2 of sexual development.
Voice changes occur between Tanner stages 3 and 4 of sexual development.
Fine pubic hair may occur at the base of the penis early in puberty, but darker hair occurs during Tanner stage 3 of sexual development.
The penis enlarges during Tanner stage 3 of sexual development.


A 13-year-old boy is concerned about bilateral breast enlargement. The most appropriate explanation by the nurse is based on knowing that this is
a. a sign of too much body fat
b. a sign of hormonal imbalance
c. a normal occurrence during puberty
d. an indication of precocious puberty

Ans: C
Gynecomastia, or enlargement of the breast tissue, is common during midpuberty in about one third of boys. For most boys, the breast enlargement disappears within 2 years.
Although overweight boys may have excess body weight in the breast area, in boys of normal body weight, gynecomastia is a normal occurrence during puberty.
If gynecomastia persists beyond 2 years, then a hormonal cause may need to be investigated.
Precocious puberty is the early onset of puberty, before age 9 years in boys, and is not related to the gynecomastia.


Which is most descriptive of the spiritual development of the older adolescent?
a. Beliefs become more abstract.
b. Rituals and practices become increasingly important.
c. Strict observance of religious customs is common.
d. Emphasis is placed on external manifestations, such as whether a person goes to church.

Ans: A
Because of their abstract thinking abilities, adolescents are able to interpret analogies and symbols related to their spiritual development.
Rituals and practices become less important as the adolescent questions values and ideals of families.
Strict observation of religious customs becomes less important as the adolescent questions values and ideals of families.
Adolescents question external manifestations when not supported by adherence to supportive behaviors. The adolescent's spiritual development is more internally driven.


An adolescent boy tells the school nurse that he is gay. The nurse's response should be based on knowledge that
a. he is too young to have had enough sexual activity to determine his sexual orientation at this time.
b. it is important to provide a nonthreatening environment for him to discuss his feelings.
c. the nurse should feel open in discussing his or her own beliefs about homosexuality.
d. homosexual adolescents do not have concerns that differ from those of heterosexual adolescents.

Ans: B
The nurse needs to be open and nonjudgmental in interactions with adolescents who have questions about their sexual orientation. This will allow a safe environment for the adolescents to speak and receive guidance from a health care professional as warranted.
Adolescence is when sexual identity develops; therefore, questions about sexual orientation often surface at this time.
The nurse's own beliefs should not bias the interaction with this student and, therefore, are irrelevant.
Homosexual adolescents have different challenges to growing up and their sexual identity than heterosexual adolescents, often related to societal, cultural, religious, and spiritual influences.


When conducting a class on sex and sexual activities with adolescents, the most appropriate approach by the nurse is to
a. use dolls to teach the content.
b. present normal body functions in a straightforward manner.
c. refer the adolescents to their parents for sexual information.
d. delay giving information about pregnancy unless the adolescents are sexually active.

Ans: B
The nurse should provide accurate and complete information using correct terminology that is understandable to the adolescent.
Dolls are appropriate for teaching a younger age-group of children. Using the correct terminology is more appropriate for a group of adolescents.
Parents are important for conveying the morals and values surrounding sexual activities, but nurses may provide adolescents with accurate, complete information.
Adolescents should have information before they become sexually active about the potential consequences of sex, including the practice of safe sex to prevent pregnancy and the transmission of sexually transmitted diseases.


What is an important consideration for the school nurse planning a class on injury prevention for adolescents?
a. Adolescents generally are not risk takers.
b. Adolescents can anticipate the long-term consequences of serious injuries.
c. Adolescents need to discharge energy, often at the expense of logical thinking.
d. During adolescence, participation in sports should be limited to prevent permanent injuries.

Ans: C
The physical, sensory, and psychomotor development of adolescents provides a sense of strength and confidence. There is also an increase in energy coupled with risk taking that puts them at risk, because they often ignore logical thinking.
Adolescents tend to be risk takers because of their feelings of indestructibility.
The feelings of indestructibility that accompany adolescence interfere with understanding the consequences of their behavior, thus increasing their potential for injuries.
Sports can be a useful way to discharge energy and should not be limited. Care must be taken to avoid overuse injuries and to use appropriate protective equipment.


The school nurse is teaching a class on injury prevention. What should be included when discussing firearms?
a. Adolescents are too young to use a gun properly for hunting.
b. Gun carrying among adolescents is on the rise, primarily among inner-city youth.
c. Nonpowder guns (air rifles, BB guns) are a relatively safe alternative to powder guns.
d. Adolescence is the peak age for being either a victim or an offender in an injury involving a firearm.

