The nurse is providing anticipatory teaching to parents about pubescent changes in school-aged and young adolescent girls. Which of the following changes should the nurse include in the teaching?
Vocal changes
Decreased height
Breast development
Menarche
Increased axillary hair
Correct Answer : C,D,E
A. Vocal changes are more pronounced in boys during puberty; girls typically do not experience significant vocal changes.
B. Height does not decrease; instead, girls experience a growth spurt during puberty before reaching their adult height.
C. Breast development is one of the first signs of puberty in girls, typically occurring between ages 8 and 13.
D. Menarche, the first menstrual period, usually occurs later in puberty and is an important milestone indicating the onset of reproductive capability.
E. Increased axillary hair growth is also a common change that occurs during puberty as hormone levels rise.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Using a tongue depressor can provoke spasm of the epiglottis and lead to airway obstruction; therefore, this action is contraindicated in a child with epiglottitis.
B. Airborne precautions are not necessary for epiglottitis; droplet precautions are more appropriate due to the risk of transmission.
C. Monitoring oxygen saturation is critical in this situation to assess the child's respiratory status and ensure adequate oxygenation, making it the most appropriate action.
D. Obtaining a throat culture may not be safe or practical in this scenario, as it can provoke further distress and complications; immediate assessment and stabilization are prioritized.
Correct Answer is D
Explanation
A. Preparing for immediate surgery is necessary, but the priority intervention is to ensure adequate oxygenation and blood flow through the ductus arteriosus before surgery can be performed.
B. Initiating feeding through a nasogastric tube is not a priority for an infant with this condition, as their immediate need is to address the circulatory issue rather than feeding.
C. Administering oxygen via nasal cannula may provide some relief but is not sufficient as a standalone intervention for transposition of the great vessels, which requires maintaining ductal patency to allow mixing of oxygenated and deoxygenated blood.
D. Administering prostaglandin E1 (PGE1) is the priority intervention, as it helps maintain patency of the ductus arteriosus, allowing for temporary stabilization of the infant’s condition until surgical intervention can be performed.
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