Unit G-Care of the Developing Child (School Age and Adolescent))

Question 1

Which statement accurately describes physical development of a child during the school-age
years?
a. The child’s weight almost triples.
b. A child grows an average of 2 inches/year.
c. Few physical differences are apparent among children at the end of middle
childhood.
d. Fat gradually increases, which contributes to the child’s heavier appearance.

Answer 1

ANS: B
In middle childhood, growth in height and weight occur at a slower pace. Between the ages of
6 and 12 years, children grow 2 inches/year. In middle childhood, children’s weight will
almost double; they gain 3 kg/year. At the end of middle childhood, girls grow taller and gain
more weight than boys. Children take on a slimmer look with longer legs in middle childhood.

Question 2

Generally what is the earliest age at which puberty begins?

a. 13 years in girls, 13 years in boys
b. 11 years in girls, 11 years in boys
c. 10 years in girls, 12 years in boys
d. 12 years in girls, 10 years in boys

Answer 2

ANS: C
Puberty signals the beginning of the development of secondary sex characteristics. This
begins in girls earlier than in boys. Usually a 2-year difference occurs in the age at onset. Girls
and boys do not usually begin puberty at the same age; girls usually begin earlier than boys
do.

Question 3

Which statement describes the cognitive abilities of school-age children?
a. Have developed the ability to reason abstractly
b. Become capable of scientific reasoning and formal logic
c. Progress from making judgments based on what they reason to making judgments
based on what they see
d. Have the ability to classify, group and sort, and hold a concept in their minds while
making decisions based on that concept

Answer 3

ANS: D
In Piaget’s stage of concrete operations, children have the ability to group and sort and make
conceptual decisions. Children cannot reason abstractly until late adolescence. Scientific
reasoning and formal logic are skills of adolescents. Making judgments on what the child sees
versus what he or she reasons is not a developmental skill.

Question 4

What describes moral development in younger school-age children?
a. The standards of behavior now come from within themselves.
b. They do not yet experience a sense of guilt when they misbehave.
c. They know the rules and behaviors expected of them but do not understand the
reasons behind them.
d. They no longer interpret accidents and misfortunes as punishment for misdeeds.

Answer 4

ANS: C
Children who are ages 6 and 7 years know the rules and behaviors expected of them but do
not understand the reasons for them. Young children do not believe that standards of behavior
come from within themselves but that rules are established and set down by others. Younger
school-age children learn standards for acceptable behavior, act according to these standards,
and feel guilty when they violate them. Misfortunes and accidents are viewed as punishment
for bad acts.

Question 5

Which statement characterizes moral development in older school-age children?
a. They are able to judge an act by the intentions that prompted it rather than just by
the consequences.
b. Rules and judgments become more absolute and authoritarian.
c. They view rule violations in an isolated context.
d. They know the rules but cannot understand the reasons behind them

Answer 5

ANS: A
Older school-age children are able to judge an act by the intentions that prompted the behavior
rather than just by the consequences. Rules and judgments become less absolute and
authoritarian. Rule violation is likely to be viewed in relation to the total context in which it
appears. Both the situation and the morality of the rule itself influence reactions.

Question 6

An 8-year-old girl tells the nurse that she has cancer because God is punishing her for “being
bad.” She shares her concern that, if she dies, she will go to hell. How should the nurse
interpret this belief?
a. It is a belief common at this age.
b. It is a belief that forms the basis for most religions.
c. The belief is suggestive of excessive family pressure.
d. The statement suggests a failed attempt to develop a conscience.

Answer 6

ANS: A
Children at this age may view illness or injury as a punishment for a real or imagined
mystique. The belief in divine punishment is common at this age.

Question 7

What is the role of the peer group in the life of school-age children?

a. Gives them an opportunity to learn dominance and hostility.
b. Allows them to remain dependent on their parents for a longer time.
c. Decreases their need to learn appropriate sex roles.
d. Provides them with security as they gain independence from their parents.

