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Maternal and Child Health Nursing 3rd Edition London Ladewig Ball

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Maternal and Child Health Nursing 3rd Edition London Ladewig Ball

ISBN-13: 978-0135078464

ISBN-10: 0135078466

 

Description

Maternal and Child Health Nursing 3rd Edition London Ladewig Ball

ISBN-13: 978-0135078464

ISBN-10: 0135078466

 

 

 

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Free Nursing Test Questions:

Chapter 14    Health Promotion and Maintenance of the Adolescent

 

MULTIPLE CHOICE.  Choose the one alternative that best completes the statement or answers the question.

 

1)

 

An adolescent is being seen in the clinic to discuss health promotion behaviors. What should the nurse include in the evaluation of the plan?

 

  1. A)

 

Effectiveness of the plan, and methods to expand and sustain successful approaches

 

  1. B)

 

The adolescent’s attitude on how the adolescent perceives health

 

  1. C)

 

Instruction on what is considered healthy behavior

 

  1. D)

 

Advising the adolescent that promoting health behaviors will maintain a healthy lifestyle

 

Answer:

 

A

 

Explanation:

 

  1. A)

 

When establishing youth programs, whether with individual adolescents or with groups, the nurse includes evaluation of the effectiveness of the plan and methods to expand and sustain successful approaches.

 

  1. B)

 

Including the adolescent’s attitude toward health has little to do with evaluating the success of the plan.

 

  1. C)

 

Instruction on healthy behaviors would be included in the implementation phase of the plan.

 

  1. D)

 

Advising why promoting healthy behaviors is important is part of the implementation phase of the plan.

 

Cognitive Level: Application

 

Client Need: Health Promotion and Maintenance

 

Nursing Process: Evaluation

 

Learning Outcome: 14-1

 

 

 

 

 

2)

 

The nurse is preparing to see an adolescent patient to assess relationships with others. What should the nurse do when conducting this assessment?

 

  1. A)

 

Tell the parents they are not allowed to come into the examination room.

 

  1. B)

 

Provide time alone with both the adolescent and the parents.

 

  1. C)

 

Let the parents know the nurse will share the information with them after the exam.

 

  1. D)

 

Do not ask the parents their opinions of the adolescent’s friends.

 

Answer:

 

B

 

Explanation:

 

  1. A)

 

The nurse cannot keep the parents out of the examination room, especially if the adolescent wants the parents there.

 

  1. B)

 

Provide time alone with both the adolescent and the parents so that everyone has time to talk freely and ask questions.

 

  1. C)

 

The nurse cannot to share the information about the exam, as this is a breach of patient confidentiality.

 

  1. D)

 

The nurse should include the parents’ opinions of their child’s friends.

 

Cognitive Level: Application

 

Client Need: Health Promotion and Maintenance

 

Nursing Process: Planning

 

Learning Outcome: 14-1

 

 

 

 

 

3)

 

An adolescent is visiting the clinic for the first time. What should the nurse keep in mind when attending to this patient?

 

  1. A)

 

Adolescents are comfortable with their surroundings.

 

  1. B)

 

Adolescents usually are quiet, and will offer no opinions.

 

  1. C)

 

The nurse should explain procedures and introduce personnel to adolescents.

 

  1. D)

 

The nurse should attend to adolescents quickly and discharge them.

 

Answer:

 

C

 

Explanation:

 

  1. A)

 

When adolescents are visiting the same office or clinic that they came to during childhood, they usually know and feel comfortable with the care providers. case if it is a first visit.

 

  1. B)

 

Adolescents most often will readily offer their opinions.

 

  1. C)

 

If the setting is new to them, explain the procedures and introduce personnel so they feel more at ease.

 

  1. D)

 

It is important that the adolescent feel welcome, important, and unrushed, in order to gain trust.

 

Cognitive Level: Analysis

 

Client Need: Health Promotion and Maintenance

 

Nursing Process: Assessment

 

Learning Outcome: 14-1

 

 

 

 

 

4)

 

An adolescent comes to the clinic because of a concern with a skin lesion, and is accompanied by a parent. When the adolescent is called back to the exam room, the parent comes with the adolescent. What approach by the nurse would be most appropriate?

 

  1. A)

 

Allow the parent to come into the exam room with the adolescent.

