HESI Patient Review Adolescent answers

Hesi patient review Adolescents Ashley (11 years) and Mark (12 years) are both considered adolescents. Adolescence includes three developmental phases: early, middle, and late adolescence. Ashley and Mark are in which phase of adolescence? Early adolescence Correct Maturing females and males 11-14 years of age are considered in early adolescence. Early adolescence is the beginning of the transition period between childhood and early adulthood. During adolescence, sexual, psychological, and social maturation occur gradually. Maturing females and males 14-17 years of age are considered in middle adolescence. Maturing females and males ages 17-20 years of age are considered in late adolescence. Middle adolescence Ashley and Mark are not in middle adolescence. Maturing females and males 14-17 years of age are considered in middle adolescence. Late adolescence Ashley and Mark are not in late adolescence. Maturing females and males ages 17-20 years of age are considered in late adolescence. Ashley and Mark are prepubescent, meaning that they are: beginning to develop physical secondary sex characteristics Correct Prepubescent adolescents experience hormonal changes that cause their reproductive organs to start functioning. Physical maturation is noted in the beginning development of secondary sex characteristics. at the peak of achieving mature physical secondary sex characteristics The prepubescent period does not include achievement of mature physical secondary sex characteristics. sexually mature The prepubescent period does not include achievement of sexual maturity. capable of reproduction Prepubescent adolescents are not able to produce and bear children. Which of the following will be used to assess physical sexual maturity? Clinical growth charts for (female and male) children and adolescents age 2-20 years Both Ashley and Mark will have their weight and standing height (stature) measured and plotted on clinical growth charts appropriate for their ages and sex. Their percentile rankings for stature and weight will be determined. However, these charts do not assess physical sexual maturity. Tanner stages Correct Five stages of sexual maturity, as described by Tanner, are useful for assessing physical sexual maturity. Both Ashley and Mark will be examined and their stages of sexual maturity, as defined by Tanner, will be determined. Body surface area (BSA) Body surface area (BSA) in square meters (m2) does not provide information about physical sexual maturity. BSA measurement is often important when drug dosages and other treatments (fluids, radiation etc.) are planned. Body mass index (BMI) Body mass index (BMI) does not provide information about physical sexual maturity. 4. For girls, Tanner's sexual maturity ratings evaluate: Select all that apply (there are 2 correct answers). pubic hair growth and distribution Correct For girls, Tanner's sexual maturity ratings evaluate pubic hair growth and distribution. The location, density, and coarseness of pubic hair help define the stage of sexual maturity. breast changes and growth Correct For girls, Tanner's sexual maturity ratings evaluate breast changes and growth. Changes in nipples and areola are considered. Changes in breast size and contour are also evaluated. These changes help define the stage of sexual maturity. onset of menarche The first menstrual period, menarche, signals puberty. However, onset of menarche is not a component of Tanner staging. behavioral changes Behavioral changes occur with adolescence, and onset of menses. However, behavioral changes are not considered for Tanner staging. 5. For boys, Tanner's sexual maturity ratings evaluate: Select all that apply (there are 4 correct answers). pubic hair growth and distribution Correct For boys, Tanner's sexual maturity ratings evaluate pubic hair growth and distribution. The location, density, and coarseness of pubic hair help define the stage of sexual maturity. onset of seminal emissions The ability to ejaculate semen (have seminal emissions) signals male puberty. However, the ability to have seminal emissions is not considered for Tanner staging. penis growth and development Correct The size and shape of the penis are evaluated as part of Tanner staging. testes growth and development Correct The size and shape of the testes are evaluated as part of Tanner staging. scrotum growth and development Correct The size and shape of the scrotum, and the color and texture of scrotal skin, are evaluated as part of Tanner staging. Referring to Tanner's stages, Ashley's sexual maturity (breasts) is rated as: Tanner Stage 1 Ashley is not in Tanner Stage 1 for sexual maturity (breasts). Tanner Stage 1 is prepubertal. Nipples