Flashcards in Final Exam Chapter 15 Deck (41):
1. The nurse is teaching a group of 10- to 12-year-old children about physical development during the school-age years. Which statement made by a participant, indicates the correct understanding of the teaching?
a. “My body weight will be almost triple in the next few years.”
b. “I will grow an average of 2 inches per year from this point on.”
c. “There are not that many physical differences among school-age children.”
d. “I will have a gradual increase in fat, which may contribute to a heavier appearance.”
In middle childhood, growth in height and weight occurs at a slower pace. Between the ages of 6 and 12 years, children grow 2 inches per year. In middle childhood, children’s weight will almost double; they gain 3 kg/year. At the end of middle childhood, girls grow taller and gain more weight than boys. Children take on a slimmer look with longer legs in middle childhood.
2. Generally, the earliest age at which puberty begins is _____ years in girls, _____ in boys.
a. 13; 13
b. 11; 11
c. 10; 12
d. 12; 10
Puberty signals the beginning of the development of secondary sex characteristics. This begins earlier in girls than in boys. Usually a 2-year difference occurs in the age of onset. Girls and boys do not usually begin puberty at the same age. Girls generally begin puberty 2 years earlier than boys.
3. Which describes the cognitive abilities of school-age children?
a. Have developed the ability to reason abstractly
b. Are capable of scientific reasoning and formal logic
c. Progress from making judgments based on what they reason to making judgments based on what they see
d. Are able to classify, to group and sort, and to hold a concept in their minds while making decisions based on that concept
In Piaget’s stage of concrete operations, children have the ability to group and sort and make conceptual decisions. Children cannot reason abstractly and logically until late adolescence. Making judgments based on what they reason to making judgments based on what they see is not a developmental skill.
4. Which describes moral development in younger school-age children?
a. The standards of behavior now come from within themselves.
b. They do not yet experience a sense of guilt when they misbehave.
c. They know the rules and behaviors expected of them but do not understand the reasons behind them.
d. They no longer interpret accidents and misfortunes as punishment for misdeeds.
Children who are ages 6 and 7 years know the rules and behaviors expected of them but do not understand the reasons for these rules and behaviors. Young children do not believe that standards of behavior come from within themselves, but that rules are established and set down by others. Younger school-age children learn standards for acceptable behavior, act according to these standards, and feel guilty when they violate them. Misfortunes and accidents are viewed as punishment for bad acts.
5. Which statement characterizes moral development in the older school-age child?
a. They are able to judge an act by the intentions that prompted it rather than just by the consequences.
b. Rules and judgments become more absolute and authoritarian.
c. They view rule violations in an isolated context.
d. They know the rules but cannot understand the reasons behind them.
Older school-age children are able to judge an act by the intentions that prompted the behavior rather than just by the consequences. Rules and judgments become less absolute and authoritarian. Rule violation is likely to be viewed in relation to the total context in which it appears. The situation and the morality of the rule itself influence reactions.
6. An 8-year-old girl tells the nurse that she has cancer because God is punishing her for “being bad.” She shares her concern that if she dies, she will go to hell. The nurse should interpret this as:
a. a belief common at this age.
b. a belief that forms the basis for most religions.
c. suggestive of excessive family pressure.
d. suggestive of a failure to develop a conscience.
Children at this age may view illness or injury as a punishment for a real or imagined misdeed. The belief in divine punishment is common for an 8-year-old child.
7. Parents ask the nurse whether it is common for their school-age child to spend a lot of time with peers. The nurse should respond, explaining that the role of the peer group in the life of school-age children provides:
a. opportunity to become defiant.
b. time to remain dependent on their parents for a longer time.
c. time to establish a one-on-one relationship with the opposite sex.
d. security as they gain independence from their parents.
Peer-group identification is an important factor in gaining independence from parents. Children learn how to relate to people in positions of leadership and authority and how to explore ideas and the physical environment. Becoming defiant in a peer-group relationship may lead to bullying. Peer-group identification helps in gaining independence rather than remaining dependent. One-on-one opposite sex relationships do not occur until adolescence. School-age children form peer groups of the same sex.
8. A group of boys ages 9 and 10 years have formed a “boys-only” club that is open to neighborhood and school friends who have skateboards. This should be interpreted as:
a. behavior that encourages bullying and sexism.
b. behavior that reinforces poor peer relationships.
c. characteristic of social development at this age.
d. characteristic of children who later are at risk for membership in gangs.
