fat tissue atrophies, causing breast size and elasticity to diminish, resulting in breasts that sag. The mother of a 10-year-old boy asks the nurse to discuss the recognition of puberty. The nurse should reply by saying: Puberty usually begins about age fifteen. The first sign of puberty is enlargement of the testes. Penis size does not increase until about the age of sixteen. “The development of pubic hair precedes testicular or penis enlargement. A patient has bilateral pitting edema of the feet. While assessing the peripheral vascular system, the nurse’s primary focus should be: The correct answer is: Venous function of the lower extremities During an examination, the nurse notes severe nystagmus in both eyes of a patient. Which of the following conclusions is correct? 1.This is a normal occurrence. 2.This may indicate disease of the cerebellum or brainstem. 3.This is a sign that the patient is nervous about the examination. 4.This indicates a visual problem and a referral to an ophthalmologist is indicated. End-point nystagmus at an extreme lateral gaze occurs normally. Assess any other nystagmus carefully. Severe nystagmus occurs with disease of the vestibular system, cerebellum, or brainstem. When performing a musculoskeletal assessment, the nurse knows the correct approach for the examination should be: proximal to distalA 43-year-old woman is at the clinic for a routine examination. She reports that she has had a breast lump in her right breast for years. Recently, it has begun to change in consistency and is becoming harder. She reports that 5 years ago her physician evaluated the lump and determined that it was nothing to worry about. The examination validates the presence of a mass in the right upper outer quadrant at 1 oclock, approximately 5 cm from the nipple. It is firm, mobile, nontender, with borders that are not well defined. The nurses recommendation to her is: Because of the change in consistency of the lump, it should be further evaluated by a physician.