Flashcards in Finale Exam Chapter 16 Deck (39):
1. In girls, the initial indication of puberty is:
b. growth spurt.
c. growth of pubic hair.
d. breast development.
In most girls, the initial indication of puberty is the appearance of breast buds, an event known as thelarche. The usual sequence of secondary sex characteristic development in girls is breast changes, rapid increase in height and weight, growth of pubic hair, appearance of axillary hair, menstruation, and abrupt deceleration of linear growth.
2. A school nurse is teaching a group of preadolescent girls about puberty. Which is the mean age of menarche for girls in the United States?
a. 11 1/2 years
b. 12 3/4 years
c. 13 1/2 years
d. 14 years
The average age of menarche is 12 years 9.5 months in North American girls, with a normal range of 10 1/2 to 15 years. Ages 11 1/2, 13 1/2, and 14 are within the normal range for menarche, but these are not the average ages.
3. A school nurse is teaching a group of preadolescent boys about puberty. By which age should concerns about pubertal delay be considered?
a. 12 to 12 1/2 years
b. 12 1/2 to 13 years
c. 13 to 13 1/2 years
d. 13 1/2 to 14 years
Concerns about pubertal delay should be considered for boys who exhibit no enlargement of the testes or scrotal changes from 13 1/2 to 14 years. Ages 12 to 13 1/2 years is too young for initial concern.
4. A 14-year-old male mentions that he now has to use deodorant but never had to before. The nurse’s response should be based on knowledge that which occurs during puberty?
a. Eccrine sweat glands in the axillae become fully functional during puberty.
b. Sebaceous glands become extremely active during puberty.
c. New deposits of fatty tissue insulate the body and cause increased sweat production.
d. Apocrine sweat glands reach secretory capacity during puberty.
The apocrine sweat glands, nonfunctional in children, reach secretory capacity during puberty. They secrete a thick substance as a result of emotional stimulation that, when acted on by surface bacteria, becomes highly odoriferous. They are limited in distribution and grow in conjunction with hair follicles, in the axilla, genital, anal, and other areas. Eccrine sweat glands are present almost everywhere on the skin and become fully functional and respond to emotional and thermal stimulation. Sebaceous glands become extremely active at this time, especially those on the genitalia and the “flush” areas of the body such as face, neck, shoulders, upper back, and chest. This increased activity is important in the development of acne. New deposits of fatty tissue is not the etiology of apocrine sweat gland activity.
5. According to Erikson, the psychosocial task of adolescence is developing:
Traditional psychosocial theory holds that the developmental crises of adolescence lead to the formation of a sense of identity. Intimacy is the developmental stage for early adulthood. Independence is not one of Erikson’s developmental stages.
6. A nurse is planning a teaching session for a group of adolescents. The nurse understands that by adolescence the individual is in which stage of cognitive development?
a. Formal operations
b. Concrete operations
c. Conventional thought
d. Post-conventional thought
Cognitive thinking culminates with capacity for abstract thinking. This stage, the period of formal operations, is Piaget’s fourth and last stage. Concrete operations usually occur between ages 7 and 11 years. Conventional and post-conventional thought refer to Kohlberg’s stages of moral development.
7. Which aspect of cognition develops during adolescence?
a. Capability to use a future time perspective
b. Ability to place things in a sensible and logical order
c. Ability to see things from the point of view of another
d. Progress from making judgments based on what they see to making judgments based on what they reason
Adolescents are no longer restricted to the real and actual. They also are concerned with the possible; they think beyond the present. During concrete operations (between ages 7 and 11 years), children exhibit these characteristic thought processes.
8. Parents are concerned about the number of hours their teenage daughter spends with peers. The nurse explains that peer relationships are important during adolescence for which reason?
a. Adolescents dislike their parents.
b. Adolescents no longer need parental control.
c. They provide adolescents with a feeling of belonging.
d. They promote a sense of individuality in adolescents.
The peer group serves as a strong support to teenagers, providing them with a sense of belonging and a sense of strength and power. During adolescence, the parent-child relationship changes from one of protection-dependency to one of mutual affection and quality. Parents continue to play an important role in the personal and health-related decisions. The peer group forms the transitional world between dependence and autonomy.