are present and elevated. Glandular breast tissue is not present. Tanner Stage 2 Correct Ashley is correctly rated in Tanner Stage 2 for sexual maturity (breasts). Tanner Stage 2 is the breast bud stage. A small mound of breast tissue is present. Nipples are elevated. The diameter of each areola is enlarged. As breast tissue develops, some soreness may be felt. Tanner Stage 3 Ashley is not in Tanner Stage 3 for sexual maturity (breasts). In Tanner stage 3, breasts are larger and have more elevation. Each areola is in contour with the breast tissue. Tanner Stage 4 Ashley is not in Tanner Stage 4 for sexual maturity (breasts). In Tanner stage 4, breasts are larger and each areola projects from the breast contour. Tanner Stage 5 Ashley is not in Tanner Stage 5 for sexual maturity (breasts). In Tanner stage 5, breasts are mature, with nipple projection and some receding of each areola to the general contour of the breast. Ashley's exam also includes assessment of pubic hair distribution. A small amount of fine straight hair is noted along her labia. Referring to Tanner's stages, Ashley's sexual maturity (pubic hair) is rated as: Tanner Stage 1 Ashley is not in Tanner Stage 1 for sexual maturity (pubic hair). In Tanner Stage 1 (pubic hair), there is no pubic hair. Tanner Stage 2 Correct Ashley is in Tanner Stage 2 for sexual maturity (pubic hair). In Tanner Stage 2 (pubic hair), pubic hair growth is sparse. Hair is straight and fine, along the labia. Tanner Stage 3 Ashley is not in Tanner Stage 3 for sexual maturity (pubic hair). In Tanner Stage 3 (pubic hair), pubic hair growth spreads from the labia over the symphysis pubis. Hair is darker, coarser, and curlier than that in Tanner Stage 2. Tanner Stage 4 Ashley is not in Tanner Stage 4 for sexual maturity (pubic hair). In Tanner Stage 4 (pubic hair), pubic hair growth covers a wider area than in Tanner Stage 3. Tanner Stage 5 Ashley is not in Tanner Stage 5 for sexual maturity (pubic hair). In Tanner Stage 5 (pubic hair), pubic hair growth is mature, spreading on the medial surfaces of the thighs. Ashley wants to know when she will get her "period." You correctly tell her that there is no way of knowing for sure, but commonly menstruation begins: Hint a few months after breast tissue starts to develop It is not accurate that menstruation begins a few months after breast tissue starts to develop. 1-2 years after breast tissue starts to develop Correct Menstruation (menarche) usually occurs within two years of the start of breast tissue development and the appearance of pubic hair. Menstruation usually coincides with physical sexual maturity. at age 13 years Menstruation often begins around 13 years of age. However, physical sexual maturity, and not age, is related to the onset of menstruation. when pubic hair appears It is not accurate that menstruation begins when pubic hair appears. You review Ashley's immunization history with her mother. Ashley has not received the hepatitis B vaccine series. Which of the following approaches is likely to be taken by the Nurse Practitioner today? Hint Since hepatitis B is only a threat to infants, Ashley will not need the vaccine It is not true that hepatitis B is only a threat to infants. The hepatitis B vaccine series will be started today Correct Although Ashley is not required to have the hepatitis B vaccine series until high school in her community, the vaccine should not be delayed. It is likely that the hepatitis B vaccine series will be started today. Hepatitis B is a serious communicable health problem caused by the hepatitis virus. It can spread from an infected person to others by means of blood, body fluids, and intimate sexual contact. Hepatitis B is a special threat to adolescents who may be sexually active and/or using drugs. Chronic hepatitis B infection can occur in some individuals, who then become carriers of the infection. The likelihood of becoming chronically infected is especially high in infants and young children who are infected. Chronic hepatitis B infection causes liver damage and increases risk of liver cancer. Since the hepatitis B vaccine series will be required for high school, the vaccine series will be started at a later date Although Ashley is not required to have the hepatitis B vaccine series until high school in her community, the vaccine should not be delayed. 