Chapter 9: Health Promotion for Adolescents - Key Concepts and Definitions

The nurse is explaining Tanner staging to an adolescent and 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 based on primary and secondary sexual

characteristics

d. Staging of puberty based on the initiation of primary sexual characteristics

c. Predictable stages of puberty based on primary and secondary sexual

(Tanner sexual-maturing ratings are based on the development of stages of primary and secondary sexual characteristics. Tanner

stages are not based on chronologic age. The age at which an adolescent enters puberty is variable. The puberty stage in girls

begins with breast development. Puberty stage in boys begins with genital enlargement. 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.

b. The adolescent is self-absorbed and self-centered and has sudden mood swings.

(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." The peer group validates acceptable behavior during adolescence. 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. 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."

c. "During adolescence this behavior is not unusual."

(Egocentric and narcissistic behavior, such as staring at oneself in the mirror, is normal during this period of development. The

teenager is seeking a personal identity. Stricter limits are not an appropriate response for a behavior that is part of normal

development. More responsibility at home is not an appropriate response for this situation. 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. "Try to collaborate to set limits that are perceived as being reasonable."

c. "Increasing your teen's involvement with her peers will improve her behavior."

d. "Allow your teenager to choose the type of discipline that is used in your home."

b. "Try to collaborate to set limits that are perceived as being reasonable."

(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. Setting stricter limits typically does not decrease rebelliousness or decrease testing of parental limits. Increasing peer involvement does not typically improve behavior. 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 he needs immediate help."

d. "If your friend mentions suicide again get your friend some help."

c. "Your friend's threat needs to be taken seriously and he needs immediate help."

(Suicide is the second most common cause of death among American adolescents and young adults.)

When planning care for adolescents, the nurse should

a. teach parents first, and they, in turn, will teach the teenager.

b. provide information for long-term health needs.

c. provide explanations for treatment and procedures to the parents only.

d. give information privately to adolescents on specific problems that they identify.

d. give information privately to adolescents on specific problems that they identify.

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

b. 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?"

d. "Can you tell me how your life will be if you have an infant?"

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 can be healthy for this population.

c. an adolescent on a vegetarian diet is less likely to eat high-fat foods.

d. a vegetarian diet requires little extra meal planning.

b. a vegetarian diet can be healthy for this population.

Which is assessed with Tanner staging?

a. Hormone levels

b. Secondary sex characteristics

c. Growth hormone secretion

d. Hyperthyroidism

b. Secondary sex characteristics

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.

a. testicular enlargement.

A student nurse learns that according to Erikson, the psychosocial task of adolescence is to develop

a. intimacy.

b. identity.

c. initiative.

d. independence.

b. identity.

A student nurse learns that 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

a. Formal operations

A student nurse asks the faculty why peer relationships become more important during adolescence. Which of the following is the

nurse's best response?

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.

c. They provide adolescents with a feeling of belonging.

A 14-year-old male seems to be always eating, although his weight is appropriate for his height. The parents ask the nurse if they

should be concerned about this behavior. Which response by the nurse is best?

a. This is normal because of increase in body mass during this time.

b. This is abnormal and suggestive of possible future obesity.

c. His caloric intake would have to be excessive for him to gain weight.

d. He is substituting food for unfilled needs.

a. This is normal because of increase in body mass during this time.

What does the nurse learn that predisposes the adolescent to feel an increased need for sleep?

a. An inadequate diet

b. Rapid physical growth

c. Decreased activity

d. Typical lack of ambition

b. Rapid physical growth

A nurse wants to volunteer for an organization that helps prevent death in older adolescents. What action by the nurse would have

the most impact?

a. Volunteer for a suicide hotline.

b. Teach firework safety classes.

c. Work on a poison control hot line.

d. Educate teens on gun safety.

a. Volunteer for a suicide hotline.

In girls, the initial indication of puberty is

a. menarche.

b. growth spurt.

c. growth of pubic hair.

d. breast development.

d. breast development.

