A nurse is reviewing the medical record of a client who is requesting an oral contraceptive for birth control.
The nurse should identify which of the following findings as a contraindication for the use of oral contraceptives for this client?
Migraine with aura.
Hypotension.
Dysmenorrhea.
History of ovarian cysts.
The Correct Answer is A
Choice A rationale
Migraine with aura is considered a Category 4 contraindication (unacceptable health risk) for the use of combined hormonal contraceptives (CHCs), including oral contraceptives. The estrogen component in CHCs increases the risk of ischemic stroke, and this risk is substantially amplified in clients who experience migraine headaches with focal neurological symptoms (aura), necessitating the selection of an alternative birth control method.
Choice B rationale
Hypotension (low blood pressure) is typically not a contraindication for oral contraceptive use. In fact, some studies suggest a potential, though often clinically insignificant, increase in blood pressure with CHC use due to a potential increase in circulating angiotensinogen, the precursor to the vasoconstrictive hormone angiotensin II. The use of CHCs is not restricted based on hypotension.
Choice C rationale
Dysmenorrhea (painful menstruation) is often significantly improved or resolved by the use of combined oral contraceptives (COCs). COCs work by suppressing ovulation and thinning the endometrial lining, which typically reduces prostaglandin production, thus decreasing the cramping and pain associated with the menstrual cycle, making it an indication, not a contraindication.
Choice D rationale
A history of ovarian cysts is generally not a contraindication for combined oral contraceptive use, provided the cysts were non-malignant and resolved or are benign. In fact, COCs can be used to treat or prevent the recurrence of functional ovarian cysts by suppressing the hormonal stimulation of the ovaries that leads to their formation, making it a potential therapeutic benefit.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Although antiviral medications such as acyclovir or valacyclovir can suppress viral replication and reduce the frequency, duration, and severity of outbreaks, they do not eliminate the virus from the body. Genital herpes simplex virus (HSV-2) infection is a chronic, lifelong condition for which there is currently no known cure, therefore, medication will only manage the symptoms.
Choice B rationale
Genital herpes simplex virus (HSV-2) can be transmitted vertically from mother to fetus or newborn, particularly during a primary infection in pregnancy or during vaginal birth. Neonatal herpes infection can be severe or fatal, causing disseminated disease, central nervous system involvement, or mucocutaneous lesions, thus, it is a significant risk to the developing fetus/newborn.
Choice C rationale
The risk of neonatal transmission of HSV-2 is significantly higher (around 25.
Choice D rationale
Wearing tight-fitting undergarments can increase heat and moisture in the genital area, leading to friction and irritation of the lesions, which can prolong healing and increase discomfort during an outbreak. Clients are advised to wear loose-fitting cotton undergarments to keep the area dry and promote air circulation, which helps with lesion healing.
Correct Answer is A
Explanation
Choice A rationale: Ceftriaxone IM is the recommended treatment for Neisseria gonorrhoeae infection during pregnancy. Untreated gonorrhea increases the risk of chorioamnionitis, preterm labor, premature rupture of membranes, and neonatal complications such as ophthalmia neonatorum. Ceftriaxone is safe in pregnancy and effective against gonorrhea. Prompt treatment prevents maternal complications and vertical transmission to the neonate. Therefore, administration of ceftriaxone IM is the correct nursing action in this case.
Choice B rationale: A blood culture is not indicated for a localized gonorrhea infection. Blood cultures are obtained when systemic infection or sepsis is suspected, which is not the case here. The client is asymptomatic aside from the positive culture result, with no fever, chills, or systemic signs of bacteremia. Therefore, obtaining a blood culture would not be an appropriate or necessary intervention in this scenario.
Choice C rationale: The rubella vaccine is a live attenuated vaccine and is contraindicated during pregnancy because of the potential teratogenic effects on the fetus. Women who are non-immune to rubella, as indicated by a titer less than 1:8, should be vaccinated postpartum before discharge to prevent infection in future pregnancies. Administering the vaccine during pregnancy is unsafe and therefore not an appropriate action at this time.
Choice D rationale: Maternal serum alpha-fetoprotein (MSAFP) screening is typically performed between 15 and 20 weeks of gestation to assess for neural tube defects and chromosomal abnormalities. At 12 weeks, it is too early to obtain this specimen, and the result would not be reliable. Therefore, ordering MSAFP at this gestational age is inappropriate. The correct timing should be discussed and scheduled for later in the pregnancy.
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