Chapter 9: Health Promotion and Maintenance for the School-Age Child and Adolescent

Question 1

An adolescent female presents at a nurse practitioner’s office and requests a signature for working papers. The nurse reviews her chart and notes that the last physical examination was two years ago. In addition to providing the signature for the working papers, what else should the nurse use this visit?

1. An opportunity to discuss birth-control measures
2. A time to discuss exercise and sports participation
3. A health-supervision opportunity
4. A chance to discuss the importance of pursuing post-secondary education

Answer 1

3. A health-supervision opportunity

Question 2

An adolescent is accompanied by the mother for an annual physical examination. The nurse is aware of privacy issues related to the adolescent. While the mother is in the room, the nurse should avoid which questions? Select all that apply.

1. Sexual activity
2. Cigarette smoking
3. School performance
4. Use of alcohol
5. Car seatbelt use

Answer 2

1. Sexual activity
2. Cigarette smoking
3. Use of alcohol

Question 3

The school nurse performs screenings on all students in the middle school. In addition, the nurse will perform selected screenings on individual school-age children. When planning the screenings for the year, which screenings will the nurse include for all school-age children? Select all that apply.

1. Hearing
2. Height and weight
3. Blood-pressure measurement
4. Hepatitis B profile serology
5. Chest x-ray

Answer 3

1. Hearing
2. Height and weight
3. Blood-pressure measurement

Question 4

A school nurse is performing annual height and weight screening. The nurse notes that three females who are close friends each lost 15 pounds over the past year. What is the priority nursing action in this situation?

1. Call the respective parents to discuss the eating patterns of each adolescent.
2. Speak with the girls in a group to discuss the problems associated with anorexia nervosa.
3. Refer these adolescents to the school psychologist.
4. Obtain a nutritional history for each of these adolescents.

Answer 4

4. Obtain a nutritional history for each of these adolescents.

Question 5

A school-age client who recently moved to a new school in a different town presents to an ambulatory care center and describes the following: “I have no friends in my new school and I no longer want to play soccer. I know I will be lonely there, too.” Which of these takes priority when speaking with the school-age client?

1. Helping the school-age client realize the value of soccer
2. Promoting healthy mental-health outcomes
3. Acknowledging the fact that it takes several months to make new friends at a new school
4. Stressing the importance of remaining in a close parent-child relationship during these stressful times

Answer 5

2. Promoting healthy mental-health outcomes

Question 6

An adolescent reports participating in an exercise program at school each Wednesday throughout the school year. Further history reveals that the adolescent does not participate in any other physical activities. Which outcome is most appropriate for this adolescent?

1. The adolescent is reporting information consistent with what 60 percent of adolescents report as participation in physical activities.
2. The adolescent is not meeting the recommendations of the Healthy People 2020 initiative.
3. The adolescent should be encouraged to continue this program of exercise, since something is better than nothing.
4. The adolescent should be encouraged to vigorously exercise for at least 5 minutes each day.

Answer 6

2. The adolescent is not meeting the recommendations of the Healthy People 2020 initiative.

Question 7

An adolescent reports the following: “I get up at 6 a.m., I attend early-morning band classes three times each week, I play sports for 2 hours each day after school, and homework takes me 3 hours each night. I always feel tired.” Which question by the nurse is most appropriate based on this information?

1. “How many hours of sleep do you get each night?”
2. “Do you consume foods high in iron?”
3. “Do you think you are doing too much?”
4. “Have you considered talking with your teachers about decreasing your homework, since you have so many extracurricular activities?”

Answer 7

1. “How many hours of sleep do you get each night?”

Question 8

The nurse working in the clinic includes an adolescent history in every client intake interview. Which issue should the nurse address when the parents are not present?

1. Possible domestic violence
2. Teen job responsibilities
3. Activities that are done as a family
4. The adolescent’s role in the family

Answer 8

1. Possible domestic violence

Question 9

The nurse is reviewing the immunization record of an adolescent who will be seen later in the day. Which item in the client’s history makes hepatitis B status a priority?

1. Chronic acne
2. Overuse injuries from playing varsity sports
3. Chronic asthma
4. Plans to get a tattoo

Answer 9

4. Plans to get a tattoo

Question 10

An obese adolescent who adamantly denies sexual activity has a positive pregnancy test, which was performed in the adolescent clinic. Which statement by the nurse is the most appropriate in this situation?

1. “Tell me how you feel about your body image.”
2. “When was your last menstrual period (LMP)?”
3. “Let’s discuss some activities that you have done within the past few months that could possibly lead to pregnancy.”
4. “Were you involved in a date rape and are you hesitant to speak about it?”