Answer 7

ANS: D
Peer-group identification is an important factor in gaining independence from parents.
Through peer relationships, children learn ways to deal with dominance and hostility. They
also learn how to relate to people in positions of leadership and authority and explore ideas
and the physical environment. Peer-group identification helps in gaining independence rather
than remaining dependent. A child’s concept of appropriate sex roles is influenced by
relationships with peers.

Question 8

A group of boys ages 9 and 10 years have formed a “boys-only” club that is open to
neighborhood and school friends who have skateboards. How should this behavior be
interpreted?
a. Behavior that encourages bullying and sexism.
b. Behavior that reinforces poor peer relationships.
c. Characteristic of social development of this age.
d. Characteristic of children who later are at risk for membership in gangs.

Answer 8

ANS: C
One of the outstanding characteristics of middle childhood is the creation of formalized
groups or clubs. Peer-group identification and association are essential to a child’s
socialization. Poor relationships with peers and a lack of group identification can contribute to
bullying. A boys-only club does not have a direct correlation with later gang activity.

Question 9

Which statement is descriptive of the play of school-age children?
a. Individuality in play is better tolerated than at earlier ages.
b. Knowing the rules of a game gives an important sense of belonging.
c. They like to invent games, making up the rules as they go.
d. Team play helps children learn the universal importance of competition and
winning.

Answer 9

ANS: B
Play involves increased physical skill, intellectual ability, and fantasy. Children form groups
and cliques and develop a sense of belonging to a team or club. At this age, children begin to
see the need for rules. Conformity and ritual permeate their play. Their games have fixed and
unvarying rules, which may be bizarre and extraordinarily rigid. With team play, children
learn about competition and the importance of winning, an attribute highly valued in the
United States.

Question 10

What is the characteristic of dishonest behavior in children ages 8 to 10 years?
a. Cheating during games is now more common.
b. Lying results from the inability to distinguish between fact and fantasy.
c. They may steal because their sense of property rights is limited.
d. They may lie to meet expectations set by others that they have been unable to
attain

Answer 10

ANS: D
Older school-age children may lie to meet expectations set by others to which they have been
unable to measure up. Cheating usually becomes less frequent as the child matures. In this
age-group, children are able to distinguish between fact and fantasy. Young children may lack
a sense of property rights; older children may steal to supplement an inadequate allowance, or
it may be an indication of serious problems

Question 11

A 9 year old often comes to the school nurse complaining of stomach pains. The teacher says
that the child has lately been somewhat aggressive and stubborn in the classroom. What
should the school nurse recognize as the possible trigger for these behaviors?
a. Signs of stress
b. Developmental delay
c. A physical problem causing emotional stress
d. Lack of adjustment to the school environment

Answer 11

ANS: A
Signs of stress include stomach pains or headache, sleep problems, bed-wetting, changes in
eating habits, aggressive or stubborn behavior, reluctance to participate, or regression to early
behaviors. This child is exhibiting signs of stress, not developmental delay, a physical
problem, or lack of adjustment.

Question 12

Which statement best describes fear in school-age children?
a. They are increasingly fearful for body safety.
b. Most of the new fears that trouble them are related to school and family.
c. They should be encouraged to hide their fears to prevent ridicule by peers.
d. Those who have numerous fears need continuous protective behavior by parents to
eliminate these fears.

Answer 12

ANS: B
During the school-age years, children experience a wide variety of fears, but new fears related
predominantly to school and family bother children during this time. During the
middle-school years, children become less fearful of body safety than they were as
preschoolers. Parents and other persons involved with children should discuss their fear with
them individually or as a group activity. Sometimes school-age children hide their fears to
avoid being teased. Hiding the fears does not end them and may lead to phobias.

Question 13

The father of 12 year old tells the nurse that he is concerned about his child getting “fat.” The
child’s body mass index for age is at the 60th percentile. What is the most appropriate nursing
action to address the father’s concern?
a. Reassure the father that his child is not “fat.”
b. Reassure the father that the weight is just a growing child.
c. Suggest a low-calorie, low-fat diet, and provide food suggestions.
d. Explain that this is typical of the growth pattern of children at this age.

