The school nurse is teaching a group of female students about the female reproductive system. A student asks how she will know she is starting puberty. Which information should the nurse discuss?

A dark line of pigmentation occurs along the midline of the abdomen.

Weight gain becomes obvious as the hip circumference increases.

The areolar color of the nipples changes from pink to dark brown.

The development of breast buds will form under the nipples.

Answer and Explanation

The Correct Answer is D

A. A dark line of pigmentation occurs along the midline of the abdomen: This refers to linea nigra, which is more commonly associated with hormonal changes during pregnancy rather than puberty. It is not a typical sign of puberty in adolescent females.

B. Weight gain becomes obvious as the hip circumference increases: While changes in body shape and fat distribution occur during puberty especially with increased fat around the hips and thighs, it is usually a gradual process and not the first noticeable sign.

C. The areolar color of the nipples changes from pink to dark brown: Areolar pigmentation may darken with puberty in some individuals, but it varies by skin tone and is not a reliable or universal first sign of puberty.

D. The development of breast buds will form under the nipples: The appearance of breast buds or thelarche, small, firm lumps form under the nipples, which can sometimes be tender, is typically the first visible sign of puberty in girls, usually occurring around ages 8–13. It signals the beginning of hormonal changes and physical development.

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Correct Answer is D

Explanation

A. Tears of the anal mucosa with old blood around anus: This description aligns more with anal fissures, which are painful tears in the mucosa. Anal fissures typically present with bright red blood and sharp pain during bowel movements and are often associated with pain not a shiny, purple mass.

B. Serosanguineous and purulent exudate from anus: This finding suggests infection or an abscess rather than hemorrhoids. Purulent discharge would indicate pus, which is not characteristic of external hemorrhoids and would require a different diagnostic and treatment approach.

C. Anal mucosa prolapse and loose sphincter tone: While anal mucosa prolapse can occur, the presence of a purple, shiny, protruding mass with dark red blood more accurately describes thrombosed external hemorrhoids rather than mucosal prolapse or incontinence.

D. Dried dark red blood on swollen external hemorrhoids: This is the most accurate documentation. External hemorrhoids can appear as shiny, swollen, purple masses, and dried dark red blood indicates prior bleeding from engorged and irritated veins typical in these hemorrhoids.

A. Right side deep tendon reflex 2+. B. Right side deep tendon reflex 0. C. Right side deep tendon reflex 4+. D. Right side deep tendon reflex 1+.

Correct Answer is D

Explanation

A. Right side deep tendon reflex 2+: A 2+ reflex is considered normal and would not correlate with the nurse’s observation of diminished reflexes. Documenting 2+ would fail to reflect the neurological deficit noted in the assessment.

B. Right side deep tendon reflex 0: A 0 reflex indicates complete absence of a response, suggesting flaccid paralysis or severe lower motor neuron damage. The nurse observed diminished reflexes, not absent, so 0 would overstate the impairment.

C. Right side deep tendon reflex 4+: A 4+ reflex indicates hyperreflexia, often associated with upper motor neuron lesions, not weakness and diminished reflexes. This would contradict the nurse’s findings of decreased neuromuscular activity on the right side.

D. Right side deep tendon reflex 1+: A 1+ rating represents diminished or hypoactive reflexes, which aligns with the nurse’s findings of generalized weakness and reduced deep tendon activity. This accurately reflects the likely residual neurological effects post-CVA.

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The school nurse is teaching a group of female students about the female reproductive system. A student asks how she will know she is starting puberty. Which information should the nurse discuss?

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Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

The nurse observes generalized weakness and diminished deep tendon reflexes on the right side of an older adult client who has a history of a cerebrovascular accident. Which deep tendon reflex response should the nurse document to support the client's clinical assessment?

Correct Answer is D

Explanation

The nurse is assessing a client who has a history of kidney stones and returns to the clinic with flank pain. Which intervention should the nurse implement first?

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The school nurse is teaching a group of female students about the female reproductive system. A student asks how she will know she is starting puberty. Which information should the nurse discuss?

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