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. Trying to separate from their parents

d. A belief that they are invulnerable

e. Impulsivity

a. Peer pressure

d. A belief that they are invulnerable

e. Impulsivity

A parent calls the emergency department (ED) reporting a front tooth completely knocked out of an adolescent's mouth while

playing soccer. What information should the nurse provide? (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.

d. Come to the ED within 1 hour.

e. Prognosis is best if they are seen within 30 minutes.

a. Rinse the tooth in lukewarm tap water.

b. Place the tooth in saline, milk, or water.

e. Prognosis is best if they are seen 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

b. Skipping classes to go to the mall

d. Unexplained source of money

e. Fear of the police

The school nurse is presenting information on some risks of tattoos. What information should the nurse provide? (Select all that

apply.)

a. Amateur tattoos are difficult to remove.

b. Tattoos pose a risk for bloodborne and skin infections.

c. A tattoo may keep you from getting an MRI.

d. Tattoo dyes may cause allergic reactions.

e. Tattoo parlors are well regulated.

b. Tattoos pose a risk for bloodborne and skin infections.

c. A tattoo may keep you from getting an MRI.

d. Tattoo dyes may cause allergic reactions.

The school nurse is evaluating the school's athletic programs for safety. What factors should the nurse assess? (Select all that

apply.)

a. Students get adequate rest periods.

b. Equipment is in good condition.

c. Practices are appropriate for students.

d. Post-game concussion assessment if needed

e. Adequate fluids are available at all times.

a. Students get adequate rest periods.

b. Equipment is in good condition.

c. Practices are appropriate for students.

e. Adequate fluids are available at all times.

A safe athletic program has several features including adequate rest periods, good quality equipment, appropriate practice

schedules and regimes, and adequate fluids. Concussion testing if warranted, should occur immediately as the student is withdrawn

from the game, and not wait until after the game is over.

A nurse is planning for a sports pre-participation physical exam day. What goals for this event does the nurse set? (Select all that

apply.)

a. Comprehensive physical examination

b. Assess general health

c. Identify limiting conditions

d. Provide wellness counseling

e. Adhere to insurance requirements

b. Assess general health

c. Identify limiting conditions

d. Provide wellness counseling

e. Adhere to insurance requirements

A nurse works for an organization that seeks to limit adolescent violence. In talking with donors, which risk factors for violence

may lead to programming decisions? (Select all that apply.)

a. Drug or alcohol use/abuse

b. Poverty

c. Hopelessness about the future

d. Narcissism

e. Lack of supervision

a. Drug or alcohol use/abuse

b. Poverty

c. Hopelessness about the future

e. Lack of supervision

The nurse is discussing contraceptive choices with an adolescent girl who wants to become sexually active. Which factors are

important to consider? (Select all that apply.)

a. Motivation

b. Cognitive development

c. Chronological age

d. Parental opinions

e. Frequency of intercourse

a. Motivation

b. Cognitive development

e. Frequency of intercourse

While caring for hospitalized adolescents, the nurse observes that sometimes they are skeptical of their parents' religious beliefs/practices. How should the nurse interpret this behavior?

a. It is normal in spiritual development.

b. It is abnormal in spiritual development.

c. It is related to illness and occurs only at times of crisis.

d. It is related to the inability of parents to explain adequately their beliefs/practices.

a. It is normal in spiritual development.

A 16-year-old girl tells the school nurse that she has not started to menstruate yet. The onset of secondary sexual characteristics occurred in this girl about 3 years ago. The appropriate action by the nurse is to

a. explain that this is not unusual.

b. refer the adolescent for an evaluation.

c. assume that the adolescent is pregnant.

e. suggest that the adolescent stop exercising until menarche occurs.

b. refer the adolescent for an evaluation.

A parent tells the nurse, "I am worried about my 13-year-old son. He hasn't started puberty, and my daughter did when she was 11 years of age." How can the nurse explain the difference to the parent?

a. That this is unusual and requires further evaluation of the son.

b. This is unusual because the onset of pubescence is usually the same in siblings.

c. This is normal because the onset of pubescence is usually earlier in girls than it is in boys.

d. This is abnormal because the onset of pubescence is usually earlier in boys than it is in girls.

c. This is normal because the onset of pubescence is usually earlier in girls than it is in boys.

(Girls begin puberty an average of approximately 2 years before boys. The average age of onset for puberty in boys is 12 years. In boys, puberty is considered delayed if testicular enlargement or pubic hair development has not occurred by age 14 years.)

What change in boys indicates the onset of puberty?

a. Voice changes

b. Testicular enlargement

c. Growth of dark pubic hair

d. An increasing penis size

b. Testicular enlargement

(Testicular enlargement is the first change that signals puberty in boys; it usually occurs between the ages of 9 and 14 years during Tanner stage 2 development. Voice change occurs between Tanner stages 3 and 4. Fine pubic hair may occur at the base of the penis; darker hair and increasing penis size occurs during Tanner stage 3.)

