Jonah and Anna are both put to the test- Jonah needs his driver's license, and Anna needs her learner's permit. Meanwhile, Alex is diagnosed with central apnea and undergoes an MRI to find out whether he needs brain surgery.
Alex is getting ready to undergo brain surgery, and Amber decides to give him a new haircut - which has disastrous results. While Alex is in the hospital, Trent takes the other Johnston children to see the Harlem Globetrotters.
In preparation for his 40th birthday, Trent decides he wants to shed some weight, but the process isn't as much fun as he expected. Meanwhile, Amber plans a surprise birthday party for Trent that he will never forget.
Jonah's grades are slipping and Anna would rather do hair and makeup than go to college. Amber and Trent arrange a college tour to motivate Jonah and suggest Anna job shadow at a salon to show her the big issues facing a little person in the workplace.
Elizabeth decides to do something she's never done before -- enter the local beauty pageant! Meanwhile, Trent and Amber take steps to finalize Emma and Anna's adoptions.
The Johnstons need a break, so the family takes off for a tropical vacation in Puerto Rico. Meanwhile, Amber and Trent deliberate on whether they should add another member to the family.