Chapter 35: The Adolescent and Family Nursing School Test Banks

Chapter 35: The Adolescent and Family

MULTIPLE CHOICE

1. In girls, the initial indication of puberty is:

a.

Menarche.

c.

Growth of pubic hair.

b.

Growth spurt.

d.

Breast development.

ANS: D

In most girls, the initial indication of puberty is the appearance of breast buds, an event known as the larche. 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.

PTS: 1 DIF: Cognitive Level: Knowledge REF: 1011

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

2. The mean age of menarche in the United States is:

a.

11.5 years

c.

13.5 years

b.

12.5 years

d.

14 years

ANS: B

The average age of menarche is 12 years and 4 months in North American girls, with a normal range of 10.5 to 15 years.

PTS: 1 DIF: Cognitive Level: Knowledge REF: 1011

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

3. By what age should concerns about pubertal delay be considered in boys?

a.

12 to 12.5 years

c.

13 to 13.5 years

b.

12.5 to 13 years

d.

13.5 to 14 years

ANS: D

Concerns about pubertal delay should be considered for boys who exhibit no enlargement of the testes or scrotal changes by 13.5 to 14 years of age. Ages younger than 13.5 years are too young for initial concern.

PTS: 1 DIF: Cognitive Level: Knowledge REF: 1012

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

4. Steve, 14 years old, mentions that he now has to use deodorant but never had to before. The nurses response should be based on knowledge that:

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.

ANS: D

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 axillae, genital and anal areas, 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 genitals 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 insulate the body and cause increased sweat production, but this is not the etiology of apocrine sweat gland activity.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1014

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

5. According to Erikson, the psychosocial task of adolescence is developing:

a.

Intimacy.

c.

Initiative.

b.

Identity.

d.

Independence.

ANS: B

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. Initiative is the developmental stage for early childhood. Independence is not one of Eriksons developmental stages.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1014

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

6. According to Piaget, the adolescent is in the fourth stage of cognitive development, or period of:

a.

Formal operations.

c.

Conventional thought.

b.

Concrete operations.

d.

Postconventional thought.

ANS: A

Cognitive thinking culminates with capacity for abstract thinking. This stage, the period of formal operations, is Piagets fourth and last stage. The concrete operations stage usually develops between ages 7 and 11 years. Conventional and postconventional thought refer to Kohlbergs stages of moral development.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1015

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

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

ANS: A

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 the ability to place things in a sensible and logical order, the ability to see things from anothers point of view, and the ability to make judgments based on what they reason rather than just what they see.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1015

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

8. The parents of a 14-year-old girl express concerns about the number of hours their daughter spends with her friends. The nurse explains that peer relationships become more important during adolescence because:

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

The peer group serves as a strong support to teenagers, providing them with a sense of belonging and 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 personal and health-related decisions. The peer group forms the transitional world between dependence and autonomy.

PTS: 1 DIF: Cognitive Level: Application REF: 1017

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

9. An adolescent boy tells the nurse that he has recently had homosexual feelings. The nurses response should be based on knowledge that:

a.

This indicates that the adolescent is homosexual.

b.

This indicates that 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.

ANS: D

These adolescents are at increased risk for health-damaging behaviors, not because of the sexual behavior itself, but because of societys reaction to the behavior. The nurses first priority is to give the young man permission to discuss his feelings about this topic, knowing that the nurse will maintain confidentially, appreciate his feelings, and remain sensitive to his need to talk it. In recent studies among self-identified gay, lesbian, and bisexual adolescents, many of the adolescents report changing their self-labels one or more times during their adolescence.

PTS: 1 DIF: Cognitive Level: Application REF: 1020

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

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.

