In vitro fertilization-embryo transfer (IVF-ET) is a common approach for women with blocked fallopian tubes or unexplained infertility and for men with very low sperm counts. A husband and wife have arrived for their preprocedural interview. The husband asks the nurse to explain what the procedure entails. The nurse's most appropriate response is:

Choice A reason: Quickening is the first perception of fetal movement by the pregnant woman, usually felt between 16 and 20 weeks of gestation. However, quickening can also be confused with gas or peristalsis, which are normal digestive processes that cause sensations in the abdomen.

Choice B reason: Chadwick sign is a bluish discoloration of the cervix, vagina, and vulva due to increased blood flow during pregnancy. It can be observed by the examiner as early as 6 weeks of gestation. However, Chadwick sign can also be caused by pelvic congestion, which is a chronic condition of enlarged and dilated veins in the pelvis².

Choice C reason: Amenorrhea is the absence of menstrual periods, which is one of the most common signs of pregnancy. However, amenorrhea can also be caused by stress, endocrine problems, or other factors that affect the hormonal balance and ovulation.

Choice D reason: Goodell sign is the softening of the cervix due to increased vascularity and edema during pregnancy. It can be palpated by the examiner around 6 to 8 weeks of gestation. Goodell sign is not associated with any other condition besides pregnancy, unlike cervical polyps, which are benign growths of the cervical tissue that can cause bleeding or discharge.

Choice A reason: Asking the woman to reschedule the appointment for the examination is not the best response, as it may delay the detection and treatment of any potential problems. The nurse should inform the woman about the possible effect of the vaginal cream on the Pap test and offer her the option to reschedule or proceed with the examination.

Choice B reason: Asking the woman to describe the symptoms that indicate to her that she has a vaginal infection is a good way to assess the woman's condition and provide education, but it is not the initial response. The nurse should first inform the woman about the possible effect of the vaginal cream on the Pap test and then ask her about her symptoms.

Choice C reason: Reassuring the woman that using vaginal cream is not a problem for the examination is not true, as vaginal creams can alter the pH of the vaginal environment and affect the accuracy of the Pap test. The nurse should inform the woman about the possible effect of the vaginal cream on the Pap test and explain the importance of avoiding vaginal creams, douches, or intercourse for 48 hours before the test.

Choice D reason: Informing the woman that vaginal creams may interfere with the Pap test for which she is scheduled is the best response, as it educates the woman about the purpose and procedure of the Pap test and allows her to make an informed decision about whether to reschedule or proceed with the examination. The nurse should also explain the risks and benefits of both options and respect the woman's choice.