Peds Week 3

Which information should the nurse include when preparing a 5-year-old child for a cardiac catheterization?
a. A detailed explanation of the procedure
b. A description of what the child will feel and see during procedure
c. An explanation about the dye that will go directly into his vein
d. An assurance to the child that he and the nurse can talk about the procedure when it is over

ANS: B


Feedback
A Explaining the procedure in detail is probably more than the 5-year-old child can comprehend, and it will likely produce anxiety.
B For a preschooler, the provision of sensory information about what to expect during the procedure will enhance the child's ability to cope with the events of the procedure and will decrease anxiety.
C Using the word "dye" with a preschooler can be frightening for the child.
D The child needs information before the procedure.

An important consideration for the nurse who is communicating with a very young child is to
a. Speak loudly, clearly, and directly.
b. Use transition objects, such as a puppet.
c. Disguise own feelings, attitudes, and anxiety.
d. Initiate contact with child when parent is not present.

ANS: B


Feedback
A Speaking in this manner will tend to increase anxiety in very young children.
B Using a transition object, such as a puppet or doll, allows the young child an opportunity to evaluate an unfamiliar person (the nurse). This will facilitate communication with a child of this age.
C The nurse must be honest with the child. Attempts at deception will lead to a lack of trust.
D Whenever possible, the parent should be present for interactions with young children.

An effective technique for communicating with toddlers is to
a. Have the toddler make up a story from a picture.
b. Involve the toddler in dramatic play with dress-up clothing.
c. Use picture books.
d. Ask the toddler to draw pictures of his fears.

ANS: C


Feedback
A Most toddlers do not have the vocabulary to make up stories.
B Dramatic play is associated with older children.
C Activities and procedures should be described as they are about to be done. Use picture books and play for demonstration. Toddlers experience the world through their senses.
D Toddlers probably are not capable of drawing or verbally articulating their fears.

What is the most important consideration for effectively communicating with a child?
a. The child's chronologic age
b. The parent-child interaction
c. The child's receptiveness
d. The child's developmental level

ANS: D


Feedback
A The child's age may not correspond with the child's developmental level; therefore it is not the most important consideration for communicating with children.
B Parent-child interaction is useful in planning communication with children, but it is not the primary factor in establishing effective communication.
C The child's receptiveness is a consideration in evaluating the effectiveness of communication.
D The child's developmental level is the basis for selecting the terminology and structure of the message most likely to be understood by the child.

Which behavior is most likely to encourage open communication?
a. Avoiding eye contact
b. Folding arms across chest
c. Standing with head bowed
d. Soft stance with arms loose at the side

ANS: D


Feedback
A Avoiding eye contact does not facilitate communication.
B Folding arms across the chest is a closed body posture, which does not facilitate communication.
C Standing with head bowed is a closed body posture, which does not facilitate communication.
D An open body stance and positioning such as loose arms at the side invite communication and interaction.

Which strategy is most likely to encourage a child to express his feelings about the hospital experience?
a. Avoiding periods of silence
b. Asking direct questions
c. Sharing personal experiences
d. Using open-ended questions

ANS: D


Feedback
A Periods of silence can serve to facilitate communication.
B Direct questions can threaten and block communication.
C Talking about yourself shifts the focus of the conversation away from the child.
D Open-ended questions encourage conversation.

Which is the most appropriate question to ask when interviewing an adolescent to encourage conversation?
a. "Are you in school?"
b. "Are you doing well in school?"
c. "How is school going for you?"
d. "How do your parents feel about your grades?"

ANS: C


Feedback
A Direct questions with "yes" or "no" answers do not encourage conversation.
B Direct questions that can be interpreted as judgmental do not enhance communication.
C Open-ended questions encourage communication.
D Asking adolescents about their parents' feelings may block communication.

What is the most appropriate response for the nurse to make to the parent of a 3-year-old child found in a bed with the side rails down?
a. "You must never leave the child in the room alone with the side rails down."
b. "I am very concerned about your child's safety when you leave the side rails down. The hospital has guidelines stating that side rails need to be up if the child is in the bed."
c. "It is hospital policy that side rails need to be up if the child is in bed."
d. "When parents leave side rails down, they might be considered as uncaring."

ANS: B


Feedback
A Framing the communication in the negative does not facilitate effective communication.
B To express concern and then choose words that convey a policy is appropriate.
C Stating a policy to parents conveys the attitude that the hospital has authority over parents in matters concerning their children and may be perceived negatively.
D This statement conveys blame and judgment to the parent.

What is an appropriate preoperative teaching plan for a school-age child?
a. Begin preoperative teaching the morning of surgery.
b. Schedule a tour of the hospital a few weeks before surgery.
c. Show the child books and pictures 4 days before surgery.
d. Limit teaching to 5 minutes and use simple terminology.

ANS: C


Feedback
A Preoperative teaching a few hours before surgery is more appropriate for the preschool child. Preoperative materials should be introduced 1 to 5 days in advance for school-age children.
B Preparation too far in advance of the procedure can be forgotten or cause undue anxiety for an extended period of time.
C Preparatory material can be introduced to the school-age child several days (1 to 5) in advance of the event. Books, pictures, charts, and videos are appropriate.
D A very short, simple explanation of the surgery is appropriate for a younger child such as a toddler.

