A 22-year-old woman visits the clinic requesting birth control. Her medical history includes dysmenorrhea, irregular menstrual cycles, and menorrhagia. She smokes half a pack of cigarettes daily and reports being sexually active with multiple partners. Which birth control method is most appropriate for this client?

Depo-Provera

Contraceptive implant

Combination oral contraceptives

Barrier methods such as female condoms

Answer and Explanation

The Correct Answer is D

A. "Depo-Provera."
Depo-Provera (medroxyprogesterone injection) is effective for contraception, but it may worsen menstrual irregularities and cause bone density loss with long-term use, making it less ideal.

B. "Contraceptive implant."
While progestin-only implants (e.g., Nexplanon) are effective, they do not protect against STIs. Additionally, irregular bleeding is a common side effect, which may not be ideal for someone with menorrhagia and irregular cycles.

C. "Combination oral contraceptives."
Estrogen-containing contraceptives (e.g., combined oral contraceptive pills) are contraindicated in women who smoke and are ≥35 years old due to the increased risk of venous thromboembolism (VTE). While this client is 22 years old, smoking still makes this option less preferable.

D. "Barrier methods such as female condoms."
Barrier methods reduce the risk of sexually transmitted infections (STIs), which is crucial for this client with multiple sexual partners. Additionally, they do not contain hormones, making them safer for smokers.

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Naxlex Comprehensive Predictor Exams

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Correct Answer is []

Explanation

A. Assessment Cues

Unprotected Sexual Activity increases the risk of sexually transmitted infections (STIs). The client has had multiple sexual partners in the past month without protection, making her susceptible to infections such as trichomoniasis, gonorrhea, chlamydia, and bacterial vaginosis. This is a significant risk factor for her symptoms.
Foul-smelling discharge is a common symptom of trichomoniasis, bacterial vaginosis, and other vaginal infections. UTIs primarily cause dysuria, frequency, urgency, and suprapubic pain, not vaginal symptoms. Since the urinalysis does not show leukocytes, nitrates, or bacteria, a UTI is unlikely.

B. Condition – Trichomoniasis

The client's symptoms—green-yellow vaginal discharge, vaginal itching, and foul-smelling odor—are classic signs of trichomoniasis, a sexually transmitted infection caused by Trichomonas vaginalis. The disease is associated with malodorous discharge, vaginal irritation, and possible dysuria.

C. Anticipated Solutions

Oral Metronidazole: The first-line treatment for trichomoniasis is oral metronidazole (Flagyl) 2g as a single dose or 500mg twice daily for 7 days. Metronidazole effectively eliminates the infection. Patients must be educated to avoid alcohol while taking metronidazole due to the risk of a disulfiram-like reaction (severe nausea and vomiting).
Safe sexual behaviors, such as consistent condom use, regular STI screening, mutual monogamy, and open communication about sexual history, are essential for reducing the risk of sexually transmitted infections (STIs), including trichomoniasis.

Incorrect answers:

Human Papillomavirus (HPV): HPV causes genital warts and increases the risk of cervical cancer, but it does not typically cause vaginal discharge, itching, or foul odor. Therefore, HPV is not the most likely condition in this case.

Depression: While multiple sexual partners and STI diagnoses can cause emotional distress, depression is not directly relevant to her current presentation. However, mental health screening may be beneficial if she expresses concerns about her emotional well-being.

Herpes simplex virus (HSV) is a sexually transmitted infection (STI) that can cause genital ulcers, pain, and discomfort. However, based on the client’s symptoms, HSV is not the most likely diagnosis.

A. Retained placental fragments B. Uterine atony C. Puerperal infection D. Thrombophlebitis

Correct Answer is B

Explanation

A. Retained placental fragments
This is incorrect because retained placental fragments are more commonly associated with prolonged third-stage labor or incomplete placental expulsion, rather than fetal macrosomia.

B. Uterine atony
This is correct because a large baby (macrosomia) causes overdistension of the uterus, increasing the risk of uterine atony (failure of the uterus to contract effectively). This can lead to postpartum hemorrhage.

C. Puerperal infection
This is incorrect because puerperal infection is usually related to prolonged rupture of membranes, poor hygiene, or invasive procedures, rather than fetal size alone.

D. Thrombophlebitis
While pregnancy increases the risk of clot formation, the most immediate concern for this client is uterine atony and postpartum hemorrhage.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Exhibits Select a condition, the assessment cues, and anticipated solutions for this client.

Correct Answer is []

Explanation

A nurse is caring for a client who is 5 hr postpartum following a vaginal birth of a newborn weighing 9 lb 6 oz. (4252 g). The nurse should recognize that this client is at risk for which of the following postpartum complications?

Correct Answer is B

Explanation

G1P1, 37 weeks' gestation patient with a scheduled nonstress test (NST) As the nurse, you can identify whether the following findings are indicative of preeclampsia, preeclampsia with severe features, or neither. Select at least one answer in each row.

A male client reports to the nurse that he took sildenafil for erectile dysfunction but did not achieve an erection. Which of the following considerations should the nurse evaluate to determine possible reasons for the lack of response?

G1P1, 37 weeks' gestation patient with a scheduled nonstress test (NST) Complete the following sentence using the drop-down options. The nurse's greatest concern is the client's risk of developing __i_____ and related to __ii____ and ___iii____.

A nurse is preparing to administer magnesium sulfate IV to a client who is experiencing preterm labor. Which of the following is the priority nursing assessment for this client?

A nurse is admitting a client who is at 30 weeks of gestation and is in preterm labor. The client has a new prescription for betamethasone and asks the nurse about the purpose of this medication. The nurse should provide which of the following explanations?

A nurse is caring for a client who is at 37 weeks of gestation and has placenta previa. The client asks the nurse why the provider does not do an internal examination. Which of the following explanations of the primary reason should the nurse provide?

A nurse is assessing a postpartum client for signs of postpartum depression. Which of the following symptoms is most indicative of postpartum depression rather than normal postpartum adjustment?