Chapter 39:The Adolescent and Family

Question 1

1. What is the initial indication of puberty in girls?
   a. Menarche
   b. Growth spurt
   c. Growth of pubic hair
   d. Breast development

Answer 1

ANS: D
In most girls, the initial indication of puberty is the appearance of breast buds, an event known as the thelarche. The usual sequence of secondary sexual development characteristic 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.

Question 2

2. What is the mean age of menarche for North American girls?
   a. 11.8 years
   b. 12.3 years
   c. 13.7 years
   d. 14.2 years

Answer 2

ANS: B
The average age of menarche is 12 years and 4 months (12.3 years) in North American girls, with a normal range of 10.5 to 15 years.

Question 3

3. By what age should the nurse be concerned about pubertal delay in boys?
   a. 12 to 12.5 years
   b. 12.5 to 13 years
   c. 13 to 13.5 years
   d. 13.5 to 14 years

Answer 3

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

Question 4

4. A 14-year-old mentions that he now has to use deodorant but that he never had to before. What knowledge is the nurse’s response based on?
   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.

Answer 4

ANS: D
The apocrine sweat glands, which are 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; they also 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 a factor in the development of acne. New deposits of fatty tissue that insulate the body and cause increased sweat production is not part of the etiology of apocrine sweat gland activity.

Question 5

5. According to Erikson, what is the psychosocial task of adolescence? a. Intimacy
   b. Identity
   c. Initiative
   d. Independence

Answer 5

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 of early adulthood. Initiative is the developmental stage for early childhood. Independence is not one of Erikson’s developmental stages.

Question 6

6. According to Piaget, which period is the adolescent in when experiencing the fourth stage of cognitive development?
   a. Formal operations
   b. Concrete operations
   c. Conventional thought
   d. Postconventional thought

Answer 6

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

Question 7

7. Which aspect of cognition develops during adolescence?
   a. Ability 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 judgements based on what they see to judgements based on
   what they reason

Answer 7

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, see things from another’s point of view, and make judgements based on what they reason rather than just what they see.

Question 8

8. Why do peer relationships become more important during adolescence?
   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.

Answer 8

NS: C
The peer group serves as a strong support system for teenagers, providing them with a sense of belonging, strength, and power. During adolescence, the parent–child relationship changes from one of protection–dependency to one of mutual affection and equality. Parents continue to play an important role in personal and health-related decisions. The peer group forms the transitional world between dependence and autonomy.

Question 9

9. An adolescent boy tells the nurse that he has recently had homosexual feelings. Which is the basis for the nurse’s response?
   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.

Answer 9

ANS: D
These adolescents are at increased risk for health-damaging behaviours, not because of the sexual behaviour itself, but because of society’s reaction to the behaviour. The nurse’s 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. In recent studies among self-identified gay, lesbian, and bisexual adolescents, many reported changing self-labels one or more times during their adolescence.

Question 10

10. The school nurse tells adolescents in the clinic that confidentiality and privacy will be maintained unless a life-threatening situation arises. Which statement is true regarding this practice?
    a. It is not appropriate in a school setting.
    b. It is never appropriate because adolescents are minors.
    c. It is important in establishing trusting relationships.
    d. It is suggestive that the nurse is meeting his or her own needs.

Answer 10

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 behaviour 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.

Question 11

11. A 14-year-old male seems to be always eating, although his weight is appropriate for his height. What is the best explanation for this assessment?
    a. This is normal because of the increase in his body mass.
    b. This is abnormal and suggestive of future obesity.
    c. His caloric intake has to be excessive to indicate problems.
    d. He is substituting food for unfilled needs.

Answer 11

ANS: A
In adolescence, nutritional needs are closely related to the increase in body mass, with peak requirements occurring in the years of maximal growth. The caloric and protein requirements are higher at that time than they are at almost any other. Matt’s eating pattern is typical for young adolescents, so as long as weight and height are appropriate, obesity is not a concern.

Question 12

12. What predisposes adolescents 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

Answer 12

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 can also contribute to fatigue. It is inaccurate to state that adolescents as a group lack ambition.

Question 13

13. What is one of the most common causes of death in the adolescent age group?
    a. Drownings
    b. Firearms
    c. Drug overdoses
    d. Motor vehicle collisions

Answer 13

ANS: D
The top three most common causes of death in this age group are motor vehicle collisions, homicide, and suicide. Drownings, firearms, and drug overdoses are major concerns in adolescence but do not cause the majority of deaths.

Question 14

14. Which statement is true about smoking in adolescence?
    a. Smoking is related to other high-risk behaviours.
    b. Smoking is more common among athletes.
    c. Smoking is less common when the adolescent’s parent(s) smokes.
    d. Smoking among adolescents is becoming more prevalent.

Answer 14

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 a teen will smoke. Cigarette smoking has declined among all groups since the 1990s.

Question 15

15. Which statement is true about smokeless tobacco?
    a. It is not addicting.
    b. It is proven to be carcinogenic.
    c. It is easy to stop using.
    d. It is a safe alternative to cigarette smoking.

