OB NCLEX

A nurse is reviewing the clients medical record and notes the papanicolaou smear lab report indicates visualization of clue cells and a vaginal ph of 3.8. what should the nurse teach this client? (select all that apply) 1. Seek care if the vaginal discharge has a fishy odor 2.seek care if experiencing white, adherent vaginal discharge 3. all vaginal infections are sexually transmitted infections 4. do not douche unless instructed by a HCP 5. Usually vaginal infections can be treated with OTC preparations

1,2,4 (Bacterial vaginosis is a clinical syndrome resulting from the replacement of normal vaginal lactobacilllus species with overgrowth of anaerobic bacteria that causes a cluster of symptoms. Presence of a thick, white, adherent vaginal discharge with a fishy odor is evidence for bacterial vaginosis, and the client should seek treatment. The client should not douche unless under medical prescriptions because douching can cause bacteria to ascend to the uterus. Bacterial vaginosis is not sexually transmitted, and it does not require treatment of the partner. Vaginal infections commonly require an exam and diagnositic assessment.)

The nurse is witnessing the client signature of the informed surgical consent for an abdominal hysterectomy. It is important to ascertain that the client understands that with this procedure she will have 1. decreased libido 2. infertility 3. depression 4. weight gain

2 (The client needs to understand that with removal of the uterus she will no longer bear children or have periods. The procedure should not change her libido or sexual function. Research does not support the idea that hysterectomy contributes to depression or weight gain. Research demonstrates that women who have managed health problems for some time before the hysterectomy may actually have a more positive effect, with less worry abou their health condition, contraception or pregnancy)

A woman is taking oral contraceptives. The nurse teaches the client to report which complication? 1. breakthrough bleeding 2. severe calf pain 3. mild headache 4. weight gain of 3 lb

2 (women who take oral contraceptives are at increased risk for thromboembolic conditions. Severe calf pain needs to be investigated as a potential sign of DVT. Breakthrough bleeding,, mild headache, or weigh gain may be common benign side effects that accompany oral contraceptive use. Clients may be monitored for these side effects without a change in treatment)

A couple visiting the infertility clinic for the first time states that they have been trying to conceive for the past 2 years without success. After a Hx and Px exam of both partners, what would be the most appropriate outcome for the couple to accomplish by the end of this visit? 1. choose an appropriate infertility Tx method 2. Acknowledge that only 50% of infertile couples achieve a pregnancy 3. discuss alternative methods of having a family such as adoption 4. describe each of the potential causes and possible Tx modalities

4

Which is the correct order from first to last for proper placement of a urinary catheter? all options must be used 1. Lubricate the catheter adequately with a water soluble lubricant 2. ensure the free flow of urine 3. insert the catheter far enough into the bladder to prevent trauma to the urethral tissue 4. prepare the sterile field

4 1 3 2 (After gathering supplies, the nurse should provide the sterile field. After lubricating the catheter adequately with a water soluble lubricant to minimize trauma to the urethra, the nurse should insert the cath far enough into the bladder so the retention balloon does not traumatize urethral tissues. Ensuring free flow of uring prevents infection; improper drainage occurs when tubing is kinked or twisted)

Which instruction about activities during menstruation would the nurse include when counseling an adolescent who has just begun to menstruate? 1. Take a mild analgesic if needed for menstrual pain 2. Avoid cold foods if menstrual pain persists 3. Stop excercise while menstruating 4. Avoid tampons until you have had your period for 1 year.

1

A nurse is teaching a client how to prevent a vaginal infection. Which activity puts the client at risk for altering the normal PH of her vagina? 1. consuming over 4 cups of coffee a day 2. having sex during her menses 3. douching unless instructed by the HCP 4. using tampons during the menstrual cycle

3 (douching may disrupt the normal flora of the vaginal lactobacilli and change the ph, which could result in overgrowth of other bacteria. The other answers are not related to changes in vaginal PH or bacterial vaginosis.)

A female client with which condition would be at risk for increased severity of vulvovvaginal candidiasis. Select all that apply 1. uncontrolled diabetes 2. immunosuppression due to cancer 3. HIV infection 4. hypertension 5. asthma

1,2,3 (Women with underlying medical conditions, such as uncontrolled diabetes and HIV infection or cancer causing immunosuppression correlate with an increasing severity of candidiasis. Hypertension and asthma are not related to immunosuppression ofr complicated candidiasis.)