Answer 13

ANS: D
This is a characteristic pattern of growth in preadolescent boys, in which the growth in height
has slowed in preparation for the pubertal growth spurt but weight is still gained. This should
be reviewed with both the father and child, and a plan should be developed to maintain
physical exercise and a balanced diet. Saying that the child is not “fat” is false reassurance.
The child’s weight is high for his/her height. The child needs to maintain his/her physical
activity. The father is concerned; an explanation is required. A nutritional diet with physical
activity should be sufficient to maintain his balance

Question 14

The school nurse has been asked to begin teaching sex education in the 5th grade. Which
statement should be the foundation for the information the nurse should present?
a. Children in 5th grade are too young for sex education.
b. Children should be discouraged from asking too many questions.
c. Correct terminology should be reserved for children who are older.
d. Sex can be presented as a normal part of growth and development.

Answer 14

ANS: D
When sex information is presented to school-age children, sex should be treated as a normal
part of growth and development. Fifth graders are usually 10 to 11 years old. This age is not
too young to speak about physiologic changes in their bodies. They should be encouraged to
ask questions. Preadolescents need precise and concrete information.

Question 15

What is an important consideration for the school nurse who is planning a class on bicycle
safety to consider?
a. Most bicycle injuries involve collision with an automobile.
b. Head injuries are the major causes of bicycle-related fatalities.
c. Children should wear bicycle helmets if they ride on paved streets.
d. Children should not ride double unless the bicycle has an extra-large seat.

Answer 15

ANS: B
The most important aspect of bicycle safety is to encourage the rider to use a protective
helmet. Head injuries are the major cause of bicycle-related fatalities. Although motor vehicle
collisions do cause injuries to bicyclists, most injuries result from falls. The child should
always wear a properly fitted helmet approved by the U.S. Consumer Product Safety
Commission. Children should not ride double

Question 16

When teaching injury prevention during the school-age years, the nurse should include what
topic?
a. Teaching the need to fear strangers.
b. Teaching basic rules of water safety.
c. Avoiding letting children cook in microwave ovens.
d. Cautioning children against engaging in competitive sports.

Answer 16

ANS: B
Water safety instruction is an important source of injury prevention at this age. The child
should be taught to swim, select safe and supervised places to swim, swim with a companion,
check sufficient water depth for diving, and use an approved flotation device. Teach stranger
safety, not fearing strangers. This includes not going with strangers, not having personalized
clothing in public places, having children tell parents if anyone makes them uncomfortable,
and teaching children to say “no” in uncomfortable situations. Teach children safe cooking
methods. Caution against engaging in hazardous sports, such as those involving trampolines.

Question 17

The ability to mentally understand that 1 + 3 = 4 and 4 − 3 = 1 occurs in which stage of
cognitive development?
a. Concrete operations stage
b. Formal operations stage
c. Intuitive thought stage
d. Preoperations stage

Answer 17

ANS: A
By 7 to 8 years of age, the child is able to retrace a process (reversibility) and has the skills
necessary for solving mathematical problems. This stage is called concrete operations. The
formal operations stage deals with abstract reasoning and does not occur until adolescence.
Thinking in the intuitive stage is based on immediate perceptions. A child in this stage often
solves problems by random guessing. In preoperational thinking, the child is usually able to
add 1 + 3 = 4 but is unable to retrace the process.

Question 18

Which activity is most appropriate for developing fine motor skills in the school-age child?

a. Drawing
b. Singing
c. Soccer
d. Swimming

Answer 18

ANS:A
Activities such as drawing, building models, and playing a musical instrument increase the
school-age child’s fine motor skills. Singing is an appropriate activity for the school-age child,
but it does not increase fine motor skills. The school-age child needs to participate in group
activities to increase both gross motor skills and social skills, but group activities do not
increase fine motor skills. Swimming is an activity that also increases gross motor skills.