When a child broke her favorite doll during a hospitalization, her primary nurse bought the child a new doll and gave it to her the next day. What is the best interpretation of the nurse's behavior?
a. The nurse is displaying signs of overinvolvement.
b. The nurse is a kind and generous person.
c. The nurse feels a special closeness to the child.
d. The nurse wants to make the child happy.

ANS: A


Feedback
A Buying gifts for individual children is a warning sign of overinvolvement.
B Nurses are kind and generous people, but buying gifts for individual children is unprofessional.
C Nurses may feel closer to some patients and families. This does not make giving gifts to children or families acceptable from a professional standpoint.
D Replacing lost items is not the nurse's responsibility. Becoming overly involved with a child can inhibit a healthy relationship.

When meeting a toddler for the first time, the nurse initiates contact by
a. Calling the toddler by name and picking the toddler up
b. Asking the toddler for her first name
c. Kneeling in front of the toddler and speaking softly to the child
d. Telling the toddler that you are her nurse

ANS: C


Feedback
A Picking a toddler up at an initial meeting is a threatening action and will more likely result in a negative response from the child.
B Toddlers are unlikely to respond to direct questions at a first meeting.
C More positive interactions occur when the toddler perceives the meeting in a nonthreatening way. Placing yourself at the toddler's level and speaking softly can be less threatening for the child.
D Telling the toddler you are the nurse is not likely to facilitate or encourage cooperation. The toddler perceives you as a stranger and will find the action threatening.

An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is to
a. Ask her why she wants to know.
b. Determine why she is so anxious.
c. Explain in simple terms how it works.
d. Tell her she will see how it works as it is used.

ANS: C


Feedback
A The nurse should respond positively for requests for information about procedures and health information. By not responding, the nurse may be limiting communication with the child.
B The child is not exhibiting anxiety, just requesting clarification of what will be occurring.
C School-age children require explanations and reasons for everything. They are interested in the functional aspect of all procedures, objects, and activities. It is appropriate for the nurse to explain how equipment works and what will happen to the child.
D The nurse must explain how the blood pressure cuff works so that the child can then observe during the procedure.

Communication entails much more than words going from one person's mouth to another person's ears. A positive, supportive technique that is effective from birth throughout adulthood is
a. Listening
b. Physical proximity
c. Environment
d. Touch

ANS: D


Feedback
A Listening is an essential component of the communication process. By practicing active listening skills, nurses can be effective listeners. Listening is a component of verbal communication.
B Individuals have different comfort zones for physical distance. The nurse should be aware of these differences and move cautiously when meeting new children and families.
C It is important to create a supportive and friendly environment for children including the use of child-sized furniture, posters, developmentally appropriate toys, and art displayed at a child's eye level.
D Touch can convey warmth, comfort, reassurance, security, caring, and support. In infancy, messages of security and comfort are conveyed when they are being held. Toddlers and preschoolers find it soothing and comforting to be held and rocked. School-aged children and adolescents appreciate receiving a hug or pat on the back (with permission).

In planning care for a preschool-age child, the nurse knows that which open body postures encourage positive communication? Select all that apply.
a. Leaning away from the preschooler
b. Frequent eye contact
c. Hands on hips
d. Conversing at eye level
e. Asking the parents to stay in the room

ANS: B, D

Feedback
Correct Frequent eye contact and conversing at eye level are both open body postures that encourage positive communication.
Incorrect Leaning away from the child and placing your hands on your hips are both closed body postures that do not facilitate effective communication. Asking the parents to stay in the room while the nurse is talking to the child is helpful but is not an open body posture.

Trust is important in establishing and maintaining a therapeutic relationship. Maintaining the balance between appropriate involvement and professional separation is quite challenging. Which behaviors may indicate professional separation or underinvolvement? Select all that apply.
a. Avoiding the child or his or her family
b. Revealing personal information
c. Calling in sick
d. Spending less time with a particular child
e. Asking to trade assignments

ANS: A, C, D, E

Feedback
Correct Whether nurses become too emotionally involved or find themselves at the other end of the spectrum—being underinvolved—they lose effectiveness as objective professional resources. These are all indications of the nurse who is underinvolved in a child's care.
Incorrect Revealing personal information to a patient or his or her family is an indication of overinvolvement.

While developing a care plan for a school-age child with a visual impairment, the nurse knows that which of the following actions are important in working with this special needs child? Select all that apply.
a. Obtain a thorough assessment of the child's self-care abilities.
b. Orient the child to various sounds in the environment.
c. Mandate that the child's parents stay continuously with their child during hospitalization.
d. Allow the child to handle equipment as procedures are explained.
e. Encourage the child to use a dry erase board to write his needs.

ANS: A, B, D

Feedback
Correct These are correct responses that can be used for a school-age child with a visual impairment.
Incorrect Mandating that the child's parents stay continuously with their child may not be possible and is not usually necessary if the school-age child is at the expected level of growth and development. Encouraging a child to write his needs on a dry erase board would be an appropriate intervention for a child who is aphonic, not for a child with a visual deficit.