After conducting a class for female adolescents about human reproduction, the nurse concludes teaching has been effective when a student makes which statement? 1. Under ideal conditions, sperm can reach the ovum in 15 to 30 mins. resulting in pregnancy 2. I will not become pregnant if I abstain from intercourse during the last 14 days o fmy cycle 3. Sperms from a healthy male usually remain viable in the female reproductive tract for 96 hrs 4. After an ovum is fertilized by a sperm, the ovum contains 21 pairs of chromosomes

1 (In ideal conditions sperm can reach the ovum in 15 to 30 mins. This is an important point to make with teens who may be active. Many people believe that the time interval is much longer and that they can wait until after intercourse to take steps to prevent conception. Without protection pregnancy and STDs can occur. When using the abstinance calendar method, the couple should abstain from intercourse on the days fo the cycle when the woman is most likely to conceive. Using a 28 day cycle as an example, a couple should abstain from sex 3-4 days before ovulation (days 10-14) and 3 to 4 days after ovulation. (days 15-18). Sperm from a healthy male can remain viable for 24 to 72 hrs in the female tract. If the female ovulates after coitus there is a possibility conception could occur. Before fertilization the ovum and sperm each contain 23 chromosomes. After fertilization the conceptus contains 46 chromosomes unless there is an abnormality.)

A 22 year old client tells the nurse that she and her husband are trying to conceive a baby. When teaching the client about reducing the incidence of neural tube defects, the nurse would emphasize the need for increasing the intake of which foods? select all that apply 1. leafy green veges 2. strawberries 3. beans 4. milk 5. sunflower seeds 6. lentils

1,2,3,5,6 (Pregnancy requires 400-800 mcg/day of folic acid. Major sources of folic acid include green leafy veges, strawberries and oranges, beans, particularly black and kidney beans, sunflower seeds and lentils. Milk and fats contain no folic acids.)

The nurse is caring for a hospitalized 22 year old with type 1 diabetes and toxic shock syndrome (TSS) Which action should the nurse perform first? 1. administer 5% dextrose in 0.45%NS solution at 150 mL/hr 2. administer 50 mg of meperidine IM every 4 hrs as needed for pain 3. Teach the client to use pads at night instead of tampons during her menstrual period 4. Administer 400 mg of ciprofloxacin IV every 12 hrs infused over 1 hr.

1 (fluid losses can occur from vomiting, diarrhea and fever and can lead to hypovolemic shock. the first nursing action is to treat the hypovolemic shock that accompanies TSS, so the IV fluids must be administered immediately. The fluid replacement is critical to avoid circulatory collapse. Pain medication and teaching can be implemented later. Antibiotics will be given because TSS is caused by a staph infection; however fluid replacement is initiated first to treat life threatening hypovolemic shock)

A client has obtained levonorgestrel as emergency contraception. After unprotected intercourse, the client calls the clinic to ask questions about taking the contraceptives. The nurse realizes the client needs further explanation when she makes which statement? 1. I can wait up to 4 days after intercourse to start taking these to prevent pregnancy 2. My boyfriend can buy levonorgestrel from the pharmacy if he is over 18 years old 3. The birth control works by preventing ovulation or fertilization of the egg 4. I may feel nauseated and have breast tenderness or a headache after using the contraceptive

1 (Levongorgestrel can reduce the chance of pregnancy if taken within 72 hrs of unprotected intercourse and then again 12 hours later. Waiting 4 days to take levonorgestrel reduces effectiveness. Males can purchase this contraceptive as long as they are over 18 years of age. Levonorgestrel works by preventing ovulation or fertilization depending on where a client is in the menstrual cycle. Common side effects include nausea, breast tenderness, vertigo and stomach pain.)

A couple is inquiring about a vasectomy as a permenant method of contraception. Which teaching statement would the nurse include in the teaching plan? 1. Another method of contraception is needed until the sperm count is 0 2. Vasectomy is easily reversed if children are desired in the future 3. vesectomy is contraindicated in males with prior history of cardiac disease 4. vasectomy requires only a yearly follow up once the procedure is complete

1 (another method of birth control is needed until all sperm have been cleared from the body. The number of ejaculates for this to occur varies with the individual. and lab analysis is required to determine when that has been accomplished. Vasectomy is considered a permanent sterilization and requires microsurgery for anastomosis of the vas deferens to be completed. Studies have shown that there is no connection between cardiac disease in males and vasectomy. There is no need to follow up after verification that there is no sperm in the system)

