Chapter 14: Problems of Adolescence

Morrison-Valfre: Foundations of Mental Health Care, 7th Edition

Multiple Choice

1. The child in early adolescence experiences developmental issues with his or her identity as evidenced by: a. feeling stable with his or her self-esteem. b. conforming to group norms. c. being very self-centered. d. being idealistic.

ANS: B

Acceptance and rejection of peers are very important to this age-group, so conforming to norms is frequently seen. Feeling stable with one’s self-esteem refers to late adolescence (17–20 years old), and being self-centered and idealistic applies to middle adolescence (14–17 years old).

DIF: Cognitive Level: Comprehension REF: p. 157 | Table 14.1

OBJ: 1 TOP: Psychosocial Development

KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

2. Internal developmental problems are seen as a causative factor for some behavioral and family problems during adolescence. Psychological developmental issues that can lead to problems during late adolescence (17–20 years old) include: a. wide mood swings. b. tendency to withdraw when upset. c. intense daydreaming. d. concealing of anger.

ANS: D

Even though adolescents in this age-group experience few mood swings, they tend to conceal their anger to a greater extent than do adolescents from other developmental periods. Wide mood swings are typical of the early adolescent period (11–14 years old), and the tendency to withdraw when upset and intense daydreaming refer to middle adolescence (14–17 years old).

DIF: Cognitive Level: Comprehension REF: p. 158 | Table 14.1

OBJ: 1 TOP: Psychosocial Development

KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

3. A male adolescent client tells the nurse that he is almoasbtirpbocsoitmiv/teesth t at he is homosexual This realization most likely has occurred during the developmental period of: a. late childhood. b. early adolescence. c. middle adolescence. d. lateadolescence.

ANS: C

Usually by the age of 14 to 17 years, most adolescents have discovered their sexual preference.

DIF: Cognitive Level: Comprehension REF: p. 158 | Table 14.1

OBJ: 1 TOP: Psychosocial Development

KEY: Nursing Process Step: Assessment

MSC: Client Needs: Health Promotion and Maintenance a. 3 b. 7 c. 11 d. 14

4. Environmental problems often lead to mental health problems among adolescents. Approximately million children and adolescents must cope with the issue of having a parent in jail or on parole.

ANS: B

These adolescents have to deal with the many issues associated with having a parent in this circumstance while maintaining the energy necessary to focus on the typical growth and development issues that adolescents experience.

DIF: Cognitive Level: Knowledge REF: p. 158

TOP: External (Environmental) Problems

KEY: Nursing Process Step: Assessment

MSC: Client Needs: Health Promotion and Maintenance

OBJ: 1

5. The nurse is working with a 15-year-old girl and her parents on a treatment plan for her diagnosis of attention-deficit/hyperactivity disorder (ADHD). The nurse should be sure to: a. encourage the parents to seek teachers for their daughter who are going to be lenient with assignment schedules because of her diagnosis. b. remind the parents to determine ahead of time consequences/punishment that they will give their daughter when she is not listening to them and/or teachers. c. teach the parents how to structure and enforce limits on their daughter’s behavior that are appropriate to her condition. d. inform the client and her parents that medications typically used for ADHD are very safe and have few side effects.

ANS: C

Consistent limit-setting is helpful to teens with ADHD because it is difficult for them to set limits for themselves. Encouraging lenient teachers violates this principle. The parents should seek teachers who are understanding of their daughter’s condition but remain consistent in setting limits in their course. Positive reinforcement for appropriate behavior is more effective than punishment, and many medications for ADHD react with other medications and sometimes have serious side effects.

DIF: Cognitive Level: Application REF: p. 161

OBJ: 3

TOP: Behavioral Disorders KEY: Nursing Process Step: Intervention

MSC: Client Needs: Psychosocial Integrity a. Assessing and/or stabilizing the home environment b. Teaching effective communication skills to the client and family members c. Advocating behavior modification for the client to gain self-control d. Teaching effective discipline techniques

6. The nurse is working with a teen in whom conduct disorder was diagnosed and his family on developing a plan of care for treatment. What is the nurse’s first intervention?

ANS: A

After the home environment has been assessed and stabilized, the other interventions can be implemented in the order necessary according to priority of need.