 

  1. B)

 

Tell the parent she cannot come into the exam room with the adolescent.

 

  1. C)

 

Instruct the parent to stay in the waiting room and the adolescent will give her a report on the exam.

 

  1. D)

 

Reassure the parent that you will talk with her about any of her concerns and questions.

 

Answer:

 

D

 

Explanation:

 

  1. A)

 

The adolescent chooses when the parent comes into the room.

 

  1. B)

 

The adolescent decides when the parent comes into the room.

 

  1. C)

 

The adolescent makes the decision about the parent’s presence and whether to report the exam to her.

 

  1. D)

 

If someone comes with the adolescent, be alert that you might need to provide some private time by asking the other person to wait outside for a moment. Reassure the parent that you will talk with her about any of her concerns and questions, and provide her with an opportunity to ask questions and get information as well.

 

Cognitive Level: Analysis

 

Client Need: Health Promotion and Maintenance

 

Nursing Process: Implementation

 

Learning Outcome: 14-1

 

 

 

 

 

5)

 

A 17-year-old female presents at a nurse practitioner’s office and requests a signature for work papers. The nurse reviews her chart and notes that the last physical examination was within the year. In addition to providing the signature for the work papers, the nurse should use this visit as:

 

  1. A)

 

An opportunity to discuss birth control measures.

 

  1. B)

 

A time to discuss exercise and sports participation.

 

  1. C)

 

A health supervision opportunity.

 

  1. D)

 

A chance to discuss the importance of pursuing postsecondary education.

 

Answer:

 

C

 

Explanation:

 

  1. A)

 

While discussing birth control measures is important, it is only a small portion of the health supervision requirements.

 

  1. B)

 

Discussing the importance of exercise and sports is important, and should be included in overall health supervision.

 

  1. C)

 

All visits should be used as health promotion and health supervision opportunities.

 

  1. D)

 

Discussing future educational plans is important, but these can be included in the overall health supervision protocols.

 

Cognitive Level: Application

 

Client Need: Health Promotion and Maintenance

 

Nursing Process: Planning

 

Learning Outcome: 14-2

 

 

 

 

 

6)

 

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. The priority nursing action is to:

 

  1. A)

 

Call the respective parents to discuss the eating patterns of each adolescent.

 

  1. B)

 

Speak with the girls in a group to discuss the problems associated with anorexia nervosa.

 

  1. C)

 

Refer these adolescents to the school psychologist.

 

  1. D)

 

Obtain a nutritional history for each of these adolescents.

 

Answer:

 

D

 

Explanation:

 

  1. A)

 

Speaking with the parents would not be appropriate at this time.

 

  1. B)

 

Discussing anorexia nervosa at this point is too extreme.

 

  1. C)

 

Referring the adolescents to a school psychologist without performing a complete nursing assessment is not appropriate.

 

  1. D)

 

The school nurse must evaluate why these three friends have all lost 15 pounds in one year. The best way to begin this assessment is to obtain a nutritional history for each client.

 

Cognitive Level: Analysis

 

Client Need: Health Promotion and Maintenance

 

Nursing Process: Assessment

 

Learning Outcome: 14-2

 

 

 

 

 

7)

 

A nurse is planning to present a lecture/discussion on health maintenance to adolescents in their high school health class. The nurse will include which topic in the presentation information?

 

  1. A)

 

Limiting refined sugar and high-fat intake

 

  1. B)

 

Resources for treatment of eating disorders for all adolescents

 

  1. C)

 

Type 2 diabetes mellitus and insulin resistance

 

  1. D)

 

The importance of decreasing calcium intake once full adult height is achieved

 

Answer:

 

A

 

Explanation:

 

  1. A)

 

A general presentation should focus on normal expected behaviors for health promotion, such as limiting refined sugar intake and including dairy in the diet.

 

  1. B)

 

Discussing eating disorders and diabetes mellitus is not appropriate for health promotion activities.

 

  1. C)

 

Discussing eating disorders and diabetes mellitus is not appropriate for health promotion activities.

 

  1. D)

 

Decreasing calcium would not be a recommendation for teenagers.