A client taking oral contraceptives is placed on a 10 day course of antibiotics for infection. Which instruction should the nurse include in the teaching plan? 1. Use a barrier method of birth control for the rest of your cycle 2. You should stop taking the oral contraceptives while taking the antibiotic 3. call your HCP for increased hunger or fluid retention 4. Take the antibiotics 2 hrs after the oral contraceptive

1 (antibiotics may decrease the effectiveness of oral contraceptives. The client should be instructed to continue the contraceptives and use a barrier method as a backup method of birth control until the next menstrual cycle. The client should NOT stop taking her BC pills, ant there is no indication for or benefit to taking the antibiotic 2 hrs after the contraceptive. There is no incidenceof the adverse effects of hunger and fluid retention with the interaction of antibiotic therapy and oral contraceptives.)

A client is asking for information about using an IUD. Which question when asked by the nurse would provide pertinent information on whether or not a client is a candidate for an IUD? 1. do you smoke? 2. do you have hypertension? 3. how often do you have sex? 4. are you in a monogamous relationship?

4 (due to the increased risk of pelvic inflammatory disease, candidates for the IUD should be in a monogamous relationship. Smoking and hypertension are not contraindications for an IUD. The frequency of sexual relations will not affect the IUD use.)

A couple is visiting the clinic because they have been unable to conceive a baby after 3 years of frequent coitus. The nurse determines that the couple needs further instruction when they identify which factor as a cause of male infertility? 1. seminal fluid with an alkaline PH 2. frequent exposure to heat sources 3. abnormal hormonal stimulation 4. immunologic factors

1 (the couple needs further instruction when they identify that one cause of male infertility is decreased sperm count due to seminal alkaline PH. A slightly alkaline PH is necessary to protect the sperm from the acidic secretions of the vagina and is a normal finding. Seminal fluid that is abnormal in amount, consistency, or chemical composition suggests obstruction, inflammation or infection, which can decrease sperm production. The typical number of sperm produced during ejaculation is 400 million. Freq exposure to heat sources such as sauna's and hot tubs can decrease sperm procuction, as can abnormal hormonal stimulation. Immunologic factors produced by the man against his own sperm (antibodies) or by the woman can cause the sperm to clump or be unable to penetrate the ovum, thus contributing to infertility)

When instructing the client about the proper use of condoms for pregnancy prevention, the nurse should include which instruction to ensure maximum effectiveness? 1. place the condom over the erect penis before coitus 2. withdraw the condom after coitus when the penis is flaccid 3. ensure that the condom is pulled tightly over the tip of the penis before coitus 4. obtain a prescription for a condom with nonoxynol 9

1 (to ensure max effect, the condom should always be placed on a erect penis before coitus. The penis should be withdrawn before becoming flaccid. The condom should have space left at the tip of the penis to allow the condom to contain the sperm. Nonoxynol 9 is OTC)

A client is prescriped oral metronidazole for treatment of bacterial vaginosis. What should the nurse instrucct the client to avoid during treatment and for 24 hours thereafter? 1. douching 2. sexual intercourse 3. hot tub baths 4. alcohol consumption

4 (metronidazole interacts with alcohol and can cause a serious disulfiram type reaction, with severe prolonoged vomiting. The client should not douche unless following a medical perscription, but douching does not interact with metronidazole. Sexual intercourse and hot tub baths are not known to affect the incidence and treatment of bacterial vaginosis.)

A 39 year old multigravid client asks the nurse for information about female sterilization with a tubal ligation. Which client statement indicates effective teaching? 1. My fallopian tubes will be tied off thru a small abdominal incision 2. reversal of tubal ligation is easily done with a pregnancy success rate of 80% 3. after this procedure I must abstain from sex for at least 3 weeks 4. both of my ovaries will be removed during the tubal ligation

1 (tubal ligation a female sterilization involves ligation (tying off) or cauterization of the fallopian tubes through a small abd incision(laparotomy). Reversal of a tubal ligation in not easy to do and preg rate after is 30%. AFter a tubal ligation the client may engage in sex 2-3 days after. The ovaries are not removed. )

A female with uterine fibroids has dysmenorrhea and menorrhagia. After reviewing the lab reports, the nurse should report which results to the HCP? select all that apply 1. hemoglobin 9.0 g/dL 2. hematocrit 27.1% 3. WBC 10,000 cells/mm 4. K 4.0 mEq/L 5. normocytic RBCs