A preschool age child is being admitted for some diagnostic tests and possible surgery. The nurse planning care should use which phrases when explaining procedures to the child? Select all that apply.
a. Fluids will be given through tubing connected to a small tiny tube inserted into your arm.
b. After surgery we will be doing dressing changes.
c. You will get a shot before surgery.
d. The doctor will give you medicine that will help you go into a deep sleep.
e. We will take you to surgery on a bed on wheels.

ANS: A, D, E

Feedback
Correct A preschool child needs simple concrete explanations that cannot be misinterpreted. An IV should be explained as fluids going into a tube connected to a small tube in your hand; anesthesia can be explained as a medicine that will help you go into a deep sleep (put to sleep should be avoided); and a stretcher can be described as riding on a bed with wheels.
Incorrect The term "dressing changes" is ambiguous and will not be understood by a preschooler. The term "get a shot" should not be used. A preschooler or young child is likely to misinterpret this information.

For the child who speaks another language, the nurse must identify an interpreter who is proficient in both languages. The patient's 12-year-old brother has accompanied him to the hospital and would be an ideal candidate to interpret before any treatment or surgical procedure. Is this statement true or false?

ANS: F
Other children should not be used as interpreters under any circumstances. An adult family member, a friend of the family, or an interpreter service should be used whenever possible. This is necessary in order to explain procedures, teach new skills, and assess patient needs.

Which statement made by a mother of a school-age boy indicates a need for further teaching?

a. My child is playing soccer this year.

b. He is always busy with his friends playing games. He is very active.

c. I limit his television watching to about 2 hours a day.

d. I am glad his coach is a good role model. He emphasizes the importance of winning in todays society. The kids really are disciplined.

ANS: D

Rationale: Team sports are important for the development of sportsmanship and teamwork and for exercise and refinement of motor skills. A coach who emphasizes winning and strict discipline is not appropriate for children in this age-group

Which behavior is not demonstrated in the 8-year-old child?

a. Understands that his or her point of view is not the only one

b. Enjoys telling riddles and silly jokes

c. Understands that pouring liquid from a small to large container does not change the amount

d. Engages in fantasy and magical thinking

ANS: D

Rationale: The preschool-age child engages in fantasy and magical thinking. The school-age child moves away from this type of thinking and becomes more skeptical and logical. Belief in Santa Claus or the Easter Bunny ends in this period of development.

The ability to mentally understand that 1 + 3 \= 4 and 4 1 \= 3 occurs in which stage of cognitive development?

a. Concrete operations

b. Formal operations

c. Intuitive thought

d. Preoperations

ANS: A

Rationale: By 7 to 8 years of age, the child is able to retrace a process (reversibility) and has the skills necessary for solving mathematical problems. This stage is called concrete operations.

Which activity is most appropriate for developing fine motor skills in the school-age child?

a. Drawing

b. Singing

c. Soccer

d. Swimming

ANS: A

Rationale: Activities such as drawing, building models, and playing a musical instrument increase the school-age childs fine motor skills.

A school nurse is teaching a health class for 5th grade children. The nurse plans to include which statement to best describe growth in the early school-age period?

a. Boys grow faster than girls.

b. Puberty occurs earlier in boys than in girls.

c. Puberty occurs at the same age for all races and ethnicities.

d. It is a period of rapid physical growth.

ANS: A

Rationale: During the school-age developmental period, boys are approximately 1 inch taller and 2 pounds heavier than girls.

Which comment is most developmentally typical of a 7-year-old boy?

a. I am a Power Ranger, so dont make me angry.

b. I dont know whether I like Mary or Joan better.

c. My mom is my favorite person in the world.

d. Jimmy is my best friend.

ANS: D

Rationale: School-age children form friendships with peers of the same sex, those who live nearby, and other children who have toys that they enjoy.

A school nurse is conducting a class on safety for a group of school-age children. Which statement indicates that the children may need further teaching?

a. My sister and I know two different ways to get out of the house.

b. I can dial 911 if there is a fire or a burglar in the house.

c. My mother has told us that if we have a fire, we have to meet at the neighbors house.

d. If there is a fire I will have to go back in for my cat Fluffy because she will be scared.

ANS: D

Rationale: Children should be taught never to return to a burning house, not even for a pet.

Which statement is the most accurate about moral development in the 9-year-old school-age child?

a. Right and wrong are based on physical consequences of behavior.

b. The child obeys parents because of fear of punishment.

c. The school-age child conforms to rules to please others.

d. Parents are the determiners of right and wrong for the school-age child.

ANS: C

Rationale:
The 7- to 12-year-old child bases right and wrong on a good-boy or good-girl orientation in which the child conforms to rules to please others and avoid disapproval.

In providing anticipatory guidance to parents, which parental behavior is the most important in fostering moral development?

a. Telling the child what is right and wrong

b. Vigilantly monitoring the child and her peers

c. Weekly family meetings to discuss behavior

d. Living as the parents say they believe

ANS: D

Rationale:
Parents living what they believe gives nonambivalent messages and fosters the childs moral development and reasoning.

