A 14-year-old adolescent female presents to the nurse practitioner because she is concerned that she has not started to menstruate. History is noncontributory, and the physical examination findings are within normal limits. She is in Tanner stage 3 for sexual development. Based on these findings, the nurse practitioner should:
refer the adolescent to an adolescent gynecologist for further evaluation.
obtain follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels.
obtain a serum human chorionic gonadotropin (hCG) level.
reassure and educate the adolescent
The Correct Answer is D
Rationale:
A. Referral to a specialist is not immediately necessary when physical development is normal and there are no other concerning findings.
B. Measuring FSH and LH is indicated if there are signs of delayed puberty or abnormal secondary sexual characteristics, which are absent in this case.
C. hCG testing is used to assess for pregnancy, which is not relevant in a 14-year-old with normal pubertal development and no history suggesting pregnancy.
D. Reassurance and education are appropriate, as menarche typically occurs around Tanner stage 3–4, and variation in timing is normal. Most healthy adolescents who have normal physical development and no other symptoms will begin menstruating by age 15.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Rationale:
A. Pubarche (development of pubic hair) may occur, but it is not usually the first sign in girls.
B. Leukorrhea (vaginal discharge) can appear later but is not the initial sign of puberty.
C. Rapid onset acne may accompany puberty but is not the earliest or most obvious sign.
D. Breast enlargement (thelarche) is typically the first and most noticeable sign of precocious puberty in girls.
Correct Answer is C
Explanation
Rationale:
A. A grayish-white, malodorous fishy discharge is characteristic of bacterial vaginosis, not trichomoniasis.
B. Mucopurulent and bloody discharge is more suggestive of gonorrhea or chlamydia infection.
C. Trichomoniasis typically presents with a frothy, copious, pale yellow to gray-green vaginal discharge, often accompanied by vaginal itching, dysuria, and a “strawberry cervix” on examination.
D. White, cottage cheese-like discharge is classic for Candida albicans infection (yeast infection) and not trichomoniasis.
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