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Chapter 16: Health Promotion of the Adolescent and Family

MULTIPLE CHOICE
1. In girls, the initial indication of puberty is:
a. menarche.
b. growth spurt.
c. growth of pubic hair.
d. breast development.
ANS: D

In most girls, the initial indication of puberty is the appearance of breast buds, an event known
as thelarche. The usual sequence of secondary sex characteristic development in girls is breast
changes, rapid increase in height and weight, growth of pubic hair, appearance of axillary hair,
menstruation, and abrupt deceleration of linear growth.
PTS: 1
DIF: Cognitive Level: Understand
REF: 477
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
2. A school nurse is teaching a group of preadolescent girls about puberty. Which is the mean

age of menarche for girls in the United States?


11 1/2 years
12 3/4 years
13 1/2 years
14 years

a.
b.
c.
d.

ANS: B

The average age of menarche is 12 years 9.5 months in North American girls, with a normal
range of 10 1/2 to 15 years. Ages 11 1/2, 13 1/2, and 14 are within the normal range for
menarche, but these are not the average ages.
PTS: 1
DIF: Cognitive Level: Remember
REF: 478
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance
3. A school nurse is teaching a group of preadolescent boys about puberty. By which age should

concerns about pubertal delay be considered?


12 to 12 1/2 years
12 1/2 to 13 years
13 to 13 1/2 years
13 1/2 to 14 years

a.
b.
c.
d.

ANS: D

Concerns about pubertal delay should be considered for boys who exhibit no enlargement of
the testes or scrotal changes from 13 1/2 to 14 years. Ages 12 to 13 1/2 years is too young for
initial concern.
PTS: 1
DIF: Cognitive Level: Remember
REF: 478
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance

4. A 14-year-old male mentions that he now has to use deodorant but never had to before. The

nurses response should be based on knowledge that which occurs during puberty?
a. Eccrine sweat glands in the axillae become fully functional during puberty.
b. Sebaceous glands become extremely active during puberty.
c. New deposits of fatty tissue insulate the body and cause increased sweat

production.
d. Apocrine sweat glands reach secretory capacity during puberty.
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 axilla, genital, anal, and other areas. Eccrine sweat
glands are present almost everywhere on the skin and become fully functional and respond to
emotional and thermal stimulation. Sebaceous glands become extremely active at this time,
especially those on the genitalia and the flush areas of the body such as face, neck,
shoulders, upper back, and chest. This increased activity is important in the development of
acne. New deposits of fatty tissue is not the etiology of apocrine sweat gland activity.
PTS: 1
DIF: Cognitive Level: Understand
REF: 479 | 481
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance
5. According to Erikson, the psychosocial task of adolescence is developing:
a. intimacy.
b. identity.
c. initiative.
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.
Independence is not one of Eriksons developmental stages.
PTS: 1
DIF: Cognitive Level: Understand
REF: 481
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
6. A nurse is planning a teaching session for a group of adolescents. The nurse understands that

by adolescence the individual is in which stage of cognitive development?


Formal operations
Concrete operations
Conventional thought
Post-conventional thought

a.
b.
c.
d.

ANS: A

Cognitive thinking culminates with capacity for abstract thinking. This stage, the period of
formal operations, is Piagets fourth and last stage. Concrete operations usually occur between
ages 7 and 11 years. Conventional and post-conventional thought refer to Kohlbergs stages of
moral development.

PTS: 1
DIF: Cognitive Level: Understand
REF: 482
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of 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 these characteristic thought processes.
PTS: 1
DIF: Cognitive Level: Remember
REF: 482
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
8. Parents are concerned about the number of hours their teenage daughter spends with peers.