Ans: D
Gun carrying among adolescents is on the rise. The increase in gun availability is linked to increased gun injuries and deaths among children.
Adolescents can be taught to safely use and store guns for hunting.
Gun carrying is on the rise in adolescents and is not limited to stereotypical inner-city youth.
Nonpowder guns, such as air rifles and BB guns, cause almost as many injuries as powder guns.


Evidence-based research shows that the most successful strategy for preventing smoking in teenagers is
a. emphasis on immediate effects of smoking.
b. emphasis on long-term effects of smoking.
c. large-scale public information campaigns.
d. threatening the social norms of groups most likely to smoke.

Ans: A
An emphasis on immediate effects of smoking has proven to be one of the most effective strategies for preventing smoking. Information focuses on tobacco smell and other aesthetic issues.
Because this age-group is neither future oriented nor consequence oriented, emphasis on the long-term effects of smoking does not work as well as focusing on the immediate effects.
Public campaigns can be effective when focused on the immediate effects of smoking, but they often focus on the more long-term effects of smoking.
Threatening social norms in adolescents is not an effective strategy for the prevention of smoking.


A 16-year-old girl tells the school nurse that she has not started to menstruate. The most appropriate nursing intervention is to
a. explain that this is not unusual.
b. refer the adolescent for an evaluation.
c. assume that the adolescent is pregnant.
d. suggest the adolescent stop exercising until menarche occurs.

Ans: B
This meets the definition of primary amenorrhea and should be evaluated.
Menstruation usually begins approximately 2 years after the beginning of secondary sex characteristics.
Although pregnancy is a possibility, the nurse should not assume that the girl is pregnant until further assessment is performed.
There is no indication that the adolescent is exercising excessively.


In planning sex education and contraceptive teaching for adolescents, what should the nurse consider?
a. Most teenagers today are knowledgeable about reproductive anatomy and physiology.
b. Both sexual activity and contraception require planning.
c. Most teenagers who become pregnant do so as an act of hostility, especially toward the parents.
d. Teenagers need contraception education in both oral and written form.

Ans: D
Sex education and contraceptive information need to be concrete and concise. Oral explanations with demonstrations and written explanations with diagrams should be provided.
Sex education and contraceptive teaching are independent of adolescents' knowledge of reproductive anatomy and physiology.
Contraception requires planning. Most adolescents are sexually active for 6 months to 1 year before seeking contraceptive information. Most adolescent sexual activity is unplanned.
There are no data to support that most teenage pregnancies occur as acts of hostility toward parents.


A sexually active adolescent asks the school nurse about prevention of sexually transmitted diseases (STDs). The most appropriate recommendation by the nurse is the use of
a. condoms.
b. prophylactic antibiotics.
c. any type of contraception method.
d. withdrawal method of contraception.

Ans: A
Prophylactic antibiotics are not recommended to prevent STDs. Antibiotics are only effective against bacteria, not viruses.
Condoms provide a barrier to the organisms that cause STDs.
Only condoms create a physical barrier that prevents contact with the organisms that cause STDs.
Only condoms create a physical barrier that prevents contact with the organisms that cause STDs.


An adolescent girl is brought to the hospital emergency department by her parents after being raped. The girl is calm and controlled throughout the interview and examination. The nurse should recognize that this behavior is
a. one of a variety of behaviors normally seen in rape victims.
b. indicative of a higher-than-usual level of maturity in the adolescent.
c. suggestive that a rape has not actually occurred.
d. suggestive that the adolescent had severe emotional problems before the rape occurred.

Ans: A
Rape victims display a wide range of behaviors. A controlled manner may be an attempt to maintain composure and control while hiding inner turmoil.
The responses described are indicative of those often assessed in rape victims.
There are no data to support that a rape has not occurred. Physical assessment will provide valuable information.
There are no data to support that the adolescent had prior emotional problems.


The management of adolescent obesity should include
a. planning a low-calorie, low-protein diet.
b. incorporating favorite foods into the diet.
c. encouraging diversional activities during mealtimes.
d. using nutritious foods as a method of reward.

Ans: B
Incorporating small amounts of the adolescent's favorite foods will increase adherence to the nutritional plan.
A food plan high in nutrients with calories and fats at a healthy level is recommended. Adolescents need calories and protein in appropriate amounts to allow continued physical growth during a growth spurt and puberty.
Diversional activities such as television watching may contribute to overeating and should be discouraged.
Food should never be used as a reward.


An adolescent is accompanied by their mother for an annual physical examination. Based on the nurse’s knowledge of this age group, the nurse should avoid questions on which topics? (Select all that apply.)
a. Alcohol use
b. Sexual activity
c. Cigarette smoking
d. School performance
e. Use of car seat belts

Ans: A, B, C