DIF: Cognitive Level: Application REF: p. 161 OBJ: 3

TOP: Behavioral Disorders KEY: Nursing Process Step: Intervention

MSC: Client Needs: Psychosocial Integrity

7. In a research study of eating disorders, it was found that the most frequent weight loss method used by female high school students was: a. exercising. b. skipping meals. c. using diet pills. d. vomiting.

ANS: B

Forty-nine percent of high school females in this study used skipping meals as a weight loss method, followed by exercising, using diet pills, and vomiting.

DIF: Cognitive Level: Knowledge REF: p. 162 OBJ: 5

TOP: Eating Disorders KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity

8. A 15-year-old girl is being admitted to an inpatient mental health clinic with the diagnosis of anorexia nervosa. The nurse knows that the most common personality characteristic of teens affected with this disorder is: a. excessive cooperation. b. underachievement. c. normal body weight. d. positive self-esteem.

ANS: A

Characteristics of the personality of female teens with anorexia nervosa include being excessively cooperative and achievement oriented and having a body image of being overweight. Underachievement and positive self-esteem are opposite traits to those seen in a teen with anorexia nervosa, and normal body weight may characterize a teen with a healthy self-concept, or it may be a characteristic of bulimia.

DIF: Cognitive Level: Knowledge REF: p. 163 OBJ: 5

TOP: Eating Disorders KEY: Nursing Process Step: Planning

MSC: Client Needs: Psychosocial Integrity

9. When one is developing the care plan for a female adolescent with an eating disorder, the primary issue to consider as the underlying cause is: a. control. b. body image. c. self-esteem. d. coping skills.

ANS: A

Although any of the issues listed in these options can be an underlying cause, control is the primary issue with an eating disorder. The client often feels that this is the only thing in her life over which she has complete control.

DIF: Cognitive Level: Comprehension REF: p. 164 OBJ: 5

TOP: Eating Disorders

KEY: Nursing Process Step: Nursing Diagnosis

MSC: Client Needs: Psychosocial Integrity

10. One of the major goals of therapy for adolescents with chemical dependency is: a. replacing the use of the chemical with effective coping skills. b. placing the chemically dependent adolescent in a residential treatment program. c. finding a group home setting to which the adolescent will be able to adjust. d. isolating the adolescent from family and friends during withdrawal from the chemical.

ANS: A

This is the overall goal of therapy, so the adolescent will not feel the need to depend on the chemical for coping with stressors. A residential treatment program or a group home setting may be a necessary intervention in some cases, but it is not a goal of therapy. Isolation during withdrawal is not necessary.

DIF: Cognitive Level: Comprehension REF: p. 164 OBJ: 6

TOP: Chemical Dependency KEY: Nursing Process Step: Planning

MSC: Client Needs: Psychosocial Integrity

11. Personality disorders in the adolescent are characterized by: a. onset usually in middle childhood. b. impulsivity. c. flexibility. d. high self-esteem.

ANS: B

Behavior is typically impulsive, leading to poor decision-making skills. Onset of personality disorder usually occurs in adolescence or early adulthood. These individuals tend to be inflexible when dealing with others, and their self-esteem is generally low.

DIF: Cognitive Level: Knowledge REF: p. 164 OBJ: 1

TOP: Personality Disorders KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity a. Their daughter is playing sports typically considered boys’ sports. b. Their daughter has more male friends than female friends. c. Their daughter does not like to change her clothes in front of anyone. d. Their daughter frequently wears clothes designed for males.

12. The parents of a 13-year-old girl are concerned that their daughter has a gender identity disorder. Which sign or symptom most indicates that their concern is correct?

ANS: D

This behavior is more indicative of gender identity disorder than the other options. This behavior fulfills the need for this girl to identify with the male gender. Playing sports typically considered boys’ sports and having more male friends are not considered behaviors of gender identity disorders unless other characteristic behaviors of the disorder occur. Not wanting to change clothes in front of anyone is a common behavior that reflects a 13 year old’s need for privacy.

DIF: Cognitive Level: Application REF: p. 165 OBJ: 1

TOP: Sexual Disorders KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity

13. Signs and symptoms of schizophrenia often are first seen in: a. early childhood. b. adolescence. c. early adulthood. d. middle adulthood.