Which behavior by parents or teachers will best assist the child in negotiating the developmental task of industry?

a. Identifying failures immediately and asking the childs peers for feedback

b. Structuring the environment so that the child can master tasks

c. Completing homework for children who are having difficulty in completing assignments

d. Decreasing expectations to eliminate potential failures

ANS: B

Rationale: The task of the caring teacher or parent is to identify areas in which a child is competent and to build on successful experiences to foster feelings of mastery and success. Structuring the environment to enhance self-confidence and to provide the opportunity to solve increasingly more complex problems will promote a sense of mastery.

A nurse is assessing an older school-age child recently admitted to the hospital. Which assessment indicates that the child is in an appropriate stage of cognitive development?

a. The childs addition and subtraction ability

b. The childs ability to classify

c. The childs vocabulary

d. The childs play activity

ANS: B

Rationale: The ability to classify things from simple to complex and the ability to identify differences and similarities are cognitive skills of the older school-age child; this demonstrates use of classification and logical thought processes.

Which is an appropriate disciplinary intervention for the school-age child?

a. Using time-out periods

b. Using a consequence that is consistent with the inappropriate behavior

c. Using physical punishment

d. Using lengthy dialog about inappropriate behavior

ANS: B

Rationale:
A consequence that is related to the inappropriate behavior is the recommended discipline.

In general, the earliest age at which puberty begins is \____ years in girls and \_____ years in boys.

a. 13; 13

b. 11; 11

c. 10; 12

d. 12; 10

ANS: C

Rationale: Puberty signals the beginning of the development of secondary sex characteristics. This begins in girls earlier than in boys. Usually, there is a 2-year difference in the age at onset.

An 8-year-old girl tells the nurse that she has cancer because God is punishing her for being bad. She shares her concern that if she dies, she will go to hell. The nurse should interpret this as being

a. A belief common at this age

b. A belief that forms the basis for most religions

c. Suggestive of excessive family pressure

d. Suggestive of a failure to develop a conscience

ANS: A

Rationale: Children at this age may view illness or injury as a punishment for a real or imagined mystique.

A group of boys ages 9 and 10 years have formed a boys-only club that is open to neighborhood and school friends who have skateboards. This should be interpreted as

a. Behavior that encourages bullying and sexism

b. Behavior that reinforces poor peer relationships

c. Characteristic of social development of this age

d. Characteristic of children who later are at risk for membership in gangs

ANS: C

Rationale: One of the outstanding characteristics of middle childhood is the creation of formalized groups or clubs.

A 9-year-old girl often comes to the school nurse complaining of stomach pains. Her teacher says she is completing her schoolwork satisfactorily, but lately she has been somewhat aggressive and stubborn in the classroom. The school nurse should recognize this as

a. Signs of stress

b. Developmental delay

c. Physical problem causing emotional stress

d. Lack of adjustment to school environment

ANS: A

Rationale: Signs of stress include stomach pains or headache, sleep problems, bedwetting, changes in eating habits, aggressive or stubborn behavior, reluctance to participate, or regression to early behaviors.

The school nurse has been asked to begin teaching sex education in the 5th grade. The nurse should recognize that

a. Children in 5th grade are too young for sex education.

b. Children should be discouraged from asking too many questions.

c. Correct terminology should be reserved for children who are older.

d. Sex can be presented as a normal part of growth and development.

ANS: D

Rationale: When sexual information is presented to school-age children, sex should be treated as a normal part of growth and development.

An important consideration for the school nurse who is planning a class on bicycle safety is

a. Most bicycle injuries involve collision with an automobile.

b. Head injuries are the major causes of bicycle-related fatalities.

c. Children should wear bicycle helmets if they ride on paved streets.

d. Children should not ride double unless the bicycle has an extra-large seat.

ANS: B

Rationale:
The most important aspect of bicycle safety is to encourage the rider to use a protective helmet. Head injuries are the major cause of bicycle-related fatalities.

Which demonstrates the school-age childs developing logic in the stage of concrete operations? Select all that apply.

a. The school-age child is able to recognize that 1 lb of feathers is equal to 1 lb of metal.

b. The school-age child is able to recognize that he can be a son, brother, or nephew at the same time.

c. The school-age child understands the principles of adding, subtracting, and reversibility.

d. The school-age child has thinking that is characterized by egocentrism, animism, and centration.

ANS: A, B, C

Rationale: Correct- The school-age child understands that the properties of objects do not change when their order, form, or appearance does. Conservation occurs in the concrete operations stage. Comprehension of class inclusion occurs as the school-age childs logic increases. The child begins to understand that a person can be in more than one class at the same time. This is characteristic of concrete thinking and logical reasoning. The school-age child is able to understand principles of adding and subtracting, as well as the process of reversibility, which occurs in the stage of concrete operations.

Incorrect-This type of thinking occurs in the intuitive thought stage, not the concrete operations stage of development.

Which interventions are appropriate for preventing childhood obesity? Select all that apply.

a. Establish consistent times for meals and snacks.

b. Eliminate all snacks. Eat three nutritious meals a day.

c. Teach the family and child how to select foods and prepare foods.

d. Encourage schools to provide snack machines with popcorn, cookies, and diet soda.

e. Limit computer and television time.

