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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Set of building blocks: While building blocks can be engaging toys for children, they may not effectively address the emotional needs of a child experiencing distress or separation anxiety. Building blocks are more suitable for activities that promote creativity and fine motor skills.
B. Toy hammer and pounding boarD. Toys that involve physical activity, such as a toy hammer and pounding board, may not be appropriate for a child experiencing emotional distress. These toys may require energy and concentration that the child may not be able to focus on during a tantrum.
C. Picture book about hospitals: While a picture book about hospitals may help familiarize the child with the hospital environment, it may not provide immediate comfort during a tantrum. This type of resource may be more beneficial for preparing the child for medical procedures or explaining what to expect during hospitalization.
D. Stuffed animal: Providing a stuffed animal can offer comfort and reassurance to a child experiencing stress or separation anxiety. A soft and cuddly toy like a stuffed animal can serve as a transitional object, providing emotional support and security when the parent is not present. Children often form attachments to stuffed animals, which can help them cope with unfamiliar or challenging situations.
Correct Answer is C
Explanation
A. Describing the tongue extrusion reflex: The tongue extrusion reflex is typically present in
infants up to around 4 to 6 months of age and diminishes as they begin to eat solid foods. At 7 months, this reflex is likely no longer prominent.
B. Explaining how to prepare table meats: While introducing solid foods is important around 6 months of age, meats are often introduced later in infancy due to their texture and potential
allergenicity. At 7 months, infants may still be primarily consuming pureed or mashed foods.
C. Advising about increased caloric needs: At 7 months, infants are transitioning to a more varied diet that includes solid foods alongside breast milk or formula. Guidance on meeting their
increasing nutritional needs is crucial at this stage.
D. Discussing the type of sippy cup to usE. Sippy cups are typically introduced closer to the end of the first year or during the transition to weaning from the bottle. While it's important to
discuss appropriate feeding utensils, addressing increased caloric needs is a more immediate concern for a 7-month-old infant.
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