One of the outstanding characteristics of middle childhood is the creation of formalized groups or clubs. Peer-group identification and association are essential to a child’s socialization. Poor relationships with peers and a lack of group identification can contribute to bullying. A boys-only club does not have a direct correlation with later gang activity.
9. A school nurse observes school-age children playing at recess. Which is descriptive of the play the nurse expects to observe?
a. Individuality in play is better tolerated than at earlier ages.
b. Knowing the rules of a game gives an important sense of belonging.
c. They like to invent games, making up the rules as they go.
d. Team play helps children learn the universal importance of competition and winning.
Play involves increased physical skill, intellectual ability, and fantasy. Children form groups and cliques and develop a sense of belonging to a team or club. At this age, children begin to see the need for rules. Conformity and ritual permeate their play. Their games have fixed and unvarying rules, which may be bizarre and extraordinarily rigid. With team play, children learn about competition and the importance of winning, an attribute highly valued in the United States.
10. Teasing can be common during the school-age years. The nurse should recognize that which applies to teasing?
a. Can have a lasting effect on children
b. Is not a significant threat to self-concept
c. Is rarely based on anything that is concrete
d. Is usually ignored by the child who is being teased
Teasing in this age group is common and can have a long-lasting effect. Increasing awareness of differences, especially when accompanied by unkind comments and taunts from others, may make a child feel inferior and undesirable. Physical impairments such as hearing or visual defects, ears that “stick out,” or birth marks assume great importance.
11. Which is characteristic of dishonest behavior in children ages 8 to 10 years?
a. Cheating during games is now more common.
b. Lying results from the inability to distinguish between fact and fantasy.
c. They may steal because their sense of property rights is limited.
d. They may lie to meet expectations set by others that they have been unable to attain.
Older school-age children may lie to meet expectations set by others to which they have been unable to measure up. Cheating usually becomes less frequent as the child matures. In this age group, children are able to distinguish between fact and fantasy. Young children may lack a sense of property rights; older children may steal to supplement an inadequate allowance, or it may be an indication of serious problems.
12. A 9-year-old girl often comes to the school nurse complaining of stomach pains. Her teacher says she is completing her school work satisfactorily but lately has been somewhat aggressive and stubborn in the classroom. The school nurse should recognize this as:
a. signs of stress.
b. developmental delay.
c. physical problem causing emotional stress.
d. lack of adjustment to school environment.
Signs of stress include stomach pains or headache, sleep problems, bed-wetting, changes in eating habits, aggressive or stubborn behavior, reluctance to participate, or regression to early behaviors. This child is exhibiting signs of stress.
13. Which statement best describes fear in the school-age child?
a. They are increasingly fearful for body safety.
b. Most of the new fears that trouble them are related to school and family.
c. They should be encouraged to hide their fears to prevent ridicule by peers.
d. Those who have numerous fears need continuous protective behavior by parents to eliminate these fears.
During the school-age years, children experience a wide variety of fears, but new fears relate predominantly to school and family. During the middle-school years, children become less fearful for body safety than they were as preschoolers. Parents and other persons involved with children should discuss children’s fears with them individually or as a group activity. Sometimes school-age children hide their fears to avoid being teased. Hiding their fears does not end them and may lead to phobias.
14. The father of a 12-year-old child tells the nurse that he is concerned about his son getting “fat.” His son is at the 50th percentile for height and the 75th percentile for weight on the growth chart. The most appropriate nursing action is to:
a. reassure the father that his child is not fat.
b. reassure the father that his child is just growing.
c. suggest a low-calorie, low-fat diet.
d. explain that this is typical of the growth pattern of boys at this age.
This is a characteristic pattern of growth in preadolescent boys, where the growth in height has slowed in preparation for the pubertal growth spurt, but weight is still gained. The nurse should review this with both the father and the child and develop a plan to maintain physical exercise and a balanced diet. It is false reassurance to tell the father that his son is not fat. His weight is high for his height. The child needs to maintain his physical activity. The father is concerned, so an explanation is required. A nutritional diet with physical activity should be sufficient to maintain his balance.
