Flashcards in Chapter 36 Deck (29):
The nurse develops and implements a health promotion plan for an adolescent client. What should the nurse include in the evaluation of the plan?
1. Methods to expand and sustain successful approaches
2. Instruction to the client on what is considered healthy behavior
3. Advice for promoting health behaviors that will maintain a healthy lifestyle
4. Information on the client’s attitude toward health
The nurse is assessing an adolescent client to determine relationships with others. Which nursing action is appropriate?
1. Telling the parents that information from the assessment will be shared with them after the examination
2. Providing separate time to communicate with both the adolescent and the parents
3. Avoiding asking the parents their opinions of the adolescent’s friends
4. Telling the parents they are not allowed to come into the examination room.
Which should the nurse keep in mind when providing care to an adolescent client during the initial visit?
1. The importance of explaining procedures and introducing personnel to adolescents.
2. Adolescents usually are quiet and will offer no opinions.
3. The importance of attending to and discharging the adolescent quickly.
4. Adolescents are comfortable with their surroundings
Which nursing action is appropriate when providing care to an adolescent client who is accompanied to an appointment by a parent?
1. Instructing the parent to stay in the waiting room with the explanation that the adolescent will provide a report after the examination
2. Telling the parent it is against policy for a parent to accompany the adolescent to the examination room
3. Reassuring the parent that the nurse will discuss any parental concerns or questions after the examination
4. Allowing the parent to come into the examination room with the adolescent
A school nurse is performing annual height and weight screening. The nurse notes that three adolescent girls who are close friends each lost 15 pounds over the past year. Which is the priority nursing action?
1. Obtaining a nutritional history for each of these adolescents
2. Referring these adolescents to the school psychologist
3. Calling the respective parents to discuss the eating patterns of each adolescent
4. Speaking with the adolescents in a group to discuss the problems associated with anorexia nervosa
The following information is collected during the nursing assessment: the adolescent’s menses began when she was 12 years old; a current body mass index (BMI) of 27.5; inconsistent school performance over the last several years. Which is the priority area of teaching for this adolescent?
1. Menstrual cycle
2. Nutritional intake
3. School performance
4. Mental health status
The nurse is assessing an adolescent patient during a scheduled health maintenance visit. The adolescent’s mother is currently in the examination room with the patient. Which topic should the nurse avoid until the mother has left the examination room?
1. School performance
2. Cigarette smoking
3. School friends
4. Seat belt use
The nurse is assessing an adolescent client during a scheduled health maintenance appointment. Which issues should the nurse address when the parents are not present?
1. The adolescent’s role in the family
2. Teen job responsibilities
3. Possible domestic violence
4. Activities done as a family
An obese adolescent who adamantly denies sexual activity has a positive pregnancy test. Which response by the nurse is most appropriate?
1. “When was your last menstrual period (LMP)?”
2. “Tell me how you feel about your body image.”
3. “Let’s discuss some activities that you have done within the past few months that could possibly lead to pregnancy.”
4. “Why are you denying sexual intercourse?”
A mother reports that her adolescent daughter is always late. The mother states, “She was born late and has been late every day of her life.” Which response by the nurse is appropriate?
1. “Setting specific alarms and then reinforce the value of being ‘on-time’ may be helpful strategies to assist her to be more of an ‘on-time’ individual.”
2. “Just let it go for now. Teachers and, in the future, employers will be the best people to help her be ‘on-time.’”
3. “You need to establish specific time frames for your adolescent and be certain she adheres to them.”
4. “You have a major problem. There must be a lot of screaming in your home.”
Which screening is appropriate for the school nurse to perform on all adolescent students?
1. Respiratory rate
2. Hepatitis B profile
3. Chest x-ray
During a health maintenance visit an adolescent states, “I have no friends in my new school, and I no longer want to go to college. I know I will be lonely there, too.” Which is the priority nursing action?
1. Stressing the importance of remaining in a close parent–child relationship during these stressful times
2. Promoting healthy mental health outcomes
3. Acknowledging the fact that it takes several months to make new friends at a new school due to adolescent exclusion behaviors
4. Helping the adolescent realize the value of postsecondary education
The nurse is planning to teach a group of adolescents about what can happen when having unprotected sex. Which nursing action will allow effective communication with the group?
