# Situation: The school nurse of a public school that serves Grades 1 to 10 provides health appraisal, screening, and health education for the learners. A 12-year-old girl says that breast budding, her first sign of puberty, appeared at age 10 and that she now also has pubic hair. She asks when her first menstruation will come. The nurse explains that menarche usually occurs:

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629436  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: The school nurse of a public school that serves Grades 1 to 10 provides health appraisal, screening, and health education for the learners.

A 12-year-old girl says that breast budding, her first sign of puberty, appeared at age 10 and that she now also has pubic hair. She asks when her first menstruation will come. The nurse explains that menarche usually occurs:

## 보기

1. About 2 to 2½ years after breast budding began **✔ 정답**
2. Before her fastest growth in height begins
3. About 4 to 5 years after the breast budding began
4. About 6 months after breast budding began

**정답: 1**

## 해설

In girls, the first sign of puberty is breast budding (thelarche). Pubic hair follows, then the peak height velocity, and then menarche, about 2 to 2½ years after thelarche. Her first sign at age 10 means menarche can be expected at about 12 to 12½ years.

## 심화 해설

When menarche usually comes
In girls, the first visible sign of puberty is breast budding (thelarche). Puberty then follows a fairly predictable sequence: pubic hair appears, the growth spurt reaches its peak height velocity, and menarche follows. Menarche usually occurs about 2 to 2½ years after breast budding begins. This girl's breast budding started at age 10, so her first period can be expected at about 12 to 12½ years. Breast budding is the starting point for estimating menarche, which follows about 2 to 2½ years later.

Menarche follows peak growth
A key teaching point is that menarche comes after the fastest growth in height, not before it. By the time a girl has her first period, most of her height growth is behind her, though she continues to grow more slowly for a while. The option stating that menarche comes before her fastest growth reverses this order. Watch out! Boys differ: their peak height velocity comes later in puberty, which is why girls are often taller than boys in early adolescence.

Why the time spans in the distractors are wrong
Six months is too short; the hormonal changes that lead to ovulation and menstruation take longer to mature. Four to five years is too long and would describe a delay that might itself need evaluation. The usual interval of about 2 to 2½ years lies between these extremes.

| Usual order in girls | What happens |
| --- | --- |
| 1. Thelarche | Breast budding, the first sign of puberty |
| 2. Pubarche | Appearance of pubic hair |
| 3. Peak height velocity | Fastest growth in height |
| 4. Menarche | First menstruation, about 2 to 2½ years after thelarche |

Using this in school health
The school nurse can use this sequence to give the girl a realistic expectation, to prepare her with practical information on menstrual hygiene, and to reassure her that her development is on track. Knowing the normal timeline also helps the nurse recognize when puberty is unusually early or late and needs referral.

Exam takeaway
In girls: breast budding first, then pubic hair, then peak height velocity, then menarche about 2 to 2½ years after breast budding. Key point! Estimate the expected age of menarche by adding about 2 to 2½ years to the age at which breast budding began.

## 임상 시나리오

Predicting MenarcheSchool nurse counseling a 12-year-old girl
The first sign of puberty in girls is breast budding (thelarche), followed by pubic hair and the peak height velocity.

Menarche usually comes about 2 to 2½ years after breast budding. With budding at age 10, expect menarche at about 12 to 12½ years.

Use the visit to teach menstrual hygiene and reassure her that her development is normal.

CautionMenarche follows the growth spurt; it does not come before the fastest growth in height.

## 핵심 개념

- **Thelarche** — The onset of breast development, usually the first sign of puberty in girls.
- **Menarche** — The first menstrual period, usually about 2 to 2½ years after breast budding.
- **Peak height velocity** — The period of fastest growth in height during the pubertal growth spurt.
- **Pubarche** — The appearance of pubic hair during puberty.

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