 

Cognitive Level: Application

 

Client Need: Health Promotion and Maintenance

 

Nursing Process: Planning

 

Learning Outcome: 14-2

 

 

 

 

 

8)

 

A 15-year-old female adolescent’s body mass index (BMI) is 27.5. The adolescent’s height is 5 feet, 2 inches, and she weighs 160 pounds. The girl’s menses began when she was 12 years old. School performance has been spotty. The priority client teaching would be related to:

 

  1. A)

 

Nutritional intake.

 

  1. B)

 

School performance.

 

  1. C)

 

Adolescent mini mental health status examination.

 

  1. D)

 

Menstrual cycle.

 

Answer:

 

A

 

Explanation:

 

  1. A)

 

The BMI for this client is too high, placing the adolescent at risk for cardiovascular disease, hypertension, and diabetes mellitus in later life. Therefore, nutritional intake is the most important topic to focus on with this client at this time.

 

  1. B)

 

School performance is not as high a priority as the BMI.

 

  1. C)

 

The mental health screening exam is not as high a priority as the BMI.

 

  1. D)

 

The menstrual cycle appears to have started at a normal time, and so is not the priority.

 

Cognitive Level: Analysis

 

Client Need: Health Promotion and Maintenance

 

Nursing Process: Assessment

 

Learning Outcome: 14-2

 

 

 

 

 

9)

 

An adolescent reports the following: “I get up at 6 a.m., attend early-morning band classes three times each week, play sports for two hours each day after school, and homework takes me three hours each night. I always feel tired.” The priority history question is:

 

  1. A)

 

How many hours of sleep do you get each night?

 

  1. B)

 

Do you consume foods high in iron?

 

  1. C)

 

Do you think you are doing too much?

 

  1. D)

 

Have you considered talking with your teachers about decreasing your homework?

 

Answer:

 

A

 

Explanation:

 

  1. A)

 

The data in this scenario reveal very little time for sleep; therefore, the history should focus on sleep patterns.

 

  1. B)

 

The scenario does not include information about food intake, and low iron might cause the tired feeling described.

 

  1. C)

 

It is obvious the adolescent is doing too much; however, it is doubtful she would think it excessive.

 

  1. D)

 

This is inappropriate; the adolescent needs to decrease extracurricular activities, not homework.

 

Cognitive Level: Analysis

 

Client Need: Health Promotion and Maintenance

 

Nursing Process: Assessment

 

Learning Outcome: 14-3

 

 

 

 

 

10)

 

The school nurse performs screenings on all students in the high school. One student tells the nurse that since starting high school, she is constantly tired and moody. Which of these should the nurse investigate further?

 

  1. A)

 

Sleep deprivation

 

  1. B)

 

School adjustment

 

  1. C)

 

New friends

 

  1. D)

 

New teachers

 

Answer:

 

A

 

Explanation:

 

  1. A)

 

The effects of sleep deprivation can be serious. Teens cannot perform to their potential in school or at work. Many parents state that adolescents are moody and difficult to communicate with when they are tired.

 

  1. B)

 

There is no indication that school adjustment has been an issue.

 

  1. C)

 

No mention of friends is made in the scenario.

 

  1. D)

 

New teachers would not be a cause for the student to be tired and moody.

 

Cognitive Level: Analysis

 

Client Need: Health Promotion and Maintenance

 

Nursing Process: Intervention

 

Learning Outcome: 6-3

 

 

 

 

 

11)

 

During an annual physical, the adolescent reports typical food intake to the nurse. Which requires further assessment by the nurse?

 

  1. A)

 

“I have a salad for lunch at school.”

 

  1. B)

 

“I have fried eggs and soda for breakfast.”

 

  1. C)

 

“I have meat, a vegetable, and rice for dinner.”

 

  1. D)

 

“I have a piece of fruit for snack.”

 

Answer:

 

B

 

Explanation:

 

  1. A)

 

Having a salad for lunch at school is not a problem and does not require further assessment.

 

  1. B)

 

Health maintenance plans center on those practices that prevent disease, including limiting refined sugar and high-fat intake such as soft drinks and fried foods in order to maintain weight at the recommended level.

 

  1. C)

 

There is no issue with the adolescent having meat, a vegetable, and rice for dinner.

 

  1. D)

 

Snacking on fruit is healthy, and so requires no additional assessment.