1. Offering personal opinions on the topic
2. Allowing for discussion among the participants
3. Lecturing on the topic for the allotted time without any discussion
4. Discussing sex education related to religious belief
Which nursing action is best when teaching adolescent health promotion and health maintenance topics?
1. Contacting the parents and asking what issues they have with their adolescents
2. Having the adolescents identify a personal health goal
3. Asking the advice of the counselors at school
4. Telling the adolescents information that will be included in the lecture
Which screenings are appropriate for an adolescent client who admits to being sexually active during a scheduled health maintenance visit? Select all that apply.
1. Herpes simplex virus
Which nursing action maintains confidentiality when performing height and weight measurements during a co-ed physical education class?
1. Having a student worker record the screening findings on the appropriate adolescent’s record
2. Having a volunteer weigh and measure the adolescents and verbally give the findings to the nurse to calculate the body mass index and record
3. Providing a privacy screen and have the health aid record the findings directly on the record. The nurse will then calculate body mass index
4. Using a buddy system with the students, having the students measure each other and record the findings.
The nurse is planning care for an overweight adolescent. Which topic may also be appropriate for the nurse to include in the adolescent’s plan of care?
1. Substance abuse
2. School phobia
3. Spiritual distress
4. Negative self-esteem
The school nurse is assessing an adolescent who reports getting less than 6 hours of sleep at night. Which consequences of inadequate sleep will the nurse include when responding to the adolescent? Select all that apply.
2. Increased nocturnal emissions
3. Increased risk of automobile accidents when driving
5. An inability to perform well at school
Which teaching topics are appropriate for the nurse to include for an adolescent who admits to the use of chewing tobacco? Select all that apply.
1. Lung cancer
2. Nicotine addiction
3. Mouth cancers
5. Mouth ulcers
Which question is appropriate for the nurse to include in the assessment for an adolescent client related to developmental tasks?
1. “How are you adapting to the high school setting?”
2. “What type of relationship do you have with your friends?
3. “Have you thought about your future career goals?”
4. “Do you play any team sports?”
The nurse notes dental issues during the assessment of an adolescent client. Which topics will the nurse explore further to determine the cause of the issues? Select all that apply.
1. Use of fluoridated water
2. Use of a mouth guard when playing physical sports
3. Anorexia nervosa
4. Bulimia nervosa
5. Use of daily vitamins
The nurse is planning care for an adolescent whose parents have both recently been laid off from their jobs. Which is the priority diagnosis for the adolescent and family?
1. Disturbed Sleep Pattern
2. Imbalanced Nutrition: Less Than Body Requirements
3. Knowledge Deficit
4. Risk for Injury
Which is the most appropriate assessment question for the nurse to ask when collecting nutritional data from an adolescent client?
1. “How do you feel about your weight and the way you look?”
2. “What did you have to eat so far today?”
3. “What is your favorite grocery store?”
4. “Do you eat school lunches or pack a lunch from home each day?”
A nurse obtains a nutritional health history from a 10-year-old child. Which food increases the risk for dental caries necessitating education regarding oral hygiene?
1. Sorbet and yogurt
2. Fluoridated water
3. Gummy bears and licorice
4. Peanuts and crackers
The mother of a 12-year-old child informs the nurse that the child’s father died from sudden cardiac death at 44 years old. Which laboratory tests does the nurse anticipate will be prescribed by the healthcare provider?
1. Chest x-ray
2. Complete blood count (CBC) with differential
3. Electroencephalogram (EEG)
4. Lipid profile
Which will the nurse include in the assessment process for a school-age child who is exhibiting poor school performance? Select all that apply.
1. Hearing screen
2. Muscle tone
3. Dental inspection
4. Vision screen
5. Throat culture
The school nurse is planning an education program for fourth-grade children regarding prepubescent changes. What nursing action will make the educational program successful?
1. Discussing program content with the parents
2. Talking to all of the classes at one time
3. Planning the program for after school
4. Having the parents present during the program
During the psychosocial portion of the nursing assessment a school-age child states, “I know I am not as good as them, so I just play by myself at recess every day.” Which conclusion by the nurse is accurate?
1. The child has a good sense of self-worth.
2. The child has a poor body image.
3. The child has decreased self-esteem.
4. The child has a self-determined concept.