A nurse is teaching adolescent boys about pubertal changes. The first sign of pubertal change seen with boys is

During painful episodes of juvenile arthritis, a plan of care should include proper positioning of the affected joints to prevent musculoskeletal complications. Proper positioning helps to alleviate pain, reduce inflammation, and minimize stress on the affected joints. It also promotes joint stability and prevents contractures or deformities that can occur due to prolonged immobility.

a weight-control diet to decrease stress on the joints in (option A) is incorrect because it, may be a consideration in managing overall joint health and reducing excessive strain on the joints. However, it is not the primary nursing intervention during painful episodes of juvenile arthritis.

high-resistance exercises to maintain muscular tone in the affected joints in (option C) is incorrect because it, may not be appropriate during painful episodes of juvenile arthritis. High-resistance exercises can potentially exacerbate pain and inflammation. Exercise should be tailored to the individual's condition and guided by healthcare professionals.

complete bed rest to decrease stress to joints in (option D) is incorrect because it, is not recommended as a nursing intervention for painful episodes of juvenile arthritis. Prolonged bed rest can lead to muscle weakness, joint stiffness, and functional decline. Instead, maintaining mobility and appropriate activity levels within the child's pain tolerance and capabilities is generally preferred.

Upper extremity fractures in children commonly occur as a result of falls. Children are more prone to falls due to their developing motor skills, balance, and coordination. They may fall from playground equipment, bicycles, or simply while running or playing.

While sports injuries (Option A) can also lead to upper extremity fractures, falls are generally the most common cause in children.

Physical abuse (Option B) is an unfortunate possibility in some cases, but it is important to approach the assessment without assuming abuse as the cause without appropriate evidence or disclosure.

Upper extremity fractures resulting from automobile crashes (Option D) are less common in children compared to falls or sports injuries, although they can occur in severe accidents.

It is always important for the nurse to assess the child's history, obtain a detailed account of the injury, and consider any additional signs or indications that may suggest non-accidental trauma if appropriate.