What maternal condition always requires delivery by cesarean section?

Choice A reason: Women without pain and who do not want to become pregnant need no treatment, as endometriosis is a benign condition that does not affect the general health or well-being of the woman. The nurse should explain to the client that endometriosis is a chronic condition that causes the growth of endometrial tissue outside the uterus, and that it can cause symptoms such as pelvic pain, dysmenorrhea, dyspareunia, and infertility. However, if the woman is asymptomatic and has no desire for pregnancy, she can choose to monitor the condition without any intervention.

Choice B reason: Surgical intervention often is needed for severe or acute symptoms, as endometriosis can cause complications such as adhesions, cysts, inflammation, or obstruction of the pelvic organs. The nurse should inform the client that surgery can be performed to remove or destroy the endometrial implants, or to perform a hysterectomy or oophorectomy in severe cases. The nurse should also discuss the benefits and risks of surgery, and the possibility of recurrence or persistence of symptoms.

Choice C reason: Side effects from the steroid danazol include masculinizing traits, as danazol is a synthetic androgen that suppresses the ovarian function and reduces the production of estrogen and progesterone. The nurse should warn the client that danazol can cause adverse effects such as acne, hirsutism, weight gain, voice changes, decreased breast size, and menstrual irregularities. The nurse should also advise the client to use a non-hormonal contraceptive method while taking danazol, as it can harm the fetus if pregnancy occurs.

Choice D reason: Bone loss from hypoestrogenism is not irreversible, as it can be prevented or treated with calcium and vitamin D supplements, bisphosphonates, or hormone replacement therapy. The nurse should educate the client that hypoestrogenism is a condition where the estrogen levels are abnormally low, and that it can occur as a result of some medications or surgical procedures for endometriosis. The nurse should also explain that hypoestrogenism can increase the risk of osteoporosis, which is a condition where the bones become weak and brittle.

Choice E reason: Women with mild pain who may want a future pregnancy may take nonsteroidal anti-inflammatory drugs (NSAIDs), as NSAIDs can reduce the inflammation and pain caused by endometriosis. The nurse should recommend the client to take NSAIDs as needed, and to follow the dosage and instructions on the label. The nurse should also inform the client that NSAIDs are not effective in treating the underlying cause of endometriosis, and that they may have side effects such as gastrointestinal irritation, bleeding, or ulcers.

Choice A reason: Amniocentesis for fetal lung maturity is not an expected diagnostic procedure for a pregnant woman with bright red, painless vaginal bleeding. It is a procedure that involves inserting a needle into the amniotic sac to obtain a sample of amniotic fluid, which can be used to assess the fetal lung development. It is usually done in late pregnancy or preterm labor, not in the second trimester.

Choice B reason: Contraction stress test (CST) is not an expected diagnostic procedure for a pregnant woman with bright red, painless vaginal bleeding. It is a test that involves stimulating uterine contractions, either by nipple stimulation or oxytocin infusion, to evaluate the fetal heart rate response. It is used to assess fetal well-being and placental function, not to diagnose the cause of bleeding.

Choice C reason: Internal fetal monitoring is not an expected diagnostic procedure for a pregnant woman with bright red, painless vaginal bleeding. It is a method of measuring the fetal heart rate and uterine contractions using electrodes or catheters that are inserted through the cervix and attached to the fetal scalp or the amniotic sac. It is usually done during labor, not in the second trimester.

Choice D reason: Ultrasound for placental location is an expected diagnostic procedure for a pregnant woman with bright red, painless vaginal bleeding. It is a test that uses sound waves to create an image of the uterus, the placenta, and the fetus. It can help to determine the position and attachment of the placenta, which can be the cause of bleeding if it is low-lying or covering the cervix (placenta previa).

Choice E reason: None of the above is not a correct answer. There is one expected diagnostic procedure for a pregnant woman with bright red, painless vaginal bleeding, which is ultrasound for placental location.