15. A child has an evulsed (knocked-out) tooth. Which medium should the nurse instruct the parents to place the tooth in for transport to the dentist?
a. In cold milk
b. In cold water
c. In warm salt water
d. In a dry, clean jar
An evulsed tooth should be placed in a suitable medium for transplant, either cold milk or saliva (under the child or parent’s tongue). Cold milk is a more suitable medium for transport than cold water, warm salt water, or a dry, clean jar.
16. The school nurse has been asked to begin teaching sex education in the fifth grade. The nurse should recognize that:
a. children in fifth grade are too young for sex education.
b. children should be discouraged from asking too many questions.
c. correct terminology should be reserved for children who are older.
d. sex can be presented as a normal part of growth and development.
When sexual information is presented to school-age children, sex should be treated as a normal part of growth and development. Fifth-graders are usually 10 or 11 years old. This age is not too young to speak about physiologic changes in their bodies. They should be encouraged to ask questions. Preadolescents need precise and concrete information.
17. The school nurse is conducting a class on bicycle safety. Which statement made by a participant indicates a need for further teaching?
a. “Most bicycle injuries occur from a fall off the bicycle.”
b. “Head injuries are the major causes of bicycle-related fatalities.”
c. “I should replace my helmet every 5 years.”
d. “I can ride double with a friend if the bicycle has an extra large seat.”
Children should not ride double. Most injuries result from falls. The most important aspect of bicycle safety is to encourage the rider to use a protective helmet. Head injuries are the major cause of bicycle-related fatalities. The child should always wear a properly fitted helmet approved by the U.S. Consumer Product Safety Commission and should replace the helmet at least every 5 years.
18. When teaching injury prevention during the school-age years, what should the nurse include?
a. Teach children to fear strangers.
b. Teach basic rules of water safety.
c. Avoid letting child cook in microwave ovens.
d. Caution child against engaging in competitive sports.
Water safety instruction is an important source of injury prevention at this age. The child should be taught to swim, select safe and supervised places to swim, swim with a companion, check for sufficient water depth before diving, and use an approved flotation device. Teach stranger safety, not fear of strangers. This includes instructing children to not go with strangers, not wear personalized clothing in public places, tell parents if anyone makes child feel uncomfortable, and say “no” in uncomfortable situations. Teach child safe cooking. Caution against engaging in hazardous sports such as those involving trampolines.
19. A nurse is teaching parents of kindergarten children general guidelines to assist their children in school. Which statement by the parents indicates they understand the teaching?
a. “We will only meet with the teacher if problems occur.”
b. “We will discourage hobbies so our child focuses on school work.”
c. “We will plan a trip to the library as often as possible.”
d. “We will expect our child to make all As in school.”
General guidelines for parents to help their child in school include sharing an interest in reading. The library should be used frequently and books the child is reading should be discussed. Hobbies should be encouraged. The parents should not expect all As. They should focus on growth more than grades.
20. A school nurse is teaching dental health practices to a group of sixth-grade children. How often should the nurse recommend the children brush their teeth?
a. Twice a day
b. Three times a day
c. After meals
d. After meals, snacks, and bedtime
Teeth should be brushed after meals, after snacks, and at bedtime. Children who brush their teeth frequently and become accustomed to the feel of a clean mouth at an early age usually maintain the habit throughout life. Twice a day, three times a day or after meals would not be often enough.
21. Parents of a twelve-year-old child ask the clinic nurse, “How many hours of sleep should our child get?’ The nurse should respond that 12-year-old children need how many hours of sleep at night?
School-age children usually do not require naps, but they do need to sleep approximately 11 hours at age 5 years and 9 hours at age 12 years each night.
22. A nurse planning care for a school-age child should take into account that which thought process is seen at this age?
b. Magical thinking
c. Ability to conserve
d. Thoughts are all-powerful
One cognitive task of school-age children is mastering the concept of conservation. At an early age (5 to 7 years), children grasp the concept of reversibility of numbers as a basis for simple mathematics problems (e.g., 2 + 4 = 6 and 6 – 4 = 2). They learn that simply altering their arrangement in space does not change certain properties of the environment, and they are able to resist perceptual cues that suggest alterations in the physical state of an object. Animism, magical thinking, and believing that thoughts are all powerful are thought processes seen in preschool children.