10. The adolescent's right to confidentiality is designed to: Select all that apply (there are 2 correct answers). Hint encourage the adolescent to seek healthcare and advice without fear Correct Fear that disclosure of information to parents or legal authorities will occur is a primary reason that adolescents avoid seeking health care and advice. It is important that adolescents know that the information they provide will be confidential. In most states, confidentiality laws cover contraception, pregnancy, abortion, sexually transmitted diseases (STDs), and drug counseling. The healthcare professional should be familiar with the state laws concerning confidentiality. Under these laws, an adolescent can obtain pregnancy testing, abortion services, and treatment for STDs without the consent of parents. support the adolescent's growing sense of autonomy Correct Adolescents have a growing need for autonomy. This need can be supported by allowing the adolescents privacy and respect for their decisions. keep information from judgmental parents The rules of privacy and confidentiality are not designed to keep information from judgmental parents. help the adolescent keep secrets about her social and sexual activities from her parents The right to confidentiality is not intended to encourage adolescents to keep secrets from their parents. 11. As Ashley and Mark experience their adolescent years, risk-taking and risk for injury may increase. This is because adolescents: Select all that apply (there are 4 correct answers). Hint May test their independence from parents by participating in behaviors disapproved of by parents Correct It is true that adolescents often test their independence by acting in ways that are not supported by their parents. Often, the behaviors they choose are high-risk. As adolescents transition into young adulthood, they try out various roles in an effort to gain an understanding of their identity. Often feel indestructible and invincible Correct Adolescence is a time when many young men and women feel immortal and indestructible. This contributes greatly to risk-taking behavior and risk for injury. tend to participate in and prefer solitary activities Adolescents tend to participate in group activities, rather than solitary activities. An adolescent is probably more likely to participate in high-risk behaviors when others are doing the same. Although participation in sports is worthwhile, athletic activity does increase risk for injury. Proper protective gear should be worn and safe technique should be practiced at all times. tend to strictly adhere to rules and regulations Many adolescents do not feel a strong need to adhere to rules. Adolescents often begin to test their independence by breaking established rules. Many rules are established to insure safety. Breaking of rules often increases risk for injury. have a strong need for peer approval Correct Adolescents display increasing resistance to parental demands during adolescence, as the peer group gains importance. The peer group is essential to an adolescent as he attempts to meet the standards and expectations of the group. The peer group, rather than objectivity and good judgment, provides the frame of reference for the adolescent. Therefore, his decisions may not always be appropriate. The ultimate goal of the adolescent is to become emancipated from parents. frequently have a strong desire to impress parental figures In the adolescent years, the need to impress peers outweighs the desire to impress parents. have a strong need to discharge energy Correct Adolescence is a time of high energy levels. Increased activity level often increases risk for injury. Because Ashley is not currently participating in any high-risk behaviors, you should: Hint defer any discussion of high-risk behaviors, so as not to give Ashley any ideas It would not be appropriate to defer discussion of high-risk behaviors. initiate a discussion of high-risk behaviors and their consequences, in hope of preventing them Correct An anticipatory guidance and preventive approach should be taken with Ashley. It is likely that she will be exposed to many possibilities for high-risk behaviors. Knowledge about these and possible consequences will possibly make Ashley think twice before choosing to participate in high-risk activity. 13. Taking a preventive approach, you discuss with Ashley some of the risks associated with smoking, alcohol, and drug use. Which of the following are accurately included in your discussion? Select all that apply (there are 4 correct answers). Hint Many young people who try cigarettes become regular users Correct Of the youth that try cigarettes, many become regular users. Ashley should be told this. The younger a person is when she starts smoking, the harder it is to quit smoking in the future Correct The younger a person is when smoking begins, the stronger the addiction, and the harder it is to stop smoking. Ashley should be told this. The younger a person is when she starts smoking, the greater the chance of developing serious health problems Correct Health problems