A nurse is reviewing contraception options for four clients.
The nurse should identify which of the following clients as having a contraindication to oral contraceptives?

Choice A rationale:
Ovarian cysts are fluid-filled sacs that form on or within an ovary. They are a common condition, affecting up to 1 in 5 women at some point in their lives. While most ovarian cysts are benign (non-cancerous), they can sometimes cause symptoms, including pelvic pain.
Ultrasound is a common imaging test that uses sound waves to create pictures of internal organs. It can be used to detect ovarian cysts, which often appear as fluid-filled sacs on the ovary.
The presence of an ovarian cyst on ultrasound, combined with the patient's symptoms of lower abdominal pelvic pain, suggests that the patient is at risk of developing complications from the cyst. These complications can include: Rupture: A ruptured ovarian cyst can cause sudden, severe pain and bleeding.
Torsion: This is when a cyst twists on its stalk, cutting off its blood supply. Torsion can also cause severe pain and may require emergency surgery.

Choice B rationale:
Appendicitis is an inflammation of the appendix, a small, finger-shaped organ located in the lower right abdomen. It is a common cause of abdominal pain, especially in young adults.

However, the patient in this scenario is experiencing pain in the lower abdominal pelvic region, not specifically in the lower right quadrant. This makes appendicitis less likely.
Additionally, the patient does not have any other symptoms that are typically associated with appendicitis, such as fever, nausea, or vomiting.

Choice C rationale:
Endometriosis is a condition in which tissue that normally lines the uterus grows outside of the uterus. It can cause pain, especially during menstruation.
However, the patient in this scenario does not report cyclical pain, which is a hallmark symptom of endometriosis. Additionally, endometriosis is not typically associated with the presence of fluid-filled sacs on the ovaries.

Choice D rationale:
Pelvic inflammatory disease (PID) is an infection of the upper genital tract, including the uterus, fallopian tubes, and ovaries. It is often caused by sexually transmitted infections (STIs).
PID can cause pelvic pain, but it is also typically associated with other symptoms, such as fever, vaginal discharge, and irregular bleeding.
The patient in this scenario does not have any of these other symptoms, and her white blood cell count is not elevated, which makes PID less likely.

Choice A:

While fetal maturity is a factor in the timing of amniocentesis, it's not the primary reason for waiting until 14 weeks.

Earlier in pregnancy, fetal cells are less abundant in the amniotic fluid, making it more challenging to obtain a sufficient sample for accurate testing.

Additionally, the procedure carries a slightly higher risk of miscarriage before 14 weeks.

Choice B:

The audibility of the fetal heartbeat is not directly related to the timing of amniocentesis.

It's typically possible to hear the heartbeat by Doppler ultrasound around 10-12 weeks, but this doesn't mean there's enough amniotic fluid for amniocentesis.

Choice D:

The accuracy of genetic results is not dependent on the timing of amniocentesis after 14 weeks.

As long as a sufficient sample of amniotic fluid is obtained, the accuracy of the results is not affected by gestational age.

Choice C:

The most accurate explanation for why amniocentesis is not performed before 14 weeks is the amount of amniotic fluid. Before 14 weeks, there's typically not enough amniotic fluid to safely extract a sample without potentially harming the fetus or the placenta.

By 14 weeks, there's usually enough fluid to adequately cushion the fetus and the needle during the procedure, reducing the risks involved.