What is the main reason why a woman who is older than 35 years may have difficulty achieving pregnancy?

Choice A reason: A daily consumption of alcohol does not necessarily indicate a risk for alcoholism, although it is not recommended for pregnant women. Alcoholism is a chronic disease that involves physical and psychological dependence on alcohol, and it requires more than one criterion to be diagnosed.

Choice B reason: She will not be at risk for abusing other substances as well, unless she has a history or predisposition for substance abuse. Alcohol use during pregnancy does not cause other substance abuse problems, although it may co-occur with them.

Choice C reason: The fetus is not at risk for multiple organ anomalies, unless the mother consumes large amounts of alcohol during the first trimester of pregnancy. This can cause fetal alcohol syndrome (FAS), which is characterized by facial dysmorphia, growth retardation, and intellectual disability. However, FAS is rare and not related to moderate alcohol intake during the second trimester.

Choice D reason: The fetus is placed at risk for altered brain growth, as alcohol can cross the placenta and affect the developing nervous system of the fetus. Alcohol exposure during the second trimester can impair the formation and migration of neurons, leading to reduced brain size and function. This can result in learning difficulties, behavioral problems, and cognitive impairments in the child.

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.