ANS: A, C, E

Rationale: Correct- Preventing obesity includes encouraging families to establish consistent times for meals and snacks and discouraging between-meal eating. Parents and children also need to be taught how to select and prepare healthful foods. Because snacks are an important aspect in childhood nutrition, nutritious snacks should be identified. School-age children usually require a healthful snack after school and in the evening. A child who spends time with social media has less interest in physical activity and going outdoors.

Incorrect- Snacks are an important aspect in childhood nutrition. Nutritious snacks should be identified, not eliminated. Healthy snack options include fruit, popcorn, nuts, and yogurt, not cookies and diet soda. In schools with snack machines, children may use their lunch money to purchase high-calorie snacks versus a nutritious lunch.

Which strategies can a nurse teach to parents of a child experiencing uncomplicated school refusal? Select all that apply.

a. The child should be allowed to stay home until the anxiety about going to school is resolved.

b. Parents should be empathetic yet firm in their insistence that the child attends school.

c. A modified school attendance may be necessary.

d. Parents need to pick the child up at school whenever the child wants to come home.

e. Parents need to communicate with the teachers about the situation.

ANS: B, C, E

Rationale: Correct- In uncomplicated cases of school refusal, the parent needs to return the child to school as soon as possible. If symptoms are severe, a limited period of part-time or modified school attendance may be necessary. For example, part of the day may be spent in the counselors or school nurses office, with assignments obtained from the teacher. Parents should be empathetic yet firm and consistent in their insistence that the child attend school.

Incorrect- Parents should not pick the child up at school once the child is there. The principal and teacher should be told about the situation so that they can cooperate with the treatment plan.

Peer victimization is becoming a significant problem for school-age children and adolescents in the United States. Parents should be educated regarding signs that a child is being bullied. These might include (select all that apply)

a. The child spends an inordinate amount of time in the nurses office.

b. Belongings frequently go missing or are damaged.

c. The child wants to be driven to school.

d. School performance improves.

e. The child freely talks about his day.

ANS: A, B, C

Correct- Signs that may indicate a child is being bullied are similar to signs of other types of stress and include nonspecific illness or complaints, withdrawal, depression, school refusal, and decreased school performance. Children express fear of going to school or riding the school bus. Very often, children will not talk about what is happening to them.

Incorrect- These are not indications of bullying.

\____________________ is the leading cause of death in children of every age-group beyond 1 year of age.

Unintentional injury

Children have a total of \__________ primary (deciduous) teeth that they begin to lose when they are school age.

20

Primary (deciduous) teeth are replaced by permanent teeth. By adulthood the child will have \__________ permanent teeth.

32

A nurse is planning a class for school-age children on obesity. Which percentile does the body mass index (BMI) need to exceed for a child to be assessed as obese?

95

Rationale: When intake of food exceeds expenditure, the excess is stored as fat. Obesity is an excessive accumulation of fat in the body and is assessed in children as a BMI that exceeds the 95th percentile for age.

The number of hours spent sleeping decreases as the child grows older. Children ages 6 and 7 years require approximately 9 or 10 hours of sleep per night. Is this statement true or false?

FALSE

Rationale: Children ages 6 and 7 actually need approximately 12 hours of sleep per night. Some children also continue to need an afternoon nap or quiet time to restore energy levels. The 12-year-old needs approximately 9 to 10 hours of sleep at night. Adequate sleep is important for school performance and physical growth. Inadequate sleep can cause irritability, inability to concentrate, and poor school performance.

The nurse is explaining Tanner staging to an adolescent and her mother. Which statement
best describes Tanner staging?
a. Predictable stages of puberty that are based on chronologic age
b. Staging of puberty based on the initiation of menarche and nocturnal emissions
c. Predictable stages of puberty that are based on primary and secondary sexual
characteristics
d. Staging of puberty based on the initiation of primary sexual characteristics

ANS: C
Feedback
A Tanner stages are not based on chronologic age. The age at which an adolescent
enters puberty is variable.
B The puberty stage in girls begins with breast development. Puberty stage in boys
begins with genital enlargement.
C Tanner sexual-maturing ratings are based on the development of stages of
primary and secondary sexual characteristics.
D Primary sexual characteristics are not the basis of Tanner staging.

Which behavior suggests appropriate psychosocial development in the adolescent?
a. The adolescent seeks validation for socially acceptable behavior from older adults.
b. The adolescent is self-absorbed and self-centered and has sudden mood swings.
c. Adolescents move from peers and enjoy spending time with family members.
d. Conformity with the peer group increases in late adolescence.

ANS: B
Feedback
A The peer group validates acceptable behavior during adolescence.
B During adolescence, energy is focused within. Adolescents concentrate on
themselves in an effort to determine who they are or who they will be.
Adolescents are likely to be impulsive and impatient. Parents often describe their
teenager as being "self-centered or lazy."
C Adolescents move from family and enjoy spending time with peers. Adolescents
also spend time alone; they need this time to think and concentrate on
themselves.
D Conformity becomes less important in late adolescence.

