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

Infants and children have open growth plates, also known as epiphyseal plates, at the ends of
their long bones. These plates are responsible for bone growth and are not fully fused until
the child reach skeletal maturity. Due to the presence of open growth plates, infants and
children are more prone to fractures because their bones are still developing and are less
dense than those of adults.

Their bones have less blood flow in (Option A) is incorrect because cchildren’s bones
actually have a greater blood flow compared to adults. This increased blood flow supports the
rapid growth and development of bones in children.

Growth occurs in children as a result of an increase in the number of muscle fibers in (option
B) is incorrect because ggrowth in children occurs primarily due to the elongation and
thickening of existing muscle fibres, not an increase in their number. This option inaccurately
suggests that children's muscles increase in fibber count to facilitate growth.

Because soft tissues are resilient in children, dislocations and spirals are less common than in
adults in (Option D is) incorrect. While soft tissues may be more resilient in children, it does
not mean that dislocations and sprains are less common than in adults. In fact, children's
ligaments and joint structures are still developing and may be more susceptible to injuries
such as sprains and dislocations compared to adults.

A change in status that should alert the nurse to increased intracranial pressure (ICP) in a child with a head injury is confusion and altered mental status. As intracranial pressure increases, it can affect brain function and lead to neurological changes, including confusion, disorientation, irritability, decreased level of consciousness, or other alterations in mental status. These changes indicate that the brain is being compressed and compromised, and immediate intervention is required.

Option B, increased diastolic pressure with narrowing pulse pressure in (option B) is incorrect because it, can be a sign of increased ICP, but it is not specific to head injuries and can be influenced by other factors such as pain, anxiety, or systemic conditions. It is important to consider the overall hemodynamic status of the child and assess for additional signs and symptoms of increased ICP.

irregular, rapid heart rate in (option C), can be a sign of increased ICP, but it is not specific to head injuries and can be influenced by other factors such as pain, anxiety, or other medical conditions. Assessment of heart rate should be considered along with other signs and symptoms of increased ICP.

rapid, shallow breathing, in (option D) can be a sign of increased ICP, but it is not specific to head injuries and can be influenced by other factors such as pain, anxiety, or respiratory conditions. Respiratory assessment should be considered along with other signs and symptoms of increased ICP.