ANS: C

Health professionals who work with adolescents should consider the adolescents increasing independence and responsibility while maintaining privacy and ensuring confidentiality. However, circumstances may occur in which they are not able to maintain confidentiality, such as self-destructive behavior or maltreatment by others. Confidentiality and privacy are necessary to facilitate trust with this age group. The nurse must be aware of the limits placed on confidentiality by local jurisdiction.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1020

OBJ: Nursing Process: Implementation

MSC: Client Needs: Safe and Effective Care Environment

11. Matt, age 14 years, seems to be always eating, although his weight is appropriate for his height. The best explanation for this is:

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

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. This describes the expected eating pattern for young adolescents as long as weight and height are appropriate; obesity and substitution of food for unfilled needs are not concerns.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1023

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

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

ANS: B

During growth spurts, the need for sleep is increased. Rapid physical growth, the tendency toward overexertion, and the overall increased activity of this age contribute to fatigue.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1024

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

13. The most common cause of death in the adolescent age-group involves:

a.

Drownings.

c.

Drug overdoses.

b.

Firearms.

d.

Motor vehicles.

ANS: D

The leading cause of all adolescent deaths in the United States is motor vehicle accidents. Drownings, firearms, and drug overdoses are major concerns in adolescence but do not cause the majority of deaths.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1040

OBJ: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment

14. Which statement is true about smoking in adolescence?

a.

Smoking is related to other high-risk behaviors.

b.

Smoking is more common among athletes.

c.

Smoking is less common when the adolescents parent(s) smokes.

d.

Smoking among adolescents is becoming more prevalent.

ANS: A

Cigarettes are considered a gateway drug. Teenagers who smoke are 11.4 times more likely to use an illicit drug. Teens who refrain from smoking often have a desire to succeed in athletics. If a parent smokes, it is more likely that the teen will smoke. Cigarette smoking has declined among all groups since the 1990s.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1040

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

15. The nurse is completing a health history with a 16-year-old male. He informs the nurse that he has started using smokeless tobacco after he plays baseball. Which information regarding smokeless tobacco would be most correct for the nurse to provide to this teen?

a.

Not addicting.

b.

Proven to be carcinogenic.

c.

Easy to stop using.

d.

A safe alternative to cigarette smoking.

ANS: B

Smokeless tobacco is a popular substitute for cigarettes and poses serious health hazards to children and adolescents. Smokeless tobacco is associated with cancer of the mouth and jaw. Smokeless tobacco is just as addictive as cigarettes. Although teens believe that it is easy to stop using smokeless tobacco, this is not the case. A popular belief is that smokeless tobacco is a safe alternative to cigarettes; this has been proven incorrect. Half of all teens who use smokeless tobacco agree that it poses significant health risks.

PTS: 1 DIF: Cognitive Level: Application REF: 1040

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

16. A 14-year-old boy and his parents are concerned about bilateral breast enlargement. The nurses discussion of this should be based on knowing that:

a.

This is usually benign and temporary.

b.

This is usually caused by Klinefelters syndrome.

c.

Administration of estrogen effectively reduces gynecomastia.

d.

Administration of testosterone effectively reduces gynecomastia.

ANS: A

The male breast responds to hormone changes. Some degree of bilateral or unilateral breast enlargement occurs frequently in boys during puberty. This is not a manifestation of Klinefelters syndrome. Administration of estrogen or testosterone will have no effect on the reduction of breast tissue and may aggravate the condition.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1030

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

17. Which statement is correct about childhood obesity?

a.

Heredity is an important factor in the development of obesity.

b.

Childhood obesity in the United States is decreasing.

c.

Childhood obesity is the result of inactivity.

d.

Childhood obesity can be attributed to an underlying disease in most cases.

ANS: A

Heredity is an important fact that contributes to obesity. Identical twins reared apart tend to resemble their biologic parents to a greater extent than their adoptive parents. It is difficult to distinguish between hereditary and environmental factors. The rate of childhood obesity has increased so dramatically that it has now reached epidemic proportions. Inactivity is an important contributing factor; however, obesity is the result of a combination of a number of other factors. Fewer than 5% of all cases of obesity can be linked to underlying disease.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1032

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

18. The psychologic effects of being obese during adolescence include:

a.

Sexual promiscuity.

b.

Poor body image.

c.

Memory having no effect on eating behavior.

d.

Accurate body image but self-deprecating attitude.