1. A nurse is planning care for a 7-year-old child hospitalized with osteomyelitis. Which activities should the nurse plan to bring from the playroom for the child? (Select all that apply.)
a. Paper and some paints
b. Board games
d. Stuffed animals
e. Computer games
ANS: A, B, E
School-age children become fascinated with complex board, card, or computer games that they can play alone, with a best friend, or with a group. They also enjoy sewing, cooking, carpentry, gardening, and creative activities such as painting. Jack-in-the-box and stuffed animals would be appropriate for a toddler or preschool child.
2. A nurse teaches parents that team play is important for school-age children. Which can children develop by experiencing team play? (Select all that apply.)
a. Achieve personal goals over group goals.
b. Learn complex rules.
c. Experience competition.
d. Learn about division of labor.
ANS: B, C, D
Team play helps stimulate cognitive growth because children are called on to learn many complex rules, make judgments about those rules, plan strategies, and assess the strengths and weaknesses of members of their own team and members of the opposing team. Team play can also contribute to children’s social, intellectual, and skill growth. Children work hard to develop the skills needed to become team members, to improve their contribution to the group, and to anticipate the consequences of their behavior for the group. Team play teaches children to modify or exchange personal goals for goals of the group; it also teaches them that division of labor is an effective strategy for attaining a goal.
Which behavior is most characteristic of the concrete operations stage of cognitive development?
a. Progression from reflex activity to imitative behavior
b. Inability to put oneself in another's place
c. Increasingly logical and coherent thought processes
d. Ability to think in abstract terms and draw logical conclusions
Increasingly logical and coherent thought processes are characteristic of concrete operations. Children in this stage are able to classify objects.
Progression from reflex activity to imitative behavior is characteristic of the sensorimotor stage, which occurs from birth to 2 years of age.
Inability to put oneself in another's place is characteristic of the preoperational stage, ages 2 to 7 years.
Adolescents, in the formal operations stage, have the ability to think in abstract terms and draw logical conclusions.
Parents of a 10-year-old child are concerned that their child has been recently showing signs of low self-esteem. Which should the nurse consider when discussing this issue with the parents?
a. Changing self-esteem is difficult after about age 5 years.
b. Self-esteem is the objective judgment of one's worthiness.
c. Transitory periods of lowered self-esteem are expected developmentally.
d. High self-esteem develops when parents show adequate love for the child.
Self-esteem changes with development. Transient declines are expected and, with positive encouragement and support, are only temporary.
Self-esteem is influenced throughout adolescence.
One aspect of self-esteem is a subjective judgment of one's worthiness.
Self-esteem is based on several factors, including competence, sense of control, moral worth, and worthiness of love and acceptance.
What is an important consideration related to childhood stress?
a. Children should be protected from stress.
b. Children do not have coping strategies.
c. Parents cannot prepare children for stress.
d. Some children are more vulnerable to stress than others.
Children's age, temperament, life situation, and state of health affect their vulnerability, reactions, and ability to handle stress.
It is not feasible to protect children from all stress.
Children can be taught coping strategies. Supportive interpersonal relationships are essential to the psychological well-being of children.
Adults need to recognize signs of stress before they become overwhelming. Providing children with interpersonal security helps them develop coping strategies for dealing with stress.
A parent tells the nurse, "I am worried about my 13-year-old son. He hasn't started puberty, and my daughter did when she was 11 years of age." The most appropriate explanation by the nurse is
a. "This is unusual and requires further evaluation of your son."
b. "This is unusual because the onset of pubescence is usually the same in siblings."
c. "This is normal because the onset of pubescence is usually earlier in girls than it is in boys."
d. "This is abnormal because the onset of pubescence is usually earlier in boys than it is in girls."
Girls begin puberty on average approximately 2 years before boys.
Puberty usually begins no earlier than age 12 years in boys, with an average age of onset of 14 years; therefore, no further evaluation is necessary at this time.
The age of pubescence is gender related, with the average age of puberty onset being 12 years for girls and 14 years for boys.
Puberty usually begins no earlier than age 12 years in boys, with an average age of onset of 14 years; therefore, her son is not having an abnormal onset of puberty.
Which is characteristic of the psychosocial development of school-age children?
a. A developing sense of initiative is important.
b. Peer approval is not yet a motivating factor.
c. Motivation comes from extrinsic rather than intrinsic sources.
d. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment.
