Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pediatrics > School-Age and Adolescent Growth & Development > Flashcards

School-Age and Adolescent Growth & Development Flashcards

1
Q

School Agers

A
  • Slow but steady growth
  • They get taller and lose “baby fat.”
  • Talking about kids age 6-12 years old
  • Strength increases yet muscles remain functionally immature
  • Toothless wonders/ ugly ducklings
  • Overuse injury to muscles common to see in sports
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

GI

A

fewer stomach upsets seen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Bladder Capacity

A

Girls have a larger bladder capacity then boys.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Bones

A

Are now all calcified

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Prepubescence

A
  • time before puberty
  • 2 years difference between boys and girls
  • Girls average onset is 12-13
  • Boys average onset is 14
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Psychosocial Development

A
  • Latency Period (Freud) kids are more tranquil
  • Industry vs Inferiority (Erickson) kids are acquiring technical and social skills
  • Ability to cooperate and deal with others
  • Over Achievers: watch for compensation.
  • Society values academics over athletics
  • Repeated school failures will really defeat these kids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Cognitive Development

A
  • Concrete operational stage (Piaget)
  • Higher level thinking; can hold onto concepts
  • Conservability: understanding of volume, mass. length
  • Can now think backwards i.e. retrace previous steps
  • Classification: means of grouping
  • READING is the most significant skill a schoolager acquires.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Moral Developent

A
  • Colburg’s Theory
  • Young schoolagers (6-7 years) judge acts by their consequences; rewards/punishments drive actions.
  • Older schoolagers are able to judge an act by the intention that prompted it. These kids are far less absolute and have an increased cooperation and level of respect.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Spiritual Development

A
  • Want to learn about God
  • Are fascinated with heaven and hell
  • Find tremendous comfort in tradition
  • Want and expect to be punished for misdeeds
  • Find comfort in prayers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Language development

A
  • Very efficient
  • Can interpret directives without visual cues
  • Develop metalinguistic awareness; jokes and riddles, magic kits.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Social Development

A

-Friends are now very important
-Joining groups
-Develop intimate friendships between same-sex peers “best friends”
-Clubs and cliques; security; exclusion of others may occur here.
Bullies: often defiant and antisocial-at greater risk for psych and criminal disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Self Concept Development / Self Esteem

A
  • Nothing succeeds like success
  • Self-confidence vs self-doubt
  • Body image; comparison against others
  • self-esteem is fragile
  • parents, friends, teachers huge influences
  • Grades and teachers/parents remarks can make or break a child
  • Positive feelings equate to confidence in trying new things.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Sexuality Development

A
  • Experimentalists
  • Parents should assume the primary role in educating children regarding sexual behavior.
  • School nurse: often caught in the middle of sex education.
  • Be factual. Use proper terminology.
  • Younger kids need the focus to be around respect and responsibility.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Play

A
  • Kids need to be taught how to follow rules and how to be a “good sport.”
  • Rules and rituals
  • Team Play; can be very rough on kids if they aren’t taught about following rules and that they aren’t always going to win at everything they do.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Concerns related to normal growth and development

A
  • Limit setting/discipline/restrictions is very important
  • Withhold privileges
  • Lying is viewed as normal
  • Cheating is common; mostly unintended
  • Stealing in younger kids is usually due to limited sense of property rights of others.
  • Stress occurs from violence, fears, latchkey kids. Signs include crying, screaming, daydreams, acting out, aggression.
  • Stress is highest in kids today compared to previous generations
  • PTSD: replay over and over to help the child overcome the traumatic event.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Promoting optimal health

A

Nutrition: quality of food is very important. These kids will become junk food monsters if they are allowed to.

  • Sleep and rest is now highly individualized but some kids will require 10 to 12 hours of rest a night.
  • Physical fitness: kids need to participate in physical activity.
  • Television and video games, may desensitize kids
  • Dental health: more permanent teeth now in place
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Anticipatory Guidance and Injury Prevention

A
  • MVA: 2.5 x more fatalities as pedestrians
  • Kids under 12 need to ride in the back seat of the car
  • Head injury is the leading cause of bicycle fatalities
  • Ride-on mower injuries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Health Problems

A

ADHD: developmentally abnormal inability to concentrate; etiology is poorly understood; treated with stimulants; behavior modification - time management, study skills, modify environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Stages of Adolescence