9. An adolescent boy tells the nurse that he has recently had homosexual feelings. The nurse’s response should be based on knowledge that:
a. this indicates the adolescent is homosexual.
b. this indicates the adolescent will become homosexual as an adult.
c. the adolescent should be referred for psychotherapy.
d. the adolescent should be encouraged to share his feelings and experiences.
These adolescents are at increased risk for health-damaging behaviors, not because of the sexual behavior itself, but because of society’s reaction to the behavior. The nurse’s first priority is to give the young man permission to discuss his feelings about this topic, knowing that the nurse will maintain confidentiality, appreciate his feelings, and remain sensitive to his need to talk about the topic. In recent studies among self-identified gay, lesbian, and bisexual adolescents, many of the adolescents report changing self-labels one or more times during their adolescence. An assessment must be made about any risks to himself or others. If these do not exist, the adolescent needs a supportive person to talk with.
10. The school nurse tells adolescents in the clinic that confidentiality and privacy will be maintained unless a life-threatening situation arises. This practice is:
a. not appropriate in a school setting.
b. never appropriate because adolescents are minors.
c. important in establishing trusting relationships.
d. suggestive that the nurse is meeting his or her own needs.
Health professionals who work with adolescents should consider adolescents’ increasing independence and responsibility while maintaining privacy and ensuring confidentiality. However, in some circumstances, such as self-destructive behavior or maltreatment by others, they are not able to maintain confidentiality. Confidentiality and privacy are necessary to build trust with this age group. The nurse must be aware of the limits placed on confidentiality by local jurisdiction.
11. A 14-year-old boy seems to be always eating, although his weight is appropriate for his height. What is the best explanation for this?
a. This is normal because of increase in body mass.
b. This is abnormal and suggestive of future obesity.
c. His caloric intake would have to be excessive.
d. He is substituting food for unfilled needs.
In adolescence, nutritional needs are closely related to the increase in body mass. The peak requirements occur in the years of maximal growth. The caloric and protein requirements are higher than at almost any other time of life. Seemingly always eating describes the expected eating pattern for young adolescents; as long as weight and height are appropriate, obesity is not a concern.
12. Which predisposes the adolescent to feel an increased need for sleep?
a. An inadequate diet
b. Rapid physical growth
c. Decreased activity that contributes to a feeling of fatigue
d. The lack of ambition typical of this age group
During growth spurts, the need for sleep increases. Rapid physical growth, the tendency toward overexertion, and the overall increased activity of this age contribute to fatigue.
13. The most common cause of death in the adolescent age group involves:
c. drug overdoses.
d. motor vehicles.
Forty percent of all adolescent deaths in the United States are the result of motor vehicle accidents. Drownings, firearms, and drug overdoses are major concerns in adolescence but are not the most common cause of death.
14. A young adolescent boy tells the nurse he “feels gawky.” The nurse should explain that this occurs in adolescents because of:
a. growth of the extremities and neck precedes growth in other areas.
b. growth is in the trunk and chest.
c. the hip and chest breadth increases.
d. the growth spurt occurs earlier in boys than it does in girls.
Growth in length of the extremities and neck precedes growth in other areas, and, because these parts are the first to reach adult length, the hands and feet appear larger than normal during adolescence. Increases in hip and chest breadth take place in a few months followed several months later by an increase in shoulder width. These changes are followed by increases in length of the trunk and depth of the chest. This sequence of changes is responsible for the characteristic long-legged, gawky appearance of early adolescent children. The growth spurt occurs earlier in girls than in boys.
15. A nurse is reviewing hormone changes that occur during adolescence. The hormone that is responsible for the growth of beard, mustache, and body hair in the male is:
Beard, mustache, and body hair on the chest, upward along the linea alba, and sometimes on other areas (e.g., back and shoulders) appears in males and is androgen dependent. Estrogen and progesterone are produced by the ovaries in the female and do not contribute to body hair appearance in the male. The pituitary hormone does not have any relationship to body hair appearance in the male.