 

Cognitive Level: Analysis

 

Client Need: Health Promotion and Maintenance

 

Nursing Process: Assessment

 

Learning Outcome: 14-3

 

 

 

 

 

12)

 

The nurse is teaching a class of adolescent students the importance of physical exercise. Which statement by a student needs further discussion?

 

  1. A)

 

“I don’t need to exercise. I am healthy, unlike my mother, who has diabetes.”

 

  1. B)

 

“I walk my dog in the neighborhood for at least 30 minutes daily.”

 

  1. C)

 

“I ride my bike instead of driving whenever I can.”

 

  1. D)

 

“I exercise daily because heart disease runs in my family.”

 

Answer:

 

A

 

Explanation:

 

  1. A)

 

Health maintenance focuses on physical activity as a method to prevent diseases such as cardiovascular disease and diabetes. Youth who have family members with these diseases, or who meet adults who have them, are more likely to understand the importance of their own activity.

 

  1. B)

 

Walking 30 minutes every day is an appropriate activity.

 

  1. C)

 

Riding bikes instead of driving is healthy, and requires no further discussion.

 

  1. D)

 

The adolescent’s comment shows an understanding of how the risk factors for heart disease can be minimizedRemember, this comment requires no further discussion.

 

Cognitive Level: Analysis

 

Client Need: Health Promotion and Maintenance

 

Nursing Process: Assessment

 

Learning Outcome: 14-3

 

 

 

 

 

13)

 

The nurse is giving a group of adolescents a lecture on sex education. After the lecture, one adolescent asks the nurse for advice regarding being pressured by a boyfriend to have sex. Which response by the nurse is most appropriate?

 

  1. A)

 

“It’s okay to have sex with your boyfriend if you love him.”

 

  1. B)

 

“If all your friends are doing it, go ahead and follow your friends.”

 

  1. C)

 

“Continue with your plan of not having sex right now.”

 

  1. D)

 

“I can provide you with condoms if you need some.”

 

Answer:

 

C

 

Explanation:

 

  1. A)

 

It is not appropriate for the nurse to tell a student it is okay to have sex.

 

  1. B)

 

It is not appropriate to support peer pressure with regard to sex.

 

  1. C)

 

Provide support for adolescents who have decided not to have sexual intercourse. Encourage them to continue this plan, telling them that sexual feelings are normal, but that their decision about sexual intercourse is their right and privilege.

 

  1. D)

 

The adolescent has decided not to have sex, and should be supported in this decision, not offered condoms.

 

Cognitive Level: Analysis

 

Client Need: Health Promotion and Maintenance

 

Nursing Process: Implementation

 

Learning Outcome: 14-3

 

 

 

 

 

14)

 

The nurse is having an informal talk with a group of adolescent at a health fair. Which statement requires follow up by the nurse?

 

  1. A)

 

“I wish I had a different body.”

 

  1. B)

 

“I like the way I look, pleasingly plump.”

 

  1. C)

 

“I can lose a few pounds, according to my doctor.”

 

  1. D)

 

“I will begin to exercise to stay healthy.”

 

Answer:

 

A

 

Explanation:

 

  1. A)

 

A healthy image includes the realization that the body has positive and less positive attributes, and that the individual can influence the body through healthy eating and physical activity. Be alert for the teen whose wish for a different body leads to eating disorders and excessive exercise or intake of nutritional supplements.

 

  1. B)

 

The adolescent who makes this statement does not require follow-up by the nurse.

 

  1. C)

 

The comment to lose a few pounds does not require follow-up.

 

  1. D)

 

The nurse would not need to follow up after hearing this comment, as this is healthy.

 

Cognitive Level: Analysis

 

Client Need: Health Promotion and Maintenance

 

Nursing Process: Assessment

 

Learning Outcome: 14-3

 

 

 

 

 

15)

 

A teenager is accompanied by his mother to the annual physical examination. The nurse is aware of privacy issues related to the teenager. While the mother is in the room, which topic should the nurse avoid?

 

  1. A)

 

School friends

 

  1. B)

 

Cigarette smoking

 

  1. C)

 

School performance

 

  1. D)

 

Seatbelt use

 

Answer:

 

B

 

Explanation:

 

  1. A)

 

The nurse can ask general questions about seatbelt use, academic performance, and school friends without breaching confidentiality.