The parents of a 14-year-old girl are concerned that their adolescent spends too much time
looking in the mirror. Which statement is the most appropriate for the nurse to make?
a. "Your teenager needs clearer and stricter limits about her behavior."
b. "Your teenager needs more responsibility at home."
c. "During adolescence this behavior is not unusual."
d. "The behavior is abnormal and needs further investigation."

ANS: C
Feedback
A Stricter limits are not an appropriate response for a behavior that is part of
normal development.
B More responsibility at home is not an appropriate response for this situation.
C Egocentric and narcissistic behavior is normal during this period of
development. The teenager is seeking a personal identity.
D The behavior is normal and needs no further investigation.

Which statement is the most appropriate advice to give parents of a 16-year-old who is
rebellious?
a. "You need to be stricter so that your teen stops trying to test the limits."
b. "You need to collaborate with your daughter and set limits that are perceived as
being reasonable."
c. "Increasing your teen's involvement with her peers will improve her self-esteem."
d. "Allow your teenager to choose the type of discipline that is used in your home."

ANS: B
Feedback
A Setting stricter limits typically does not decrease rebelliousness or decrease
testing of parental limits.
B Allowing teenagers to choose between realistic options and offering consistent
and structured discipline typically enhances cooperation and decreases
rebelliousness. Structure helps adolescents to feel more secure and assists them
in the decision-making process.
C Increasing peer involvement does not typically increase self-esteem.
D Allowing teenagers to choose the method of discipline is not realistic and
typically does not reduce rebelliousness.

Which statement by the nurse is most appropriate to a 15-year-old whose friend has
mentioned suicide?
a. "Tell your friend to come to the clinic immediately."
b. "You need to gather details about your friend's suicide plan."
c. "Your friend's threat needs to be taken seriously, and immediate help for your
friend is important."
d. "If your friend mentions suicide a second time, you will want to get your friend
some help."

ANS: C
Feedback
A Instructing a 15-year-old to tell a friend to come to the clinic immediately
provides the teen with limited information and does not address the concern.
B It is important to determine whether a person threatening suicide has a plan of
action; however, the best information for the 15-year-old to have is that all
threats of suicide should be taken seriously and immediate help is important.
C Suicide is the third most common cause of death among American adolescents.
A suicide threat from an adolescent serves as a dramatic message to others and
should be taken seriously. Adolescents at risk should be targeted for supportive
guidance and counseling before a crisis occurs.
D It is imperative that help is provided immediately for a teenager who is talking
about suicide. Waiting until the teen discusses it a second time may be too late.

When planning care for adolescents, the nurse should
a. Teach parents first, and they, in turn, will teach the teenager.
b. Provide information for their long-term health needs because teenagers respond
best to long-range planning.
c. Maintain the parents' role by providing explanations for treatment and procedures
to the parents only.
d. Give information privately to adolescents about how they can manage the specific
problems that they identify.

ANS: D
Feedback
A Teenagers are socially and cognitively at the developmental stage where the
health care provider can teach them.
B Teenagers are more interested in immediate health care needs than in long-term
needs.
C Teenagers are at the developmental level that allows them to receive
explanations about health care directly from the nurse.
D Problems that teenagers identify and are interested in are typically the problems
that they are the most willing to address. Confidentiality is important to
adolescents. Adolescents prefer to confer privately (without parents) with the
nurse and health care provider.

A 17-year-old tells the nurse that he is not having sex because it would make his parents
very angry. This response indicates that the adolescent has a developmental lag in which
area?
a. Cognitive development
b. Moral development
c. Psychosocial development
d. Psychosexual development

ANS: B
Feedback
A Cognitive development is related to moral development, but it is not the pivotal
point in determining right and wrong behaviors.
B The appropriate moral development for a 17-year-old would include evidence
that the teenager has internalized a value system and does not depend on parents
to determine right and wrong behaviors. Adolescents who remain concrete
thinkers may never advance beyond conformity to please others and avoid
punishment.
C Identity formation is the psychosocial development task. Energy is focused
within the adolescent, who exhibits behavior that is self-absorbed and egocentric.
D Although a task during adolescence is the development of a sexual identity, the
teenager's dependence on the parents' sanctioning of right or wrong behavior is
more appropriately related to moral development.

What is the best response a nurse can make to a 15-year-old girl who has verbalized a
desire to have a baby?
a. "Have you talked with your parents about this?"
b. "Do you have plans to continue school?"
c. "Will you be able to support the baby?"
d. "Can you tell me how your life will be if you have an infant?"

ANS: D
Feedback
A Asking the teenager whether she has talked to her parents is not particularly
helpful to the teen or the nurse and may terminate the communication.
B A direct question about continuing school will not facilitate communication.
Open-ended questions encourage communication.
C Asking the teenager about how she will support the child will not facilitate
communication. Open-ended questions encourage communication.
D Having the teenager describe how the infant will affect her life will allow the
teen to think more realistically. Her description will allow the nurse to assess the
teen's perception and reality orientation.