The school-age child is eager to develop skills and participate in activities. All children are not able to do all tasks well, and the child must be prepared to accept some feelings of inferiority, as highlighted in Erikson's stage for this age-group of industry versus inferiority.
Initiative versus guilt is the stage characteristic of preschoolers.
Peer group formation is one of the major characteristics of school-age children.
School-age children gain satisfaction from independent behaviors that are internally driven and accomplished.
The parents of 9-year-old twins tell the nurse, "They have filled up their bedroom with collections of rocks, shells, stamps, and cars." The nurse should recognize that this behavior is characteristic of
b. typical "twin" behavior.
c. cognitive development at this age.
d. psychosocial development at this age.
Classification skills are developed during the school-age years. This age-group enjoys sorting objects according to shared characteristics.
Giftedness is not measured simply by a school-age child's ability to classify objects, which is an expected cognitive skill for this age-group. Giftedness signs include specific academic aptitudes, advanced memory skills, creative thinking, ability in the visual or performing arts, and psychomotor ability, either individually or in combination.
The development of classification skills is characteristic of the school-age child and is not related to the behavior of twins.
Psychosocial development of the school-age child is focused on accomplishment or industry, not the cognitive skills of classification that are described.
Which is descriptive of the social development of school-age children?
a. Identification with peers is minimal
b. Children frequently have "best friends"
c. Boys and girls play equally with each other
d. Peer approval is not yet an influence toward conformity
Same-sex peers form relationships that encourage sharing of secrets and jokes and coming to each other's aid.
Identification with the peer group is an important milestone for the school-age child to move toward independence from families.
During the school-age years, same-sex peer groups are more prevalent; therefore, there is less interaction between boys and girls.
Conforming to the rules is an essential part of group membership and, therefore, an important skill for the school-age child to learn in terms of peer relationships.
The school nurse is asked to speak with the parents of a 10-year-old boy who has been bullying other children. The nurse's response should be based on knowledge that
a. Bullying at this age is considered normal
b. Children who bully others usually join gangs
c. Bullying is a short-term problem that is generally outgrown by the end of the school-age years
d. Bullying often manifests itself in children who are different or have poor academic or social skills
Poor relationships with peers and a lack of group identification, such as looking different or having poor academic or social skills, contribute to bullying behavior.
Bullying is a maladaptive response to poor relationships with peers and lack of group identification; therefore, it is not considered normal behavior.
Children who chronically bully tend to be impulsive, easily frustrated, and at increased risk for dropping out of school, but there is no direct correlation between bullies and joining gangs.
Children who bully may be at risk for long-term psychological disturbances and psychiatric symptoms. Future problems for bullies may include violence, substance abuse, and criminal convictions, which often occur in adulthood.
What should the nurse include when giving parents guidelines about helping their children in school?
a. Help children as much as possible with their homework.
b. Punish children who fail to perform adequately.
c. Communicate with teachers if there appears to be a problem.
d. Accept responsibility for children's successes and failures.
Parents should communicate with teachers if there is a problem and not wait for a scheduled conference. Parent involvement is one factor in children's success in school.
Children need to do their own homework. This cultivates responsibility.
Discipline should be used to help children control behaviors that might be affecting school performance, but failure to perform adequately should not be punished itself. Communicating with the child is a better solution to getting to the "root" of the school performance problem.
School-age children need to develop responsibility. Keeping promises and meeting deadlines lays a successful foundation for adulthood and adult responsibilities.
The parents of an 8-year-old girl tell the nurse that their daughter wants to join a soccer team. Based on the nurse’s knowledge of this age-group, the most appropriate recommendation is
a. Organized sports, such as soccer, are not appropriate at this age
b. Competition is detrimental to the establishment of a positive self-image
c. Sports participation is encouraged if the sport is appropriate to the child's abilities
d. Girls should compete only against girls because at this age boys are larger and have more muscle mass
The parents should help the child select a sport that is suitable to her capabilities and interests. Team sports contribute to the school-age child's social, intellectual, and skill growth.
Organized sports for school-age children can provide safe, appropriate activities with supportive parents and coaches.
The desire to participate in competitive team sports develops out of a need for peer interaction for the school-age child. A sport should be selected that meets the child's capabilities and interests.
The physical changes in boys described take place during puberty, later in the school-age years; therefore, there is no reason for boys and girls to compete separately at age 8 years.
