A woman complains of severe abdominal and pelvic pain around the time of menstruation that has gotten worse over the last 5 years. She also complains of pain during intercourse and has tried unsuccessfully to get pregnant for the past 18 months. These symptoms are most likely related to:

Choice A reason: An FHR greater than 110 beats/min is not a sufficient indicator of fetal well-being during labor. The normal range of FHR is between 110 and 160 beats/min, but it can vary depending on the gestational age, fetal activity, and maternal factors. A high or low FHR may indicate fetal distress or compromise.

Choice B reason: Maternal pain control is not a direct measure of fetal well-being during labor. However, maternal pain can affect the FHR indirectly by causing maternal stress, anxiety, or hyperventilation, which can alter the blood flow and oxygen delivery to the fetus. Therefore, adequate pain management is important for both maternal and fetal health.

Choice C reason: The response of the FHR to UCs is the most reliable and accurate way of assessing fetal well-being during labor. UCs can cause temporary reductions in the blood flow and oxygen supply to the fetus, which can affect the FHR. A normal response of the FHR to UCs is either no change or a slight increase (acceleration), which indicates a well-oxygenated and resilient fetus. An abnormal response of the FHR to UCs is a decrease (deceleration), which indicates a compromised or hypoxic fetus.

Choice D reason: Accelerations in the FHR are not a definitive measure of fetal well-being during labor. Accelerations are transient increases in the FHR above the baseline, usually caused by fetal movement, stimulation, or UCs. Accelerations are generally reassuring and indicate a responsive and well-oxygenated fetus, but they are not always present or consistent. The absence of accelerations does not necessarily mean fetal distress, as some fetuses may have periods of sleep or reduced activity.

Choice A reason: Limiting time spent wearing a wet bathing suit is a good preventive measure, as it can reduce the moisture and warmth that can promote the growth of bacteria and fungi in the genital area. The nurse should advise the 15-year old to change into dry clothes as soon as possible after swimming or bathing.

Choice B reason: Not douching is a good preventive measure, as it can preserve the natural balance of the vaginal flora and pH. The nurse should explain to the 15-year old that douching can wash away the protective mucus and lactobacilli that prevent infections, and it can also introduce harmful substances or microorganisms into the vagina.

Choice C reason: Wearing nylon undergarments is not a good preventive measure, as it can trap heat and moisture in the genital area and create a favorable environment for infections. The nurse should recommend the 15-year old to wear cotton or breathable fabrics that can absorb sweat and allow air circulation.

Choice D reason: Using floral scented bath salts is not a good preventive measure, as it can irritate the genital mucosa and alter the vaginal pH. The nurse should caution the 15-year old to avoid using any products that contain perfumes, dyes, or chemicals in the genital area, as they can cause allergic reactions or infections.

Choice E reason: Decreasing sugar intake is a good preventive measure, as it can lower the risk of yeast infections. The nurse should educate the 15-year old that sugar can feed the growth of Candida albicans, which is a common cause of vaginal candidiasis. The nurse should also encourage the 15-year old to eat a balanced diet that includes probiotics, such as yogurt, to maintain a healthy vaginal flora.

Choice F reason: Avoiding tight-fitting jeans is a good preventive measure, as it can prevent friction and pressure on the genital area. The nurse should suggest the 15-year old to wear loose or comfortable clothing that can reduce the risk of skin irritation or injury, which can lead to infections.