ANS: B

Common emotional consequences of obesity include poor body image, low self-esteem, social isolation, and feelings of depression and isolation. Sexual promiscuity is an unlikely effect of obesity. The obese adolescent often substitutes food for affection. Eating behaviors are closely related to memory. Memory and appetite are closely linked and can be modified over time with treatment. Obese adolescents most often have a very poor self-image.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1031

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

19. Anorexia nervosa may best be described as:

a.

Occurring most frequently in adolescent males.

b.

Occurring most frequently in adolescents from lower socioeconomic groups.

c.

Resulting from a posterior pituitary disorder.

d.

Resulting in severe weight loss in the absence of obvious physical causes.

ANS: D

The etiology of anorexia remains unclear, but a distinct psychologic component is present. The diagnosis is based primarily on psychologic and behavioral criteria. Anorexia nervosa is observed more commonly in adolescent girls and young women. It does not occur most frequently in adolescents from a lower socioeconomic group. In reality, anorexic adolescents are often from families of means who have high parental expectations for achievement. Anorexia is a psychiatric disorder.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1035

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

20. The weight loss of anorexia nervosa is often triggered by:

a.

Sexual abuse.

c.

Independence from family.

b.

School failure.

d.

Traumatic interpersonal conflict.

ANS: D

Weight loss may be triggered by a typical adolescent crisis such as the onset of menstruation or a traumatic interpersonal incident; situations of severe family stress such as parental separation or divorce; or circumstances in which the young person lacks personal control, such as being teased, changing schools, or entering college. There may in fact be a history of sexual abuse; however, this is not the trigger. These adolescents are often overachievers who are successful in school, not failures in school. The adolescent is most often enmeshed with his or her family.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1036

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

21. Which statement is most descriptive of bulimia during adolescence?

a.

Strong sense of control over eating behavior

b.

Feelings of elation after the binge-purge cycle

c.

Profound lack of awareness that the eating pattern is abnormal

d.

Weight that can be normal, slightly above normal, or below normal

ANS: D

Individuals with bulimia are of normal weight or more commonly slightly above normal weight. Those who also restrict their intake can become severely underweight. Behavior related to this eating disorder is secretive, frenzied, and out of control. These cycles are followed by self-deprecating thoughts and a depressed mood. These young women are keenly aware that this eating pattern is abnormal.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1035

OBJ: Nursing Process: Diagnosis MSC: Client Needs: Psychosocial Integrity

22. The nurse is caring for an adolescent brought to the hospital with acute drug toxicity. Cocaine is believed to be the drug involved. Data collection should include the:

a.

Mode of administration.

b.

Actual content of the drug.

c.

Function the drug plays in the adolescents life.

d.

Adolescents level of interest in rehabilitation.

ANS: A

When the drug is questionable or unknown, every effort must be made to determine the type, amount of drug taken, the mode and time of administration, and factors relating to the onset of presenting symptoms. Because the actual content of most street drugs is highly questionable, this information would be difficult to obtain. It is helpful to know the pattern of use but not essential during this emergency. This is an inappropriate time for an evaluation about the level of interest in rehabilitation.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1043

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

23. An adolescent girl tells the nurse that she has suicidal thoughts. The nurse asks her if she has a specific plan. Asking this should be considered:

a.

An appropriate part of the assessment.

b.

Not a critical part of the assessment.

c.

Suggesting that the adolescent needs a plan.

d.

Encouraging the adolescent to devise a plan.

ANS: A

Routine health assessments of adolescents should include questions that assess the presence of suicidal ideation or intent. Questions such as Have you ever developed a plan to hurt yourself or kill yourself? should be part of that assessment. Threats of suicide should always be taken seriously and evaluated. Suggesting that the adolescent needs a plan and encouraging her to devise this plan would be inappropriate statements by the nurse.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1044

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

24. 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

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. The puberty stage in boys begins with genital enlargement. Primary sexual characteristics are not the sole basis of Tanner staging.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1011

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

25. 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

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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1021

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

26. The parents of a 15-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

Egocentric and narcissistic behavior 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.

