# A nurse is conducting an annual well-adolescent visit for a 15-year-old client per AAP Bright Futures recommendations. Which assessments are routine and recommended at this visit? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=366228&lang=en  
> language: en  
> subject: Developmental Stages and Transitions  
> category: HPM

## Question

A nurse is conducting an annual well-adolescent visit for a 15-year-old client per AAP Bright Futures recommendations. Which assessments are routine and recommended at this visit? Select all that apply.

1

Routine prostate cancer screening with PSA and DRE for male adolescents

2

Blood pressure, BMI, vision and hearing screening

3

Routine biennial mammography for adolescent females per screening guidelines

4

Annual depression screen using PHQ-9 starting at age 12

5

HEEADSSS psychosocial screen (Home, Education, Eating, Activities, Drugs, Sexuality, Suicide/depression, Safety)

## Explanation

Bright Futures and USPSTF adolescent recommendations include the HEEADSSS psychosocial assessment, annual depression screening with PHQ-9 from age 12, BP, BMI, vision, and hearing screening. PSA screening is generally considered for men over 50 (and only with shared decision-making) and is not recommended for adolescents. Mammography starts at age 40-50 per shared decision-making and not in adolescents.

## In-depth explanation

Clinical Judgment
Adolescent well-visit pillars: HEEADSSS, PHQ-9, BP/BMI/vision/hearing, immunization update (HPV, MenACWY, Tdap), risk reduction counseling. Confidentiality with privacy from parents is essential to gather honest answers about sexuality, substances, and safety.

Memory Tip
Adolescent visit: HEEADSSS + PHQ-9 + BP/BMI/Vision/Hearing + Vaccines

KR vs US
AAP Bright Futures (US) and Korean Adolescent Health Promotion Schedule both include psychosocial screening, mental health assessment, and vaccination updates. Korean schools also conduct annual physical exams; community pediatric clinics handle Bright-Futures-equivalent visits.

## Clinical scenario

Clinical Practice Guide
Bright Futures adolescent (11-21) annual visit:
- HEEADSSS: structured psychosocial interview privately with the adolescent
- Mental health: PHQ-9 annually from age 12; ASQ for suicide risk
- Substance use: CRAFFT screen; SBIRT brief intervention
- Sexual health: confidential interview; STI testing per CDC for sexually active; HIV at least once age 13-64
- Vital signs and growth: BP, BMI, vision, hearing
- Immunizations: HPV (start 9-12), MenACWY 11-12 with booster 16, MenB 16-23 SDM, Tdap 11-12, annual influenza, COVID-19 per current
- Anticipatory guidance: nutrition, exercise, sleep, screen time, safety

Caution
State laws vary on minor confidentiality and consent for sexual health, mental health, and substance use treatment. Know your state laws and document carefully. Mandatory reporting still applies for abuse and imminent harm.

## Key concepts

- **HEEADSSS** — Adolescent psychosocial assessment framework: Home, Education/Employment, Eating, Activities, Drugs, Sexuality, Suicide/depression, Safety. Conducted privately with the adolescent. Provides structured assessment of risk and protective factors.
- **Bright Futures** — AAP comprehensive periodicity schedule for pediatric and adolescent care from infancy through age 21. Provides evidence-based recommendations for screening, anticipatory guidance, and immunizations at each visit.
- **PHQ-9 / ASQ** — PHQ-9 is a 9-item depression screen scored 0-27 (5 mild, 10 moderate, 15 moderately severe, 20 severe). USPSTF recommends annual depression screening from age 12. ASQ (Ask Suicide-Screening Questions) is a 4-item screen for suicide risk in youth.

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