A 20-year-old woman presents to the sexual health clinic. Her history includes trichomoniasis and irregular menses. Her last menstrual period began 4 days ago. She states that her periods are heavy and last between 2 and 9 days. She has an intrauterine device (IUD) in place for birth control, and she does not wish to change her current method of birth control. She is on an antidepressant.
On arrival, her blood pressure is 108/74 mmHg, pulse 75 bpm, respiratory rate 18 breaths/min, and temperature 98.2°F (36.8°C). She is 5'7" (170 cm) and weighs 190 pounds (86 kg) (BMI 29.75 kg/m). The client is waiting to be evaluated by the healthcare provider, and the nurse is conducting a detailed health history. Which aspect of the client's history requires further investigation by the nurse?
The use of an antidepressant medication.
The client's history of irregular menses.
The client's blood pressure of 108/74 mmHg.
The client's current weight and BMI status.
The Correct Answer is B
Choice A rationale
The use of an antidepressant, such as a selective serotonin reuptake inhibitor (SSRI), can occasionally cause sexual dysfunction or menstrual irregularities, like amenorrhea or menorrhagia, as a side effect due to its influence on neurotransmitter levels, particularly serotonin. The client's heavy and irregular menses may be a consequence, warranting further inquiry regarding the specific drug, dosage, and start date relative to the onset of the menstrual issues to assess for a correlation. This may require further investigation.
Choice B rationale
Irregular menses, characterized by variability in cycle length and bleeding patterns (normal cycle length is 21-35 days), are concerning, especially when coupled with heavy bleeding (menorrhagia) and a history of a sexually transmitted infection (STI) like trichomoniasis, which suggests potential pelvic inflammatory disease (PID). This may indicate an underlying endocrine disorder such as polycystic ovary syndrome (PCOS) or other structural issues, necessitating further investigation, including hormonal assays or pelvic ultrasound, to determine the etiology.
Choice C rationale
A blood pressure of 108/74 mmHg is considered within the normal, healthy range for an adult (normal is generally ≤ 120/80 mmHg). Hypotension is typically defined as a systolic pressure <90 mmHg or a diastolic pressure <60 mmHg, or a drop in blood pressure that causes symptoms. Therefore, this specific vital sign is reassuring and does not require immediate or extensive further investigation unless the client reports symptoms of dizziness or syncope.
Choice D rationale
A Body Mass Index (BMI) of 29.75 kg/m falls within the overweight category (BMI 25.0-29.9 kg/m), nearing obesity (BMI ≥ 30.0 kg/m). While excess adiposity can contribute to menstrual irregularity due to estrogen production by adipose tissue, promoting anovulation, the irregular menses is the immediate clinical problem. The BMI itself is an important risk factor for future health issues but is not the most urgent aspect requiring immediate in-depth investigation compared to the abnormal bleeding pattern.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Adolescent pregnancy is scientifically categorized as a high-risk situation due to increased incidence of complications like preeclampsia, preterm birth, low birth weight infants, and cephalopelvic disproportion, reflecting an immature maternal physiology and often poorer prenatal care adherence. Alternative birth centers generally cater to low-risk pregnancies to ensure safety, making the client's high-risk status the paramount factor in determining the appropriateness of this delivery setting.
Choice B rationale
While psychosocial support is important, the potential physiological risks associated with an adolescent pregnancy, such as inadequate uterine blood flow or nutritional deficiencies, outweigh the concern regarding the support group's subjective opinion on the birth center choice. The nurse's primary focus must be on maternal-fetal safety based on scientific risk stratification, not social approval.
Choice C rationale
The eligibility criteria for alternative birth centers are based on maternal and fetal risk status, not solely on the client's chronological age. The absolute contraindication for delivery in such centers is the presence of high-risk factors, regardless of age, which include complex medical conditions or anticipated obstetrical complications, thus the age restriction is not the most important consideration.
Choice D rationale
Alternative birth centers are appropriate only for low-risk, uncomplicated pregnancies where a spontaneous, unmedicated birth is expected, and immediate specialized interventions are not anticipated. High-risk conditions, like those often seen in adolescent pregnancies (e.g., preeclampsia, prematurity risk), mandate delivery in a hospital setting where advanced life support is immediately available.
Correct Answer is B
Explanation
Choice A rationale
The Anthropoid pelvis is characterized by an oval inlet with a greater anteroposterior diameter than the transverse diameter. While a variant of the female pelvis, it is less ideal for childbirth compared to the gynecoid type because its shape can sometimes lead to a persistent occiput posterior position, making the labor process potentially longer and more difficult.
Choice B rationale
The Gynecoid pelvis is considered the classic female pelvis and is the most common and most favorable for vaginal delivery. It possesses a rounded inlet, a wide and deep posterior segment, a wide pubic arch (usually >90°), and walls that are straight. This structure allows the fetal head to easily descend and rotate through the birth canal, making it ideal for childbirth.
Choice C rationale
The Android pelvis, typically considered the male pelvis type, has a characteristic heart-shaped or triangular inlet and a narrow pubic arch. Its structure is less favorable for labor as the contracted planes can impede the fetal head's descent and rotation, often leading to a need for operative delivery or a cesarean section due to pelvic disproportion.
Choice D rationale
The Platypelloid pelvis is characterized by a distinctive flat, oval shape with a narrow anteroposterior diameter and a widened transverse diameter. This shape is the least common and is considered the least favorable for vaginal birth because the severely restricted anteroposterior space often prevents the fetal head from entering the pelvis in the optimal transverse or oblique position, often requiring a cesarean section.
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