An African American woman noticed some bruises on her newborn girl's buttocks.
She asks the nurse who spanked her daughter.
The nurse explains that these marks are called:

Choice A rationale

Oral contraceptives primarily work by inhibiting ovulation through hormonal regulation. They do not inherently increase the risk of pelvic inflammatory disease (PID). In some cases, they may even offer a protective effect against PID by thickening cervical mucus, which can act as a barrier to ascending infections.

Choice B rationale

Frequent alcohol use can impair the immune system, potentially making an individual more susceptible to infections. However, it is not a direct cause of PID. PID is primarily caused by ascending infections, often sexually transmitted infections, rather than the direct effects of alcohol consumption.

Choice C rationale

Chlamydia trachomatis is a common sexually transmitted bacterium and a major cause of pelvic inflammatory disease. Untreated chlamydia infections can ascend from the cervix and uterus to the fallopian tubes and ovaries, leading to inflammation, scarring, and potentially long-term complications such as infertility and ectopic pregnancy.

Choice D rationale

Recurrent cystitis, an infection of the bladder, primarily affects the lower urinary tract. While urinary tract infections are common in women, they do not typically ascend to the reproductive organs and cause pelvic inflammatory disease. PID involves infection of the upper genital tract, including the uterus, fallopian tubes, and ovaries.

The nurse should anticipate a provider prescription for pyridoxine due to the client’s severe dehydration.

Rationale for correct answers

Pyridoxine (vitamin B6) is recommended for nausea and vomiting in pregnancy (NVP), commonly known as hyperemesis gravidarum (HG), especially in patients with persistent symptoms leading to dehydration. Severe dehydration is confirmed by elevated urine specific gravity (normal: 1.002–1.030), low sodium (normal: 135–145 mEq/L), and positive ketones, indicating excessive vomiting and malnutrition.

Rationale for incorrect Response 1 options

• Antibiotics: There is no evidence of infection; urinalysis and WBC count are within normal limits.
• Magnesium sulfate: Used for eclampsia or preterm labor prevention, not for HG.
• Oxytocin: Stimulates uterine contractions and is contraindicated during early pregnancy unless labor induction is required.

Rationale for incorrect Response 2 options

• Urinary tract infection: No leukocytes or nitrites in urine, and WBC count is normal (4,500–11,000/mm³).
• Preeclampsia: No proteinuria or hypertension (≥140/90 mm Hg).
• Preterm labor: No uterine contractions or cervical changes.