1,2 (A woman with uterine fibroids and dysmenorrhea is at risk for iron deficiency anemia. The hemoglobin and hematocrit indicate the likelihood that the fibroids causeing heavy menstrual blood loss have resulted in anemia. A hemoglobin of <12 g/dL in women is considered low. The white blood cell count and K are within normal limits, and normocytic RBC's are normal)

A 20 year old primigravid client tells the nurse that her mother had a friend who died from hemorrhage about 10 years ago during a vaginal birth. Which response is most helpful? 1. todays modern tech has resulted in a low maternal mortality rate 2. do not concern yourself with things that happened in the past 3. in north america, mothers seldom die in childbirth 4. what is it that concerns you about pregnancy, labor and birth?

4 (the client is verbalizing concerns about death during childbirth, asking questions about these concerns would be most helpful to determine the clients knowledge base and to provide the nurse with opportunity to answer questions and clarify misconceptions)

Before advising a 24 year old client desiring oral contraceptives for family planning, the nurse would assess the client for which signs and symptoms? 1. anemia 2. hypertension 3. dysmenorrhea 4. acne vulgaris

2 (Before advising a client about oral contraceptives the nurse needs to assess the client for S/S of HTN. Clients who have HTN, thrombophlebitis, obesity or family history of cerebral or CVA are poor candidates for oral contraceptives. In addittion women who smoke, are older than 40, or have a Hx of pulmonary disease should be advised to use a different method. Iron deficiency, anemia, or dysmenorrhea, and acne are not contraindications. Oral contraceptives decrease the amount of iron lost through menses, so its beneficial to clients with anemia. Low dose oral contraceptives to prevent ovulation may be effective in decreasing the severity of dysmenorrhea (pain). Dysmenorrhea is thought to be caused by the release of prostaglandins in response to tissue destruction during the ischemic phase of the cycle. Use of oral contraceptives commonly improves facial acne.)

Which information would the nurse include in the teaching plan for a 32 year old female client requesting info about using a diaphragm for family planning? 1. douching with an acidic solution after intercourse is recommended 2. diaphragms should not be used if the client develops acute cervicitis 3. the diaphragm should be washed in weak solution of bleach and water 4. the diaphragm should be left in place for 2 hrs after intercourse

2 (The teaching should include a caution that if the diaphragm should not be used if the client develops acute cericitis possibly aggravated by contact with the rubber of the diaphragm. Some studies have also associated diaphragm use with increased incidence of UTI. Douching after use of diaphragm and sex is not recommended because pregnancy could occur. The diaphragm should be inspected and washed with mild soap and water after each use. A diaphragm should be left in place for 6 hrs but no longer than 24 hrs after intercourse. More spermicidal jelly or cream should be used if intercourse is repeated during this period)

A 23 year old nulliparous client visiting the clinic for routine exam tells the nurse that she desires to use the basal body temp method for family planning. What instructions should the nurse give the client? 1. Check the cervical mucus to see if it is thick and sparse 2. take the temp the same time each morning before getting out of bed 3. document the ovulation when her temp decreases at least 1 degree F 4. avoid sex for 10 days after a slight rise in temp

2 (the basal temp method requires the client take the temp each morning before getting OOB. preferably at the same time each day before eating or any other activity. Just before the day of ovulation, the temp falls by 0.5 degree F. At the time of ovulation the temp rises 0.4-0.8 degree F. because of the increased progesterone secretion in response to the luteinizing hormone. The temp remains higher for the rest of the cycle. The client should keep a diary of the 6 months of cycles to calculate "safe" days. There is no mucus for the first 3 or 4 days after menses. and then thick sticky mucus begins to appear. As estrogen increases the mucus changes to clear, slippery, and stretchy. This condition termed spinnbarkeit, is present during ovulation. After ovulation, the mucus decreases in amt and becomes thick and sticky again until menses. Because the ovum typically survives about 24 hours and sperm can survive 72 couples must avoid coitus when the cervical mucus is copious and for about 3-4 days before and after to avoid pregnancy.)