Answer 10

3. “Let’s discuss some activities that you have done within the past few months that could possibly lead to pregnancy.”

Question 11

A mother reports that her adolescent is always late. The mother states, “She was born late and has been late every day of her life.” Which response should the nurse make to this mother?

1. “You need to establish specific time frames for your adolescent and be certain she adheres to them.”
2. “You should not expect your adolescent to be an ‘on-time’ individual unless you set specific alarms and then reinforce the value of being ‘on-time.’”
3. “You should not expect your adolescent to be on time. Teenagers are always late.”
4. “You have a major problem. There must be a lot of screaming in your home.”

Answer 11

2. “You should not expect your adolescent to be an ‘on-time’ individual unless you set specific alarms and then reinforce the value of being ‘on-time.’”

Question 12

When examining a 7-year-old, which action by the nurse would be most appropriate?

1. Allow the child to participate in the exam.
2. Ask the parent what kind of food the child likes to eat.
3. Ask the child whether he plays outside for at least 30 minutes a day.
4. Allow the child to decide whether he is ready for his next immunization.

Answer 12

1. Allow the child to participate in the exam.

Question 13

The school health nurse recognizes that children who display certain characteristics are at risk for poor school performance. The nurse will, therefore, observe each school-age child for which characteristics? Select all that apply.

1. Decreased ability to perform visual tracking.
2. Decreased auditory stimulation.
3. Decreased muscle tone.
4. Multiple dental caries.
5. Chronic tonsillitis.

Answer 13

1. Decreased ability to perform visual tracking.
2. Decreased auditory stimulation.
3. Decreased muscle tone.

Question 14

A nurse obtains a nutritional health history from a 10-year-old child. Which of these food selections, if consumed on a regular basis, should lead the nurse to become concerned about the need for improving oral hygiene?

1. Peanuts and crackers
2. Sorbet and yogurt
3. Gummy bears and licorice
4. Fluoridated water

Answer 14

3. Gummy bears and licorice

Question 15

The school health nurse is evaluating the home environment of several children as it relates to child safety. The nurse visits the home of each child and gathers the following data. Which activity places a child at greatest risk for bodily harm?

1. The parents are in a methadone program.
2. The parents consume alcohol on a daily basis.
3. The child is permitted to target practice with a revolver, unsupervised.
4. The child is a latchkey child.

Answer 15

3. The child is permitted to target practice with a revolver, unsupervised.

Question 16

The school nurse is teaching a class about safety. The nurse will teach the children that they should wear protective athletic gear when participating in selected activities. Which of these activities require protective athletic gear? Select all that apply.

1. Skateboarding
2. Playing football
3. Swimming
4. Playing lacrosse
5. Performing acrobatic tricks

Answer 16

1. Skateboarding
2. Playing football
3. Playing lacrosse

Question 17

A 9-year-old child who has been followed in the same pediatric home since birth is at the healthcare center for a well-child visit. A nurse who measures the height and weight of the child documents 35th percentile for height and 90th percentile for weight. How should the nurse interpret these data?

1. The child is beginning a growth spurt.
2. The child is obese and needs dietary counseling.
3. The parents are most likely below the 50th percentile for height and weight.
4. As soon as the child begins the adolescent growth spurt, the height and weight measurements will normalize.

Answer 17

2. The child is obese and needs dietary counseling.

Question 18

The nurse is preparing to complete a health surveillance appointment with a school-age client and parents. Which observations would necessitate the need for further assessment by the nurse? Select all that apply.

1. Client who does not make eye contact
2. Client with visible bruises in various stages of healing
3. Client holding a video game talking with parent
4. Client playing a card game with sibling
5. Client who appears red in the face while walking to exam room

Answer 18

1. Client who does not make eye contact
2. Client with visible bruises in various stages of healing
3. Client who appears red in the face while walking to exam room

Question 19

The nurse is teaching the adolescent and family about sleep hygiene. What behaviors should the nurse suggest? Select all that apply.

1. Avoid naps in the late afternoon and evening
2. Sleep 12 hours a day
3. Avoid caffeine, tea, coffee, carbonated beverages and energy drinks for several hours before sleep.
4. Avoid setting an alarm clock
5. Go to bed and get up at the same time each day, including weekends

Answer 19

1. Avoid naps in the late afternoon and evening
2. Avoid caffeine, tea, coffee, carbonated beverages and energy drinks for several hours before sleep.
3. Go to bed and get up at the same time each day, including weekends

Question 20

When reviewing the adolescent health record, which immunizations should the nurse encourage? Select all that apply.

1. Varicella
2. Human papillomavirus
3. HIV
4. Cholesterol
5. Hepatitis B

Answer 20

1. Varicella
2. Human papillomavirus
3. Hepatitis B