Question 19

Which comment is most developmentally typical of a 7-year-old boy?

a. “I am a Power Ranger, so don’t make me angry.”
b. “I don’t know whether I like Mary or Joan better.”
c. “My mom is my favorite person in the world.”
d. “Jimmy is my best friend

Answer 19

ANS: D
School-age children form friendships with peers of the same sex, those who live nearby, and
other children who have toys that they enjoy sharing. Magical thinking is developmentally
appropriate for the preschooler. Opposite-sex friendships are not typical for the 7-year-old
child. Seven-year-old children socialize with their peers, not their parents.

Question 20

Identify the statement that is the most accurate about moral development in the 9-year-old
school-age child.
a. Right and wrong are based on physical consequences of behavior.
b. The child obeys parents because of fear of punishment.
c. The school-age child conforms to rules to please others.
d. Parents are the determiners of right and wrong for the school-age child.

Answer 20

ANS: C
The 7- to 12-year-old child bases right and wrong on a good-boy or good-girl orientation in
which the child conforms to rules to please others and avoid disapproval. Children 4 to 7 years
of age base right and wrong on consequences, the most important consideration for this
age-group. Parents determine right and wrong for the child younger than 4 years of age.

Question 21

Which behavior by parents or teachers will best assist the child in negotiating the
developmental task of industry?
a. Identifying failures immediately and asking the child’s peers for feedback
b. Structuring the environment so the child can master tasks
c. Completing homework for children who are having difficulty in completing
assignments
d. Decreasing expectations to eliminate potential failures

Answer 21

ANS:B
The task of the caring teacher or parent is to identify areas in which a child is competent and
to build on successful experiences to foster feelings of mastery and success. Structuring the
environment to enhance self-confidence and to provide the opportunity to solve increasingly
more complex problems will promote a sense of mastery. Asking peers for feedback
reinforces the child’s feelings of failure. When teachers or parents complete children’s
homework for them, it sends the message that they do not trust the children to do a good job.
Providing assistance and suggestions and praising their best efforts are more appropriate.
Decreasing expectations to eliminate failures will not promote a sense of achievement or
mastery.

Question 22

A nurse is assessing an older school-age child recently admitted to the hospital. Which
assessment indicates that the child is in an appropriate stage of cognitive development?
a. The child’s addition and subtraction ability
b. The child’s ability to classify
c. The child’s vocabulary
d. The child’s play activity

Answer 22

ANS: B
The ability to classify things from simple to complex and the ability to identify differences
and similarities are cognitive skills of the older school-age child; this demonstrates use of
classification and logical thought processes. Subtraction and addition are appropriate
cognitive activities for the young school-age child. Vocabulary is not as valid an assessment
of cognitive ability as is the child’s ability to classify. Play activity is not as valid an
assessment of cognitive function as is the ability to classify.

Question 23

A child has an avulsed (knocked-out) tooth. In which medium should the nurse instruct the
parents to place the tooth for transport to the dentist?
a. Cold milk
b. Cold water
c. Warm salt water
d. A dry, clean jar

Answer 23

ANS: A
An avulsed tooth should be placed in a suitable medium for transport, either cold milk or
saliva (under the child’s or parent’s tongue). Cold milk is a more suitable medium for
transport than cold water, warm salt water, or a dry, clean jar.

Question 24

A nurse is teaching parents of first-grade children general guidelines to assist their children in
adapting to school. Which statement by the parents indicates they understand the teaching?
a. “We will only meet with the teacher if problems occur.”
b. “We will discourage hobbies so our child focuses on schoolwork.”
c. “We will plan a trip to the library as often as possible.”
d. “We will expect our child to make all As in school.”

Answer 24

ANS: C
General guidelines for parents to help their child in school include sharing an interest in
reading. The library should be used frequently and books the child is reading should be
discussed. Hobbies should be encouraged. The parents should not expect all As. They should
focus on growth more than grades.

