A nurse is performing Leopold Maneuvers prior to auscultating the fetal heart rate for a client who is at 30 weeks of gestation.
The client asks, "Why do you feel around on my belly first?" Which of the following responses should the nurse make?

Choice A rationale

Dysuria, or painful urination, is more commonly a symptom of urinary tract infections, cystitis, or sexually transmitted infections rather than a primary indicator of ovarian cancer. While a very large ovarian mass could potentially press on the bladder and cause urinary frequency or urgency, dysuria itself is not a classic hallmark of early or late-stage ovarian malignancy. Clinical focus for ovarian cancer usually remains on gastrointestinal and vague abdominal symptoms that persist over several weeks.

Choice B rationale

Abdominal pain or pelvic discomfort is a frequent manifestation of ovarian cancer. As the tumor grows, it can cause pressure on surrounding organs, stretching of the ovarian capsule, or the accumulation of fluid in the peritoneal cavity, known as ascites. This pain is often described as persistent bloating or a feeling of fullness. Because these symptoms are vague and mimic digestive issues, ovarian cancer is often diagnosed at later stages, making abdominal assessment a priority.

Choice C rationale

While ovarian cancer can cause an increase in abdominal girth due to ascites or tumor growth, it is more often associated with unexplained weight loss rather than generalized weight gain. The metabolic demands of the malignancy and the feeling of early satiety often lead to a decreased caloric intake and cachexia. If a client reports their clothes feeling tighter around the waist but their overall weight is stable or decreasing, it strongly suggests fluid accumulation or a mass.

Choice D rationale

Amenorrhea is not a reliable indicator of ovarian cancer. Many individuals diagnosed with ovarian cancer are postmenopausal and have already ceased menstruation. In premenopausal clients, menstrual irregularities can occur, but the total absence of a period is less common than other symptoms like persistent bloating or pelvic pressure. Therefore, healthcare providers look for more specific signs of adnexal masses rather than relying on the client's menstrual status to support a diagnosis of ovarian malignancy.

Choice A rationale

Frequent showering is generally a hygiene practice and does not typically predispose a woman to vulvovaginal candidiasis unless it involves the use of harsh, scented soaps or internal douching. Douching can disrupt the natural pH and flora of the vagina. However, simple external showering is not considered a primary risk factor for yeast overgrowth. Maintaining a healthy acidic environment is key to preventing the opportunistic growth of Candida albicans in the vaginal canal.

Choice B rationale

A copper intrauterine device is a form of long-acting reversible contraception that works primarily by causing a localized inflammatory response that is toxic to sperm. While any foreign object in the vagina or uterus could theoretically affect local flora, copper IUDs are more commonly linked to increased menstrual bleeding and cramping rather than fungal infections. There is no strong scientific evidence suggesting that copper IUD use is a major independent risk factor for developing candidiasis.

Choice C rationale

Wearing loose-fitting clothing and breathable fabrics like cotton is actually a recommended preventative measure against vulvovaginal candidiasis. Tight, synthetic clothing can trap heat and moisture in the perineal area, creating a warm, damp environment that encourages the proliferation of yeast. Therefore, loose clothing helps maintain dryness and airflow, which discourages the growth of Candida. Choosing natural fibers is a standard piece of health education provided to women prone to recurrent infections.

Choice D rationale

Antibiotics are a major risk factor for vulvovaginal candidiasis because they are not selective in the bacteria they kill. While treating an infection, antibiotics often destroy the beneficial Lactobacillus species in the vagina. These bacteria normally produce lactic acid to keep the vaginal pH between 3.8 and 4.5, which inhibits yeast. When the protective bacterial population is depleted, the pH rises, and Candida can multiply unchecked, leading to a symptomatic yeast infection.