16. A nurse is caring for an adolescent hospitalized for cellulitis. The nurse notes that the adolescent experiences many “mood swings” throughout the day. The nurse interprets this behavior as:
a. requiring a referral to a mental health counselor.
b. requiring some further lab testing.
c. normal behavior.
d. related to feelings of depression.
Adolescents vacillate in their emotional states between considerable maturity and childlike behavior. One minute they are exuberant and enthusiastic; the next minute they are depressed and withdrawn. Because of these mood swings, adolescents are frequently labeled as unstable, inconsistent, and unpredictable, but the behavior is normal. The behavior would not require a referral to a mental health counselor or further lab testing. The mood swings do not indicate depression.
17. A nurse is conducting parenting classes for parents of adolescents. Which parenting style should the nurse recommend?
Parents should be guided toward an authoritative style of parenting in which authority is used to guide the adolescent while allowing developmentally appropriate levels of freedom and providing clear, consistent messages regarding expectations. The authoritative style of parenting has been shown to have both immediate and long-term protective effects toward adolescent risk reduction. The laissez-faire method would not give adolescents enough structure. The disciplinarian and confrontational styles would not allow any autonomy or independence.
18. A 14-year-old adolescent never had chickenpox as a child. Which should the nurse recommend?
a. One dose of the varicella vaccination
b. Two doses of the varicella vaccination 4 weeks apart
c. One dose of the varicella immune globulin
d. No vaccinations—the child is past the age to receive it
All adolescents should also be assessed for previous history of varicella infection or vaccination. Vaccination with the varicella vaccine is recommended for those with no previous history; for those with no previous infection or history, the varicella vaccine may be given in two doses 4 or more weeks apart to adolescents 13 years or older. The varicella immune globulin is given to immunosuppressed children exposed to chickenpox to boost immunity; it is only temporary. The varicella vaccination should be given to adolescents, no matter the age, who have not had chickenpox as a child.
1. A 13-year-old is being seen in the clinic for a routine health check. The adolescent has not been in the clinic for 3 years but was up to date on immunizations at that time. Which immunizations should the adolescent receive? (Select all that apply.)
a. DTaP (tetanus, diphtheria, acellular pertussis)
b. MMR (measles, mumps, rubella)
c. Hepatitis B
e. MCV4 (meningococcal)
ANS: A, D, E
The DTaP (tetanus, diphtheria, acellular pertussis) vaccine is recommended for adolescents 11 to 18 years old who have not received a tetanus booster (Td) or DTaP dose and have completed the childhood DTaP/DTP series. Meningococcal vaccine (MCV4) should be given to adolescents 11 to 12 years of age with a booster dose at age 16 years. Annual influenza vaccination with either the live attenuated influenza vaccine or trivalent influenza vaccine is recommended for all children and adolescents. The adolescent, previously up to date on vaccinations, would have received the MMR and hepatitis B as a child.
2. The nurse should teach the adolescent that the long-term effects of tanning can cause which conditions? (Select all that apply.)
a. Phototoxic reactions
b. Increased number of moles
c. Premature aging
e. Increased risk of skin cancer
ANS: A, C, E
Long-term effects of tanning include premature aging of the skin, increased risk of skin cancer, and, in susceptible individuals, phototoxic reactions. There has been no correlation to an increase in moles or striae (streaks or stripes on the skin, usually on the abdomen) development.
3. Which screening tests should the school nurse perform for the adolescent? (Select all that apply.)
ANS: B, C, E
The school nurse should perform vision, hearing, and scoliosis screening tests according to the school district’s required schedule. Glucose and cholesterol screening would be performed in the medical clinic setting.
1. The estimated average requirement of calcium for an adolescent is _____ milligrams. (Record your answer in a whole number.)
The EAR (estimated average requirement) for calcium in adolescents 14 to 18 years of age is 1100 mg.
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.
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.
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
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.
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
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.
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.
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
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.
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.
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.
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.
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.
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
b. prophylactic antibiotics.
c. any type of contraception method.
d. withdrawal method of contraception.
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.
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.
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.