Many adolescents decide to follow a vegetarian diet during their teen years. The nurse can
advise the adolescent and his or her parents that
a. This diet will not meet the nutritional requirements of growing teens.
b. A vegetarian diet is healthy for this population.
c. An adolescent on a vegetarian diet is less likely to eat high-fat or low-nutrient
foods.
d. A vegetarian diet requires little extra meal planning.

ANS: B
Feedback
A Several dietary organizations have suggested that a vegetarian diet, if correctly
followed, is healthy for this population.
B A vegetarian diet is healthy for this population, and the low-fat aspect of the diet
can prevent future cardiovascular problems.
C As with any adolescent, nurses need to advise teens who follow a vegetarian
eating plan to avoid low-nutrient, high-fat foods.
D The nurse can assist with planning food choices that will provide sufficient
calories and necessary nutrients. The focus is on obtaining enough calories for
growth and energy from a variety of fruits and vegetables, whole grains, nuts,
and soymilk.

Which is assessed with Tanner staging?
a. Hormone levels
b. Secondary sex characteristics
c. Response to growth hormone secretion tests
d. Hyperthyroidism

ANS: B
Feedback
A Hormone levels are assessed by their concentration in the blood.
B Tanner stages are used to assess staging of secondary sex characteristics at
puberty.
C Growth hormone secretion tests are not associated with Tanner staging.
D Tanner stages are not associated with hyperthyroidism.

A nurse is teaching adolescent boys about pubertal changes. The first sign of pubertal
change seen with boys is
a. Testicular enlargement
b. Facial hair
c. Scrotal enlargement
d. Voice deepens

ANS: A
Feedback
A The first sign of pubertal changes in boys is testicular enlargement in response to
testosterone secretion, which usually occurs in Tanner stage 2. Slight pubic hair
is present and the smooth skin texture of the scrotum is somewhat altered.
B During Tanner stages 4 and 5, facial hair appears at the corners of the upper lip
and chin.
C As testosterone secretion increases, the penis, testes, and scrotum enlarge.
D During Tanner stages 4 and 5, rising levels of testosterone cause the voice to
deepen.

According to Erikson, the psychosocial task of adolescence is to develop
a. Intimacy
b. Identity
c. Initiative
d. Independence

ANS: B
Feedback
A Intimacy is the developmental stage for early adulthood.
B Traditional psychosocial theory holds that the developmental crises of
adolescence lead to the formation of a sense of identity.
C Initiative is the developmental stage for early childhood.
D Independence is not one of Erikson's developmental stages.

According to Piaget, the adolescent is in the fourth stage of cognitive development, or
period of what?
a. Formal operations
b. Concrete operations
c. Conventional thought
d. Postconventional thought

ANS: A
Feedback
A Cognitive thinking culminates with capacity for abstract thinking. This stage, the
period of formal operations, is Piaget's fourth and last stage.
B Concrete operations usually develops between ages 7 and 11 years.
C Conventional and postconventional thought refer to Kohlberg's stages of moral
development.
D Conventional and postconventional thought refer to Kohlberg's stages of moral
development.

Why do peer relationships become more important during adolescence?
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.

ANS: C
Feedback
A During adolescence, the parent/child relationship changes from one of
protection-dependency to one of mutual affection and quality.
B Parents continue to play an important role in the personal and health-related
decisions.
C The peer group serves as a strong support to teenagers, providing them with a
sense of belonging and a sense of strength and power.
D The peer group forms the transitional world between dependence and autonomy.

A 14-year-old male seems to be always eating, although his weight is appropriate for his
height. The best explanation for this is that
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

ANS: A
Feedback
A 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.
B This describes the expected eating pattern for young adolescents; as long as
weight and height are appropriate, obesity is not a concern.
C This describes the expected eating pattern for young adolescents; as long as
weight and height are appropriate, obesity is not a concern.
D This describes the expected eating pattern for young adolescents; as long as
weight and height are appropriate, obesity is not a concern.

What 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

ANS: B
Feedback
A Rapid physical growth, the tendency toward overexertion, and the overall
increased activity of this age contributes to fatigue.
B During growth spurts, the need for sleep is increased.
C Rapid physical growth, the tendency toward overexertion, and the overall
increased activity of this age contributes to fatigue.
D Rapid physical growth, the tendency toward overexertion, and the overall
increased activity of this age contributes to fatigue.

The most common cause of death in the adolescent age-group involves
a. Drownings
b. Firearms
c. Drug overdoses
d. Motor vehicles

ANS: D
Feedback
A Drownings are major concerns in adolescence but do not cause the majority of
deaths.
B Firearms are major concerns in adolescence but do not cause the majority of
deaths.
C Drug overdoses are major concerns in adolescence but do not cause the majority
of deaths.
D Risk taking behaviors play a major role in the high incidence of motor vehicle
injuries and death among teenagers i.e. alcohol use, failure to wear a seatbelt,
and inexperience.

In girls, the initial indication of puberty is
a. Menarche
b. Growth spurt
c. Growth of pubic hair
d. Breast development

ANS: D
Feedback
A The usual sequence of secondary sexual 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.
B The usual sequence of secondary sexual 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.
C The usual sequence of secondary sexual 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.
D In most girls, the initial indication of puberty is the appearance of breast buds, an
event known as thelarche.

