Chapter 16: Health Problems of School-Age Children and Adolescents Flashcards
The nurse is discussing health behaviors with a 14-year-old who recently began smoking cigarettes. An appropriate tactic for the nurse to use when discussing this lifestyle choice is
a. Cigarette smoking is only “cool” in high school and is not accepted in college
b. Cigarette smoking can cause permanent damage to the lungs and can cause cancer as an adult
c. Cigarettes are expensive, and a 14-year-old will not be able to afford them, so he should stop smoking
d. Cigarettes contain nicotine and this will cause addiction to other drugs
b. Cigarette smoking can cause permanent damage to the lungs and can cause cancer as an adult
Cigarette smoking can cause permanent damage to the lungs and can cause cancer as an adult. At 14, the child only thinks of the present. The nurse would need to include and explain, and even use pictures to illustrate, what might happen to the body if the child continues to smoke. Saying cigarette smoking is only cool in high school and is not accepted in college is not a useful tactic the nurse should use when discussing smoking cigarettes. Suggesting that cigarettes are not affordable and the 14-year-old should therefore stop smoking is not a healthy approach to teaching adolescents to stop smoking. Cigarettes contain nicotine, and this will cause addiction to other drugs. Adolescents are not often concerned with whether cigarette smoking will lead to other addictions.
What is a characteristic of children with PTSD?
a. Denial as a defense mechanism is unusual
b. Traumatic effects cannot remain indefinitely
c. Previous coping strategies and defense mechanisms are not useful
d. Children often play out the situation over and over again in an attempt to come to terms with their fear
d. Children often play out the situation over and over again in an attempt to come to terms with their fear
This is an expected response by a child to a traumatic event. Play is often the safest means of communication for children and should be encouraged as a means of expression with a child experiencing PTSD. Denial is a defense mechanism commonly used by children and adolescents. Professional help is indicated if the stages of response are prolonged. Coping strategies and defense mechanisms that have been effective previously may be effective for PTSD.
A child is becoming increasingly anxious over attending school with increasing frequency as the school year has gone on. Now the child is also presenting with physical symptoms which subside when the child remains at home. Based on this finding, the nurse would suspect that the child has
a. School phobia
b. Passive aggressive disorder
c. Psychosomatic complaints
d. General anxiety disorder
a. School phobia
School phobia (school refusal and school avoidance) refers to expression of fear or increasing anxiety related to the attendance of school. Physical symptoms may accompany this presentation and resolve when the child is not in attendance at school. The described behavior does not indicate passive aggressive disorder or general anxiety disorder. And while the child manifests psychosomatic complaints, these are correlated directly with the school environment as a trigger.
A sexually active adolescent asks the school nurse about prevention of STDs. the most appropriate recommendation by the nurse is the use of
a. Condoms
b. Prophylactic antibiotics
c. Any type of contraceptive method
d. Withdrawal method of contraception
a. Condoms
Condoms provide a barrier to the organisms that cause STDs. Prophylactic antibiotics are not recommended to prevent STDs. Antibiotics are only effective against bacteria, not viruses. Only condoms create a physical barrier that prevents contact with the organisms that cause STDs.
When caring for the suicidal adolescent, the most important nursing intervention is
a. Emphasizing that a suicide attempt is an immature way of dealing with stress
b. Paying attention to children who are withdrawn and are giving away their personal belongings
c. Ignoring threats of suicide because they are usually bids for attention
d. Recognizing a suicide attempt as an impulsive act resulting from a temporary crisis
b. Paying attention to children who are withdrawn and are giving away their personal belongings
It is imperative that the nurse recognize warning signs of a potential suicide. For the depressed youngster, suicide may appear to be the only way out, and telling a child that he or she is immature in feelings or behavior will exacerbate an already crisis-laden situation. All threats of suicide must be taken seriously and should never be ignored. Even if the crisis is temporary, the child’s perception may be that suicide is the only way out of it.
Which finding if found in a male adolescent would indicate a medical priority for treatment?
a. Epididymitis
b. Varicocele
c. Testicular torsion
d. Gynecomastia
c. Testicular torsion
Testicular torsion if found in a male patient (regardless of age) would be considered to be a medical emergency and as such would require immediate intervention. Epididymitis is an infectious process that requires appropriate antibiotic therapy. Depending on the presentation of a varicocele with associated symptoms, intervention may be required. Gynecomastia requires investigational work-up to identify the etiology but in some cases it is idiopathic and self-limiting.
Which action should be included in a plan of care for an adolescent who is being treated for depression with tricyclic antidepressants?
a. Restriction of fluids is needed to prevent fluid overload
b. Recording of daily weight
c. Make sure that dental hygiene is being performed on a routine basis
d. Increase in caloric intake to maintain weight
c. Make sure that dental hygiene is being performed on a routine basis
The use of tricyclic antidepressants exerts a significant effect on dentition ranging to increased incidence of dental caries and decreased amount of saliva. Therefore, a dental hygiene program should be included as part of therapeutic management in order to avoid potential complications. Fluid intake should be encouraged and there is no need for documented daily weights or increase in caloric intake to maintain weight.
