A 56-year-old menopausal woman reports to the registered nurse that she has been experiencing vaginal itching, burning, and an increase in vaginal infections over the past 3 years.
What important factor should the nurse consider before responding to the client's concerns?
The client's vaginal pH may increase during menopause.
The client's dietary habits and fluid intake.
The client's history of sexually transmitted infections.
The client's genitourinary disorder will be alleviated over time.
The Correct Answer is A
Choice A rationale
During menopause, estrogen levels significantly decline. Estrogen plays a crucial role in maintaining the acidic environment of the vagina, which inhibits the growth of pathogenic bacteria and yeast. A decrease in estrogen leads to a rise in vaginal pH (normal premenopausal pH is 3.8 to 4.5), making the vaginal environment less acidic and more susceptible to infections, including bacterial vaginosis and yeast infections, thus explaining the client's symptoms.
Choice B rationale
While dietary habits and fluid intake can influence overall health, they are not the primary factors directly causing the increased risk of vaginal itching, burning, and infections in a menopausal woman. Hormonal changes are the most significant contributing factor.
Choice C rationale
A history of sexually transmitted infections (STIs) is important to consider, but the onset of these symptoms three years into menopause suggests that hormonal changes related to estrogen deficiency are a more likely primary cause for the recurrent vaginal issues. While past STIs can sometimes have long-term effects, the timing aligns with menopausal changes.
Choice D rationale
The client's genitourinary disorder (specifically, the vaginal changes due to estrogen deficiency) will not alleviate over time without intervention. The decrease in estrogen is a permanent physiological change associated with menopause, and the associated symptoms often persist or worsen without treatment such as hormone therapy or other local treatments to restore vaginal health.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"A":{"answers":"B"},"B":{"answers":"B"},"C":{"answers":"C"},"D":{"answers":"B"},"E":{"answers":"B"}}
Explanation
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Blood pressure (Worsening):
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Elevated or worsening blood pressure can indicate the progression of hypertension or a related condition, such as preeclampsia. It’s a serious sign that needs immediate attention.
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Deep tendon reflexes (DTR) (Worsening):
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Increased or hyperactive deep tendon reflexes often indicate an abnormal neurological or medical condition, such as preeclampsia or nervous system distress. This worsening could signal a more severe condition, needing further evaluation.
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Vaginal exam (client denies pain) (Unrelated):
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The absence of pain during a vaginal exam may not be directly related to the client’s overall worsening or improving condition. It’s neutral in terms of contributing to any significant changes in the client’s condition.
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Decreased sensation in legs (Worsening):
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A worsening loss of sensation in the legs can suggest a neurological issue, such as nerve compression or even complications from a vascular condition. This condition is concerning, as it indicates progression and requires immediate investigation.
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Creatinine (Worsening):
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Elevated creatinine levels are a marker of kidney dysfunction or damage. If creatinine levels are worsening, it indicates a decline in kidney function, which could be a sign of renal failure or preeclampsia and needs urgent attention.
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Correct Answer is ["B","C","E"]
Explanation
Choice A rationale
A urinalysis with a specific gravity within the expected range (typically 1.005 to 1.030) suggests that the client's kidneys are able to concentrate urine appropriately. This finding does not directly indicate a urinary tract infection or vaginal infection. It reflects the hydration status and renal function.
Choice B rationale
The presence of ketones in the urine typically indicates fat metabolism due to insufficient carbohydrate intake, which is not a direct indicator of a urinary tract infection or vaginal infection. However, the presence of bacteria in the urinalysis strongly suggests a urinary tract infection, a potential cause of the client's symptoms.
Choice C rationale
Pain, particularly pelvic or lower abdominal pain, along with foul-smelling vaginal discharge are classic signs and symptoms of a vaginal infection, such as bacterial vaginosis or trichomoniasis. These symptoms are indicative of an inflammatory or infectious process in the reproductive tract.
Choice D rationale
Denying unprotected sexual activity reduces the likelihood of sexually transmitted infections as the cause of symptoms like vaginal discharge. However, other types of vaginal infections (e.g., bacterial vaginosis, yeast infection) or urinary tract infections can occur regardless of sexual activity.
Choice E rationale
A cloudy appearance in the urinalysis suggests the presence of particulate matter, such as bacteria, white blood cells, or epithelial cells, which can indicate an infection in the urinary tract. While the pH is not provided, a pH outside the normal range (typically 4.6 to 8.0) can also support the suspicion of a urinary tract infection.
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