associated with smoking begin sooner and are generally more serious in persons who started smoking at younger ages. Ashley should be told this. If only a few cigarettes are smoked a day, it is not hard to quit smoking Nicotine is addicting. It is always hard to quit smoking. Once drugs or alcohol are used, it becomes very hard to quit Correct When adolescents use alcohol and drugs early in their teen years, the more likely it is that dependence and addiction will develop. It is important that Ashley know that it is important not to experiment with alcohol and drugs. If she does start using drugs and alcohol, it is likely she may become dependent and have difficulty stopping. Referring to Tanner's stages, Mark's sexual maturity is rated as: Tanner Stage 1 Mark is not correctly rated in Tanner Stage 1 for sexual maturity. In Tanner Stage 1, the penis and testes are prepubertal without pubic hair. Tanner Stage 2 Correct Mark is correctly rated in Tanner Stage 2 for sexual maturity. In Tanner Stage 2, there is enlargement of the scrotum and testes, but the penis is not enlarged. The scrotal skin is reddened and there is a sparse growth of long slightly pigmented downy hair at the base of the penis. Tanner Stage 3 Mark is not correctly rated in Tanner Stage 3 for sexual maturity. In Tanner Stage 3, the testes and scrotum continue to enlarge, and the penis increases in length. Pubic hair becomes coarse and curly, and extends across the pubis. Tanner Stage 4 Mark is not correctly rated in Tanner Stage 4 for sexual maturity. In Tanner Stage 4, there is further enlargement of the testes and scrotum, and the penis increases in length and circumference. Pubic hair increases in area but does not extend to the thighs. Tanner Stage 5 Mark is not correctly rated in Tanner Stage 5 for sexual maturity. In Tanner Stage 5, pubic hair extends to the medial surfaces of the thighs. Mark expresses concern that his sister is younger but taller than he is. Which of the following responses to Mark would be best? Hint "Boys experience a growth spurt at a later age than girls." Correct This comment would relay accurate information and be appropriate. The growth spurt for boys begins about two years after the growth spurt for girls. Usually the peak growth spurt period is at about age 14. It lasts 2-3 years and generally coincides with physical sexual maturity. "Your growth spurt will occur when you are more sexually mature." Although it is true that a boy's growth spurt usually coincides with his physical sexual maturity, it is not likely that Mark would understand this concept or terminology. 16. Mark is 144.8 cm (57 inches) tall and weighs 41 kg (90 pounds). Using a clinical growth chart for boys 2-20 years (Stature-for-age and Weight-for-age), what percentiles is Mark in for stature and weight? (Select growth chart button at left to view relevant growth chart.) Hint 10th percentile for stature, 25th percentile for weight Using Mark's data, these percentiles are not correct. 25th percentile for stature, 50th percentile for weight Correct Using a clinical growth chart for boys 2-20 years (Stature-for-age and Weight-for-age), Mark falls at the 25th percentile for stature, and roughly the 50th percentile for weight. 50th percentile for stature, 25th percentile for weight Using Mark's data, these percentiles are not correct. 15th percentile for stature, 15th percentile for weight Using Mark's data, these percentiles are not correct. 17. To determine Mark's weight status category, which of the following is used? Mark's body weight of 41 kg For adolescents, body weight is not used to determine weight status category. Mark's body weight percentile at 50% For adolescents, body weight percentile is not used to determine weight status category. Mark's body mass index (BMI) of 19.6 For adolescents, body mass index (BMI) is not used to determine weight status category. Mark's body mass index (BMI) percentile at 75% Correct For adolescents, body mass index (BMI) percentile is used to determine weight status category. Mark has a cold. Should he receive vaccines at this visit? No, Mark should not be immunized at this visit Immunizations may be withheld for moderate or severe infections. Immunizations are not postponed for a minor illness like a cold. Yes, Mark should be immunized at this visit Correct Immunizations may be withheld for moderate or severe infections. Immunizations are not postponed for a minor illness like a cold. 19. Mrs. Johnson becomes agitated and says "I'm already late for work, these physicals have taken so long! Can't I read these later and mail them back to you?" Which response on your part is best? Hint "Yes, that will be OK." It would not be OK to administer the vaccines without