Answer 15

ANS: B
Smokeless tobacco is a popular substitute for cigarettes and poses serious health hazards to children and adolescents. It is carcinogenic, particularly associated with cancer of the mouth and jaw. Smokeless tobacco is just as addictive as cigarettes, so although teens believe that it is easy to stop using it, this is not the case. A popular belief among teens 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.

Question 16

16. A 14-year-old boy and his parents are concerned about bilateral breast enlargement. What should the nurse’s discussion about this concern be based on?
    a. This is usually benign and temporary.
    b. This is usually caused by Klinefelter syndrome.
    c. Administration of estrogen effectively reduces gynecomastia.
    d. Administration of testosterone effectively reduces gynecomastia.

Answer 16

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 Klinefelter syndrome. Administration of estrogen and testosterone will have no effect on the reduction of breast tissue and may aggravate the condition.

Question 17

17. Which statement is correct about childhood obesity?
    a. Genetics is an important factor in the development of obesity.
    b. Childhood obesity in Canada is decreasing.
    c. Childhood obesity is the result of inactivity.
    d. Childhood obesity can be attributed to an underlying disease in most cases.

Answer 17

ANS: A
A report by the Government of Canada Standing Committee on Health (2007) has drawn attention to the links between childhood obesity and the key determinants of overall health. In particular, family income, education, social support, geographic location, cultural norms and values, biological and genetic factors, accessibility of services for health, and gender are important determinants of body weight; therefore, genetics is an important factor that contributes to obesity. Identical twins reared apart tend to resemble their biological 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.

Question 18

18. Which is a psychological effect of being obese during adolescence?
    a. Sexual promiscuity
    b. Poor body image
    c. Memory has no effect on eating behaviour
    d. Accurate body image but self-deprecating attitude

Answer 18

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

Question 19

19. Which sentence best describes anorexia nervosa?
    a. It occurs most frequently in adolescent males.
    b. It occurs most frequently in adolescents from lower socioeconomic groups.
    c. It results from a posterior pituitary disorder.
    d. It results in severe weight loss in the absence of obvious physical causes.

Answer 19

ANS: D
The etiology of anorexia remains unclear, but a distinct psychological component is present. The diagnosis is based primarily on psychological and behavioural 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, individuals with the disorder are often from families of means who have high parental expectations for achievement. Anorexia is a psychiatric disorder.

Question 20

20. What is the weight loss of anorexia nervosa often triggered by?
    a. Sexual abuse
    b. School failure
    c. Independence from family
    d. Traumatic interpersonal conflict

Answer 20

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 girls are often overachievers who are successful in school, not failures. The adolescent is most often enmeshed with his or her family.

Question 21

21. Which statement best describes adolescents with bulimia?
    a. Strong sense of control over eating behaviour
    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 average or slightly above average

Answer 21

ANS: D
Individuals with bulimia are of average or slightly above-average weight. Those who also restrict their intake can become severely underweight. Behaviour 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.

Question 22

22. The nurse is caring for an adolescent brought to the hospital with acute drug toxicity. Cocaine is believed to be the drug involved. Which is a crucial aspect of data collection?
    a. Mode of administration
    b. Actual content of the drug
    c. Function the drug plays in the adolescent’s life
    d. Adolescent’s level of interest in rehabilitation

Answer 22

ANS: A
When the drug is questionable or unknown, every effort must be made to determine the type, the amount 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 is difficult to obtain. It is helpful to know the pattern of use, but this is not essential during this emergency. This is an inappropriate time to evaluate the adolescent’s level of interest in rehabilitation.

Question 23

23. An adolescent girl tells the nurse that she is very suicidal. Which is accurate if the nurse asks her if she has a specific suicide plan?
    a. It is an appropriate part of the assessment.
    b. It is not a critical part of the assessment.
    c. It suggests that the adolescent needs a plan.
    d. It encourages the adolescent to devise a plan.

Answer 23

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 or kill yourself?” should be part of that assessment. Threats of suicide should always be taken seriously and evaluated. The nurse does not ask this question to suggest that the adolescent needs a plan, nor does it encourage the girl to devise one.

Question 24

24. Which is considered to be an unsuccessful smoking cessation program among teens?
    a. Youth-to-youth education and support
    b. Information on the long-term effects of smoking
    c. Programs including the media
    d. School-based programs

Answer 24

ANS: B
For the most part, smoking prevention programs that focus on the negative long-term effects have been ineffective. Two types of anti-smoking campaigns that have shown success are those that are peer-led (youth-to-youth) and those that 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.
DIF: Cogniti

Question 25

1. When assessing an adolescent for suicide risk, which are warning signs of suicide? Select all that apply. Express answer in small letters followed by a comma and a space—e.g., a, b, c.
   a. Increased energy and activity
   b. Recurrent stomach pain and headaches
   c. Antisocial behaviour
   d. Improved concentration
   e. Focuses on school attendance
   f. Alteration in sleep pattern
   g. Flat affect

Answer 25

ANS: B, C, F, G
Warning signs of suicide include physical complaints (e.g., stomach aches, headaches), antisocial behaviour, alteration in sleep pattern (either too much or too little), and a flat affect, frozen facial expression. Other signs are a decrease in energy and activity, withdrawal from school and friends, and a decrease in concentration.