 

  1. B)

 

The nurse must maintain the nurse-client relationship, which is between the nurse and the adolescent, and the nurse must maintain confidentiality. Therefore, the nurse cannot ask any personal questions while the mother is in the room, such as those related to sexual activity, drug and alcohol use, and smoking cigarettes.

 

  1. C)

 

The nurse can ask general questions about seatbelt use, academic performance, and school friends without breaching confidentiality.

 

  1. D)

 

The nurse can ask general questions about seatbelt use, academic performance, and school friends without breaching confidentiality.

 

Cognitive Level: Application

 

Client Need: Health Promotion and Maintenance

 

Nursing Process: Implementation

 

Learning Outcome: 14-4

 

 

 

 

 

16)

 

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

 

  1. A)

 

Possible domestic violence

 

  1. B)

 

Teen job responsibilities

 

  1. C)

 

Activities done as a family

 

  1. D)

 

The adolescent’s role in the family

 

Answer:

 

A

 

Explanation:

 

  1. A)

 

If domestic violence is suspected, it would be appropriate to ask these questions only when the teenager is alone with the nurse or health care provider.

 

  1. B)

 

Job responsibilities are not confidential, and could be discussed in front of the parents.

 

  1. C)

 

The activities of the family are not confidential, and could be discussed when the parents are present.

 

  1. D)

 

The adolescent’s role in the family is not confidential, and could be discussed when the parents are present.

 

Cognitive Level: Application

 

Client Need: Health Promotion and Maintenance

 

Nursing Process: Implementation

 

Learning Outcome: 14-4

 

 

 

 

 

17)

 

An obese adolescent who adamantly denies sexual activity has a positive pregnancy test. Which of the following statements would be most appropriate for the nurse to make to this adolescent?

 

  1. A)

 

“Tell me how you feel about your body image.”

 

  1. B)

 

“When was your last menstrual period (LMP)?”

 

  1. C)

 

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

 

  1. D)

 

“Why are you denying sexual intercourse?”

 

Answer:

 

C

 

Explanation:

 

  1. A)

 

The adolescent’s body image does not address the teen’s current situation.

 

  1. B)

 

Asking about the LMP does not help connect the adolescent’s past behavior to her pregnancy.

 

  1. C)

 

The nurse must help the adolescent realize that previous behaviors have led to a positive pregnancy test. The only response by the nurse that will accomplish this goal is to ask a direct question in which the nurse and client search for an answer.

 

  1. D)

 

This option is too confrontational, and may alienate the adolescent.

 

Cognitive Level: Application

 

Client Need: Health Promotion and Maintenance

 

Nursing Process: Implementation

 

Learning Outcome: 14-4

 

 

 

 

 

18)

 

A mother reports that her adolescent daughter 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. A)

 

“You need to establish specific time frames for your adolescent and be certain she adheres to them.”

 

  1. B)

 

“Setting specific alarms and then reinforce the value of being ‘on-time’ may be helpful strategies to assisting her to be more of an ‘on-time’ individual.”

 

  1. C)

 

“Just let it go for now. Teachers and, in the future, employers will be the best people to help her be ‘on-time’.”

 

  1. D)

 

“You have a major problem. There must be a lot of screaming in your home.”

 

Answer:

 

B

 

Explanation:

 

  1. A)

 

The nurse who tells the mother to establish time frames is making the assumption this is not already the case in the household.

 

  1. B)

 

The best response is to help the mother find a way to help the teen deal with the problem of lateness.

 

  1. C)

 

It is not appropriate for the nurse to advise the mother to do nothing. The parents are the ones responsible for changing their child’s behavior.

 

  1. D)

 

This answer choice makes assumptions about the household communication in which the parent and adolescent live.

 

Cognitive Level: Application

 

Client Need: Health Promotion and Maintenance

 

Nursing Process: Implementation

 

Learning Outcome: 14-4

 

 

 

 

 

19)

 

The school nurse performs screenings on all students in the high school. In addition, the nurse will perform selected screenings on individual teenagers. When planning the screenings for the year, the nurse will include which screening for all teenagers?

 

  1. A)

 

Scoliosis

 

  1. B)

 

Hepatitis B profile

 

  1. C)

 

Respiratory rate

 

  1. D)

 

Chest x-ray

 

Answer:

 

A

 

Explanation:

 

  1. A)

 

Routine screening for adolescents includes checking for scoliosis, height, and weight, and blood pressure measurements.