Mrs. Johnson having read the information sheets, asked any questions, and signed the appropriate forms. Federal law requires that parents or guardians do this. "If you sign the forms now and promise to read copies later, then that will be OK." It would not be OK to administer the immunizations without Mrs. Johnson having read the information sheets, asked any questions, and signed the appropriate forms. Federal law requires that parents or guardians do this. "I'm sorry, I cannot administer the vaccines to your children until you have read and signed the forms." Correct This response is appropriate. Federal law requires that a parent or guardian read vaccine information sheets, ask questions, and sign appropriate forms before vaccines are administered to children. "I think your children are more important than your job." It is not your place to be judgmental or chastising of Mrs. Johnson. 20. Which of the following are possible contributing factors to the development of acne in adolescents? Select all that apply (there are 5 correct answers). "Fatty" foods Contrary to popular belief, fatty foods are not a contributing factor for acne. Environmental irritants Correct Dirt, smoke, grease, and other irritants in the air and environment can settle on the skin and contribute to acne. Chocolate Despite popular belief, chocolate is not a contributing factor for acne. Androgens Correct During adolescence, testosterone and other androgens stimulate the development of male characteristics. These substances also cause sebaceous glands to produce sebum, which increases the size of sebaceous glands and the amount of oil on the skin. This contributes to the development of acne. Hereditary factors Correct Hereditary factors play a role in the development of acne. Children whose parents had acne are more likely to have acne themselves. Menstrual cycle Correct During the female menstrual cycle, increased hormone levels cause increased sebum production and exacerbation of acne. Poor hygiene Correct Poor hygiene, and use of topical cosmetics, can clog pores. The skin should be cleansed thoroughly twice daily to remove dirt and excess oils. 21. Mark has received advice regarding acne from his school nurse. Which advice was correct? Select all that apply (there are 2 correct answers). Avoid soda, chocolate, and fried food No evidence exists that foods play a part in acne. Dietary restrictions are unnecessary. Scrub skin vigorously three times daily Scrubbing can lead to irritation of the skin and should be avoided. The face should be washed gently 2-3 times daily with a mild soap. Practice stress management techniques Correct Stress tends to increase the severity of acne. Stress-reducing activities, such as relaxation, can be utilized by the adolescent. Avoid squeezing or popping pimples Correct Except for skin cleansing, and any prescribed medication, acne should be left alone. Touching, squeezing, or popping pimples can lead to inflammation and scarring and should be avoided. Many acne treatments can take 2-3 months to be effective. Acne may actually get worse before it gets better. Which question is appropriately asked of Ashley at this time? Hint "Is there anything causing you to be sad or depressed?" It may be important to get this information, but another question is better at this time. "What is the ideal weight you would like to achieve?" Another question is more direct and better at this time. "What do you think about your size and weight?" Correct It is most important to assess whether Ashley has a realistic view of her size and weight. Ashley is presenting with signs of anorexia nervosa. Individuals with anorexia nervosa have an unrealistic view of their size and weight. Their body image is distorted. "What do your friends think about your weight?" Another question is more directed at Ashley's feelings about herself and is better at this time. 23. Which of the following, evident with Ashley, are consistent with anorexia nervosa? Select all that apply (there are 4 correct answers). Hint Low body temperature Correct With anorexia nervosa, a decreased caloric intake causes a slowed metabolic rate. A slow metabolic rate causes body temperature to be lower than normal. Tachycardia With a pulse rate of 54 beats per minute, Ashley has bradycardia, not tachycardia. With anorexia nervosa, a decreased caloric intake causes a slowed metabolic rate, and bradycardia is often noted. Blood pressure may also be low. Dry skin and brittle nails Correct With anorexia nervosa, nutritional deficiencies are common. Skin becomes dry, and nails become brittle. Weight loss despite increase in stature Correct Weight is expected to increase during growth spurts of increased stature. Weight loss during periods of growth is cause for concern, and often characterizes anorexia nervosa. Irregular menses Correct Irregular periods or secondary amenorrhea (the absence of menses after menarche) is often present in adolescent girls with anorexia nervosa. 