The nurse explains that peer relationships are important during adolescence for which reason?
a. Adolescents dislike their parents.
b. Adolescents no longer need parental control.
c. They provide adolescents with a feeling of belonging.
d. They promote a sense of individuality in adolescents.
ANS: 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. During adolescence, the parent-child
relationship changes from one of protection-dependency to one of mutual affection and
quality. Parents continue to play an important role in the personal and health-related decisions.
The peer group forms the transitional world between dependence and autonomy.
PTS: 1
DIF: Cognitive Level: Apply
REF: 483
TOP: Integrated Process: Teaching/Learning
MSC: Area of 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 the adolescent is homosexual.
b. this indicates the adolescent will become homosexual as an adult.
c. the adolescent should be referred for psychotherapy.
d. the adolescent should be encouraged to share his feelings and experiences.
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 confidentiality, appreciate his feelings, and remain sensitive to his
need to talk about the topic. In recent studies among self-identified gay, lesbian, and bisexual
adolescents, many of the adolescents report changing self-labels one or more times during
their adolescence. An assessment must be made about any risks to himself or others. If these
do not exist, the adolescent needs a supportive person to talk with.
PTS: 1
DIF: Cognitive Level: Apply
REF: 486
TOP: Integrated Process: Communication and Documentation
MSC: Area of 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:


not appropriate in a school setting.
never appropriate because adolescents are minors.
important in establishing trusting relationships.
suggestive that the nurse is meeting his or her own needs.

a.
b.
c.
d.

ANS: C

Health professionals who work with adolescents should consider adolescents increasing
independence and responsibility while maintaining privacy and ensuring confidentiality.
However, in some circumstances, such as self-destructive behavior or maltreatment by others,
they are not able to maintain confidentiality. Confidentiality and privacy are necessary to build
trust with this age group. The nurse must be aware of the limits placed on confidentiality by
local jurisdiction.
PTS: 1
DIF: Cognitive Level: Understand
TOP: Integrated Process: Communication and Documentation
MSC: Area of Client Needs: Management of Care

REF: 487

11. A 14-year-old boy seems to be always eating, although his weight is appropriate for his

height. What is the best explanation for this?


This is normal because of increase in body mass.
This is abnormal and suggestive of future obesity.
His caloric intake would have to be excessive.
He is substituting food for unfilled needs.

a.
b.
c.
d.

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. Seemingly always eating describes the expected
eating pattern for young adolescents; as long as weight and height are appropriate, obesity is
not a concern.
PTS: 1
DIF: Cognitive Level: Understand
REF: 478-479
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
12. Which predisposes the adolescent to feel an increased need for sleep?

a.
b.
c.
d.

An inadequate diet
Rapid physical growth
Decreased activity that contributes to a feeling of fatigue
The lack of ambition typical of this age group

ANS: B

During growth spurts, the need for sleep increases. Rapid physical growth, the tendency
toward overexertion, and the overall increased activity of this age contribute to fatigue.
PTS: 1
DIF: Cognitive Level: Understand
REF: 490
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
13. The most common cause of death in the adolescent age group involves:
a. drownings.
b. firearms.
c. drug overdoses.
d. motor vehicles.
ANS: D

Forty percent of all adolescent deaths in the United States are the result of motor vehicle
accidents. Drownings, firearms, and drug overdoses are major concerns in adolescence but are
not the most common cause of death.
PTS: 1
DIF: Cognitive Level: Understand
REF: 487
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Safe and Effective Care Environment: Safety and Infection Control
14. A young adolescent boy tells the nurse he feels gawky. The nurse should explain that this

occurs in adolescents because of:


growth of the extremities and neck precedes growth in other areas.
growth is in the trunk and chest.
the hip and chest breadth increases.
the growth spurt occurs earlier in boys than it does in girls.

a.
b.
c.
d.

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: Apply
REF: 478
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance
15. A nurse is reviewing hormone changes that occur during adolescence. The hormone that is

responsible for the growth of beard, mustache, and body hair in the male is:
a. estrogen.

b. pituitary.
c. androgen.
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: Analyze
REF: 481
TOP: Integrated Process: Nursing Process: Evaluation
MSC: Area of Client Needs: Health Promotion and Maintenance
16. A nurse is caring for an adolescent hospitalized for cellulitis. The nurse notes that the

adolescent experiences many mood swings throughout the day. The nurse interprets this
behavior as:
a. requiring a referral to a mental health counselor.
b. requiring some further lab testing.
c. normal behavior.
d. related to feelings of depression.
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: Understand
REF: 482
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
17. A nurse is conducting parenting classes for parents of adolescents. Which parenting style

should the nurse recommend?


Laissez-faire
Authoritative
Disciplinarian
Confrontational

a.
b.
c.
d.