 

  1. B)

 

The hepatitis B profile is needed only once, prior to administration of hepatitis B vaccine; however, this is not a required screening for all adolescents.

 

  1. C)

 

A respiratory rate is not a screening exam for all adolescents. It is done throughout childhood at each health supervision visit.

 

  1. D)

 

A chest x-ray is not a routine screening test for adolescents.

 

Cognitive Level: Application

 

Client Need: Health Promotion and Maintenance

 

Nursing Process: Planning

 

Learning Outcome: 14-5

 

 

 

 

 

20)

 

A nursing history on a 17-year-old female reveals that the adolescent takes a multivitamin with 0.5 mg of fluoride each day and one with 0.4 mg of folic acid each day. What concern should the nurse bring to the attention of the physician?

 

  1. A)

 

The presence of fluoride in the multivitamin

 

  1. B)

 

The amount of fluoride in the multivitamin; it should be increased to 1.0 mg each day.

 

  1. C)

 

The intake of folic acid

 

  1. D)

 

The need for a daily iron tablet

 

Answer:

 

A

 

Explanation:

 

  1. A)

 

Fluoride supplementation is not recommended for teenagers over the age of 16.

 

  1. B)

 

Fluoride supplementation is not recommended for teenagers over the age of 16.

 

  1. C)

 

Folic acid is recommended for all women of childbearing age to prevent neural tube defects.

 

  1. D)

 

There are no data to support iron recommendations for the client in this scenario.

 

Cognitive Level: Analysis

 

Client Need: Health Promotion and Maintenance

 

Nursing Process: Evaluation

 

Learning Outcome: 14-5

 

 

 

 

 

21)

 

An adolescent 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 go to college. I know I will be lonely there, too.” Which of the following takes priority when speaking with the adolescent?

 

  1. A)

 

Helping the adolescent realize the value of postsecondary education

 

  1. B)

 

Promoting healthy mental health outcomes

 

  1. C)

 

Acknowledging the fact that it takes several months to make new friends at a new school due to adolescent exclusion behaviors

 

  1. D)

 

Stressing the importance of remaining in a close parent-child relationship during these stressful times

 

Answer:

 

B

 

Explanation:

 

  1. A)

 

It would not be appropriate to discuss the importance of a college education at this time, since the adolescent must deal with the loss of friends and with developing new friends first.

 

  1. B)

 

The adolescent is obviously lonely with the move to the new school. The nurse should focus on appropriate coping skills, which will enhance good mental health outcomes for the child.

 

  1. C)

 

It would be more upsetting to the adolescent if the nurse made this comment.

 

  1. D)

 

The parent-child relationship should not be used as a substitute for the development of new peer relationships.

 

Cognitive Level: Application

 

Client Need: Health Promotion and Maintenance

 

Nursing Process: Evaluation

 

Learning Outcome: 14-5

 

 

 

 

 

22)

 

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 of these outcomes is consistent with these data?

 

  1. A)

 

The adolescent is reporting information consistent with what 60% of adolescents report as participation in physical activities.

 

  1. B)

 

The adolescent is not meeting the recommendations of the Healthy People 2010 initiative.

 

  1. C)

 

The adolescent should be encouraged to continue this program of exercise, since something is better than nothing.

 

  1. D)

 

The adolescent should be encouraged to vigorously exercise for at least five minutes each day.

 

Answer:

 

B

 

Explanation:

 

  1. A)

 

There is inadequate information in this scenario to choose this answer option.

 

  1. B)

 

In this scenario, the adolescent is not receiving the recommended amount of exercise to support good health habits.

 

  1. C)

 

Suggesting that “something is better than nothing” is not good practice.

 

  1. D)

 

Encouraging the adolescent to continue as is or to exercise vigorously for five minutes each day also is not consistent with current recommendations.

 

Cognitive Level: Application

 

Client Need: Health Promotion and Maintenance

 

Nursing Process: Evaluation

 

Learning Outcome: 14-5

 

 

 

 

 

23)

 

The nurse has just completed a thorough assessment of an adolescent in the clinic who has begun dating and is now withdrawn. Which diagnosis is appropriate for the adolescent and family?

