A nurse in a gynecology office is caring for a client who reports vaginal itching and discharge in the last week.
The discharge is described as thick and “smelly.”. The client reports pain with urination and sexual intercourse.
The discharge became worse after their menstrual period this month.
The client has been treated for STIs in the past and is currently sexually active in a new relationship.
The provider has been notified, and a vaginal swab for culture and nucleic acid amplification testing (NAAT) has been performed.
Based on the information found in the client’s medical record, which of the following prescriptions should the nurse anticipate receiving from the provider?
Instruct the client to avoid alcohol for 72 hr after treatment.
Administer metronidazole 2 g PO x 1 dose.
Perform an oatmeal sitz bath.
Have the client douche every morning and night.
Recommend the client’s partner receive treatment.
The Correct Answer is B
Choice A rationale
Instructing the client to avoid alcohol for 72 hr after treatment is a common instruction given when a client is prescribed certain medications, such as metronidazole, due to the potential for a disulfiram-like reaction. However, this choice does not directly address the client’s symptoms of vaginal itching and discharge.
Choice B rationale
The client’s symptoms are indicative of Bacterial Vaginosis (BV), a common vaginal infection in women of reproductive age. Metronidazole is a medication commonly used to treat this infection. A single dose of 2 g orally is a typical treatment regimen.
Choice C rationale
An oatmeal sitz bath can help soothe irritated skin and reduce inflammation, but it does not treat the underlying cause of the client’s symptoms.
Choice D rationale
Douching is generally not recommended as it can disrupt the normal balance of bacteria in the vagina and can lead to further complications.
Choice E rationale
Recommending the client’s partner receive treatment is important in cases of sexually transmitted infections to prevent reinfection. However, this choice does not directly address the client’s immediate need for treatment.
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Correct Answer is D
Explanation
Choice A rationale
Bleeding or spotting can accompany implantation. This is a common occurrence and does not necessarily indicate a problem with the pregnancy. It happens when the fertilized egg attaches to the lining of the uterus. Some women may mistake this bleeding for a light period, but it’s a sign of pregnancy.
Choice B rationale
Fertilization typically takes place in the outer third of the fallopian tube. After ovulation, the egg travels down the fallopian tube towards the uterus. If sperm are present in the fallopian tube at this time, fertilization can occur. This is a normal part of the reproductive process.
Choice C rationale
Sperm can remain viable in the woman’s reproductive tract for 2 to 3 days. This means that intercourse does not have to coincide exactly with ovulation in order to achieve pregnancy. The sperm can survive long enough to fertilize the egg when it is released.
Choice D rationale
The statement “Implantation occurs between 2 and 3 weeks after conception” is incorrect and requires intervention by the nurse. Implantation actually occurs about 6-10 days after ovulation, which is less than 2 weeks after conception.
Correct Answer is ["A","B","C","E"]
Explanation
Choice A rationale
Anomalies in fetal chromosomes can be identified through amniocentesis. This test involves the extraction of a small amount of amniotic fluid, which contains fetal tissues. The chromosomes of the fetus can be examined for abnormalities.
Choice B rationale
Cephalopelvic disproportion refers to a condition where the mother’s pelvis is too small to allow the baby to pass through the birth canal. This condition cannot be identified through amniocentesis. Amniocentesis is a diagnostic procedure that examines the amniotic fluid (not the maternal pelvis or the size of the fetus) to detect chromosomal abnormalities and certain genetic disorders.
Choice C rationale
Fetal gender can be determined through amniocentesis. The test can identify the presence of Y chromosomes, which would indicate a male fetus.
Choice D rationale
Rh incompatibility is a condition that occurs when a mother is Rh-negative and the baby is Rh-positive. This condition cannot be identified through amniocentesis. Instead, it is typically identified through blood tests of the mother and father.
Choice E rationale
Neural tube defects, such as spina bifida and anencephaly, can be identified through amniocentesis. The test can detect high levels of alpha-fetoprotein, which is often present when a fetus has a neural tube defect.
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