Question 25

Parents of a 12-year-old child ask the clinic nurse, “How many hours of sleep should our child
get each night?” The nurse should respond that 12-year-old children need ____ hours of sleep
at night.
a. 8
b. 9
c. 10
d. 11

Answer 25

ANS: B
School-age children usually do not require naps, but they do need to sleep approximately 11
hours at age 5 years and 9 hours at age 12 years each night.

Question 26

A nurse planning care for a school-age child should take into account that which thought
process is seen at this age?
a. Animism
b. Magical thinking
c. Ability to conserve
d. Thoughts are all-powerful

Answer 26

ANS: C
One cognitive task of school-age children is mastering the concept of conservation. At an
early age (5 to 7 years), children grasp the concept of reversibility of numbers as a basis for
simple mathematics problems (e.g., 2 + 4 = 6 and 6 − 4 = 2). They learn that simply altering
their arrangement in space does not change certain properties of the environment, and they are
able to resist perceptual cues that suggest alterations in the physical state of an object.
Animism, magical thinking, and believing that thoughts are all-powerful are thought processes
seen in preschool children.

Question 27

Which demonstrates the school-age child’s developing logic in the stage of concrete
operations? (Select all that apply.)
a. The school-age child is able to recognize that he can be a son, brother, or nephew
at the same time
b. The school-age child understands the principles of adding, subtracting, and
reversibility.
c. The school-age child understands the principles of adding, subtracting, and
reversibility.
d. The school-age child has thinking that is characterized by egocentrism and
animism.

Answer 27

ANS: A, B, C
The school-age child understands that the properties of objects do not change when their
order, form, or appearance does. Conservation occurs in the concrete operations stage.
Comprehension of class inclusion occurs as the school-age child’s logic increases. The child
begins to understand that a person can be in more than one class at the same time. This is
characteristic of concrete thinking and logical reasoning. The school-age child is able to
understand principles of adding, subtracting, and the process of reversibility, which occurs in
the stage of concrete operations. Thinking that is characterized by egocentrism and animism
occurs in the intuitive thought stage, not the concrete operations stage of development.

Question 28

Peer victimization is becoming a significant problem for school-age children and adolescents
in the United States. Parents should be educated regarding signs that a child is being bullied.
These might include: (Select all that apply.)
a. The child spends an inordinate amount of time in the nurse’s office.
b. Belongings frequently go missing or are damaged.
c. The child wants to be driven to school.
d. School performance improves.
e. The child freely talks about his or her day.

Answer 28

ANS: A, B, C
Signs that may indicate a child is being bullied are similar to signs of other types of stress and
include nonspecific illness or complaints, withdrawal, depression, school refusal, and
decreased school performance. Children expressed fear of going to school or riding the school
bus, and their belongings often are damaged or missing. Very often, children will not talk
about what is happening to them

Question 29

A nurse is planning care for a 7-year-old child hospitalized with osteomyelitis. Which
activities should the nurse plan to bring from the playroom for the child? (Select all that
apply.)
a. Paper and some paints
b. Board games
c. Jack-in-the-box
d. Stuffed animals
e. Computer games

Answer 29

ANS:A,B,E
School-age children become fascinated with complex board, card, or computer games that
they can play alone, with a best friend, or with a group. They also enjoy sewing, cooking,
carpentry, gardening, and creative activities such as painting. Jack-in-the-box and stuffed
animals would be appropriate for a toddler or preschool child.

Question 30

A nurse teaches parents that team play is important for school-age children. Which abilities
can children develop by experiencing team play? (Select all that apply.)
a. Achieve personal goals over group goals.
b. Learn complex rules.
c. Experience competition.
d. Learn about division of labor

Answer 30

ANS: B, C, D
Team play helps stimulate cognitive growth because children are called on to learn many
complex rules, make judgments about those rules, plan strategies, and assess the strengths and
weaknesses of members of their own team and members of the opposing team. Team play can
also contribute to children’s social, intellectual, and skill growth. Children work hard to
develop the skills needed to become team members, to improve their contribution to the
group, and to anticipate the consequences of their behavior for the group. Team play teaches
children to modify or exchange personal goals for goals of the group; it also teaches them that
division of labor is an effective strategy for attaining a goal.

