Chapter 21: Adolescent

Edelman: Health Promotion Throughout the Life Span, 8th Edition

MULTIPLE CHOICE
1. When do females usually begin puberty?
a. 1 year before males
b. 1 year after males
c. 2 years before males
d. 2 years after males
ANS: C

Females usually begin puberty 2 years before males and experience their growth spurts earlier.
DIF: Cognitive Level: Remember (Knowledge)

REF: p. 515

2. A teenager has been using acne medications for the last 14 days. Her acne is no better, and in

fact, it is a little worse. What information should the nurse offer this girl?
a. Wash your face at least four times a day, making sure to scrub well.
b. The medications can make acne appear worse at first; try to give it a few more
weeks.
c. Avoid all chocolate products.
d. Because it is summertime, it would be good for your skin if you lie out in the sun
for a few hours each day.
ANS: B

Acne is common in adolescents. Evidence indicates that dietary restrictions for acne are
unnecessary. Although washing with soap and water is the best way to remove dirt, vigorous
scrubbing should be discouraged. Furthermore, although sunlight can have a beneficial effect on
acne, prolonged exposure should be avoided. Topical acne products make acne appear worse
initially, and improvement occurs slowly over several months. Nurses should provide this
information to teenagers planning to use acne products, so they are not discouraged early in
therapy.
DIF: Cognitive Level: Apply (Application)

REF: p. 517

3. The mother of a 13-year-old girl is concerned because her daughter has not started menstruating

yet. The girl developed breast buds and started her height spurt at 12 years of age. Which of the
following statements would be the most appropriate response from the nurse?
a. Usually, girls start menstruating when they develop breast buds; an endocrine
evaluation might be warranted.
b. Everyone is different; it will happen when it happens.
c. Based on when the breast buds first appeared, she should starting menstruating
around the age of 14.
d. She will not start menstruating until her breasts are of adult size and contour.
ANS: C

The first sign of puberty in females is the appearance of breast buds, followed by a growth spurt.
The onset of menstruation occurs approximately 2 years after the appearance of breast buds and
near the end of the growth spurt. Thus, based on the age of breast bud appearance, the girl should
start menstruating around age 14.
DIF: Cognitive Level: Apply (Application)

REF: p. 518

4. Which female disorder is characterized by only one X chromosome present instead of two?
a. Gynecomastia
b. Menstruation
c. Turner syndrome
d. Klinefelter syndrome
ANS: C

A female disorder in which only one X chromosome is present instead of two is known as Turner
syndrome.
DIF: Cognitive Level: Remember (Knowledge)

REF: p. 518

5. Which of the following disorders is characterized by males having an extra chromosome,

typically being tall and initially thin, and not developing secondary sex characteristics?
a. Gynecomastia
b. Menstruation
c. Turner syndrome
d. Klinefelter syndrome
ANS: D

A disorder in which males have an extra chromosome and typically are tall and initially thin, and
do not develop secondary sex characteristics is known as Klinefelter syndrome.
DIF: Cognitive Level: Remember (Knowledge)

REF: pp. 518-519

6. Parents recently discovered that their teenage daughter has been consuming alcohol on a regular

basis. They ask the nurse for advice on how to best help their daughter. Which of the following
recommendations should the nurse give to the parents?
a. Talk to their daughter at length regarding the dangers associated with drinking.
b. Tell their daughter she will not be allowed to use her cell phone if this continues.
c. Enroll their daughter in a peer support group focused on teenage drinking.
d. Provide their daughter with literature regarding the dangers of drinking.
ANS: C

Teens do not always consider health risks associated with their risky behaviors. Additionally,
peer influence is primary and parental input is often rejected. In this case, the teenager may risk
losing her cell phone and privileges by continuing with her risky behavior, but because peer
influence is primary, the parents should enroll her in a peer support group focused on teenage
drinking.
DIF: Cognitive Level: Apply (Application)

REF: p. 519

7. Which of the following behaviors is most reflective of a teenager?

a. Riding an ATV without a helmet
b. Not skiing for fear of falling and getting hurt
c. Obeying a new parental rule without a challenge
d. Walking away from a group of friends who are smoking cigarettes
ANS: A

Teenagers are known for their risk-taking behaviors. They do not always consider the health risks
associated with their behaviors. In addition, they often do things because their friends do it.
Therefore, riding an ATV without a helmet and risking a head injury is most reflective of a
teenagers behavior.
DIF: Cognitive Level: Analyze (Analysis)

REF: p. 519

8. What percentage of adolescent females suffer from an eating disorder in the United States?
a. 5%
b. 10%
c. 15%
d. 20%
ANS: B

Ten percent of adolescent females suffer from an eating disorder in the United States.
DIF: Cognitive Level: Remember (Knowledge)