 

  1. A)

 

Rape-Trauma Syndrome related to date rape

 

  1. B)

 

Balanced Nutrition: adequate body requirement

 

  1. C)

 

High Self-Esteem related to good friends

 

  1. D)

 

Adequate Sleep Pattern related to adequate sleep schedule

 

Answer:

 

A

 

Explanation:

 

  1. A)

 

A wide array of health concerns should be included in the assessment of adolescent. Based on a thorough assessment, you will establish nursing diagnoses that are appropriate for the adolescent and family. One possible nursing diagnosis might be Rape-Trauma Syndrome related to date rape for the teen who has recently begun dating and now is withdrawn.

 

  1. B)

 

There is no inclusion of nutrition information in this scenario.

 

  1. C)

 

Withdrawal is not an indication of high self-esteem and good friendships.

 

  1. D)

 

There is no indication of sleep pattern in this scenario.

 

Cognitive Level: Analysis

 

Client Need: Health Promotion and Maintenance

 

Nursing Process: Diagnosis

 

Learning Outcome: 14-6

 

 

 

 

 

24)

 

The nurse is speaking with a group of adolescents about what can happen when having unprotected sex. The nurse understands that to communicate effectively with teens, she must:

 

  1. A)

 

Allow for discussion, and bring peers who have had experience related to the topic being discussed.

 

  1. B)

 

Lecture on the topic for the allotted time without any discussion.

 

  1. C)

 

Offer personal opinions on the topic, and cite examples of what can happen if they don’t listen.

 

  1. D)

 

Discuss sex education related to religious belief.

 

Answer:

 

A

 

Explanation:

 

  1. A)

 

Whatever the setting, the nurse partners with the adolescent, the parents, and other persons such as teachers or school counselors to plan appropriate goals and related intervention. Apply communication skills effective with teens, such as listening to concerns, allowing for discussion, and bringing peers who have had experiences related to the topic being discussed.

 

  1. B)

 

Lecturing without discussion will not draw in the adolescent to the content.

 

  1. C)

 

Personal opinions will not carry much weight with a group of adolescents.

 

  1. D)

 

Discussing sex education from a religious viewpoint is not appropriate.

 

Cognitive Level: Analysis

 

Client Need: Health Promotion and Maintenance

 

Nursing Process: Planning

 

Learning Outcome: 14-6

 

 

 

 

 

25)

 

What would be the best way for the nurse to teach adolescents regarding health promotion and health maintenance?

 

  1. A)

 

Have the adolescents identify a personal health goal.

 

  1. B)

 

Tell the adolescents what you will lecture on.

 

  1. C)

 

Ask the advice of the counselors at school.

 

  1. D)

 

Contact the parents and ask what issues they have with their adolescents.

 

Answer:

 

A

 

Explanation:

 

  1. A)

 

Teaching topics will be directed at both health promotion and health maintenance. A good starting point is to have the adolescent identify a personal health goal, and begin teaching there.

 

  1. B)

 

Lecturing an adolescent group is not as effective as is having an honest and open discussion with adequate time for questions.

 

  1. C)

 

It is not necessary for the nurse to ask the counselors at school for advice on health topics.

 

  1. D)

 

Talking to the parents first is not necessary. The same issues arise for adolescents, and should be discussed in general, and not according to specific individuals.

 

Cognitive Level: Analysis

 

Client Need: Health Promotion and Maintenance

 

Nursing Process: Planning

 

Learning Outcome: 14-6

 

 

 

 

 

1)

 

A

 

 

 

2)

 

B

 

 

 

3)

 

C

 

 

 

4)

 

D

 

 

 

5)

 

C

 

 

 

6)

 

D

 

 

 

7)

 

A

 

 

 

8)

 

A

 

 

 

9)

 

A

 

 

 

10)

 

A

 

 

 

11)

 

B

 

 

 

12)

 

A

 

 

 

13)

 

C

 

 

 

14)

 

A

 

 

 

15)

 

B

 

 

 

16)

 

A

 

 

 

17)

 

C

 

 

 

18)

 

B

 

 

 

19)

 

A

 

 

 

20)

 

A

 

 

 

21)

 

B

 

 

 

22)

 

B

 

 

 

23)

 

A

 

 

 

24)

 

A

 

 

 

25)

 

A

 

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