Injuries claim many lives during adolescence. Which factors contribute to early
adolescents engaging in risk-taking behaviors? Select all that apply.
a. Peer pressure
b. A desire to master their environment
c. Engagement in the process of separation from their parents
d. A belief that they are invulnerable
e. Impulsivity

ANS: A, D, E
Feedback
Correct Peer pressure (including impressing peers) is a factor contributing to
adolescent injuries. During early to middle adolescence, children feel that
they are exempt from the consequences of risk-taking behaviors; they
believe that negative consequences only happen to others. Feelings of
invulnerability ("It can't happen to me") are evident in adolescence.
Impulsivity places adolescents in unsafe situations.
Incorrect Mastering the environment is the task of young school-age children.
Emancipation is a major issue for the older adolescent. The process is
accomplished as the teenager gains an education or vocational training

You are working as the triage nurse in a pediatric emergency room. You receive a
telephone call from the mother of an adolescent whose front tooth was completely knocked
out of his mouth while he was playing soccer. The mother is seeking advice. Which is the
appropriate response? Select all that apply.
a. Rinse the tooth in lukewarm tap water.
b. Place the tooth in saline, milk, or water.
c. Scrub the tooth with a disinfectant, such as mouth wash.
d. Bring the child to the emergency room within the next hour for the best prognosis.

ANS: A, B
Feedback
Correct Rinse the tooth in lukewarm tap water—this is a correct response. Place
the tooth in saline, milk, or water—this is a correct response.
Incorrect The tooth should not be scrubbed, and cleaning agents and disinfectants
should be avoided. The prognosis is best if the injury is treated within 30
minutes.

Parents of a teenager ask the nurse what signs they should look for if their child is in a
gang. The nurse should include which signs when answering? Select all that apply.
a. Plans to try out for the debate team at school
b. Skipping classes to go to the mall
c. Hanging out with friends they have had since childhood
d. Unexplained source of money
e. Fear of the police

ANS: B, D, E
Feedback
Correct Signs of gang involvement include skipping classes, unexplained sources
of money, and fear of the police. Associating with new friends while
ignoring old friends is also a sign. A change in attitude toward
participating in activities is another sign of gang involvement.
Incorrect Plans to try out for the debate team at school are not a sign of gang
involvement. Hanging out with friends he or she has had since childhood
is not a sign of gang involvement.

Tattoos have become increasingly popular among mainstream adolescents. Like clothing
and hairstyles, tattoos serve to define one's identity. It is important for nurses to caution
adolescents on the health risks of obtaining a tattoo. These include (select all that apply)
a. Amateur tattoos are difficult to remove.
b. Tattoos pose a risk for bloodborne and skin infections.
c. Health care professionals must be notified of the existence of a tattoo before a
magnetic resonance imaging (MRI) scan.
d. Tattoo dyes may cause allergic reactions.
e. Tattoo parlors are well regulated.

ANS: B, C, D
Feedback
Correct Tattoos carry the risk for contracting bloodborne diseases such as hepatitis
B and HIV. Infection, allergic reaction to the dye, scarring, or keloid
formation can occur. Should an MRI ever be required, it is important to
notify the health care professionals, because the dyes can contain iron and
other metals.
Incorrect Amateur tattoos are easily removed; however, studio tattoos made with red
and green dye are extremely difficult to remove. Very little regulation
exists in the tattoo industry; therefore, the cleanliness of each tattoo parlor
varies. Teens should be counseled to avoid making an impulsive decision
to get a tattoo.

In assessing adolescents using Tanner staging, sexual maturity is rated using \_________
distinct stages. (Your answer should appear as a number.)

ANS:
5
Tanner stages of adolescent sexual development describe five distinct stages of sexual
maturity rating. There are separate rating scales for males and females, but both use five
stages.

Adolescents' eyes and ears are fully developed and, with the exception of minor infections,
the sensory system remains quite healthy during this period of development. The mother of
a 12-year-old complains to the nurse that she is concerned that her daughter frequently
needs changes to her corrective lenses. This is a condition known as \___________.

ANS:
myopia
Myopia (nearsightedness) occurs in early adolescence, between the ages of 11 and 13 and
is a normal part of adolescent development

Adolescent sexuality refers to the thoughts, feelings, and behaviors related to the teen's
sexual identity. The most recent research (2009) indicates that 46% of all adolescents have
been involved in some kind of sexual activity. The only complete protection from
pregnancy and sexually transmitted diseases (STDs) is \____________.

ANS:
abstinence
Adolescents should be encouraged that there is nothing wrong with abstaining from sexual
activity. Adolescents who engage in sexual activity at a young age are more likely to
participate in other high-risk behaviors such as alcohol and drug use. Adolescents who
demonstrate high self-esteem are more likely to delay sexual intercourse.

The use of electronic or digital media for communication has had a negative effect on the
language development of adolescents. Is this statement true or false?

ANS: T
Text messaging, instant messaging, blogs, and Twitter all contribute to abbreviated
communication techniques, which eliminate not only grammar and sentence construction,
but also word development (e.g., using ur, for you are).