Question 31

In girls, what is the initial indication of puberty?

a. Menarche
b. Growth spurt
c. Growth of pubic hair
d. Breast development

Answer 31

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

Question 32

The mean age of menarche in the United States is:

a. 11.5 years.
b. 12.5 years.
c. 13.5 years.
d. 14 years.

Answer 32

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

Question 33

By what age should concerns about pubertal delay be considered 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 33

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

Question 34

A 14 years old, mentions that he now has to use deodorant but never had to before. The
nurse’s response should be based on what knowledge?
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 34

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 axillae, genital and anal areas, 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 genitals 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 insulate the body and cause increased sweat production, but
this is not the etiology of apocrine sweat gland activity.

Question 35

According to Erikson, what is the psychosocial task of adolescence?

a. Intimacy
b. Identity
c. Initiative
d. Independence

Answer 35

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

Question 36

According to Piaget, the adolescent is in the fourth stage of cognitive development with a
focus on what area?
a. Formal operations
b. Concrete operations
c. Conventional thought
d. Postconventional thought

Answer 36

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 ages 7 and 11 years. Conventional and postconventional thought refer to
Kohlberg’s stages of moral development

Question 37

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.

Answer 37

ANS: A
Adolescents are no longer restricted to the real and actual. They are also 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, the ability to
see things from another’s point of view, and the ability to make judgments based on what they
reason rather than just what they see.

Question 38

The parents of a 14 year old express concerns about the number of hours their child spends
with friends. The nurse explains that peer relationships become more important during
adolescence because:
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 38

ANS: C
The peer group serves as a strong support to teenagers, providing them with a sense of
belonging and 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 personal and health-related decisions. The peer group forms the
transitional world between dependence and autonomy.

Question 39

An adolescent boy tells the nurse that he has recently had homosexual feelings. The nurse’s
response should be based on what knowledge?
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 39

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

Question 40

Matt, aged 14 years, seems to be always eating, although his weight is appropriate for his

height. What is the best explanation for this situation?
a. This is normal because of increase in body mass.
b. This is abnormal and suggestive of future obesity.
c. His caloric intake would have to be excessive.
d. He is substituting food for unfilled needs.

Answer 40

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. This describes the expected eating pattern for
young adolescents as long as weight and height are appropriate; obesity and substitution of
food for unfilled needs are not concerns

Question 41

Which predisposes the adolescent 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 41

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 contribute to fatigue. None
of the other options have the same or greater influence of sleep needs as so physical growth.

Question 42

What is the most common cause of death in the adolescent age-group?

a. Drownings
b. Firearms
c. Drug overdoses
d. Motor vehicles

Answer 42

ANS: D
The leading cause of all adolescent deaths in the United States is motor vehicle accidents.
Drownings, firearms, and drug overdoses are major concerns in adolescence but do not cause
the majority of deaths.

Question 43

The nurse is completing a health history with a 16-year-old male. He informs the nurse that he
has started using smokeless tobacco after he plays baseball. Which information regarding
smokeless tobacco would be most correct for the nurse to provide to this teen?
a. This form of nicotine is not addicting.
b. It has been proven to be carcinogenic.
c. It is a much easy habit to stop
d. It is a safe alternative to cigarette smoking.

Answer 43

ANS: B
Smokeless tobacco is a popular substitute for cigarettes and poses serious health hazards to
children and adolescents. Smokeless tobacco is associated with cancer of the mouth and jaw.
Smokeless tobacco is just as addictive as cigarettes. Although teens believe that it is easy to
stop using smokeless tobacco, this is not the case. A popular belief 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 44

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

Answer 44

ANS: A
The male breast responds to hormonal changes. Some degree of bilateral or unilateral breast
enlargement occurs frequently in boys during puberty. Klinefelter syndrome is a chromosomal
condition that affects male physical and cognitive development. This is not a manifestation of
Klinefelter’s syndrome. Administration of estrogen or testosterone will have no effect on the
reduction of breast tissue and may aggravate the condition.