Several adolescents approach the school nurse with questions about skin enhancement including tanning, body piercing, and tattoos. Which responses by the nurse contain correct information?

Select all that apply.

a. Generally, body piercing is harmless, but these procedures must be done under sterile conditions or there can be complications, such as bleeding, infection, keloid formation, and allergies to metal.

b. Piercing guns are a great way of easy body piercing with minimal infection.

c. There are risks of bloodborne infections, skin infections, and allergic reactions to dyes used in the tattoo process.

d. Tattoos made with red and green dyes are the easiest to remove if the person wants them removed.

e. Since many of the tattoo inks contain metal, such as iron, an adolescent needing magnetic resonance imaging (MRI) must inform the MRI center about the tattoo prior to the procedure.

f. Skin cancer occurs very rarely with the use of tanning booths.

A. Generally, body piercing is harmless, but these procedures must be done under sterile conditions or there can be complications, such as bleeding, infection, keloid formation, and allergies to metal.

C. There are risks of bloodborne infections, skin infections, and allergic reactions to dyes used in the tattoo process.

E. Since many of the tattoo inks contain metal, such as iron, an adolescent needing magnetic resonance imaging (MRI) must inform the MRI center about the tattoo prior to the procedure.

A very depressed adolescent tells the school nurse: "I just don't know how I'm going to cope with everything I'm going through—maybe it would be better if I wasn't around anymore." What approach is most important for the nurse to use when working with this student?

a. Explain that a suicide attempt is an immature way of dealing with stress.

b. Recognize he is exhibiting warning signs of suicide.

c. Ignore what he is saying—he is only trying to get attention.

d. Recognize that what he is saying is an impulsive act resulting from a temporary crisis.

b. Recognize he is exhibiting warning signs of suicide.

(It is imperative that the nurse recognize warning signs of a potential suicide. All threats must be taken seriously. For the depressed young person, suicide may appear to be the only way out. To tell the adolescent that his or her attempt is immature is a certain block to further therapeutic communication. Even if the crisis is temporary, the adolescent's perception may still be that suicide is the only way out. Remember that adolescents are focused on the here and now.)

Which is most descriptive of the spiritual development of the older adolescent?

a. The beliefs become more abstract.

b. Strict observance of religious customs is common.

c. Rituals and practices become increasingly important.

d. Emphasis is placed on external manifestations, such as whether a person goes to church.

a. The beliefs become more abstract.

(Because of their abstract thinking abilities, adolescents are able to interpret analogies and symbols. Strict observance of religious customs, rituals, and practices become less important as the adolescent questions values and ideals of families. Adolescents question external manifestations when not supported by adherence to supportive behaviors.)

A sexually active adolescent asks the school nurse about prevention of sexually transmitted diseases (STDs). What is the most appropriate recommendation by the nurse?

a. Use condoms.

b. Abstain from sex.

c. Any type of contraception method will prevent STDs.

d. The withdrawal method of contraception will prevent STDs.

a. Use condoms.

(Condoms provide the best available barrier to the organisms that cause STDs. Complete protection from pregnancy and STDs is achievable only through sexual abstinence. However, the adolescent is sexually active and the nurse needs to be open, forthright, and respectful of the decisions she made about sexual activity.)

The school nurse overhears a group of adolescent girls talking about gaining weight and getting fat deposits during puberty. What anticipatory advice would be appropriate for the nurse to give to the girls?

a. Provide reassurance that these changes are normal.

b. Suggest dietary measures to control weight gain.

c. Encourage a low-fat diet to prevent fat deposition.

d. Recommend increased exercise to control weight gain.

a. Provide reassurance that these changes are normal.

(Muscle mass increases in boys, and fat deposits increase in girls. Ultimately, diet, exercise, and hereditary factors influence adolescents' height, weight, and body build. A healthy balance must be achieved between expected healthy weight gain and obesity. Dietary measures to control weight gain or a recommendation for increased exercise would not be given unless weight gain was excessive.)

The nurse observes that a 13-year-old male has gynecomastia (breast enlargement). How should the nurse explain this to this adolescent?

a. It denotes there is too much body fat.

b. It is caused by dietary fat intake.

c. It is a sign of hormonal imbalance.

d. It is a normal occurrence during puberty.

d. It is a normal occurrence during puberty.

(Gynecomastia is common during mid-puberty in about one third of boys. For most, the breast enlargement disappears within several years. Although gynecomastia may occur in overweight children, in children of normal body weight it is a normal occurrence. It is not related to diet or hormones.)