An antenatal G2, T1, P0, A0, L1 client is discussing her postpartum plans for birth control with her HCP. In analyzing the available choices, which factor has the greatest impact on her birth control options? 1. satisfaction with prior methods 2. preference of a sex partner 3. breast or bottle-feeding plan 4. desire for another child in 2 years

3 (Birth control plans are influenced primarily by whether the mother is breast or bottle feeing her infant. The maternal milk supply must be well established prior to the initiation of most hormonal birth control methods. Low dose oral contraceptinves would be the exception. Use of estrogen progesterone based pills and progesterone only pills are commonly initiated from 4-6 weeks postpartum because the milk supply is well established. Prior experiences with birth control methods have and impact on the method chosen but they are not the most influential factor. Desire to have another child in 2 years would make some methods such as an IUD, less attractive but would still be secondary to the choice to breast feed)

When developing a teaching plan for an 18 year old client who asks about Txs for sexually transmitted infection, the nurse should explain that: 1. acyclovir can be used to cure herpes genitalis 2. Chlamydia trachomatis infections are usually treated with penicillin 3. ceftriaxone may be used to treat Neisseria gonorrhoeae infections 4. metronidazole is used to treat condylomata acuminata

3 (Ceftriaxone may be used to treat N. gonorrhoeae infections and is commonly combined with doxycycline. Both the client and her partner should be treated if gonorrhea is present. Acyclovir can be used to treat herpes genitalis; however, the drug does not cure the disease. C. trachomatis infections are usually treated with antibiotics such as doxycycline or azithromycin. Metronidazole is used to treat trichomoniasis vaginitis, not condylomata acuminata (genital warts))

Which information would be important to include in the teaching plan for the client who wants more information on ovulation and fertility management? 1. The ovum survives for 96 hours after ovulation making conception possible during the time 2. The basal body temp falls at least 0.2 F after ovulation has occured 3. Ovulation usually occurs on day 14 plus or minus 2 days, before the onset of the next menstrual cycle 4. Most women can tell they have ovulated because of severe pain and thick, scant cervical mucus

3 (For a client with a typlical cycle of 28 days, ovulation usually occurs on day 14, plus or minus 2 days, before the onset of the next cycle. Stated another way, the menstrual period begins about 2 weeks after ovulation has occurred. Ovulation does not usually occur during the menses component of the cycle when the uterine lining is being shed. In most women the ovum survives about 12 to 24 hrs after ovulation, during which time conception is possible. The basal body temp rises 0.5 F to 1.0 F when ovulation occurs. Although some women experience some pelvic discomfort during ovulation, severe or unusual pain is rare. After ovulation the cervical mucus is thin and copious.)

A client is scheduled to have in vitro fertilization (IVF) as an infertility Tx. Which client statement about IVF indicates that the client understands this procedure? 1. IVF requires supplemental estrogen to enhance the implantation process 2. The pregnancy rate with IVF is higher than that with gamete intrafallopian transfer 3. IVF involves bypassing the blocked or absent fallopian tubes 4. Both ova and sperm are instilled into the open end of a fallopian tube

3 (IVF is a technique that involves bypassing the blocked or absent fallopian tubes. The HCP removes the ova by laparosope or ultrasound guided transvaginal retrieval and mixes them with prepared sperm from the womans partner or donor. Two days later up to 4 embryos are returned to the uterus to increase the likelihood of a successful pregnancy. Supplemental progesterone, not estrogen is given to enhance the implantation process. Gamete intrafallopian transfer (GIFT) and tubal embryo transfer have a higher pregnancy rate than does IVF. However these procedures cant be used for clients who have blocked or absent fallopian tubes because the fertilized ova are placed into the fallopian tubes, subsequently entering the uterus naturally for implantation. In IVF fertilization of the ova by the sperm occurs outside the clients body. in GIFT, both ova and sperm are implanted into the fallopian tubes and allowed to fertilize within the womans body)

A 20 year old nulligravid client expresses a desire to learn more about the symptothermal method of family planning. Which information would the nurse include in the teaching plan? 1. This method has a 50% failure rate during the first year of use 2. couples must abstain from coitus for 5 days after the menses 3. cervical mucus is carefully monitored for changes 4. The male parner uses condoms for significant effectiveness

3 (The symptothermal method is a natural method of fertility mngmt. that depends on knowing when ovulation has occurred. Because cycles can vary by 1-2 days in either direction, the method requires daily basal body temp assessments plus close monitoring of cervical mucus changes. The method relies on abstinence during the period of ovulation, which occurs approx 14 days before the beginning of the next cycle. Abstinence from coitus for 5 days after menses is unnecessary because it is unlikely that ovulation will occur during this time period (days 1-10). Typically the failure rate for this method is 10-20%. Although a condom may increase the effectiveness of this method, most clients who choose natural methods are not interested in chemical or barrier types of family planning)

A client believes she is experiencing PMS, The nurse should next ask the client about what symptom? 1. menstrual cycle irregularity with increased menstrual flow 2. mood swings immediatley after menses 3. tension and fatigue before menses and through the second day of the menstrual cycle 4. midcycle spotting and abdominal pain at the time of ovulation.