Nursing interventions to promote health during middle childhood should include
a. stressing the need for increased calorie intake to meet the increased demands on the body.
b. instructing parents to defer questions about sex until the child reaches adolescence.
c. educating the child and parents about the need for effective dental hygiene because these are the years in which permanent teeth erupt.
d. advising parents that the child will need decreasing amounts of rest toward the end of this period.
Because the permanent teeth are present, it is important for the child to learn how to care for these teeth.
Caloric needs are diminished in relation to body size during the middle years; however, a balanced diet is important to prepare for the adolescent growth spurt.
Parents should approach sex education with a life span approach and ANS questions appropriate to the child's age.
School-age children often need to be reminded to go to sleep.
The school nurse is discussing dental health with some children in first grade. Which should be included?
a. Teach how to floss teeth properly.
b. Recommend a toothbrush with hard nylon bristles to get in between the teeth.
c. Emphasize the importance of brushing before bedtime.
d. Recommend nonfluoridated toothpaste.
Children should be taught to brush their teeth after meals and snacks and before bedtime to prevent dental caries.
Parents should help with flossing until children develop the dexterity required, when they are in about the third grade.
A toothbrush with soft nylon bristles is recommended to prevent damage to the gums.
The American Dental Association recommends fluoridated toothpaste for this age-group.
The nurse is teaching a community health promotion class to parents and school-age children related to bicycle safety. Issues to cover in the sessions include
a. bicycle helmets need to be worn only if the child is planning to ride in traffic.
b. reflectors should be installed only on bicycles that are to be ridden at night.
c. bicycles should be ridden against the traffic so that the rider can see the cars.
d. bicycles should be walked through busy intersections
Bicycles should be walked through busy intersections to allow the child to have full view of the traffic and be able to react accordingly, with safety the number one priority.
Bicycle helmets should be worn at all times to prevent head injuries.
Reflectors should be installed on all bicycles, whether they are ridden during the daytime or at night only.
Bicycles should always be ridden with the traffic, not against the traffic. This will assist in preventing accidents.
An important consideration in preventing injuries during middle childhood is that
a. peer pressure is not strong enough to affect risk-taking behavior.
b. most injuries occur in or near school or home.
c. injuries from burns are the highest at this age because of fascination with fire.
d. lack of muscular coordination and control results in an increased incidence of injuries.
Most children in the middle years spend the majority of their time in and around school or home; therefore, the risk for injuries is increased in and around these areas.
Peer pressure as an impetus for risk-taking behavior begins in the school-age years but is more significant in adolescence.
Burn injuries are higher in the toddler years, when children are curious and mobile. They may expose themselves to objects capable of burning them (e.g., hot pots of water in the kitchen). Automobile accidents, either as a pedestrian or passenger, account for the majority of severe accidents in the middle years.
School-age children have more refined muscle development, which results in an overall decrease in the number of accidents. Lack of muscular coordination and control leading to injuries occurs in younger children.
A 12-year-old child being seen in the clinic has not received the hepatitis B (HBV) vaccine. Based on the nurse’s knowledge of vaccines, the most appropriate recommendation is
a. only one dose of HBV will be needed sometime during adolescence.
b. one dose of HBV is needed at age 14 years.
c. the three-dose series of HBV should be started at this time.
d. the three-dose series of HBV should be started at age 16 years or sooner if the adolescent becomes sexually active.
Adolescents should be vaccinated against hepatitis B at this age if they have not been previously.
Three doses of HBV are required to achieve immunity.
Three doses of HBV are required to achieve immunity.
The recommendation is that the HBV vaccine series be started at birth. The American Academy of Pediatrics recommends that vaccinations be completed by age 13 years.
Therapeutic management of an 11-year-old girl with Turner syndrome involves
a. administration of thyroid and human growth hormones.
b. progesterone therapy until development of secondary sex characteristics.
c. estrogen therapy to promote development of secondary sex characteristics.
d. estrogen therapy until menses are well established and height no longer increases.
Although the response is variable, most girls with Turner syndrome will achieve some feminization with estrogen therapy.
Growth hormone may be administered, but unless there is a concurrent hypothyroidism, thyroid hormone is not indicated.
Progesterone does not facilitate development of secondary sex characteristics and thus is not warranted.
Menses may never be established due to lack of a uterus and ovaries, and estrogen will not promote increased height.