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

Answer and Explanation

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.

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Correct Answer is ["B","D"]

Explanation

A. At 12 months, the infant walks independently: Most infants begin walking independently between 12 and 15 months of age, but it's not typically achieved by 12 months.
B. At 7 months, the infant sits alone with some use of hands for support: This is an accurate statement. By around 6 to 8 months, infants develop the ability to sit unsupported, although they may still use their hands for balance.
C. At 9 months, the infant crawls with the abdomen off the floor: Crawling typically begins between 7 and 10 months, but the abdomen may still be close to the floor initially.
D. At 1 month, the infant lifts and turns the head to the side in the prone position: This is an accurate statement. Newborns typically exhibit head control and turning movements when placed on their stomachs (prone position) by around 1 month of age.

E. At 2 months, the infant rolls from supine to prone to back again: Rolling from supine to prone and back may begin around 4 to 6 months, but it's less likely to occur at 2 months.

Correct Answer is ["260"]

Explanation

To calculate the total fluid intake, add up the volume of each item consumed:
- 1⁄2 cup of juice = approximately 120 mL
- 3 oz gelatin = approximately 90 mL
- 1 oz of an ice pop = approximately 30 mL
- 20 mL ginger ale
Total fluid intake = 120 mL (juice) + 90 mL (gelatin) + 30 mL (ice pop) + 20 mL (ginger ale)
= 260 mL

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse caring for newborns knows that infants exhibit phenomenal increases in their gross motor skills over the first 12 months of life. Which statements accurately describe the typical infant's achievement of these milestones? Select all that apply.

Correct Answer is ["B","D"]

Explanation

A nurse is caring for a child who is on a clear liquid diet. At lunch, the child consumed 1⁄2 cup of juice, 3 oz gelatin, 1 oz of an ice pop, and 20 mL ginger ale. How many mL should the nurse record as the child's fluid intake?

Correct Answer is ["260"]

Explanation

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