A

Early Stage: 11-14 years old
Middle Stage: 14-17 years old
Late Stage: 18-20 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Adolescence

A
  • period of profound biologic, intellectual, psychosocial, and economic change
  • changes are shaped by the social environment in which the changes take place.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Tanner Stages

A
  • Sequence of development of secondary sexual characteristics that occurs in a predictable sequence.
  • This sequence has been divided into a series of five phases termed the Tanner stages.
  • Although the sequence of sexual development is predictable, the ages at which these changes occur and the rate of progression vary considerably among individuals.
  • Stage 1: immature
  • Stage 5: mature
  • Females: stages describe pubertal development based on breast size and the shape and distribution of pubic hair.
  • Males: stages describe pubertal development based on the size and shape of the penis and scrotum and the shape and distribution of pubic hair.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Cognitive Development

A
  • Future-oriented thinking
  • Can still “lose their mind” and do “silly” things; abandon rational thought
  • Formal operational thinking
  • Think in abstract terms, can theorize
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Psychosocial development

A
  • Identity vs Role confusion
  • Develop autonomy; monitor friends
  • Sense of sexuality is forming in these kids
  • Intercourse by age 15: B 33%, G 20%
  • Intercourse by 12th grade: B 64%, G 65%
  • Immunize against STD’s: Hep B, HPV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Social Environment

A
  • Family: divorced homes/dysfunctional; increase in lack of supervision in the home.
  • Poverty increases drop out rates
  • Peer groups: fill the void when no support available at home.
  • Work: unskilled laborers; monitor their money and what they are spending it on
  • Community: health promotion and education
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Drinking/Peer Groups

A

Extremely common in teens!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Factors promoting adolescent health

A
  • Mental pathology & alcoholism in parents are amongst most difficult challenges for kids.
  • Coping skills for increased success is working, going to the library and playing team sports.
  • Show competence in reading and language arts skills
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Factors Hindering Adolescent Health

A
  • Grade School: holding back destroys self-esteem
  • Drugs, alcohol, smoking, criminal activity, and pregnancy before 18 are all unconventional behaviors that increase potential for greater troubles.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Adolescent Health Problems

A
  • Acne: self-esteem challenges, tx with bcp’s or antibiotics; some meds may cause depression and suicidal ideation
  • PID: upper genitourinary pain w/ motion or manipulation. Can lead to infertility
  • Eating disorders: most common in over-achieving white females. May be related to traumatic conflict.
  • 1:6 teens has had an STI
  • Gonorrhea has highest rates in 15-19 year olds
  • Chlamydia is most common STI in the U.S.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

H.E.A.D.D.D.S.S.

A 
Home
Education
Activities
Depression
Drugs
Diet
Sex
Safety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Rape

A
  • Highest rate in adolescent girls

- Vast majority of perpetrators are not strangers to the victim.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Intentional & Unintentional Injury

A
  • You cannot release a suicidal child without intervention.
  • Intentional injury accounts for 72% of adolescent death
  • Leading cause of injury death is MVAs involving alcohol; unintentional injury
  • Homicide is 2nd leading cause of death in adolescents, usually involving firearms
  • About 8% of high schoolers report having attempted suicide once; gay/lesbian kids at very high risk; s/s include melancholy, dropping grades, family trouble, drugs, gay/lesbian; Girls usually attempt by O.D. and Guys usually complete via gun/hanging.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What accurately describes physical development during the school age years?

A

Child grows an average of 5cm (2”) per year.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is characteristic of the psychosocial development of school age children?

A

Feelings of inferiority or lack of self worth that can be derived from children themselves or from the environment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What describes the cognitive abilities of school age children?

A

They have the ability to place things in a logical order, to group and sort, and to hold a concept in their minds while making decisions on that concept.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What describes moral development in the younger school age child?

A

They know the rules and behaviors expected of them but do not understand the reason behind them.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

A group of boys ages 9 & 10 have formed a “boys only” club that is open to neighborhood and school friends who have skate boards. This should be interpreted as:

A

Characteristic of social development at this age.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Bullying can be common during the school age years. The nurse should recognize that bullying;

A

Can have lasting effects on children.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What should the nurse include when giving parents guidelines about helping their children in school?