ANS: B

Parents should be guided toward an authoritative style of parenting in which authority is used
to guide the adolescent while allowing developmentally appropriate levels of freedom and
providing clear, consistent messages regarding expectations. The authoritative style of
parenting has been shown to have both immediate and long-term protective effects toward
adolescent risk reduction. The laissez-faire method would not give adolescents enough
structure. The disciplinarian and confrontational styles would not allow any autonomy or
independence.

PTS: 1
DIF: Cognitive Level: Apply
REF: 483
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance
18. A 14-year-old adolescent never had chickenpox as a child. Which should the nurse

recommend?
a. One dose of the varicella vaccination
b. Two doses of the varicella vaccination 4 weeks apart
c. One dose of the varicella immune globulin
d. No vaccinationsthe child is past the age to receive it
ANS: B

All adolescents should also be assessed for previous history of varicella infection or
vaccination. Vaccination with the varicella vaccine is recommended for those with no
previous history; for those with no previous infection or history, the varicella vaccine may be
given in two doses 4 or more weeks apart to adolescents 13 years or older. The varicella
immune globulin is given to immunosuppressed children exposed to chickenpox to boost
immunity; it is only temporary. The varicella vaccination should be given to adolescents, no
matter the age, who have not had chickenpox as a child.
PTS: 1
DIF: Cognitive Level: Apply
REF: 489
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Health Promotion and Maintenance
MULTIPLE RESPONSE
1. A 13-year-old is being seen in the clinic for a routine health check. The adolescent has not

been in the clinic for 3 years but was up to date on immunizations at that time. Which
immunizations should the adolescent receive? (Select all that apply.)
a. DTaP (tetanus, diphtheria, acellular pertussis)
b. MMR (measles, mumps, rubella)
c. Hepatitis B
d. Influenza
e. MCV4 (meningococcal)
ANS: A, D, E

The DTaP (tetanus, diphtheria, acellular pertussis) vaccine is recommended for adolescents 11
to 18 years old who have not received a tetanus booster (Td) or DTaP dose and have
completed the childhood DTaP/DTP series. Meningococcal vaccine (MCV4) should be given
to adolescents 11 to 12 years of age with a booster dose at age 16 years. Annual influenza
vaccination with either the live attenuated influenza vaccine or trivalent influenza vaccine is
recommended for all children and adolescents. The adolescent, previously up to date on
vaccinations, would have received the MMR and hepatitis B as a child.
PTS: 1
DIF: Cognitive Level: Apply
REF: 488-489
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Health Promotion and Maintenance
2. The nurse should teach the adolescent that the long-term effects of tanning can cause which

conditions? (Select all that apply.)


a. Phototoxic reactions

b.
c.
d.
e.

Increased number of moles


Premature aging
Striae
Increased risk of skin cancer

ANS: A, C, E

Long-term effects of tanning include premature aging of the skin, increased risk of skin
cancer, and, in susceptible individuals, phototoxic reactions. There has been no correlation to
an increase in moles or striae (streaks or stripes on the skin, usually on the abdomen)
development.
PTS: 1
DIF: Cognitive Level: Apply
REF: 492
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance
3. 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: Apply
REF: 491
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Health Promotion and Maintenance
COMPLETION
1. The estimated average requirement of calcium for an adolescent is _____ milligrams. (Record

your answer in a whole number.)


ANS:

1100
The EAR (estimated average requirement) for calcium in adolescents 14 to 18 years of age is
1100 mg.
PTS: 1
DIF: Cognitive Level: Understand
REF: 489
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Health Promotion and Maintenance
ESSAY
1. Place in order the sequence of maturational changes for girls. Begin with the first change seen,

sequencing to the last change. Provide answer in using lowercase letters, separated by
commas (e.g., a, b, c, d, e).

a. Growth of pubic hair


b. Rapid increase in height and weight
c. Breast changes
d. Menstruation
e. Appearance of axillary hair
ANS:

c, b, a, e, d
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.
PTS: 1
DIF: Cognitive Level: Analyze
REF: 478
TOP: Integrated Process: Nursing Process: Evaluation
MSC: Area of Client Needs: Health Promotion and Maintenance