A nurse is working with teenagers and their parents in a school drug prevention program. Several of the parents ask how they can determine if their child has a problem with drugs. The most appropriate response by the nurse is:
a. There is no way to know until they tell you
b. At some point, the child will develop depression and attempt suicide; then you can put them in rehab
c. It is common for them to withdraw and not achieve normal developmental tasks. You should then consult a professional
d. You should make your child take a home test for drugs. You can buy those at the drugstore
c. It is common for them to withdraw and not achieve normal developmental tasks. You should then consult a professional
Children and teenagers who begin using drugs may often stop participating in routine activities and not continue to achieve the normal milestones of the adolescent period. If the parent ever has a question, they should seek information from a health care provider. Waiting for the child to tell the parent is not a way to determine if the child has a problem with drugs. It is a very passive approach to parenting. Waiting for the child to develop depression and attempt suicide is not a preventive approach to handling drug use. Taking a home test for drugs is not a measure that should be taken unless the child has been caught engaging in drug use.
A nurse is assessing a patient diagnosed with ADHD. what behavior would the nurse anticipate the patient to demonstrate?
a. Ability to complete school work during class
b. Requires reminders to keep focused and on task
c. Is defiant with parents and refuses to complete chores at home
d. Is aggressive with peers when asked to participate in team sports
b. Requires reminders to keep focused and on task
Children with ADHD are often not able to remain focused and require frequent reminders to remain focused and complete an assigned task. They generally are not able to complete work at school and require extra time to complete assignments. The ability to complete school work during class is not something the nurse would anticipate this patient to demonstrate. Defiance with parents and refusal to complete chores at home are not behaviors the nurse would anticipate this patient to demonstrate. Aggression with peers when asked to participate in team sports is not typical of ADHD behavior.
An adolescent girl is brought to the ED by her parents after being raped. The girl is calm and controlled throughout the interview and examination. The nurse should recognize that this behavior is
a. One variety of behaviors normally seen in rape victims
b. Indicative of a higher-than-usual level of maturity in the adolescent
c. Suggestive that a rape has not actually occurred
d. Suggestive that the adolescent had severe emotional problems before the rape occurred
a. One variety of behaviors normally seen in rape victims
Rape victims display a wide range of behaviors. A controlled manner may be an attempt to maintain composure and control while hiding inner turmoil. The responses described are indicative of those often assessed in rape victims. There are no data to support that a rape has not occurred. Physical assessment will provide valuable information. There are no data to support that the adolescent had prior emotional problems.
A 15-year-old female is in a free clinic seeking information on birth control. The girl tells the nurse that she is sexually active with multiple partners. She states that she does not want to have to remember to take the pill every day. The most appropriate birth control option for this patient is
a. An intrauterine device
b. Abstinence
c. Diaphragm
d. Condom
d. Condom
Condom use is recommended for birth control in teens who are sexually active with multiple partners. An intrauterine device is not a method of birth control that protects from sexually transmitted diseases. Abstinence is not an effective approach to birth control for a teen who is sexually active with multiple partners. A diaphragm is not a method of birth control that protects from sexually transmitted diseases.
A 16-year-old girl tells the school nurse that she has not started to menstruate. The most appropriate nursing intervention is to
a. Explain that this is not unusual
b. Refer the adolescent for an evaluation
c. Assume that the adolescent is pregnant
d. Suggest the adolescent stop exercising until menarche occurs
b. Refer the adolescent for an evaluation
This meets the definition of primary amenorrhea and should be evaluated. Menstruation usually begins approximately 2 years after the beginning of secondary sex characteristics. Although pregnancy is a possibility, the nurse should not assume that the girl is pregnant until further assessment is performed. There is no indication that the adolescent is exercising excessively.
The nurse is collecting history on a 16-year-old admitted for treatment for anorexia nervosa. The patient limits the answers to yes or no. What is the primary nursing goal for this patient at this time?
a. Ask about favorite foods to provide them to eat
b. Return to ask further questions when the patient wants to talk
c. Discuss the treatment plan and expected stay in the hospital
d. Develop a positive rapport with the patient
d. Develop a positive rapport with the patient
The nurse would focus on development and establishing a positive rapport with the patient at the early stage. Eating disorders in children often stem from low self-esteem. Children with eating disorders may have low self-esteem and a lack of trust in others. It is important to establish a trusting relationship with the patient. Asking the patient about favorite foods is not a question that will build rapport with the patient. Returning to ask further questions when the patient wants to talk is not the primary nursing goal at this time. Discussing the treatment plan and expected stay in the hospital is not an appropriate goal because the patient is not open to discussion at this time.
An adolescent is accompanied by their mother for an annual physical examination. Based on the nurse’s knowledge of this age group, the nurse should avoid questions on which topics? Select all that apply.
a. Alcohol use
b. Sexual activity
c. Cigarette smoking
d. School performance
e. Use of car seat belts
a. Alcohol use
b. Sexual activity
c. Cigarette smoking
The nurse must maintain confidentiality, which is between the nurse and adolescent. Therefore, while the mother is in the room, the nurse should not ask personal questions. The nurse can ask general questions about academic performance and use of car seat belts without breaching confidentiality.
The nurse is teaching a class on the dangers of “huffing”. What information is included as a major side effect of “huffing”?
a. Cardiac arrest
b. Loss of vision
c. Delay of growth
d. Loss of consciousness
d. Loss of consciousness
Skin discoloration is not a side effect of huffing. Cardiac arrest is not typically a major side effect of huffing. Loss of consciousness and respiratory arrest are major side effects of huffing. Delay of growth is not a side effect of huffing.
