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. An expected variation: Longitudinal ridges (Onychorrhexis) on the fingernails are common in older adults and are typically considered a normal part of aging. As we age, the nail matrix can become less smooth, leading to the development of these ridges. These ridges tend to become more pronounced with age and do not usually indicate any underlying pathology.

B. Chronic obstructive pulmonary disease (COPD): Nail changes associated with COPD often include clubbing, increased angle between the nail bed and the nail fold, not longitudinal ridging. The presence of ridges is not a characteristic sign of this respiratory condition.

C. Psoriasis: Psoriasis can cause nail pitting, thickening, discolouration and separation of the nail from the nail bed (onycholysis), but it does not commonly cause regular longitudinal ridging as seen in aging.

D. Fungal infection: Fungal infections typically result in discoloration (yellowish, whitish, or brownish), thickening, crumbling, or irregular texture of the nail. Longitudinal ridges without these changes are not consistent with a fungal etiology.

A. Clean the ears to remove excess wax build up: There is no indication of cerumen (ear wax) occlusion based on the visual inspection. The tympanic membranes are clearly visible, suggesting that the ear canals are not obstructed by wax.

B. Culture the white patches for possible fungal growth: Fungal infections of the ear (otomycosis) typically involve the external auditory canal, not the tympanic membrane itself. The patches described are more consistent with tympanosclerosis, which does not require culturing.

C. Referral to an audiologist for a hearing evaluation: While chronic ear infections can affect hearing, the client denies any hearing loss, and the tympanic membranes appear otherwise healthy. There is no immediate need for audiologic referral unless symptoms arise.

D. Record the findings in the client's record: The dense white patches are likely tympanosclerosis, a common, benign finding resulting from scarring due to past ear infections. No treatment is needed if the client is asymptomatic. Proper documentation is the appropriate next step.