24. Priority nursing diagnoses that apply to Ashley at this time include: Select all that apply (there are 3 correct answers). Hint Ineffective Coping related to disturbed peer relationships This nursing diagnosis does not apply at this time. Ashley may or may not be coping effectively. Her anorexia nervosa may be associated with ineffective coping. However, her coping skills have yet to be evaluated. Also, there is no data yet with regard to her peer relationships. Imbalanced Nutrition: Less Than Body Requirements related to refusal to eat enough food to supply adequate calories Correct Malnutrition is life-threatening and Ashley's most critical problem at this time. Addressing this physiological nursing diagnosis takes top priority. Disturbed Self-Concept related to inaccurate perception of self as "flabby" and "fat" Correct Ashley's disturbed self-concept plays a primary role in her health problem and must be addressed as a top priority. Risk for hypothermia related to decreased subcutaneous tissue Correct Risk for Hypothermia applies as a nursing diagnosis for Ashley. Ashley's recent temperature reading of 36 degrees C (96.8 degrees F) reflects a body temperature lower than normal, but not at a level that defines hypothermia (35.5 degrees C / 96 degrees F). However, because she is so thin and has little subcutaneous tissue, and has a slow metabolic rate, she is at risk for having hypothermia. Ashley can be taught measures to help avoid hypothermia while she is so thin (wearing gloves and socks, taking warm baths, drinking warm fluids, etc.). Ashley's stage of psychosocial development (almost 14 years) should be understood as she is treated for her health problem. According to Erikson, in which psychosocial stage of development is Ashley? Hint Autonomy vs. Shame and Doubt Autonomy vs. Shame and Doubt is the stage that occurs from 18 months to 3 years during which the task of developing independence is accomplished through the acquisition of basic self-control skills. Initiative vs. Guilt Initiative vs. Guilt is the stage that occurs from 3-6 years during which the task of developing initiative and self-direction is accomplished through exploration and curiosity. Trust vs. Mistrust Trust vs. Mistrust is the stage that occurs in infancy (birth-18 months) during which the task of developing trust in people and the environment is accomplished. Identity vs. Role Confusion Correct Identity vs. Role Confusion is the stage that occurs from 12-20 years during which the task of developing a sense of self is accomplished. In this stage, the adolescent is attempting to define her own identity. Identity becomes central during adolescence as physical, social, and cognitive development progresses. Helping Ashley develop a positive sense of self is critical at this time for her psychosocial development and the resolution of her health problem. In working with Ashley, it is also important to realize that she can reason and problem-solve. She can think about possibilities, as well as future consequences related to her actions. This kind of thinking ability is called: concrete thinking Reasoning and problem-solving are associated with abstract thinking, not concrete thinking. With concrete thinking, everything is seen as "black or white." abstract thinking Correct According to Piaget's Cognitive Theory of Development, adolescents (12-15 years) begin to think in abstract terms and refine their problem-solving skills. They begin to contemplate abstract ideas and concepts such as religion, truth, and justice. They become able to think about the possible future outcomes of their behaviors. 27. To meet Ashley's nutritional needs, which of the following approaches are appropriately implemented? Select all that apply (there are 2 correct answers). Hint Ashley and her family members work on her nutritional plan together Correct Ashley will be more compliant if her nutritional plan is developed with her input, as well as input from family members. All family members should be involved in nutritional planning, since eating is often done as a family group. Ashley will be encouraged to eat three meals a day at regular times. Ashley is expected to monitor her own diet and keep a diary of her eating habits Correct Expecting Ashley to monitor her own progress and keep a diary of her eating habits is appropriate. This should help give her a sense of control. Anorexia nervosa is often an attempt to have a feeling of control. A diet that includes