A 14-year-old adolescent female presents to the nurse practitioner because she is concerned that she has not started to menstruate. History is noncontributory, and the physical examination findings are within normal limits. She is in Tanner stage 3 for sexual development. Based on these findings, the nurse practitioner should:

Rationale: A. Referral to a specialist is not immediately necessary when physical development is normal and there are no other concerning findings. B. Measuring FSH and LH is indicated if there are signs of delayed puberty or abnormal secondary sexual characteristics, which are absent in this case. C. hCG testing is used to assess for pregnancy, which is not relevant in a 14-year-old with normal pubertal development and no history suggesting pregnancy. D. Reassurance and education are appropriate, as menarche typically occurs around Tanner stage 3–4, and variation in timing is normal. Most healthy adolescents who have normal physical development and no other symptoms will begin menstruating by age 15.