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 B
Explanation
Choice A reason: Antiestrogens are not a first-line treatment for endometriosis, as they can cause severe side effects such as bone loss, hot flashes, and vaginal dryness.
Choice B reason: Progestins are a first-line treatment for endometriosis, as they can suppress the growth of endometrial tissue and reduce pain and bleeding.
Choice C reason: Gonadotropin-releasing hormone analogues are a second-line treatment for endometriosis, as they can induce temporary menopause and cause bone loss, hot flashes, and mood changes.
Choice D reason: NSAIDs are not a treatment for endometriosis, as they can only provide symptomatic relief for pain and inflammation.

Correct Answer is D
Explanation
Choice A: Caffeine is not the correct answer because it does not interact with metronidazole. Caffeine is a stimulant that can increase alertness, energy, and heart rate. However, it has no effect on the effectiveness or side effects of metronidazole.
Choice B: Chocolate is not the correct answer because it does not interact with metronidazole. Chocolate is a food that contains caffeine, sugar, and fat. However, it has no effect on the effectiveness or side effects of metronidazole.
Choice C: Nicotine is not the correct answer because it does not interact with metronidazole. Nicotine is a substance that can be found in tobacco products, such as cigarettes, cigars, or chewing tobacco. However, it has no effect on the effectiveness or side effects of metronidazole.
Choice D: Alcohol is the correct answer because it interacts with metronidazole. Alcohol is a substance that can be found in beverages, such as beer, wine, or liquor. It can cause a severe reaction when combined with metronidazole, resulting in symptoms such as nausea, vomiting, headache, flushing, and palpitations. Therefore, the nurse should instruct the client to avoid alcohol while taking metronidazole.

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