ANS: B

The onset of schizophrenia usually occurs during adolescence. The individual usually has had a normal childhood but then begins to display behaviors associated with loss of contact with reality, such as hallucinations, delusions, and paranoid feelings.

DIF: Cognitive Level: Knowledge REF: p. 165 OBJ: 1

TOP: Psychosis KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity a. 3 b. 6 c. 9 d. 12

14. The rate of attempted suicide in adolescents is times higher with females than with males.

ANS: A

Although the rate of attempted suicide is three times higher among females, males are more successful in committing suicide because of the more lethal methods that they choose to use.

DIF: Cognitive Level: Knowledge REF: p. 166 OBJ: 7

TOP: Suicide KEY: Nursing Process Step: Evaluation

MSC: Client Needs: Psychosocial Integrity a. Depression b. Serious mental illness c. The need to influence others d. An anxiety disorder

15. A teenage girl’s boyfriend of 1 year ended their relationship and began to date someone else, resulting in the girl’s attempting suicide by taking an overdose of her mother’s sleeping medication. What is the most likely cause of this girl’s suicide attempt?

ANS: C

This is an example of her need to influence others by getting back at the boyfriend. Depression and serious mental illness are other reasons frequently noted as causative factors when adolescents attempt suicide. An anxiety disorder is not typically a causative factor.

DIF: Cognitive Level: Analysis REF: p. 166 OBJ: 7

TOP: Suicide KEY: Nursing Process Step: Evaluation

MSC: Client Needs: Psychosocial Integrity a. Concrete operations b. Pre-operational thinking c. Operational thinking d. Abstract thinking

16. By the ages of 14 to 17, teens are able to demonstrate problem-solving skills using concepts, generalizations, and being flexible in planning actions and goals. What is this an example of?

ANS: D

By the middle teens (14–17), abstract thinking (adaptable, flexible thinking that uses concepts, generalizations, and problem-solving) is well entrenched, along with a feeling of power and self-centeredness. Many believe that they can change the world by just thinking about it. At about 17, teens’ abstract thinking becomes more realistic and they become able to plan reachable actions, goals, and careers.

DIF: Cognitive Level: Analysis REF: p. 156 OBJ: 1

TOP: Psychosocial Development KEY: Nursing Process Step: Evaluation

MSC: Client Needs: Psychosocial Integrity a. Burnout b. Actively seeking c. Experimentation d. Preoccupation

17. A 15-year-old female started going to parties earlier in the year where drinking and drug use occurred. Her friends now notice that she actively looks for a party every weekend and attends even when her friends are not invited. If they suggest an alternate activity, she refuses to go with them, and she is avoiding them at school. What stage of chemical dependency is she exhibiting?

ANS: B

In the actively seeking stage, the teen looks forward to and actively seeks out the mood changes brought about by the chemicals; the teen becomes expert in the use of chemicals to regulate moods; schoolwork and relationships with family erode; and friends become limited to other teens who “use.”

DIF: Cognitive Level: Analysis REF: p. 164 | Box 14.4

OBJ: 6 TOP: Stages of Chemical Dependency

KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity

Multiple Response

1. Which of the following are common signs and symptoms of the eating disorder bulimia? (Select all that apply.)

a. Intake of less than 1000 calories per day b. Purging after meals c. Body weight greater than 20% under normal d. Consumption of 5000 to 20,000 calories per day e. Erosion of tooth enamel

ANS: B, D, E

Purging commonly occurs after bingeing, and this causes erosion of tooth enamel. Intake of less than 1000 calories per day and body weight at least 20% less than normal are typical of anorexia nervosa. Body weight is often kept normal or within 20% of normal with bulimia.

DIF: Cognitive Level: Knowledge REF: p. 163 OBJ: 5

TOP: Eating Disorders KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity a. Provides stability during change. b. Helps loosen ties to family. c. Serves as standard for dress and behavior. d. Helps to define future roles. e. Learns to doubt self-made choices.

2. Social development and forming an identity are important tasks for the adolescent. Which of the following is true regarding the function of a peer group? (Select all that apply.)

ANS: A, B, C, D

Peer groups help to loosen family ties, provide stability during times of change, and help adolescents define present and future social roles, learn to trust their own choices, and establish behavioral and dress standards.

DIF: Cognitive Level: Knowledge REF: p. 156 OBJ: 1

TOP: Functions of Peer Groups KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity