A nurse is caring for a client who is 4 days postoperative following a right radical mastectomy. Which of the following activities should the nurse anticipate being the most difficult for this client to perform with her right hand?

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.

Choice A: Diarrhea is not the correct answer because it is not a common adverse effect of radiation treatment for breast cancer. Diarrhea is a condition that causes loose, watery, or frequent stools. It can be caused by various factors such as infection, medication, or food intolerance. It is more likely to occur as an adverse effect of radiation treatment for cancers that affect the digestive system, such as colorectal or stomach cancer.

Choice B: Anorexia is not the correct answer because it is not a common adverse effect of radiation treatment for breast cancer. Anorexia is a condition that causes loss of appetite or interest in food. It can be caused by various factors such as depression, stress, or nausea. It is more likely to occur as an adverse effect of chemotherapy or other systemic treatments for cancer that affect the whole body.

Choice C: Fatigue is the correct answer because it is a common adverse effect of radiation treatment for breast cancer. Fatigue is a condition that causes extreme tiredness or exhaustion that is not relieved by rest or sleep. It can be caused by various factors such as anemia, inflammation, or pain. It is a common adverse effect of radiation treatment for any type of cancer, as radiation can damage healthy cells and tissues and affect the body's energy production.

Choice D: Alopecia is not the correct answer because it is not a common adverse effect of radiation treatment for breast cancer. Alopecia is a condition that causes hair loss or thinning on the scalp or other parts of the body. It can be caused by various factors such as genetics, hormones, or infection. It is more likely to occur as an adverse effect of chemotherapy or other systemic treatments for cancer that affect the whole body.