mostly high-calorie carbohydrates is recommended When treatment for anorexia nervosa is started, a gradual incremental increase in carbohydrates (high source of calories) is indicated, not a dramatic increase. Rapid weight gain from excess carbohydrate intake could result in cardiovascular overload and other physical problems. In addition, Ashley might feel a profound sense of being out of control if her diet all of a sudden consisted of many foods that she had been avoiding. Ashley loses social privileges when she fails to eat adequately Negative reinforcement should be avoided. It is more effective to provide positive reinforcements for progress made. 28. Which of the following nutritional guidelines are correct and included as part of Ashley's nutritional counseling? Select all that apply (there are 3 correct answers). Nutritional needs are greatest during late adolescence Adequate nutrition is critical throughout adolescence, but nutritional needs are greatest in early adolescence (11-14 years), when growth rate is most rapid. Weight gain for Ashley should be gradual, about 3-5 pounds per week A weight gain of 3-5 pounds per week would be too much for Ashley. Caloric intake should come from a combination of fats, proteins, and carbohydrates Correct For Ashley, and all adolescents, daily calories should come from a combination of carbohydrates, fats, and proteins, taken from all food groups. Although modifications might be suggested for Ashley (based on her current nutritional needs), 30-35% of calories should come from fats, 15% of calories should come from proteins, and 50-55% of calories should come from carbohydrates. Intake of sugars (simple carbohydrates) and saturated fats should be limited Correct Sugars are a concentrated source of calories, with little nutritional value. Saturated fats raise cholesterol level. Therefore, intake of these should be limited, in all age groups. Unsaturated fat sources include fish, nuts, and vegetable oils. Whole grain selections are preferred from the bread/cereal/rice/pasta group Correct Whole grains are an especially good source of fiber, which contributes to bowel health. 6-11 servings of food from the bread/cereal/rice/pasta group are recommended for adolescents. Foods in this group are complex carbohydrates. Calcium and iron supplements are often needed for adolescents Calcium and iron are especially important for adolescents, because of the accelerated bone and muscle growth that occurs during the adolescent years. However, supplements should not be needed. Foods high in calcium (milk, broccoli, cheese) and high in iron (beef, chicken, fish, peanut butter, nuts, greens) can be consumed. Also, many foods are fortified with these nutrients. Three cups per day of fat-free or low-fat milk (or milk products) are recommended for adolescents, and children over eight years of age. 29. Ashley's sexual high-risk behavior, engaging in unprotected sexual intercourse, puts her at risk for which of the following? Select all that apply (there are 6 correct answers). Pregnancy Correct Ashley has placed herself at high risk for pregnancy. This risk of pregnancy can be greatly reduced with consistent and proper use of a condom. A condom must be placed on an erect penis prior to intercourse. A condom should be worn consistently with every intercourse experience. It should be removed carefully after ejaculation. Trichomonas vaginalis Correct Ashley has placed herself at high risk for Trichomoniasis (Trichomonas vaginalis) infection. Trichomoniasis (Trichomonas vaginalis) infection is almost always sexually-transmitted and is one of the most common sexually transmitted diseases (STDs). Symptoms include a foul-smelling green frothy discharge, itching and burning of the vulva (females), and genital edema. The infection may also be asymptomatic, especially in males. Consistent and proper use of a condom is important in preventing the spread of this STD. Chlamydia trachomatis Correct Ashley has placed herself at high risk for Chlamydia trachomatis (Chlamydia). Chlamydia trachomatis (Chlamydia) is the most common sexually transmitted disease (STD). Often both males and females are asymptomatic. If symptoms do exist, they include an abnormal discharge, lower abdominal pain, spotting between periods, and dysuria. If untreated, Chlamydia can lead to pelvic inflammatory disease (PID) and sterility. Consistent and proper use of a condom is important in preventing the spread of this STD. Gonococcal infection Correct Ashley has placed herself at high risk for Gonorrhea (Nisseria gonorrhoeae). Gonorrhea (Nisseria gonorrhoeae) is a sexually transmitted disease (STD) of concern for adolescents. A large percentage of females are asymptomatic in the early disease stage. Symptoms that do occur include a mucopurulent discharge, fever, and abdominal pain. If untreated, gonorrhea can lead to pelvic inflammatory disease (PID) and sterility. Consistent and proper use of a condom is important in preventing the spread of this STD. Toxic shock syndrome Toxic shock syndrome is a multisystem disease primarily affecting menstruating females. 