REF: pp. 519-520

9. During a physical exam, a teenager asks the nurse if she can have a stronger medication for her

constipation because the laxatives she has been taking are not helping. During the physical exam,
the nurse observes mild to moderate erosion of the tooth enamel. Which of the following
disorders is the client most likely experiencing?
a. Bulimia nervosa
b. Binge eating disorder
c. Idiopathic constipation
d. Irritable bowel syndrome
ANS: A

Bulimia nervosa is characterized by binge eating and then purging by self-induced vomiting
and/or laxatives. Purging can also lead to erosion of the tooth enamel. Bulimia nervosa occurs
more commonly in females. A teenage girl asking for stronger laxatives with tooth enamel
erosion should cause any health care provider to consider the possibility of bulimia nervosa.
DIF: Cognitive Level: Apply (Application)

REF: p. 520

10. A teenager has a family history of Type 2 diabetes mellitus. He asks the nurse what he can do to

try to prevent developing it himself. Which of the following instructions should the nurse give
this client?
a. Tell him to avoid any and all sweets.
b. Tell him to be active and eat a balanced diet.
c. Tell him he should talk to his physician about genetic testing.
d. Tell him that very little can be done to avoid developing this disorder.

ANS: B

Obesity is making Type 2 diabetes mellitus common among teens and young adults. Being
overweight and inactive increases the risk. Therefore, encouraging activity and a balanced diet is
the best information the nurse can give to the client. Telling him to avoid all sweets would be an
impossible request, and genetic testing does not detect the development of this disorder.
DIF: Cognitive Level: Apply (Application)

REF: p. 521

11. Which of the following teenage behaviors is cause for concern?

a. Has difficulty waking up in the morning and naps during the day
b. Goes to bed late and naps during the day
c. Takes frequent naps and states it is because he is bored
d. Participates in after school activities and has difficulty waking up
ANS: C

Adolescents need at least 8 hours of sleep per night. Often, they stay up late and wake up for
school before their sleep cycles have finished; therefore, napping is common. However, those
with a decreased energy level who use words such as bored or sad should be further
evaluated for suspected depression. Therefore, a teenager who takes frequent naps and states it is
because he is bored is cause for concern because this behavior might indicate depression.
DIF: Cognitive Level: Analyze (Analysis)

REF: p. 522 | p. 525

12. A mother is concerned because her daughter has been taking a nap every day after school. Which

of the following statements would be the best response by the nurse?

a. Dont worry; all teenagers do that.
b. Tell me about your daughters schedule.
c. Lets bring her in for some blood work.
d. Have you addressed the topic of drugs with you daughter?
ANS: B

Many teenagers take naps, although this does not address the mothers concern. Although the nap
can be a symptom of a health problem or drug use, additional information is necessary to make
that determination. Asking the mother to tell you about her daughters schedule provides
information to determine whether the behavior is normal or whether it requires further
investigation.
DIF: Cognitive Level: Analyze (Analysis)

REF: p. 522

13. Which of the following teenagers is at risk for not meeting his developmental task?
a. Arrested for petty theft
b. Decided he wants to major in accounting
c. Has recently broke up with his girlfriend
d. Is a member of the varsity basketball team
ANS: A

The central task of adolescence according to Erikson is the establishment of identity, with the
primary risk being role confusion. As the adolescent searches for direction, he makes choices in
social, recreational, volunteer, academic, familial, and occupational activities. When the threat of
confusion is exceedingly great, delinquent behavior and alterations in mental health can occur.
Thus, a teenager arrested for petty theft is displaying delinquent behavior that may place him at
risk for not meeting his developmental task of identity.
DIF: Cognitive Level: Analyze (Analysis)

REF: p. 522

14. Which of the following actions should parents take to help their teenager meet his developmental

task?
a. Set strict rules to prevent the teenager from getting into any trouble.
b. Maintain an ongoing dialogue about important issues and upcoming challenges.
c. Maintain a friendship with the teenager, so he views parents as peers.
d. Be very lenient with the teenager so that he can figure out who he is as a person.
ANS: B

Imposing strict limits and eliminating all rules are not helpful to teenagers. Families in which
parents maintain a willingness to listen, demonstrate an ongoing affection for and acceptance of
their adolescent, yet still maintain some consistent limits, experience more constructive, positive
outcomes during adolescence. Thus, maintaining an ongoing dialogue about important issues and
upcoming challenges demonstrates the parents willingness to listen and their concern.
DIF: Cognitive Level: Apply (Application)

REF: pp. 523-524

15. Which of the following teenagers is at increased risk for acquiring a sexually transmitted disease

and should be provided with anticipatory guidance?

a. Asks the nurse for information about condoms
b. Feels her friends and family do not care about her
c. Has multiple friends and feels good about herself
d. Talks to her boyfriend on the phone for hours
ANS: B