A

Communicate with teachers if there appears to be a problem.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Sleep problems in the school aged child are often demonstrated by:

A

Delaying tactics because they do not wish to go to bed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

The parents of an 8 year old girl tell the nurse that their daughter wants to join a soccer team. The nurse should suggest:

A

Sports participation is encouraged if the type of sport is appropriate to the child’s abilities.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

The school nurse is discussing dental health with some children in 1st grade. What should be included?

A

Emphasize importance of brushing before bed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

When determining the etiology of a skin problem, which of the following is essential to the diagnosis of the lesions?

A

Careful inspection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

The term used to describe an abnormal sensation such as burning or prickling is:

A

Paresthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Which of the following factors promotes wound healing?

A

Moist, crust-free wound environment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

A child falls on the playground and has a small laceration on the forearm. The school nurse should do which of the following to cleanse the wound?

A

Rinse the wound with sterile water or saline, using a syringe to generate mild pressure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

When applying wet compresses or dressings to the skin, the nurse should do which of the following?

A

Apply desired solution on cotton gauze or soft cotton cloths, such as clean handkerchiefs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

An important nursing consideration when caring for a child with impetigo contagiosa is which of the following?

A

Thoroughly wash hands and maintain cleanliness when caring for an infected child.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Ringworm, frequently found in schoolchildren, is caused by which of the following?

A

Fungus

49
Q

Which of the following should the nurse include when explaining how to manage pediculosis capitis?

A

Remove nits with an extra-fine tooth comb or tweezers.

50
Q

Matt’s mother tells the nurse that he keeps scratching the areas where he has poison ivy. The nurse’s response should be based on which of the following?

A

Scratching the lesions may cause them to become secondarily infected.

51
Q

A boy scout sustains frostbite to his feet while out hiking in the mountains. Before he is transported to the nearest emergency treatment center, which of the following is important in managing his care?

A

Prevent him from walking any father.

52
Q

A child has an evulsed (knocked out) tooth. The parents are reluctant to try to reimplant the tooth. What should the tooth be placed in for transport to the dentist?

A

Cold milk

53
Q

Which of the following is an important consideration when the nurse is discussing enuresis with the parents of a young child?

A

Encourage the child to take charge of treatment interventions.

54
Q

Which of the following is descriptive of attention deficit hyperactivity disorder (ADHD)?

A

Manifestations affect every aspect of the child’s life but are most obvious in the classroom.

55
Q

A mother calls the school nurse saying that her daughter has developed school phobia. She has been out of school 3 days. The nurse’s recommendations should include which of the following?

A

Immediately return the child to school.

56
Q

Which of the following is a characteristic of children with depression?

A

Change in appetite, resulting in weight loss or gain.

57
Q

In the U.S., which of the following is approximate mean age of menarche?

A

12.55 years

58
Q

By what age should one be concerned about pubertal delay in boys?

A

13.5 to 14 years

59
Q

How does the peak of the pubertal growth velocity compare in girls and boys?

A

On average girls reach their peak growth rate 2 years earlier than boys.

60
Q

According to Piaget, the adolescent is in the fourth stage of cognitive development, the period of:

A

Formal operations

61
Q

While caring for hospitalized adolescents, the nurse observes that sometimes they are skeptical of their parents’ religious beliefs and practices. The nurse should recognize that this is which of the following?

A

Normal spiritual development

62
Q

An adolescent boy tells the nurse that he has recently had homosexual feelings. The nurse’s response should be based on the knowledge that:

A

The adolescent should be encouraged to share his feelings and experiences.

63
Q

Why do peer relationships become more important during adolescence?

A

Peer relationships provide adolescents with sources of social reinforcement.

64
Q

The school nurse tells adolescents in the clinic that confidentiality and privacy will be maintained unless a life-threatening situation arises. This practice is:

A

Important in establishing trusting relationships.

65
Q

The single greatest source of unintentional injury and death in the adolescent age-group involve which of the following?

A

Motor vehicle crashes.

66
Q

When teaching the adolescent about the management of acne, the nurse should include which of the following interventions?

A

Clean face gently with a mild soap once or twice a day.

67
Q

The school nurse is discussing testicular self-examination with adolescent males. Why is this important?

A

Testicular tumors during adolescence are generally malignant.

68
Q

An adolescent asks the nurse what causes primary dysmenorrhea. The nurse’s response should include which of the following?

A

One factor is the onset of ovulatory cycles.

