Health Promotion for the Adolescent

MULTIPLE CHOICE

1. A nurse is teaching an adolescent about Tanner stages. Which statement best describes Tanner staging?

a.
Predictable stages of puberty that are based on chronological 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. They are not based on chronological 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 basis of Tanner staging.

DIF: Cognitive Level: Comprehension REF: p. 151

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

2. 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. 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.

DIF: Cognitive Level: Comprehension REF: p. 154

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

3. 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

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.

DIF: Cognitive Level: Application REF: p. 154

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

4. Which factor contributes to early adolescents engaging in risk-taking behaviors?

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

ANS: D

During early to middle adolescence, children feel that they are exempt from the consequences of risk-taking behaviors: they believe negative consequences happen only to others. Impressing peers is more typically the factor influencing behavior of older school-age children. 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.

DIF: Cognitive Level: Comprehension REF: p. 161

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

5. Which statement is the most appropriate advice to give parents of a 16-year-old teenager who is rebellious?

a.
“You need to be stricter so that your teenager feels more secure.”
b.
“You need to allow your teenager to make realistic choices while using consistent and structured discipline.”
c.
“Increasing your teen’s involvement with his peers will improve his 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. Setting stricter limits typically does not decrease rebelliousness or increase feelings of security. Increasing peer involvement does not typically increase self-esteem. Allowing teenagers to choose the method of discipline is not realistic and typically does not reduce rebelliousness.

DIF: Cognitive Level: Application REF: p. 156

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

6. Which statement by the nurse is most appropriate to a 15-year-old adolescent 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

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 adolescent 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 adolescent to have is that all threats of suicide should be taken seriously and immediate help is important. 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.

DIF: Cognitive Level: Application REF: p. 162

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

7. 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 healthcare provider. Teenagers are socially and cognitively at the developmental stage where the healthcare provider can teach them and can receive explanations about healthcare directly from the nurse. Teenagers are more interested in immediate healthcare needs than in long-term needs.

DIF: Cognitive Level: Application REF: p. 157

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

8. A 17-year-old adolescent 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

The appropriate moral development for a 17-year-old adolescent would include evidence that the teenager has internalized a value system and does not depend on parents to determine right and wrong behaviors. 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 teenager’s dependence on the parent’s sanctioning of right or wrong behavior is more appropriately related to moral development.

DIF: Cognitive Level: Analysis REF: p. 157

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

9. The best response a nurse can make to a 15-year-old girl who has verbalized a desire to have a baby is:

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 change if you have an infant?”

ANS: 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. Asking the teenager if she has talked to her parents is not particularly helpful to the teen or the nurse and may terminate the communication. A direct question about continuing school and how the teenager will support the child will not facilitate communication. Open-ended questions encourage communication.

DIF: Cognitive Level: Application REF: p. 153

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

10. In an interview with the nurse, a mother states that she is concerned that her 14-year-old teen is critical and finding fault with her. The nurse counsels the mother that:

a.
the family needs to change its value system to meet the teenager’s changing needs.
b.
the parent–teen relationship is important for the teenager and conflicts are to be expected.
c.
teenagers create psychological distance from the parent to separate from the parent.
d.
parents need to relinquish their relationship with their teenager to the teen’s peers.

ANS: C

The teenager uses critical and fault-finding behavior as a mechanism to separate from the parent and become independent. Changing the family’s value system to meet the teenager’s needs is not realistic and will result only in the teenager’s being critical of the new system. The parent–teen relationship is not as important to the teenager as it was in earlier years. Friends and peers become more important. Parents should not relinquish their relationship with their teenager to the teen’s peers. Maintaining a consistent parental relationship with the adolescent is important.

DIF: Cognitive Level: Application REF: p. 149

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

11. A nurse is teaching adolescent boys about pubertal changes. Which is the first sign of pubertal change seen with boys?

a.
Testicular enlargement
b.
Facial hair
c.
Scrotal enlargement
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.

DIF: Cognitive Level: Comprehension REF: pp. 151-152

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. 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.
Skips classes to go to the mall
c.
Hangs out with friends they have had since childhood
d.
Has an unexplained source of money
e.
Fears the police

ANS: B, D, E

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 another sign, so hanging out with friends they have had since childhood is not a sign of gang involvement. A change in attitude toward participating in activities is another sign of gang involvement. Plans to try out for the debate team at school are not a sign of gang involvement.

DIF: Cognitive Level: Application REF: p. 156

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

OTHER

1. Place in order the signs of female sexual maturity beginning with the first sign and ending with the last. Use the following format for your answers: A, B, C, D

a. Growth of pubic hair

b. Menarche

c. Appearance of breast buds

d. Ovulation is established

ANS:

C, A, B, D

Sexual maturation in girls begins with the appearance of breast buds (thelarche), which is the first sign of ovarian function. Thelarche occurs at approximately age 8 to 11 years and is followed by the growth of pubic hair. Linear growth slows, and menarche begins approximately 1 year after the peak height velocity (PHV). Ovulation occurs with menarche but may or may not accompany the first 2 years of menarche so it is not established until later.

DIF: Cognitive Level: Analysis REF: p. 151

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance