Last exam OB

normal newborn temp

97.7-99.7

An initial outbreak of HSV treated with which medication?

Acyclovir

Evaporation intervention

Make sure baby is dry. NO WETNESS

what are the disadvantages of myomectomy?

the fibroids may grow back in the future

A nurse is caring for a client who has been prescribed gonadotropin-releasing hormone (GnRH) medication for uterine fibroids (uterine myomas). For which side effect of GnRH medications should the nurse monitor the client?

vaginal dryness Explanation: Vaginal dryness is one of the side effects of GnRH medications. The other side effects of GnRH medications are hot flashes, headaches, mood changes, musculoskeletal malaise, bone loss, and depression.

positive whiff test

vaginal secretion are mixed with a drop of 10% potassium hydroxide on a slide producing fishy odor and is a sign of bacterial vaginosis.

Causative organism : HPV

venereal warts

conduction nursing interventions

warm blankets, skin to skin

The mnemonic can help a woman remember the early warning signs when taking birth control?

ACHES

A nurse is conducting a teaching session with a group of adolescent females at a local women's health clinic. When describing appropriate screening guidelines for cervical cancer, at which age would the nurse would instruct the group to have their first Papanicolaou test?

ACOG (2015) recommends that cervical cancer screening should begin at age 21 years (regardless of sexual history) since women younger than age 21 are at very low risk of cancer.

Causative organism : trachomatis (bacteria)

Chlamydia

Esophageal Atresia and Tracheoesophageal Fistula

E.A; interrupted esophagus T.F; abnormal connection between trachea and esophagus DX only by xray/ultrasound/mri

A nurse is caring for a client for whom estrogen replacement therapy has been recommended for pelvic organ prolapse. Which nursing intervention is the most appropriate for the nurse to implement before the start of the therapy?

Evaluate the client to validate her risk for complications. Explanation: Before starting estrogen replacement therapy, each woman must be evaluated on the basis of a thorough medical history to validate her risk for complications such as endometrial cancer, myocardial infarction, stroke, breast cancer, pulmonary emboli, or deep vein thrombosis.

True or false: the nurvaring is a good option for contraception for breast feeding mothers?

False because of the estrogen.

physiological jaundice

Occurs after 24 hours and beyond

Lochia alba

Yellowish/white discharged; from day 12 to about 3 wks postpartum til gone.

The most common early signs for ovarian cancer

abdominal bloating, early satiety, fatigue, vague abdominal pain, urinary frequency, diarrhea or constipation, and unexplained weight loss or gain

nursing assessment for NEC

abdominal distention/tenderness, bloody stools, feeding intolerance, sepsis, lethargy, apnea, KUB

this condition occurs most frequently at the beginning and end of the reproductive years?

abnormal uterine bleeding

predisposing factors for uterine fibroids

age, smoking, obesity

The presence of clue cells on the microscope would indicate ?

bacterial vaginosis

periventricular intraventricular hemorrhage (PVH-IVH)

bleeding within the brain due to immature cerebral ventricular system. -happens in the first 24-72 hrs of life. Risk factors: prematurity, low birth wt, asphyxia, unstable BP, seizures, blood loss, mechanical ventilation

During a routine assessment, a client reports to the nurse a new lump in her right breast and occasional nipple pain. The client has a family history of breast cancer. The nurse will anticipate preparing the client for which procedure first?

breast examination Explanation: The nurse will first prepare the client for a breast examination to be done by the health care provider to assess the client's reported symptoms. Testing begins with the least invasive and then progresses as needed.

Hep B vaccine

consist of a series of three injections given within 6 months

most common types of pelvic/genital prolapse

cystocele rectocele enterocele uterine prolapse

lochia rubra

dark red/fleshy smell; from birth until 3/4 days postpartum. -similar to heavy menstrual period

GI Postpartum adaptations

decrease bowel sounds, decreased peristalsis, constipation( commonly due to fear to push),

A woman is diagnosed with polycystic ovary syndrome (PCOS). Which treatment would the nurse not explain to the client?

estrogen replacement therapy Explanation: Glucophage, clomiphene, and oral contraceptive pills are part of the treatment modality for PCOS. Estrogen replacement therapy, however, is used in structure/prolapse disorders to improve tone and vascularity of supporting tissues.`

Subinvolution

failure of uterus to return to non-pregnant state

recommended treatment: antivirals used to treat first episode, recurrence, suppression, Acyclovir, Valacyclovir, Famciclovir mainstay in TX

herpes type 2 ( genital herpes)

the 2 most common symptoms of endometriosis are?

infertility and pelvic pain

Which medications are appropriate to treat vaginal candidiasis? Select all that apply.

miconazole fluconazole Explanation: Therapeutic management for vaginal candidiasis includes miconazole, clotrimazole, terconazole, and fluconazole. FUNGAL INFECTION!

nursing management for PVH_IVH

monitor fontanel size, reduce stimulation, cluster care, adequate oxygenation

Stimulates; pituitary

new born sucking breast ________ the __________ gland, causing the release of prolactin and oxytocin

secondary amenorrhea

no menses for 3 months

Which are modifiable risk factors for breast cancer? Select all that apply.

obesity smoking alcohol consumption duration of breastfeeding sedentary lifestyle

pathological jaundice

occurs before 24 hours and may indicate ABO incompatibility, kernicterus, Rh isoimmunization

What is the medication of choice for early syphilis?

penicillin G benzathine Explanation: A single dose of penicillin G benzathine intramuscular injection is the medication of choice for early syphilis or early latent syphilis of less than 1 year's duration.

puerperium

period from delivery until the reproductive organs return to normal (about 6 wks)

cervicitis

presence of inflammation or infection of the cervix; chlamydia, gonorrhea

Five stages of syphilis

primary chancre on place of entrance of bacteria secondary maculopapular rash, flu like symptoms latent NO SYMPTOMS, 1-2 year tertiary tumors of bone, skin, liver

nursing management MAS

suctioning at birth adequate tissue perfusion neutral thermal environment parent support and education

what trait is often displayed by abusers?

they exhibit antisocial behaviors

What reasons would a lumpectomy not be suited for some women?

those who have more than one kind of cancer sites and cant be removed from one incision. whos surgery wont result in a clean margin of tissue

nursing assessment Esophageal Atresia and Tracheoesophageal Fistula

-maternal HX (polyhydramnios?) copious frothy bubbles of mucus/drooling/coughing/chocking/cyanosis abdominal distention

normal blood loss csection

1000mL

how many calories does a newborn require?

108kcal/kg/day starting at birth til about 6 months

normal males have more than _____ million sperm

20 million

The most common cause of menstrual abnormality in reproductive age women is?

Annovulation

This test is considered the GOLD standard for assessing patency of the fallopian tubes?

Hysterosalpingography

Letting go phase

PT reestablished relationship with others

This stage of syphilis presents with a maculopapular rash on hands/feet and sore throat?

Secondary

What causes mastitis?

Staphylococcus aureus, haemophilus influenza

recommended treatment: Benzathine penicillin G injection

Syphilis

A woman with ovarian cancer has been told that she is in stage III of the cancer. The nurse is reviewing the information with her. Which statement would help in the woman's understanding of stage III ovarian cancer

The growth has spread to the lymph nodes and other areas/organs in the abdominal cavity. Explanation: The staging and diagnosis is performed by a laparoscopy. The staging is I to IV. Stage III means the cancer has spread to the lymph nodes and other areas in the abdominal cavity. A five-year survival rate for this stage is 30% to 60%.

syphilis

an STD that attacks many parts of the body and is caused by a small bacterium called a spirochete.

What day does ovulation occur?

day 14

painful intercourse associated with menopause is known as?

dyspareunia

risk factors for transient tachypnea newborn

maternal sedation, csection , precipitous delivery

radiation interventions

radiant warmer, keep bebe away from exterior walls

Causative organism : Treponema pallidum (spirochete bacteria)

syphilis

convection intervention

warm clothes, warm isolette

A woman diagnosed with breast cancer is to undergo a lumpectomy followed by radiation therapy. When reviewing the treatment plan with the client, the nurse determines that the woman has understood the information based on which client statement?

"After they remove the tumor and some of the normal tissue, I'll start radiation in about 2 to 4 weeks." Explanation: Women undergoing breast-conserving therapy receive radiation after lumpectomy with the goal of eradicating residual microscopic cancer cells to limit locoregional recurrence. In women who do not require adjuvant chemotherapy, radiation therapy typically begins 2 to 4 weeks after surgery to allow healing of the lumpectomy incision site. Radiation is administered to the entire breast at daily doses over a period of several weeks. Breast-conserving surgery, the least invasive procedure, is the wide local excision (or lumpectomy) of the tumor along with a 1-cm margin of normal tissue.

A nurse is preparing a client for intrauterine device (IUD) insertion. Which education will the nurse provide to the client?

"Checking the strings is recommended following insertion." Explanation: The nurse should instruct the client to check the strings/threads regularly to make sure that the IUD is in place. Current recommendations are to check the strings monthly after insertion, but some clients may be instructed to check less frequently after the first 3 months following insertion because expulsion of the IUD is less common after that time. An IUD does not protect against STIs, and the insertion procedure may involve mild to moderate cramping pain; however, the client should not expect to have continuous cramping pain following insertion.

The nurse is teaching a client with mastitis about care measures. Which client statement indicates effective teaching?

"I can use warm soaks to my breast to relieve the discomfort." Explanation: Applying warm soaks to the breast or letting warm water from the shower flow over the breast can help to relieve some of the discomfort.

The nurse is caring for a 52-year-old woman whose sisters and mother died of breast cancer. The client states, "My doctor wants me to take tamoxifen to help prevent breast cancer. What do you think?" What would be the nurse's best response?

"Tamoxifen reduces the incidence." Explanation: Tamoxifen is referred to as a chemopreventive agent, not a chemotherapeutic agent. It does prevent osteoporosis, but this response does not address breast cancer prevention. Raloxifene is another drug that shows promise as a chemopreventive agent. Tamoxifen reduces breast cancer incidence by 49%.

respiratory system adaptations postpartum

-Thoracic cavity and rib cage return to normal fast, so SOB and rib aches of pregnancy are relieved. -Tidal volume, minute volume, vital capacity, functional residual capacity return to prepregnant values within 1-3 weeks postpartum

How should the nurse instruct a woman to perform a breast self-examination? Select all that apply.

-You will need to visually inspect both breasts and palpate them for changes." -"Look for any changes in shape, size, contour, or symmetry between the breasts, as well as any skin discoloration." -"It doesn't matter which pattern you use to palpate the breast as long as you cover the entire breast.

endocrine system adaptions postpartum

-estrogen/progesterone levels drop quickly -placenta hormones decline rapidly -prolactin levels start to decline once placenta is delivery if breastfeeding doesn't happen, usually takes two weeks

Normal newborn respiratory rate

30-60 breaths per minute being shallow and irregular, periodic breathing and apnea

At what age should a woman with no risk factors begin mammography screening for breast cancer?

40

normal blood loss natural birth

500 mL

In order for LAM to be effective a women must breast feed at least ______ times a day?

6

How many wet diapers per day?

6-8

how many hours after a baby is born is the first void?

8-12 hrs

normal newborn blood volume

80-85 ml/kg

A woman is diagnosed with endometrial polyps after undergoing a hysteroscopy. When reviewing the documentation about the findings of this procedure, the nurse would expect to see the polyps being described as which color?

Cherry-red Explanation: Endocervical polyps are typically cherry red in appearance whereas most cervical polyps are grayish-white

A 24-year-old female client states, "About a week before my period starts, I have recently started craving certain sweets, having terrible mood swings, and feeling fatigued and irritable." Which action will the nurse take next?

Educate the client on treatment for premenstrual syndrome. Explanation: The client is exhibiting symptoms of premenstrual syndrome and the nurse would provide education on treatment options for the client's specific symptoms, such as increased rest and exercise.

A woman is 2 weeks postpartum when she calls the clinic and tells the nurse that she has a fever of 101°F (38.3°C). She reports abdominal pain and a "bad smell" to her lochia. The nurse recognizes that these symptoms are associated with which condition?

Endometritis Explanation: The woman with endometritis typically looks ill and commonly develops a fever of 100.4°F (38°C) or higher (more commonly 101°F [38.3°C], possibly as high as 104°F [40° C]) on the third to fourth postpartum day. The rise in temperature at this specific time is the most significant finding. The woman exhibits tachycardia, typically a rise in pulse rate of 10 beats per minute for each rise in temperature of one degree. In addition, the woman may report chills, anorexia, and general malaise. She also may report abdominal cramping and pain, including strong afterpains. Fundal assessment reveals uterine subinvolution and tenderness. Lochia typically increases in amount and is dark, purulent, and foul-smelling. However, with certain microorganisms, her lochia may be scant or absent.

Causative organism : Niesseria goborrhoeae (bacteria)

Gonorrhea

recommended treatment: ONE TIME DUAL: cetriaxone and azithromycin, abstinence from sex until therapy is complete and symptoms are gone, retesting in 3 months

Gonorrhea

The primary care provider has prescribed estrogen replacement therapy (ERT) for a menopausal woman who has been diagnosed with pelvic organ prolapse (POP). The client asks the nurse why she needs to be on hormones. Which would be the nurse's best response?

Hormone replacement will increase blood perfusion and the elasticity of the vaginal wall. Explanation: Hormone replacement therapy may improve the tone and vascularity of the supporting tissue in perimenopausal and menopausal women by increasing blood perfusion and the elasticity of the vaginal wall.

nursing assessment meconium aspiration syndrome

Inspection: staining of amniotic fluid/nails/skins/umbilical cord Respiratory distress: prolonged tachypnea, increase respiratory distress, intercostal retractions, end-expiratory grunting, cyanosis chest xray: patchy fluffy infiltrates, hypoaeration with atelectasis Lab work: metabolic acidosis

The nurse is assisting a woman in scheduling an appointment for a Papanicolaou test. The woman's last menstrual period started on May 2 and ended on May 6. Which date would be most appropriate for the appointment?

May 17 Explanation: A Papanicolaou test should be scheduled at least 1 week after menses ends to increase the chance of getting the best sample of cervical cells without menses. In this case, the date would be May 17.

this medication inhibits prostaglandins?

NSAIDs

Necrotizing Enterocolitis (NEC)

Occurs in premature and newborn infants. Inflammation/ischemic/necrosis of bowels. Three pathologic mechanisms: bowel ischemia, bacterial flora, and effect of feeding. Treatment: Withholding feedings. Administering antibiotics. Blood transfusions., education.

Lochia serosa

Pinkish/brown, serosanguineous. Lasts day 4-12 postpartum

nursing management Esophageal Atresia and Tracheoesophageal Fistula

Preop: NPO and IV hydration elevate head 30 degrees oxygen and suction nonnutritive sucking aspiration prevention Postop: TPN and antibiotics oral feedings resumes within 1 wk parental teaching

A client is scheduled to start taking tadalafil for erectile dysfunction. A nurse should teach the client to observe for side effects and notify a health care provider immediately if what occurs?

Priapism Explanation: Priapism (erection lasting longer than 4 hours) is a side effect of tadalafil that warrants notifying a health care provider immediately.

A small amount of breast milk is obtained for culture and sensitivity testing from a client with mastitis. The nurse would expect the results to identify which organism as the most likely cause?

Staphylococcus aureus Explanation: The most common causative microorganism associated with mastitis is Staphylococcus aureus.

The nurse is preparing to teach a client how to conduct the basal body temperature method to determine her fertile window. Which instruction should the nurse prioritize?

Temperature should be taken prior to any activity every morning. Explanation: BBT is the basal body temperature method and requires the woman to take her temperature and record it every morning. This should be the first activity of the day before exiting the bed or doing other activities. To prevent conception, avoid unprotected intercourse from the day the BBT drops through the fourth day of temperature elevation.

exam findings: yellow/green/frothy discharge with foul odor, dysuria, petechiae on cervix

Trichomoniasis

recommended treatment: metronidazole or tinidazole, abstinence until therapy complete

Trichomoniasis

true or false: A PT with syphilis is complaining of pain while urinating due to genital ulcers, a proper nursing intervention would be to instruct the PT to urinate in water?

True this is okay for the patient

A nurse is providing medication teaching related to oral contraceptive pills (OCPs) that a client is being given to prevent unwanted pregnancy. Which is the most important intervention for the nurse to include?

Use a second form of contraception for the initial seven days on the OCPs. Explanation: OCPs are not effective for the first 7 days, so the priority intervention the nurse should include would be for the client to use a second form of contraception during this time.

The nursing instructor is teaching about Bartholin cysts and informs the students that Bartholin cysts are the most common cystic growth in the vulva. She describes this type of cyst as being:

a swollen, fluid-filled, sac-like structure. Explanation: A Bartholin cyst is a swollen, fluid-filled, sac-like structure that results when one of the ducts of the Bartholin's gland becomes blocked.

what does the AGS recommend for breast exams?

annual mammograms and clinical breast exam for women starting at 40. Self exam starting at 20 and onward

Which pharmacologic treatment would not be therapeutic for a woman with fibrocystic breast changes?

antihistamines Explanation: Oral contraceptives will keep hormone levels stable to avoid peaks and troughs, which may cause breast edema and pain. Anti-inflammatory medications will be helpful in reducing pain from fibrocystic breast changes. Diuretics can be helpful in reducing excess fluid leading to edema and subsequent pain in the breast. Antihistamines are used to treat an overactive immune response, not edema from breast changes

According to the CDC, _____ is an STI characterized by cervicitis

chalmydia

taking hold phase

characterized by dependent and independent maternal behavior

recommended treatment: Azithromycin, doxycycline, levofloxacin Ofloxacin, abstinence from sex until therapy complete and symptoms are gone, retesting in 3 months

chlamydia

what is considered emotional abuse?

destroying valued possessions or attacking pets

caput succedaneum

diffuse edema of the fetal scalp that crosses the suture lines.

WHat medications can someone take if they have a dx of syphilis but are allergic to penicillin?

doxycycline, tetracycline, erythromycin

neonatal abstinence syndrome (NAS)

drug dependency acquired in utero. withdraw symptoms begin within 72 hours temperature instability, hypoglycemia, and abnormal cry

Which finding would the nurse most likely find in a male diagnosed with a chlamydia trachomatis infection?

dysuria Explanation: A male with the diagnosis of chlamydia will first experience dysuria as the primary symptom. The other symptoms listed do not correlate to men with the diagnosis of chlamydia.

A nurse is reviewing the history and physical examination of a client diagnosed with secondary dysmenorrhea for possible associated causes. Which etiology would the nurse need to keep in mind as being the most common?

endometriosis Explanation: Secondary dysmenorrhea is painful menstruation due to pelvic or uterine pathology. Endometriosis is the most common cause of secondary dysmenorrhea. Other recognized causes include adenomyosis, fibroids, pelvic infection, an intrauterine device, cervical stenosis, or congenital uterine or vaginal abnormalities.

nursing assessment RDS

expiratory grunting, nasal flaring, chest wall retractions, seesaw respirations, generalized cyanosis, HR 150-180, tachypnea with fine inspiratory crackles xray findings: hypoaeration underexpansion, ground glass pattern

nursing assessment IDM

full cheeks/ruddy skin short neck/buffalo hump/massive shoulders distended upper abdomen respiratory distress hypoglycemia hyperbilirubinemia

a PT with HPV will most likely present with what finding?

genital warts

nursing assessment for PVH-IVH

high pitch cry, bulging fontanel, weak suck, seizures, respiratory distress, unstable bp, drop in hematocrit, poor perfusion, drop in O2

taking in phase

immediately after birth, The PT needs others to meet her needs; relives the birth process

A nurse is asked to teach a woman to take her basal body temperature daily to assess the time of ovulation. She can detect her day of ovulation, following ovulation, because her temperature will:

increase a degree. Explanation: The effect of progesterone, released with ovulation, is to increase body temperature.

how does the newborn conserve heat?

increasing metabolic rate increase muscle activity peripheral vasoconstriction assume fetal position

nursing assessment NAS

maternal medical HX CNS dysfunction metabolic dysfunction vasomotor dysfunction respiratory issues GI issues

symptoms of mammary duct ectasia

presence of green, brown, straw-colored, reddish, gray, or cream-colored nipple discharged with a consistency of toothpaste

A nurse is conducting a presentation for a local women's group about pelvic organ prolapse. When describing the different types, which information would the nurse incorporate into the description of a cystocele?

protrusion of the bladder wall through the anterior vaginal wall Explanation: A cystocele occurs when the posterior bladder wall protrudes downward through the anterior vaginal wall. A rectocele occurs when the rectum sags and pushes into or against the posterior vaginal wall. An enterocele occurs when the small intestine bulges through the posterior vaginal wall. Uterine prolapse occurs when the uterus descends through the pelvic floor and into the vaginal canal

nursing management NAS

provide comfort; decrease stimuli/cluster care/nonnutritive sucking nutrition; increase calorie intake (150-250kcal/kg) prevent complications promote parental interaction

recommendation for pessary care

removing pessary twice weekly and cleaning with soap and water. douching with diluted vinegar or hydrogen peroxide helps to reduce uti and odor

tamoxifen

selective estrogen receptor modulator used to prevent further spread of cancer in women with ER-positive cancer

hyperbilirubinemia

serum level is greater than 5. At 12-15 mg/dL start phototherapy levels greater than 20 exchange transfusion

nursing management RDS

supportive care and close monitoring ventilation (CPAP/PEEP) exogenous surfactant oxygen therapy antibiotics for + cultures correct metabolic acidosis fluids and vasopressors gavage or IV feeding glucose monitoring prone/side lying position

nursing assessment for TTN

tachypnea, grunting, retractions, nasal flaring, labored breathing, mild cyanosis, Xray finding: mild symmetric lung overaeration and prominent perihilar interstitial marks/streaks

The micro-organism associated with Syphilis is?

treponema pallidum-spirochete bacteria

Causative organism : protozoa

trichomoniasis

a single cell protozoan parasite seen on the microscope would indicate?

trichomoniasis

Which factor in a client's history indicates she is at risk for candidiasis?

use of corticosteroids Explanation: Small numbers of the fungus Candida albicans are commonly in the vagina. Because corticosteroids decrease host defense, they increase the risk of candidiasis.

A female client, who has been newly diagnosed with herpes simplex virus (HSV) ask the nurse how long it will take for the "sores" to go away. How should the nurse respond?

will take about 2 weeks for the outbreak to fully heal." Explanation: During an initial occurrence vesicles appear on the labia or perineum. These vesicles open, begin to weep, then crust over, dry and then disappear without scar formation. This is the process of viral shedding and takes about 2 weeks to complete.

normal newborn HR

110-160 bpm greater than 160 could indicate heart disease, hyperthyroidism, low volume less than 110 could indicate apnea and hypoxia

The nurse is caring for four female clients, all prescribed oral contraceptive pills. The nurse will question giving an oral contraceptive pill to which client?

37-year-old client who has migraines with aura several times a week and smokes Explanation: The nurse would question giving an oral contraceptive to the 37-year-old client who has migraines with aura and smokes. This client has three risk factors (age, migraines with aura, and smokes) for complications such as deep vein thrombus formation, myocardial infarction, and cerebrovascular accidents.

Which stage of syphilis occurs when the infected person has no signs or symptoms of syphilis?

latency Explanation: Primary syphilis occurs 2 to 3 weeks after initial inoculation with the organism. Secondary syphilis occurs when the hematogenous spread of organisms from the original chancre leads to generalized infection. A period of latency occurs when the infected person has no signs or symptoms of syphilis. Tertiary syphilis presents as a slowly progressive inflammatory disease with the potential to affect multiple organs.

Trastuzumab

monoclonal antibody used in tx of breast cancer and is considered immunotherapy adverse effects cardiac toxicity, vascular thrombosis, hepatic failure fever, chills, n/v, pain with first infusion

lifestyle changes to avoid breast cancer

-restrict intake of sodium -limit intake of processed foods -consume at least five servings of proteins daily

Staging of breast cancer

0-early type 1-localized tumor <1 in diameter II-tumor 1-2 in diameter, spread to axillary lymph node III-Tumor 2 in or larger; spread to other lymph and tissues IV-Cancer metastasized to other organs

A nurse is reviewing the medical records of four female clients. The nurse will identify which client at the highest risk for breast cancer?

A 56-year-old client of African descent with a body mass index (BMI) of 27, stopped taking oral contraceptives (OCs) 2 years ago and lives a sedimentary lifestyle. Explanation: The nurse knows the 56-year-old client is most at risk with 4 risk factors (age, BMI, OC use, and sedimentary lifestyle). The 21-year-old client has 1 risk factor (alcohol use). The 32-year-old client has 2 risk factors (OC use and lifestyle), the 44-year-old client has 2 risk factors (European heritage and alcohol consumption). There are multiple factors that place a woman at increased risk of developing breast cancer. These include alcohol consumption, a lack of physical activity, oral contraceptive use, age 55 and older, genetics, European descent, being overweight or obese, and a family history of breast cancer. It takes about 10 years after stopping oral contraceptive use for a client's risk to decrease. Research also suggests that women keep a maximum BMI of 25 or lower. Factors not related to breast cancer development include breast implants, unprotected intercourse, smoking, and drug use.

A client presents with vulvar itching and diffuse green vaginal discharge. Upon evaluation, she is prescribed metronidazole. What is the paramount nursing intervention in discharge planning?

Instruct the client not to drink alcohol with this treatment. Explanation: While counseling to abstain from sex for one week is appropriate, the most important intervention is counseling to avoid alcohol during metronidazole treatment. Alcohol consumption while taking metronidazole creates a severe gastrointestinal reaction of nausea, vomiting, and flushing.

A client prescribed a combined oral contraceptive (COC) has presented for a routine visit. Which finding if reported by the client upon assessment should the nurse prioritize?

abdominal pain Explanation: The warning signs to report for a client on combined oral contraceptives are severe abdominal or chest pain, dyspnea, headache, weakness, numbness, blurred or double vision, speech disturbances, or severe leg pain and edema. Light bleeding, light flow, and cramping are all normal.

The nurse is assessing a female client diagnosed with primary stage genital herpes simplex virus. Which finding will the nurse report to the health care provider?

loss of genital hair Explanation: Genital herpes simplex virus (HSV) is characterized by blisters and sores of the vulva, vagina, and perineal areas. The nurse would report symptoms not expected or associated with the client's current diagnosis. Alopecia is a symptom of syphilis, not of primary genital HSV. This should be reported as additional assessment and testing may be needed to determine the cause. Findings of the primary stage of a genital HSV infection include fluid-filled, either clear or cloudy, blisters; red skin behind the blisters; ruptured blisters that turn into sores; painful urination; and perineal pruritis.