A postmenopausal woman with uterine prolapse is being fitted with a pessary. The nurse would be most alert for which side effect?

Choice A: Sporadic vaginal bleeding accompanied by chronic pelvic pain is not the correct answer because it is not a symptom of cystocele or rectocele. This symptom may indicate other conditions such as endometriosis, fibroids, or cervical cancer.

Choice B: Menstrual irregularities and hirsutism on the chin are not the correct answers because they are not symptoms of cystocele or rectocele. These symptoms may indicate other conditions such as polycystic ovary syndrome (PCOS), thyroid disorder, or menopause.

Choice C: Heavy leukorrhea with vulvar pruritus is not the correct answer because it is not a symptom of cystocele or rectocele. This symptom may indicate other conditions such as bacterial vaginosis, yeast infection, or sexually transmitted infection (STI).

Choice D: Stress incontinence with a feeling of low abdominal pressure is the correct answer because it is a symptom of cystocele or rectocele. Stress incontinence is a condition that causes leakage of urine when there is increased pressure on the bladder, such as during coughing, sneezing, laughing, or lifting. Cystocele or rectocele can cause stress incontinence by weakening the pelvic floor muscles and connective tissue that supports the bladder and urethra. The feeling of low abdominal pressure is also a symptom of cystocele or rectocele, as it indicates that the bladder or rectum is protruding into the vagina.

Choice A: A 26-year-old client who has migraine headaches at the start of each menstrual cycle is not the correct answer because they do not have a contraindication for receiving oral contraceptives. Oral contraceptives are pills that contain synthetic hormones (estrogen and progestin) that prevent ovulation and pregnancy. They can also help reduce menstrual cramps, bleeding, and migraines in some women. However, oral contraceptives may increase the risk of stroke in women who have migraines with aura (visual disturbances), so they should be used with caution and under medical supervision.

Choice B: A 28-year-old client who has a history of pelvic inflammatory disease is not the correct answer because they do not have a contraindication for receiving oral contraceptives. Pelvic inflammatory disease is an infection that affects the female reproductive organs, such as the uterus, fallopian tubes, or ovaries. It can be caused by various bacteria, such as chlamydia or gonorrhea, and can lead to infertility, ectopic pregnancy, or chronic pelvic pain if left untreated. Oral contraceptives can help prevent pelvic inflammatory disease by creating a thick cervical mucus that blocks the entry of bacteria into the uterus.

Choice C: A 32-year-old client who has benign breast disease is not the correct answer because they do not have a contraindication for receiving oral contraceptives. Benign breast disease is a term that refers to various noncancerous conditions that affect the breast tissue, such as fibrocystic changes, fibroadenomas, or mastitis. They can cause symptoms such as breast pain, tenderness, or lumps. Oral contraceptives can help reduce the symptoms of benign breast disease by regulating the hormonal fluctuations that influence breast tissue growth.

Choice D: A 38-year-old client who reports smoking one pack of cigarettes every day is the correct answer because they have a contraindication for receiving oral contraceptives. Smoking is a habit that involves inhaling tobacco smoke, which contains harmful substances such as nicotine, tar, or carbon monoxide. Smoking can increase the risk of various diseases such as lung cancer, chronic obstructive pulmonary disease (COPD), or cardiovascular disease. Oral contraceptives can further increase the risk of cardiovascular disease in smokers, especially those who are over 35 years old, by increasing blood pressure, cholesterol levels, and clotting factors. Therefore, oral contraceptives are not recommended for smokers and alternative methods of contraception should be used instead.