69
Q

An adolescent girl tells the nurse she has some type of vaginitis. Which of the following clinical manifestations is most suggestive of candidiasis?

A

Vaginal pruritus

70
Q

An adolescent tells the school nurse that she is pregnant. Her last menstrual period was 4 months ago. She has not received any medical care. She smokes but denies any other substance use. The priority nursing action is which of the following?

A

Refer her for prenatal care.

71
Q

In planning sex education and contraceptive teaching for adolescents, the nurse should consider which of the following?

A

Teenagers frequently lack a fundamental understanding of fertility.

72
Q

Prevention of pelvic inflammatory disease (PID) in adolescents is important because it:

A

Can have devastating effects on the reproductive tract of affected adolescents.

73
Q

Which of the following statements is correct about childhood obesity?

A

Heredity is an important factor.

74
Q

Nursing responsibilities in the management of adolescent obesity include which of the following?

A

Incorporate favorite foods into the child’s diet.

75
Q

Anorexia nervosa is best described as:

A

Emaciation from self-inflicted starvation.

76
Q

Which of the following symptoms would the nurse expect to observe during the physical assessment of an adolescent girl with severe weight loss and disrupted metabolism associated with anorexia nervosa?

A

Lowered body temperature.

77
Q

An adolescent with bulimia has a low potassium level. The nurse is aware of the potential for which of the following complications?

A

Cardiac arrhythmias.

78
Q

Which of the following is descriptive of bulimia during adolescence?

A

Consumption of large quantities of food used as a coping mechanism.

79
Q

Correct terminology is necessary in understanding substance abuse. Physical dependence is which of the following?

A

Involuntary physiologic responses to the pharmacologic characteristics of drugs.

80
Q

Drug abuse is suspected in an adolescent being seen in the emergency department. Which of the following physical signs is suggestive of barbiturate ingestion?

A

Ataxia

81
Q

Which of the following statements is true about smoking in adolescence?

A

Smoking is less common when an adolescent’s parents disapprove of smoking.

82
Q

Which of the following is associated with social drinking in adolescents?

A

Significant morbidity and mortality.

83
Q

The nurse is caring for an adolescent brought to the hospital with acute drug toxicity. Cocaine is believed to be the drug involved. Initial data collection should include which of the following?

A

Method of administration

84
Q

Which of the following statements is true about adolescents who attempt suicide?

A

Gay and lesbian adolescents are at high risk for suicide.

85
Q

Which of the following is the most commonly used method in completed suicides?

A

Firearms

86
Q

An adolescent girl tells the nurse that she thinks about death all of the time. The nurse asks her if she has a specific plan. This question should be considered which of the following?

A

An essential part of the assessment.

87
Q

Pruritus

A

itching

88
Q

anesthesia

A

absence of sensation

89
Q

hyperesthesia

A

excessive sensitiveness

90
Q

hypesthesia

A

diminished sensation

91
Q

Atopic dermatitis

A

often associated with allergies, frequently begins in infancy.

92
Q

Objective findings with skin issues

A

The skin lesion’s distribution, size, and morphologic characteristic provide significant information.
Usual extrinsic causes are physical, chemical, or allergic irritants or infectious agents such as bacteria, fungi, viruses, or animal parasites.
Intrinsic causes may be from a specific infection (chickenpox, measles), drug sensitization, or other allergic phenomena.

93
Q

Abrasion

A

removal of the superficial layers of skin by rubbing or scraping

94
Q

Avulsion

A

forcible pulling out or extraction of tissue

95
Q

Laceration

A

Torn or jagged wound; accidental cut wound

96
Q

Incision

A

Division of the skin made with a sharp object; cut

97
Q

Penetrating wound

A

Disruption of the skin surface that extends into underlying tissue or into a body cavity

98
Q

Puncture

A

Wound with a relatively small opening compared with the depth.

99
Q

Primary intention wound healing

A

takes place when all layers of the wound margins are neatly approximated, as with a surgical incision.

100
Q

Secondary intention wound healing

A

takes place in wounds that occur from ulceration and lacerations in which the edges cannot be approximated, such as with an avulsion or a third-degree burn.
Healing takes place from the edges inward and from the bottom of the wound upward until the defect is filled.

101
Q

Tertiary intention wound healing

A

Takes place when suturing is delayed after injury or the wound later breaks down and is sutured or resutured when granulation is present.