PTS: 1 DIF: Cognitive Level: Application REF: 1020

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

27. Which statement is the most appropriate advice to give parents of a 16-year-old girl 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 teens 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

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 increase self-esteem.

PTS: 1 DIF: Cognitive Level: Application REF: 1034

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

28. 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 friends suicide plan.

c.

Your friends 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

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. 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. 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. Taking time to gather details or waiting until the teen discusses it a second time may be too late.

PTS: 1 DIF: Cognitive Level: Application REF: 1044

OBJ: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity

29. 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

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. Teenagers are socially and cognitively at the developmental stage where the health care provider can teach them. The nurse must keep in mind that teenagers are more interested in immediate health care needs than in long-term needs.

PTS: 1 DIF: Cognitive Level: Application REF: 1022

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

30. 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

c.

Psychosocial development

b.

Moral development

d.

Psychosexual development

ANS: 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. Cognitive development is related to moral development, but it is not the pivotal point in determining right and wrong behaviors. Identity formation is the psychosocial development task. Energy is focused within the adolescent, who exhibits behavior that is self-absorbed and egocentric. Although a task during adolescence is the development of a sexual identity, the teenagers dependence on the parents sanctioning of right or wrong behavior is more appropriately related to moral development.

PTS: 1 DIF: Cognitive Level: Analysis REF: 1016

OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance

31. A nurse is teaching adolescent boys about pubertal changes. The first sign of pubertal change seen with boys is:

a.

Testicular enlargement.

c.

Scrotal enlargement.

b.

Facial hair.

d.

Voice deepens.

ANS: 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. As testosterone secretion increases, the penis, testes, and scrotum enlarge. During Tanner stages 4 and 5, rising levels of testosterone cause the voice to deepen and facial hair appears at the corners of the upper lip and chin.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1011

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

32. A young adolescent boy tells the nurse he feels gawky. The nurse should explain that this occurs in adolescents because:

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.

ANS: A

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.

PTS: 1 DIF: Cognitive Level: Application REF: 1012

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

33. 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:

a.

Estrogen.

c.

Androgen.

b.

Pituitary hormone.

d.

Progesterone.

ANS: C

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.

PTS: 1 DIF: Cognitive Level: Analysis REF: 1014

OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance

34. 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.

ANS: C

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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1015

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

35. The school nurse is discussing testicular self-examination with adolescent boys. Why is this important?

a.

Epididymitis is common during adolescence.

b.

Asymptomatic sexually transmitted diseases may be present.

c.

Testicular tumors during adolescence are generally malignant.

d.

Testicular tumors, although usually benign, are common during adolescence.

ANS: C

Tumors of the testes are not common, but when manifested in adolescence, they are generally malignant and demand immediate evaluation. Epididymitis is not common in adolescence. Asymptomatic sexually transmitted disease would not be evident during testicular self-examination. The focus of this examination is on testicular cancer. Testicular tumors are most commonly malignant.

PTS: 1 DIF: Cognitive Level: Application REF: 1029

OBJ: Nursing Process: Implementation

MSC: Client Needs: Physiologic Integrity: Reduction of Risk Potential

36. Young people with anorexia nervosa are often described as being:

a.

Independent.

c.

Conforming.

b.

Disruptive.

d.

Low achieving.

ANS: C

Individuals with anorexia nervosa are described as perfectionist, academically high achievers, conforming, and conscientious. Independent, disruptive, and low achieving are not part of the behavioral characteristics of anorexia nervosa.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1035

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

37. Which symptoms should the nurse expect to observe during the physical assessment of an adolescent girl with severe weight loss and disrupted metabolism associated with anorexia nervosa?

a.

Dysmenorrhea and oliguria

b.

Tachycardia and tachypnea

c.

Heat intolerance and increased blood pressure

d.