3 (The timing of symptoms is important to the diagnosis of PMS. The client should keep a 3 month log of symptoms and menses. With PMS, the symptoms begin 3-7 days before the menses and resolve 1-2 days after the cycle has started. Menstrual cycle irregularity and mood swings after menses are not related to PMS. and other causes should be investigated. Midcycle spotting and pain are not related to ovulation)

The nurse teaches a client about using medroxyprogesterone acetate as a birth control method. Which client statement indicates effective teaching? 1. This method of family planning requires monthly injections 2. I should have my first injection during my menstrual cycle 3. one possible adverse effect is absence of a menstrual period 4. this drug will be given by SC injection

3 (With medroxyprogesterone acetate, irregular menstrual cycles and amenorrhea are common adverse effects. Other adverse effects include weight gain, breakthrough bleeding , headaches, and depression. This method requires deep IM injections every 3 months. The first injections should occur within 5 days after menses.)

a 19 year old nulligravid client visiting the clinic for a routine exam asks the nurse about cervical mucus changes that occur during the menstrual cycle. Which information would the nurse expect to include in the teaching plan? 1. about midway through the cycle, cervical mucus is thick and sticky 2. during ovulation, the cervix remains dry without any mucus production 3. as ovulation approaches, cervical mucus is abundant and clear 4. cervical mucus disappears immediately after ovulation, resuming with menses

3 (as ovolation approaches, cervical mucus is abundant and clear, resembling raw egg white. Ovulation generally occurs 14 days (+ or - 2) before beginning of menses. During the luteal phase of the cycle, which occurs after ovulation, the cervical mucus is thick and sticky, making it difficult for sperm to pass. Changes in the cervical mucus are related to the influences of estrogen and progesterone. Cervical mucus is always present)

Which instruction should the nurse include to the client for a 30 year old multiparous client who will be using an intrauterine device (IUD) for family planning? 1. Amenorrhea is a common adverse effect of IUDs 2. The client needs to use additional protection for conception 3. IUDs are more costly than other forms of contraception 4. Severe cramping may occur when the IUD is inserted

4 (severe cramping and pain may occur as the device is passed through the internal cervical os. The insertion of the device is generally done when the client is having her menses because it is unlikely that she is pregnant at that time. Common adverse effects of IUDs are heavy menstrual bleeding and subsequent anemia, not amenorrhea. Uterine infection or ectopic pregnancy may occur. The IUD has an effectiveness rate of 98%. Therefore additional protection is not necessary to prevent pregnancy. IUDs generally are less costly than other forms of contraception because they do not require additional expense. Only one insertion is necessary compared to daily doses of oral or t the need for spermicides in conjunction with diaphragm use)

After being examined and fitted for a diaphragm, a 24 year old client receives instructions about its use. Which client statement indicates a need for further teaching? 1. I can continue to use the diaphragm for about 2-3 years if I keep it protected in the case 2. If I get pregnant I will have to be refitted for another diaphragm after childbirth 3. Before inserting the diaphragm I should coat the rim with contraceptive jelly 4 If I gain or lose 20 lbs I can still use the same diaphram

4 (Gaining or losing more than 15 lbs can change the pelvic and vaginal contours to such a degree that the diaphragm will no longer protect the client against pregnancy. The diaphragm can be used for 2-3 years if it is cared for and well protected in its case. The client should be refitted after child birth. The client should use spermicidal jelly before inserting the diaphram.)

After instructing a 20 year old nulligravid client about adverse effects of oral contraceptives, the nurse determines that further instruction is needed when the client states which as an adverse effect? 1. weight gain 2. nausea 3. headache 4. ovarian cancer

4 (The client needs further education when the client states ovarian cancer is an adverse effect. Some studies suggest that ovarian and endometrial cancers are reduced in women on oral contraceptives. Other adverse effects of oral contraceptives include weight gain, nausea, headache, breakthrough bleeding, and monilial infections. The most adverse effect is thrombophlebitis. )