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 genitourinary disorder will be alleviated over time
The client's history of sexually transmitted infections
The Correct Answer is A
A. The client's vaginal pH may increase during menopause – During menopause, estrogen levels decrease, leading to a higher vaginal pH. This disrupts the normal vaginal flora, making the client more susceptible to infections and irritation.
B. The client's dietary habits and fluid intake – While nutrition and hydration affect overall health, they are not the primary cause of menopausal vaginal symptoms and infections.
C. The client's genitourinary disorder will be alleviated over time – Without treatment (e.g., vaginal estrogen therapy or lubricants), menopausal atrophic changes usually persist or worsen, rather than resolve over time.
D. The client's history of sexually transmitted infections – While STIs can cause vaginal discomfort, the client’s symptoms are more likely due to menopausal changes rather than a past history of STIs.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. "Presence of late decelerations with each contraction during monitoring."
Late decelerations indicate uteroplacental insufficiency, which can lead to fetal hypoxia and distress. This is not a reassuring sign.
B. "Increased fetal movement between contractions."
While fetal movement is a positive sign, it is not the best indicator of fetal well-being in labor. Continuous FHR monitoring provides a better assessment.
C. "Fetal heart rate of 160 beats per minute with moderate variability."
A normal fetal heart rate (FHR) is 110–160 bpm, and moderate variability (6–25 bpm fluctuations) indicates a well-oxygenated fetus with an intact autonomic nervous system.
D. "Fetal heart rate consistently below 120 beats per minute with no accelerations."
A persistent FHR below 110 bpm (bradycardia) or minimal variability suggests possible fetal compromise.
Correct Answer is {"A":{"answers":"B"},"B":{"answers":"B"},"C":{"answers":"C"},"D":{"answers":"A"},"E":{"answers":"A"},"F":{"answers":"C"}}
Explanation
A. Deep tendon reflexes (DTR) – Worsening
On 2/10, the client had hyperreflexia (DTRs 3+) and no clonus. By 2/11, the DTRs had increased to 4+ with positive clonus, indicating neuromuscular hyperexcitability, a hallmark of worsening preeclampsia with severe features. Clonus is a concerning sign that suggests progression toward eclampsia (seizures). This indicates neurological worsening.
B. Creatinine – Worsening
The client's creatinine level increased from 1.4 mg/dL (already elevated) to 2.0 mg/dL, which is indicative of worsening renal function. Normal pregnancy should not cause a creatinine rise above 1.1 mg/dL, so this elevation suggests renal impairment due to severe preeclampsia. The worsening creatinine level indicates deteriorating kidney function, possibly due to reduced renal perfusion.
C. Client denies pain – Unrelated
The absence of pain is not directly related to the client’s condition worsening or improving. While pain can be a symptom of severe preeclampsia (such as epigastric pain from liver involvement), the client currently has an epidural, which can explain the lack of pain perception. The denial of pain does not indicate improvement in the disease process but rather effective pain management.
D. Vaginal exam – Improvement
The vaginal exam findings indicate progress in labor. On 2/10, the client was not noted to be in active labor, but by 2/11, she was 7 cm dilated, 80% effaced, and at 0 station, with contractions increasing in frequency and intensity. This progression suggests that labor is advancing appropriately.
E. Blood pressure – Worsening
The client’s blood pressure was severely elevated on 2/10 (168/100 mmHg) and remained high on 2/11 (152/86 mmHg). While slightly lower, the diastolic remains elevated, and systolic pressures are still high. Given the worsening DTRs, renal function decline, and elevated liver enzymes, the blood pressure changes are not a sign of improvement but rather persistent hypertension despite possible interventions.
F. Decreased sensation in legs – Unrelated
The client received an epidural for pain relief, which normally causes decreased sensation in the lower extremities. This finding is not related to worsening preeclampsia or labor progression but is an expected effect of the epidural anesthesia. The client’s ability to slightly move her legs confirms that the block is working properly.
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