Lowered body temperature and brittle nails

ANS: D

Symptoms of anorexia nervosa include lower body temperature, severe weight loss, decreased blood pressure, dry skin, brittle nails, altered metabolic activity, and presence of lanugo hair. Amenorrhea, rather than dysmenorrhea, and cold intolerance are manifestations of anorexia nervosa. Bradycardia, rather than tachycardia, may be present.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1036

OBJ: Nursing Process: Assessment

MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation

38. An adolescent teen has bulimia. Which assessment finding should the nurse expect?

a.

Diarrhea

c.

Cold intolerance

b.

Amenorrhea

d.

Erosion of tooth enamel

ANS: D

Some of the signs of bulimia include erosion of tooth enamel, increased dental caries from vomited gastric acid, throat complaints, fluid and electrolyte disturbances, and abdominal complaints from laxative abuse. Diarrhea is not a result of the vomiting. It may occur in patients with bulimia who also abuse laxatives. Amenorrhea and cold intolerance are characteristics of anorexia nervosa, which some bulimics have. These symptoms are related to the extreme low weight.

PTS: 1 DIF: Cognitive Level: Application REF: 1035

OBJ: Nursing Process: Assessment

MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation

39. A teen asks a nurse, What is physical dependence in substance abuse? Which is the correct response by the nurse?

a.

Problem that occurs in conjunction with addiction

b.

Involuntary physiologic response to drug

c.

Culturally defined use of drugs for purposes other than accepted medical purposes

d.

Voluntary behavior based on psychosocial needs

ANS: B

Physical dependence is an involuntary response to the pharmacologic characteristics of drugs such as opioids or alcohol. A person can be physically dependent on a narcotic/drug without being addicted; for example, patients who use opioids to control pain need increasing doses to achieve the same effect. Dependence is a physiologic response; it is not culturally determined or subject to voluntary control.

PTS: 1 DIF: Cognitive Level: Application REF: 1040

OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

40. Which statement is most descriptive of central nervous system stimulants?

a.

They produce strong physical dependence.

b.

They can result in strong psychologic dependence.

c.

Withdrawal symptoms are life threatening.

d.

Acute intoxication can lead to coma.

ANS: B

Central nervous system stimulants such as amphetamines and cocaine produce a strong psychologic dependence. This class of drugs does not produce strong physical dependence and can be withdrawn without much danger. Acute intoxication leads to violent, aggressive behavior or psychotic episodes characterized by paranoia, uncontrollable agitation, and restlessness.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1042

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

41. A school nurse is conducting a class with adolescents on suicide. Which true statement about suicide should the nurse include in the teaching session?

a.

A sense of hopelessness and despair are a normal part of adolescence.

b.

Gay and lesbian adolescents are at a particularly high risk for suicide.

c.

Problem-solving skills are of limited value to the suicidal adolescent.

d.

Previous suicide attempts are not an indication of risk for completed suicides.

ANS: B

A significant number of teenage suicides occur among homosexual youths. Gay and lesbian adolescents who live in families or communities that do not accept homosexuality are likely to suffer low self-esteem, self-loathing, depression, and hopelessness as a result of a lack of acceptance from their family or community. At-risk teenagers include those who are depressed, have poor problem-solving skills, or use drugs and alcohol. History of previous suicide attempt is a serious indicator for possible suicide completion in the future.

PTS: 1 DIF: Cognitive Level: Application REF: 1044

OBJ: Nursing Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity

42. Which is the most commonly used method in completed suicides?

a.

Firearms

c.

Self-inflected laceration

b.

Drug overdose

d.

Carbon monoxide poisoning

ANS: A

Firearms are the most commonly used instruments in completed suicides among both males and females. For adolescent boys, firearms are followed by hanging and overdose. For adolescent females, overdose and strangulation are the next most common means of completed suicide. The most common method of suicide attempt is overdose or ingestion of potentially toxic substances such as drugs. The second most common method of suicide attempt is self-inflicted laceration. Carbon monoxide poisoning is not one of the more frequent forms of suicide completion.

PTS: 1 DIF: Cognitive Level: Knowledge REF: 1044

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

43. Which is the most significant factor in distinguishing those who commit suicide from those who make suicidal attempts or threats?

a.

Social isolation

c.

Degree of depression

b.

Level of stress

d.