95% of cases occur on or near menstruation. Engaging in unprotected sexual intercourse is unrelated to the development of toxic shock syndrome. Herpes simplex virus type 2 Correct Ashley has placed herself at high risk for Herpes simplex virus type 2. Herpes simplex virus type 2 is a common sexually transmitted disease (STD). It is characterized by painful genital lesions. There is no known cure. The virus may remain latent in the body or produce exacerbations of the lesions at any time. Consistent and proper use of a condom is important in preventing the spread of this STD. Human Immunodeficiency Virus (HIV) infection Correct Ashley has placed herself at high risk for Human Immunodeficiency Virus (HIV) infection. HIV is a life-threatening disease that can be transmitted during unprotected sexual intercourse. Consistent and proper use of a condom is important in preventing the spread of HIV by this route. 30. Which of the following interventions are appropriately implemented? Select all that apply (there are 6 correct answers). Hint Consent for sexually transmitted disease (STD) treatment is obtained from Ashley's mother Adolescents can be diagnosed and treated for sexually transmitted diseases (STDs) and pregnancy without consent from parents. Ashley's parents should not be told about her sexual activities and health problem without her consent. Education regarding the importance of condom use for the prevention of HIV and sexually transmitted diseases (STDs) Correct Preventive measures are an integral part of any adolescent health-related visit. Prevention of sexually transmitted diseases (STDs) and HIV through the use of condoms must be emphasized. Antibiotic therapy for Ashley Correct Antibiotic treatment is needed. Zithromax (azithromycin) or Periostat (doxycycline) are appropriate pharmacologic therapy for treatment of Chlamydia infections. Antibiotic therapy for Ashley's boyfriend Correct Ashley's boyfriend needs antiobiotic therapy. Treatment of Chlamydia involves treatment of the infected person as well as treatment of all recent sexual partners, to prevent further transmission. Antibiotic treatment is needed. Zithromax (azithromycin) or Periostat (doxycycline) are appropriate pharmacologic therapy for treatment of Chlamydia infections. Any sexual partners of Ashley's boyfriend may also need treatment as well. Education regarding increased risk of pelvic inflammatory disease and fertility problems Correct Pelvic inflammatory disease is a syndrome of inflammatory disorders that occur as a result of migration of infecting organisms up the genital tract. It is a major consequence of sexually transmitted diseases (STDs) and can lead to future infertility. Emphasis on completing treatment and avoidance of sexual intercourse until treatment is completed Correct As part of their treatment plan, persons infected with sexually transmitted diseases (STDs) must refrain from sexual intercourse until treatment is completed. The importance of completing treatment to prevent a relapse must be stressed. Discussion of abstinence from sexual intercourse as an option in avoiding sexually transmitted diseases (STDs) and the only 100% birth control method Correct Abstinence should always be emphasized as the only 100% way to prevent pregnancy, sexually transmitted diseases (STDs), and HIV infection. If this is not an option for the adolescent, condom use is a must. 31. Which approach is best to take with Mark at this time? Advise Mark that his drinking will take him nowhere and is unacceptable Chastising Mark is not likely to help him stop his drinking behaviors with his friends. Praise Mark for his courage in telling you about his fear of alcohol "binging" Correct Praising Mark for sharing his fears should enhance his self-esteem and encourage him to continue talking with you. If he knows you are concerned and not judgmental, he will be more likely to listen to your advice about high-risk behaviors that can lead to injury to self and/or others. Schedule an appointment for Mark to meet with a psychiatrist to discuss coping skills Mark may or may not need to meet with a psychiatrist. There is not enough data to indicate a need for a psychiatrist at this time. Encourage Mark to join Alcoholics Anonymous Mark may or may not be an alcoholic. There is not information to make this judgment at this time.