# Situation: A nurse runs an adolescent-friendly health service at a Rural Health Unit (RHU) for clients aged 10 to 19 years who come for check-ups, school requirements, and counseling. After a group session on nutrition during puberty, which statement by a 14-year-old girl who has started menstruating shows that the teaching was effective?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629540  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A nurse runs an adolescent-friendly health service at a Rural Health Unit (RHU) for clients aged 10 to 19 years who come for check-ups, school requirements, and counseling.

After a group session on nutrition during puberty, which statement by a 14-year-old girl who has started menstruating shows that the teaching was effective?

## 보기

1. "I need more iron now that I menstruate, and more calcium than an adult woman." **✔ 정답**
2. "I need more iron now that I menstruate, but less calcium now that I have had my period."
3. "I need less iron once my periods are regular, and more calcium than an adult woman."
4. "I need the same iron as before, and the same calcium as an adult woman."

**정답: 1**

## 해설

Each statement has two parts, and both must be right. Menstrual losses and rapid growth raise iron needs in adolescent girls, and they stay high while she menstruates. Adolescent calcium needs exceed the adult need (Philippine Dietary Reference Intakes 2015), because adolescence is the peak time for building bone mass; menarche does not end it.

## 심화 해설

Adolescent Nutrition During Puberty: Iron and Calcium Needs

The correct response reflects two separate but simultaneous nutritional demands: the rise in iron requirement triggered by menstrual blood loss, and the uniquely high calcium requirement driven by peak bone mineral accrual during adolescence.

Both components of the statement must be accurate, and only option 1 satisfies this dual condition.

Why Iron Needs Increase After Menarche

Adolescence is marked by a large growth spurt that expands total blood volume and lean body mass, and in young females the onset of menses adds a recurring iron loss. Beard (2000) reports that overall iron requirements climb from a preadolescent level of approximately 0.7–0.9 mg Fe/day to as much as 2.2 mg Fe/day or more in heavily menstruating young women [1]. This is not a one-time adjustment: as long as menstrual cycles continue, the iron demand remains elevated because each cycle represents ongoing blood and iron loss. A cross-sectional study of post-menarchal adolescents similarly identifies the pubertal growth spurt combined with menstrual iron loss as the key drivers of iron deficiency susceptibility [3]. Therefore, the idea that iron needs drop once periods become regular (option 3) or stay the same as before menarche (option 4) is physiologically incorrect.

Why Calcium Needs Exceed the Adult Requirement

The Philippine Dietary Reference Intakes (2015) set adolescent calcium needs higher than those of adults because adolescence is the critical window for achieving peak bone mass. Menarche signals reproductive maturity, but it does not signal the end of skeletal growth or bone mineralization. Bone mass continues to accumulate throughout the teenage years, so calcium demand remains above the adult level well after the first period. Life-stage nutrition guidance reinforces that increased calcium consumption during adolescence is required for bone growth and for the prevention of osteoporosis later in life [4]. This directly invalidates option 2, which incorrectly claims calcium needs fall after menarche, and option 4, which equates adolescent and adult calcium needs.

Analyzing the Distractors

| Option | Iron component | Calcium component | Verdict |
| --- | --- | --- | --- |
| 1 | More iron due to menstruation | More calcium than an adult woman | Both correct |
| 2 | More iron due to menstruation | Less calcium after period | Calcium part wrong |
| 3 | Less iron once periods are regular | More calcium than an adult woman | Iron part wrong |
| 4 | Same iron as before | Same calcium as an adult woman | Both wrong |

Watch out! Menstruation-related food restrictions are common in some settings and can further limit dietary diversity among adolescent girls . A teaching session that corrects misconceptions about needing less iron or calcium after menarche is therefore clinically relevant, not just theoretical.

Key point! For a 14-year-old who has started menstruating, iron needs are higher than before menarche and remain elevated with ongoing cycles, while calcium needs are higher than an adult woman's because peak bone mass accrual is still underway.References (research sources)

- [1]Iron requirements in adolescent females.Research articleBeard JL (2000) · DOI: 10.1093/jn/130.2.440S

- [3]Exploring the effect of menstrual loss and dietary habits on iron deficiency in teenagers: A cross-sectional study.Research articleSöderman L, Stubbendorff A, Ladfors LV, Bolmsjö BB, Nymberg P, Wolff M. (2025) · DOI: 10.1371/journal.pone.0336688

- [4]Navigating nutrition through the decades: Tailoring dietary strategies to women's life stages.Research articleHarak SS, Shelke SP, Mali DR, Thakkar AA (2025) · DOI: 10.1016/j.nut.2025.112736

## 임상 시나리오

Adolescent Iron and Calcium RequirementsKey counseling points after menarche
After menarche, iron needs rise due to menstrual blood loss and remain elevated while cycles continue. Calcium needs also stay high because adolescence is the peak period for bone mass accrual.

Adolescent calcium requirements exceed adult needs (Philippine DRI 2015). Menarche does not signal the end of increased calcium demand.

CautionDo not advise reducing iron after periods become regular, and do not equate adolescent calcium needs with adult levels. Both errors increase risk for iron deficiency and suboptimal peak bone mass.

## 핵심 개념

- **Menarche** — The first occurrence of menstruation, marking the start of cyclic menstrual blood loss.
- **Iron deficiency** — A condition resulting from inadequate iron to meet increased demands from growth and menstrual losses.
- **Peak bone mass** — The maximum bone density attained, largely achieved during adolescence through adequate calcium intake.
- **Dietary Reference Intakes** — Nutrient reference values, such as the Philippine DRI 2015, used to plan and assess diets.
- **Growth spurt** — A rapid increase in height and weight during adolescence, increasing nutritional demands.

## 같은 주제 문제

- [Situation: A nurse from the Rural Health Unit (RHU) makes postnatal home visits to healthy…](https://mymerci.kr/pages/nclex_q.php?qn_id=629426)
- [Situation: A nurse from the Rural Health Unit (RHU) makes postnatal home visits to healthy…](https://mymerci.kr/pages/nclex_q.php?qn_id=629427)
- [Situation: A nurse from the Rural Health Unit (RHU) makes postnatal home visits to healthy…](https://mymerci.kr/pages/nclex_q.php?qn_id=629428)
- [Situation: A nurse from the Rural Health Unit (RHU) makes postnatal home visits to healthy…](https://mymerci.kr/pages/nclex_q.php?qn_id=629429)
- [Situation: A nurse from the Rural Health Unit (RHU) makes postnatal home visits to healthy…](https://mymerci.kr/pages/nclex_q.php?qn_id=629430)
- [Situation: The nurse holds a weekly well-baby clinic at a Barangay Health Station (BHS) fo…](https://mymerci.kr/pages/nclex_q.php?qn_id=629431)
- [Situation: The nurse holds a weekly well-baby clinic at a Barangay Health Station (BHS) fo…](https://mymerci.kr/pages/nclex_q.php?qn_id=629432)
- [Situation: The nurse holds a weekly well-baby clinic at a Barangay Health Station (BHS) fo…](https://mymerci.kr/pages/nclex_q.php?qn_id=629433)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._