Adolescents often talk on the phone for hours, providing a safe way for them to interact with
members of the opposite sex. However, adolescence is a time when teenagers fantasize about
relationships and sex. Teenagers decide to become sexually active for a number of reasons,
including affection. This can put them at increased risk for sexually transmitted diseases;
therefore, anticipatory guidance regarding protection from sexually transmitted diseases needs to
be provided before the adolescent is in a situation that can place him or her at risk.
DIF: Cognitive Level: Analyze (Analysis)

REF: p. 524

16. A mother is concerned because her 13-year-old daughter comes home happy one day and sad the

next. The girl also argues with her younger sister more than she did in the past, and does not like
participating in family activities anymore. Which of the following is the best initial response
from the nurse?
a. The changes during adolescence can be stressful as they struggle to come to terms
with who they are. What other types of behaviors has she been displaying?

b. Changes in affect can be a warning sign for suicide. Has she had any increase in

risk-taking behaviors or physical violence?

c. Is there any history of psychological disorders in your family?
d. Withdrawal can be a sign of substance abuse. Has she given you any indication

she might be using illicit drugs?

ANS: A

Although dramatic swings in affect can be a warning sign for suicide, and withdrawal can be a
sign of substance abuse, additional information is required before suggesting a diagnosis. Often,
mood swings and spending more time with peers and less time with the family is normal
adolescent behavior during this period of rapid change in physical, psychosocial, spiritual, moral,
and cognitive growth. Parents and teenagers should be aware of and prepared for these changes.
DIF: Cognitive Level: Analyze (Analysis)

REF: pp. 525-526

17. Which of the following is the third leading cause of death in adolescents between 10 and 24

years of age?
a. Accidents
b. Suicide
c. Cancer
d. Sport injuries
ANS: B

The third leading cause of death in adolescents between 10 and 24 years of age is suicide.
DIF: Cognitive Level: Remember (Knowledge)

REF: p. 526

18. After offering a teenager the HPV vaccine, the teenager responds by saying, I cant have the

vaccine because I have already been sexually active. Which of the following statements is the
best response by the nurse?
a. You can still benefit from the vaccine, but there is a chance it will not be as
effective.
b. The best way to protect yourself now is to make sure all your future sexual
partners have received the vaccine.
c. You are correct, the vaccine is only indicated for females who have never been
sexually active.
d. It depends on the number of partners you have had. If you have had less than five
partners, you are still eligible for the vaccine.
ANS: A

The HPV vaccine is recommended for 11- to 12-year-old girls and for 13- to 26-year olds who
have not yet received or completed the vaccine series. Ideally, females should receive the vaccine
before they are sexually active because girls who have not been infected with any of the four
HPV types covered by the vaccine will receive the full benefits of the vaccine. Females who are
sexually active may also benefit but to a lesser degree. It is not known if the vaccine is effective
in boys or men. Thus, the best response is, You can still benefit from the vaccine, but there is a
chance it will not be as effective.
DIF: Cognitive Level: Apply (Application)

REF: p. 530

19. A nurse is initiating a discussion about alcohol consumption during a physical exam with a

teenager. Which of the following questions would be most appropriate for the nurse to ask?
a. So, what do you and your friends do for fun and excitement?
b. Do you have access to alcohol?
c. Do any of your friends drink?
d. Do you want to talk about alcohol or drinking?
ANS: C

Anticipatory guidance during a physical exam is important. This includes asking about substance
use. Questions should not be vague because they may be misinterpreted. Direct questions are
useful when discussing sensitive topics. However, asking first about friends and the adolescents
feelings about them is a good lead-in approach to a discussion about substance use.
DIF: Cognitive Level: Analyze (Analysis)

REF: p. 532

20. The school nurse is working on a campaign in the school to prevent adolescent pregnancies.

Which of the following interventions should the nurse implement?

a. Talk to teenagers about sex, including abstinence, contraception, and sexually
transmitted diseases.
b. Tell the teenagers they should abstain from sex until they are old enough to cope
with the potential consequences such as an unwanted pregnancy.
c. Encourage parents of all teenage girls to make sure their daughters start oral
contraceptives early.
d. Offer all teenagers free condoms when they come in for physical exams.
ANS: A

The emergence of secondary sexual characteristics increases adolescents awareness of

themselves as sexual human beings leading to experimentation. Primary prevention is necessary
to help prevent adolescent pregnancies. Parents, teachers, and health care providers will be more
successful in assisting teens to manage their health needs if they treat them as joint partners.
Talking to teenagers about sex, contraceptive options, and sexually transmitted diseases gives
them the information and anticipatory guidance they need to help them make a decision.
DIF: Cognitive Level: Analyze (Analysis)

REF: p. 524 | p. 520 (Box 21-3)

21. A teenager asks the school nurse for advice before getting a tattoo. Which of the following

responses would be most appropriate for the nurse?

a. You should not get a tattoo.
b. It is okay to get a tattoo if you go to a licensed artist.
c. Tattoos are popular; however, they can lead to infection and/or bleeding.
d. A body piercing would be safer and less permanent.
ANS: C

Tattoos and piercings carry similar risks, which include localized infection, bleeding, and
dermatitis. In addition, tattoos carry a heightened concern for blood-borne disease such as
hepatitis and HIV. When providing anticipatory guidance, nurses should treat teenagers as
partners and give them the information they need to make an informed decision. Therefore,
informing the teenager about the risk of infection is the best response.