102
Q

Signs of wound infection are:

A
  • increased erythema, especially beyond wound margin
  • edema
  • purulent exudate
  • odor
  • pain
  • increased temperature
103
Q

Wound Care

A
  • don’t put anything in a wound that you wouldn’t put in your eye. The safest solution is normal saline.
  • advise parents that the yellow gel forming under hydrocolloid dressings may look like pus and has a distinct odor (somewhat fruity) but is normal leakage.
  • hydrogen peroxide and povidone-iodine are contraindicated for cleaning fresh, open wounds. Hydrogen peroxide can cause formation of subcutaneous gas when applied under pressure.
104
Q

Atopic individuals

A

Those with a tendency to develop allergy

105
Q

The treatment for scabies is:

A

the application of a scabicide

106
Q

Pediculosis capitis

A

Head lice
Adult louse lives only about 48 hours when away from a human host.
Life span of the average female is 1 month.
Nits, or eggs, hatch in approximately 7 to 10 days.

107
Q

Lyme disease

A

The most common tick-borne disorder in the United States.

-Enters through the saliva and feces of ticks, especially the deer tick.

108
Q

Clinical manifestations of Lyme disease:

A

stage I: tick bite followed in 3 to 30 days by erythema migrans at the site of the bite. Large ring with raised, doughnut like border resulting in a bull’s eye appearance.
Stage II: 3 to 10 weeks after inoculation. Smaller annular lesions develop without the indurated center. If untreated they disappear in 3 to 4 weeks. May also have fever, headache, malaise, fatigue, anorexia, stiff neck, lymphadenopathy, splenomegaly, pink eye, sore throat, abdominal pain, and cough.
Stage III: systemic involvement of neurologic, cardiac, and musculoskeletal systems. Appears 2 to 12 months after inoculation. Arthritis may appear.

109
Q

Cat Scratch Disease

A

Usually self-limiting. Resolves in 2 to 4 months.
Common s/s: lympadenitis.
Treatment is primarily supportive.

110
Q

Contact dermatitis

A

an inflammatory reaction of the skin to chemical substances, natural or synthetic, that evoke a hypersensitivity response or to those agents that cause direct irritation.

111
Q

Poison ivy, oak, and sumac

A
  • Nevada, Hawaii, and Alaska appear to be free of any of these plants.
  • Oak: west of the Rockies
  • ivy: east of the Rockies
  • sumac: southeast swamp areas
  • Lesions do not spread by contact with the blister serum or by scratching.
  • The lesions can become secondarily infected.
112
Q

Sunburn

A
  • maximum UV exposure occurs between 10am & 3pm
  • shorter waves are more damaging/dangerous
  • Tanning indicates sun injury
  • risks of skin cancer begin in childhood
  • Use at least SPF 15
113
Q

Chilblain

A

Redness and swelling of the skin, occurs when extremities, usually the hands are exposed intermittently to temperatures of 30 to 60 degrees F.

114
Q

Frostbite

A

tissue damage caused when excessive heat loss to local tissues allows ice crystals to form in tissues.
-amputation of extremities is usually delayed for 60 to 90 days unless there is evidence of gangrene because it is seldom possible to estimate the extent of tissue loss until new skin layers are revealed after the eschar layer separates.

115
Q

Hypothermia

A

the cooling of the body’s core temperature to injurious levels, usually identified as below 95 degrees F.
-very young children and thin persons are at the greatest risk for hypothermia.

116
Q

What are the most common manifestations of adverse drug reactions in children?

A

Rashes-exanthematous, urticarial, or eczematoid.

117
Q

Stevens Johnson Syndrome

A
  • the severe form of erythema multiforme characterized by lesions of the skin and mucous membranes, fever, and multiple systemic symptoms.
  • it is very rare, is more common in males then females, and occurs at any age.
118
Q

Dental Carries

A

The ages of greatest vulnerability are 4 to 8 years old for the primary dentition and 12 to 18 years for the secondary or permanent dentition.

119
Q

Enuresis

A
  • bed-wetting
  • defined as intentional or involuntary passage of urine into the bed (usually at night) or into clothes during the day in children who are beyond the age when voluntary bladder control should normally have been acquired.
  • It must occur at least 2 times a week for 3 months and the child must be at least 5 years old.

Pediatrics (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions