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

Choice A: Menstrual is not the correct answer because it is the phase when estrogen levels are lowest. The menstrual phase occurs when the endometrium (the lining of the uterus) is shed along with blood and mucus through the vagina.

Choice B: Ischemic is not the correct answer because it is the phase when estrogen levels are decreasing. The ischemic phase occurs when the blood supply to the endometrium is reduced due to vasoconstriction (narrowing of blood vessels). This phase prepares the endometrium for shedding if fertilization does not occur.

Choice C: Secretory is not the correct answer because it is the phase when progesterone levels are highest. The secretory phase occurs when the endometrium becomes thick and spongy due to increased secretion of mucus and glycogen (a form of sugar). This phase provides a suitable environment for implantation if fertilization occurs.

Choice D: Proliferative is the correct answer because it is the phase when estrogen levels are highest. The proliferative phase occurs when the endometrium regenerates and grows due to increased stimulation by estrogen. This phase prepares the endometrium for implantation if fertilization occurs.

Choice A:This response suggests that a physical examination is necessary before providing contraceptive advice. While a healthcare provider may conduct a physical examination as part of comprehensive care, making it a prerequisite for discussing contraception can create barriers for adolescents seeking information. Emphasizing a physical exam may deter open communication, as adolescents might feel apprehensive or judged. Effective contraceptive counseling should prioritize building rapport and understanding the individual's needs and concerns before proceeding to clinical

Choice B: "You are so young. Are you ready for the responsibilities of a sexual relationship?" This response is inappropriate and judgmental because it implies that the client is too immature or irresponsible to have a sexual relationship. It also discourages the client from seeking help or information from the nurse and may make her feel ashamed or guilty about her sexuality.

Choice C: "Because of your age, I think that a barrier method would be the best choice." This response is inappropriate and paternalistic because it assumes that the nurse knows what is best for the client without considering her individual situation or preferences. It also limits the client's options and may not address her specific needs or concerns.

Choice D:This response is appropriate as it seeks to gather more information about the adolescent's sexual activity, which is crucial for providing tailored contraceptive advice. Understanding the individual's sexual behavior, frequency of activity, number of partners, and risk factors allows the healthcare provider to recommend the most suitable contraceptive methods and address any concerns about sexually transmitted infections. The Centers for Disease Control and Prevention highlight the importance of personalized counseling that takes into account the adolescent's specific circumstances to promote effective contraceptive use and sexual health.