DIF: Cognitive Level: Apply (Application)

REF: p. 523 (Box 21-5)

22. A teenager is expecting her menstrual period on May 14. On which of the following dates would

the nurse recommend that she perform a self-breast exam?

a. May 11
b. May 14
c. May 17
d. May 23
ANS: D

The best day to perform a self-breast exam is 2 to 3 days after ones period when breasts are least
likely to be tender or swollen. A typical period lasts about 6 days. Thus, a teenager who starts her
period on May 14 should perform a breast self-exam on May 23 (14 + 6 = 20 + 3 = 23).
DIF: Cognitive Level: Apply (Application)

REF: p. 525 (Box 21-6)

23. Which of the following teenagers is exhibiting a behavior that cause for concern and requires

further evaluation?
a. Is always very happy
b. Is agitated and has trouble sleeping
c. Has a lot of homework and stays up late to finish it
d. Values his friends opinion more than his parents opinion
ANS: B

Nurses should be aware that the problem of substance abuse exists. They should also be aware of
what the signs and symptoms are. Agitation and insomnia are signs of substance abuse and
should therefore be evaluated further.
DIF: Cognitive Level: Analyze (Analysis)

REF: p. 529 (Box 21-10)

24. Which stage of male genital development is characterized by initial enlargement of the penis,

mainly in length along with further growth of the testes and scrotum?
a. 1
b. 2
c. 3
d. 4
ANS: C

In stage 3, male genital development is characterized by initial enlargement of the penis, mainly
in length along with further growth of the testes and scrotum.
DIF: Cognitive Level: Remember (Knowledge)

REF: p. 516 (Table 21-1)

25. Which stage of female breast development is characterized by enlargement of the areolar

diameter along with a small area of elevation around the papillae?

a. 1
b. 2
c. 3

d. 4
ANS: B

In stage 2, female breast development is characterized by enlargement of the areolar diameter

along with a small area of elevation around the papillae.
DIF: Cognitive Level: Remember (Knowledge)

REF: p. 516 (Table 21-1)

26. A 14-year-old female is in for a physical exam. Which finding requires further investigation?
a. A height spurt since her last visit
b. Facial acne
c. The lack of breast buds
d. Noticeable sweating and body odor with activity
ANS: C

The onset of puberty usually begins around 11 to 13 years of age. Stage 2 is the usual time of
peak height velocity for girls. Additionally, both sweat and sebaceous glands become more active
during adolescence leading to sweat, body odor, and acne. Breast buds also usually appear during
stage 2 of puberty. Females who have not begun pubertal development by age 14 should have an
endocrine evaluation. Thus, the finding of lack of breast buds on this 14-year-old girl requires
further investigation.
DIF: Cognitive Level: Analyze (Analysis)
REF: p. 516 (Table 21-1) | p. 518 (Figure 21-3)
MULTIPLE RESPONSE
1. Which of the following are symptoms or warning signs of anorexia nervosa? (select all that

apply)
a. Lack of menstruation in females
b. Preoccupation with food
c. Eating only small amounts of certain foods
d. Dramatic weight fluctuations
ANS: A, B, C, D

Symptoms or warning signs of anorexia nervosa include the relentless pursuit of thinness, selfstarving with significant weight loss, lack of menstruation in females, decreased sexual interests
in males, compulsive physical activity, preoccupation with food, portioning food carefully, eating
only small amounts of only certain foods, and a distorted body image. Dramatic weight
fluctuations are seen with bulimia nervosa.
DIF: Cognitive Level: Understand (Comprehension)

REF: p. 520

2. A nurse is discussing being a safe driver as part of a drivers education course. Which of the

following recommendations would the nurse include in this presentation? (select all that apply)
a. Carpooling with friends
b. Avoiding talking on cell phones
c. Driving during daytime hours

d. Wearing safety belt

ANS: B, C, D

The risk of motor vehicle crashes is four times higher among 16- to 19-year-old adolescents than
among any other age group. Research suggests that distractions, such as talking or texting on cell
phones, eating, or playing with the radio, increase teen drivers risk of being involved in a crash.
Nurses should talk to teens about these distractions, which can also include riding with a car full
of other teens. Teens have a much higher nighttime crash fatality rate as well.
DIF:

Cognitive Level: Apply (Application)