The nurse is assessing a 13-year-old girl. Which event would the nurse expect to have occurred first?
Growth spurt
Evidence of pubic hair
Onset of menses
Development of breast buds
The Correct Answer is D
Choice A: Growth spurt is not the correct answer because it is not the first event that occurs in female puberty. The growth spurt is a period of rapid increase in height and weight that usually occurs between 10 and 14 years of age in girls. It is influenced by various factors such as genetics, nutrition, and hormones. Growth spurt usually follows the development of breast buds and pubic hair by about 6 to 12 months.
Choice B: Evidence of pubic hair is not the correct answer because it is not the first event that occurs in female puberty. Evidence of pubic hair is the appearance of coarse, curly, and pigmented hair on the pubic area and around the genitals. It usually occurs between 8 and 13 years of age in girls. It is caused by the increased production of androgens (male hormones) by the adrenal glands and ovaries. Evidence of pubic hair usually follows the development of breast buds by about 3 to 6 months.
Choice C: Onset of menses is not the correct answer because it is not the first event that occurs in female puberty. The onset of menses is the beginning of menstrual cycles, which are regular changes in the female reproductive system that prepare the body for pregnancy. It usually occurs between 10 and 15 years of age in girls. It is caused by the maturation of the hypothalamus, pituitary gland, ovaries, and uterus, which regulate the levels of estrogen and progesterone (female hormones). The onset of menses usually follows the development of breast buds and pubic hair by about 2 to 3 years.
Choice D: Development of breast buds is the correct answer because it is the first event that occurs in female puberty. Development of breast buds is the enlargement and elevation of the nipples and areolas (dark circles around the nipples), which indicate the beginning of breast growth. It usually occurs between 8 and 12 years of age in girls. It is caused by the increased production of estrogen (female hormone) by the ovaries, which stimulates the growth of ducts (tubes) and lobules (glands) in the breast tissue. The development of breast buds is also called thelarche or breast stage 2.

Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A: Bleeding between menses is not the correct answer because it is not a specific clinical manifestation of endometrial polyps. Bleeding between menses is a condition that causes spotting or bleeding at any time other than during the normal menstrual period. It can be caused by various factors such as hormonal imbalance, infection, or pregnancy. It can also occur in some women with endometrial polyps, but it is not a definitive sign of them.
Choice B: Bleeding after intercourse is not the correct answer because it is not a specific clinical manifestation of endometrial polyps. Bleeding after intercourse is a condition that causes bleeding from the vagina or cervix after sexual activity. It can be caused by various factors such as trauma, infection, or cancer. It can also occur in some women with endometrial polyps, but it is not a definitive sign of them.
Choice C: Metrorrhagia is the correct answer because it is a specific clinical manifestation of endometrial polyps. Metrorrhagia is a condition that causes irregular or excessive bleeding from the uterus that is unrelated to the menstrual cycle. It can be caused by various factors such as polyps, fibroids, or cancer. It is a common symptom of endometrial polyps, which are benign growths of the endometrium (the lining of the uterus) that can protrude into the uterine cavity and cause bleeding.
Choice D: Vaginal discharge is not the correct answer because it is not a specific clinical manifestation of endometrial polyps. Vaginal discharge is a fluid that comes out of the vagina and varies in color, consistency, and odor depending on the phase of the menstrual cycle, sexual activity, or health status. It can be caused by various factors such as normal secretions, infection, or inflammation. It is not a common symptom of endometrial polyps, which do not usually affect the vaginal flora or pH.

Correct Answer is B
Explanation
Choice A: Protrusion of the posterior bladder wall downward through the anterior vaginal wall is not the correct answer because it describes a different condition called cystocele. A cystocele occurs when the bladder pushes into the vagina due to weakened pelvic support structures.
Choice B: Bulging of the small intestine through the posterior vaginal wall is the correct answer because it describes an enterocele. Enterocele occurs when the small intestine slides into a pouch between the rectum and vagina due to weakened pelvic support structures.
Choice C: Descent of the uterus through the pelvic floor into the vagina is not the correct answer because it describes a different condition called uterine prolapse. Uterine prolapse occurs when the uterus drops down into or out of the vagina due to weakened pelvic support structures.
Choice D: Sagging of the rectum with the pressure exerted against the posterior vaginal wall is not the correct answer because it describes a different condition called rectocele. Rectocele occurs when the rectum bulges into or out of the vagina due to weakened pelvic support structures.
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