Desire to punish others

ANS: A

Social isolation is a significant factor in distinguishing adolescents who will kill themselves from those who will not. It is also more characteristic of those who complete suicide than of those who make attempts or threats. Level of stress, degree of depression, and desire to punish others are contributing factors in suicide, but they are not the most significant factor in distinguishing those who complete suicide from those who attempt suicide.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1045

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

MULTIPLE RESPONSE

44. Research has shown that the most successful smoking cessation programs among teens include (select all that apply):

a.

Peer-led education and support.

b.

Information on the long-term effects of smoking.

c.

Programs including the media.

d.

School-based programs.

e.

Information on the immediate effects of smoking.

ANS: A, C, D, E

Two areas of antismoking campaigns that have shown success are those that are peer-led and use media in education related to smoking prevention. School-based programs have also shown success and can be strengthened by expansion into the community and youth groups. Teens respond much better to education that focuses on the immediate effects of smoking. For the most part, smoking prevention programs that focus on the negative long-term effects of smoking have been ineffective.

PTS: 1 DIF: Cognitive Level: Application REF: 1041

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

45. 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

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 cant happen to me) are evident in adolescence. Impulsivity places adolescents in unsafe situations. 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.

PTS: 1 DIF: Cognitive Level: Application REF: 1017

OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance

46. Which screening tests should the school nurse perform for the adolescent (select all that apply)?

a.

Glucose

b.

Vision

c.

Hearing

d.

Cholesterol

e.

Scoliosis

ANS: B, C, E

The school nurse should perform vision, hearing, and scoliosis screening tests according to the school districts required schedule. Glucose and cholesterol screening would be performed in the medical clinic setting.

PTS: 1 DIF: Cognitive Level: Application REF: 1025

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

MATCHING

Place in correct order the sequence of maturational changes for girls. Begin with the first change seen, sequencing to the last change.

a.

Growth of pubic hair

d.

Menstruation

b.

Rapid increase in height and weight

e.

Appearance of axillary hair

c.

Breast changes

47. First change

48. Second change

49. Third change

50. Fourth change

51. Fifth change

47. ANS: C PTS: 1 DIF: Cognitive Level: Analysis

REF: 1011 OBJ: Nursing Process: Evaluation

MSC: Client Needs: Health Promotion and Maintenance

NOT: The usual sequence of maturational changes for girls is breast changes, rapid increase in height and weight, growth of public hair, appearance of axillary hair, and then menstruation, which usually begins 2 years after the first signs.

48. ANS: B PTS: 1 DIF: Cognitive Level: Analysis

REF: 1011 OBJ: Nursing Process: Evaluation

MSC: Client Needs: Health Promotion and Maintenance

NOT: The usual sequence of maturational changes for girls is breast changes, rapid increase in height and weight, growth of public hair, appearance of axillary hair, and then menstruation, which usually begins 2 years after the first signs.

49. ANS: A PTS: 1 DIF: Cognitive Level: Analysis

REF: 1011 OBJ: Nursing Process: Evaluation

MSC: Client Needs: Health Promotion and Maintenance

NOT: The usual sequence of maturational changes for girls is breast changes, rapid increase in height and weight, growth of public hair, appearance of axillary hair, and then menstruation, which usually begins 2 years after the first signs.

50. ANS: E PTS: 1 DIF: Cognitive Level: Analysis

REF: 1011 OBJ: Nursing Process: Evaluation

MSC: Client Needs: Health Promotion and Maintenance

NOT: The usual sequence of maturational changes for girls is breast changes, rapid increase in height and weight, growth of public hair, appearance of axillary hair, and then menstruation, which usually begins 2 years after the first signs.

51. ANS: D PTS: 1 DIF: Cognitive Level: Analysis

REF: 1011 OBJ: Nursing Process: Evaluation

MSC: Client Needs: Health Promotion and Maintenance

NOT: The usual sequence of maturational changes for girls is breast changes, rapid increase in height and weight, growth of public hair, appearance of axillary hair, and then menstruation, which usually begins 2 years after the first signs.

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