Question 45

How may anorexia nervosa best be described?

a. Occurring most frequently in adolescent males.
b. Occurring most frequently in adolescents from lower socioeconomic groups.
c. Resulting from a posterior pituitary disorder.
d. Resulting in severe weight loss in the absence of obvious physical causes

Answer 45

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

Question 46

The weight loss of anorexia nervosa is often triggered by what event?

a. Sexual abuse
b. School failure
c. Independence from family
d. Traumatic interpersonal conflict

Answer 46

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

Question 47

Which statement is most descriptive of bulimia during adolescence?

a. Strong sense of control over eating behavior
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 normal, slightly above normal, or below normal

Answer 47

ANS: D
Individuals with bulimia are of normal weight or more commonly slightly above normal
weight. Those who also restrict their intake can become severely underweight. Behavior
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 48

The nurse is caring for an adolescent diagnosed with acute cocaine toxicity. Initial data
collection should include what focus?
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 48

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

Question 49

Which statement best describes Tanner staging?
a. Predictable stages of puberty that are based on chronologic 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.

Answer 49

ANS: C
Tanner sexual-maturing ratings are based on the development of stages of primary and
secondary sexual characteristics. Tanner stages are not based on chronologic 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 sole basis of Tanner staging.

Question 50

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.

Answer 50

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. Parents often describe their teenager as being “self-centered” or “lazy.” 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.

Question 51

The parents of a 15-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.”

Answer 51

ANS: C
Egocentric and 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. The behavior is normal and needs no further investigation.

Question 52

Which statement is the most appropriate advice to give parents of a 16 year old who is
rebellious?
a. “You need to be stricter so that your teen stops trying to test the limits.”
b. “You need to collaborate with your child and set limits that are perceived as being
reasonable.”
c. “Increasing your teen’s involvement with peers will improve his/her self-esteem.”
d. “Allow your teenager to choose the type of discipline that is used in your home.”

Answer 52

ANS: B
Allowing teenagers to choose between realistic options and offering consistent and structured
discipline typically enhances cooperation and decreases rebelliousness. Structure helps
adolescents to feel more secure and assists them in the decision-making process. Setting
stricter limits typically does not decrease rebelliousness or decrease testing of parental limits.
Increasing peer involvement does not typically increase self-esteem.

Question 53

Which statement by the nurse is most appropriate to a 15 year old 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.”

Answer 53

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 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 to have is that all threats of suicide should be taken
seriously and immediate help is important. Taking time to gather details or waiting until the
teen discusses it a second time may be too late.

Question 54

When planning care for adolescents, the nurse should consider which intervention?
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.

Answer 54

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 health care provider. Teenagers are
socially and cognitively at the developmental stage where the health care provider can teach
them. The nurse must keep in mind that teenagers are more interested in immediate health
care needs than in long-term needs.

Question 55

A 17 year old tells the nurse that he/she is not having sex because it would make his/her
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

Answer 55

ANS: B
The appropriate moral development for a 17 year old would include evidence that the teenager
has internalized a value system and does not depend on parents to determine right and wrong
behaviors. Adolescents who remain concrete thinkers may never advance beyond conformity
to please others and avoid punishment. 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 parents’ sanctioning of
right or wrong behavior is more appropriately related to moral development.

Question 56

What is the first sign of pubertal change seen with boys?

a. Testicular enlargement
b. Facial hair
c. Scrotal enlargement
d. Voice deepens

Answer 56

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.

Question 57

A young adolescent tells the nurse, “I feel gawky.” The nurse should explain that this occurs
in adolescents because of what physiological event?
a. Growth of the extremities and neck precedes growth in other areas.
b. Growth is in the trunk and chest.
c. The hip and chest breadth increases.
d. The growth spurt occurs earlier in girls.

Answer 57

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 but this does not address the child’s concern.

Question 58

Which hormone is responsible for the growth of beard, mustache, and body hair in the males?

a. Estrogen
b. Pituitary hormone
c. Androgen
d. Progesterone

Answer 58

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.

