The nurse is performing an assessment of the reproductive system of a 17-year-old girl. What would alert the nurse to a developmental delay in this girl?
Areola and papilla separate from the contour of the breast
Absence of first menstrual period
Developed breast tissue
Mature distribution and coarseness of pubic hair
The Correct Answer is B
A. Areola and papilla separate from the contour of the breast: This is a normal finding in breast development and indicates Tanner stage 4 or higher, which is typical for adolescent girls. It does not necessarily indicate a developmental delay.
B. Absence of first menstrual perioD. Menarche, the first menstrual period, typically occurs between the ages of 9 and 15 in girls. Absence of menarche by the age of 15 or within 3 years after the onset of breast development (thelarche) may indicate a developmental delay or underlying medical condition that should be evaluated by a healthcare provider.
C. Developed breast tissuE. Breast development, indicated by palpable breast tissue, is a normal part of female puberty and typically occurs before menarche. Developed breast tissue alone does not necessarily indicate a developmental delay.
D. Mature distribution and coarseness of pubic hair: Pubic hair development is also a part of female puberty and occurs before or around the time of menarche. While the distribution and coarseness of pubic hair can provide information about pubertal development, the absence of menarche is a more reliable indicator of a potential developmental delay.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. "This is normal behavior for infants unless the stool passed is black or green.": While black or green stools may indicate potential issues, grunting and crying during bowel movements are common behaviors in infants and are not necessarily indicative of a problem.
B. "This is normal behavior for infants due to the immaturity of the gastrointestinal system.": Grunting and crying during bowel movements are typical behaviors in infants, especially during the first few months of life. This is because the infant's gastrointestinal system is still developing and they may have difficulty coordinating their muscles to pass stool smoothly.
C. "This is normal behavior for infants unless the stool passed is hard and dry.": While hard and dry stools may indicate constipation, grunting and crying during bowel movements can still be normal behaviors in infants, regardless of the consistency of the stool.
D. "This indicates a blockage in the intestine and must be reported to the health care provider.": Grunting and crying during bowel movements are not necessarily indicative of a blockage in the intestine. These behaviors are common in infants and usually resolve as the infant's gastrointestinal system matures.
Correct Answer is B
Explanation
A. "You should leave the room while the tantrum is happening.": Leaving the room during a
toddler's tantrum may not be the most effective strategy, as it may reinforce the behavior or make the child feel abandoned. It is generally recommended to stay nearby and provide support and guidance during tantrums.
B. "Temper tantrums are the toddler's attempt to gain control of a situation.": Temper tantrums are often a normal part of toddler development and can occur when toddlers feel frustrated, overwhelmed, or unable to express their needs effectively. Understanding that tantrums are a way for toddlers to assert some control over their environment can help parents respond appropriately.
C. "Temper tantrums are a type of learning disability.": Temper tantrums are not indicative of a learning disability. While they can be challenging for parents to manage, they are typically considered a normal phase of development and are not associated with cognitive impairments.
D. "You should get a psychological consult for the temper tantrums.": Seeking psychological consultation for temper tantrums may be unnecessary unless there are other concerning behaviors or developmental delays present. Tantrums are typically addressed through behavior
management techniques and parent education rather than psychological intervention.
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