Question 59

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 laboratory testing.
c. normal behavior.
d. related to feelings of depression

Answer 59

ANS: C
Adolescents vacillate in their emotional states between considerable maturity and child-like
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 laboratory testing. The mood swings do not
indicate depression.

Question 60

Young people diagnosed with anorexia nervosa are often described as possessing what
personal characteristic?
a. Independent
b. Disruptive
c. Conforming
d. Low achieving

Answer 60

ANS: C
Individuals with anorexia nervosa are described as perfectionist, academically high achievers,
conforming, and conscientious. Independent, disruptive, and low achieving are not part of the
behavioral characteristics of anorexia nervosa

Question 61

Which symptoms should the nurse expect to observe during the physical assessment of an
adolescent girl with severe weight loss and disrupted metabolism associated with anorexia
nervosa?
a. Dysmenorrhea and oliguria
b. Tachycardia and tachypnea
c. Heat intolerance and increased blood pressure
d. Lowered body temperature and brittle nails

Answer 61

ANS: D
Symptoms of anorexia nervosa include lower body temperature, severe weight loss, decreased
blood pressure, dry skin, brittle nails, altered metabolic activity, and presence of lanugo hair.
Amenorrhea, rather than dysmenorrhea, and cold intolerance are manifestations of anorexia
nervosa. Bradycardia, rather than tachycardia, may be present

Question 62

Which statement is most descriptive of central nervous system stimulants?

a. They produce strong physical dependence.
b. They can result in strong psychologic dependence.
c. Withdrawal symptoms are life threatening.
d. Acute intoxication can lead to coma

Answer 62

ANS: B
Central nervous system stimulants such as amphetamines and cocaine produce a strong
psychologic dependence. This class of drugs does not produce strong physical dependence
and can be withdrawn without much danger. Acute intoxication leads to violent, aggressive
behavior, or psychotic episodes characterized by paranoia, uncontrollable agitation, and
restlessness.

Question 63

A school nurse is conducting a class with adolescents on suicide. Which true statement about
suicide should the nurse include in the teaching session?
a. A sense of hopelessness and despair are a normal part of adolescence.
b. Gay and lesbian adolescents are at a particularly high risk for suicide.
c. Problem-solving skills are of limited value to the suicidal adolescent.
d. Previous suicide attempts are not an indication of risk for completed suicides.

Answer 63

ANS:B
A significant number of teenage suicides occur among homosexual youths. Gay and lesbian
adolescents who live in families or communities that do not accept homosexuality are likely to
suffer low self-esteem, self-loathing, depression, and hopelessness as a result of a lack of
acceptance from their family or community. At-risk teenagers include those who are
depressed, have poor problem-solving skills, or use drugs and alcohol. History of previous
suicide attempt is a serious indicator for possible suicide completion in the future.

Question 64

Which is the most commonly used method in completed suicides?

a. Firearms
b. Drug overdose
c. Self-inflected laceration
d. Carbon monoxide poisoning

Answer 64

ANS: A
Firearms are the most commonly used instruments in completed suicides among both males
and females. For adolescent boys, firearms are followed by hanging and overdose. For
adolescent females, overdose and strangulation are the next most common means of
completed suicide. The most common method of suicide attempt is overdose or ingestion of
potentially toxic substances such as drugs. The second most common method of suicide
attempt is self-inflicted laceration. Carbon monoxide poisoning is not one of the more
frequent forms of suicide completion

Question 65

Which is the most significant factor in distinguishing those who commit suicide from those
who make suicidal attempts or threats?
a. Social isolation
b. Level of stress
c. Degree of depression
d. Desire to punish others

Answer 65

ANS: A
Social isolation is a significant factor in distinguishing adolescents who will kill themselves
from those who will not. It is also more characteristic of those who complete suicide than of
those who make attempts or threats. Level of stress, degree of depression, and desire to punish
others are contributing factors in suicide, but they are not the most significant factor in
distinguishing those who complete suicide from those who attempt suicide.