A nurse in a provider's office is reviewing the medical record of a client who is requesting a diaphragm. Which of the following findings in the client's history should the nurse identify as a contraindication for this type of contraception?
Deep-vein thrombosis.
Tobacco use.
Recurrent urinary tract infections.
History of positive group B streptococcus B-hemolytic.
The Correct Answer is A
Choice A rationale
Deep-vein thrombosis (DVT) is a contraindication for diaphragm use due to the increased risk of thromboembolic events with estrogen-based contraceptives.
Choice B rationale
Tobacco use, although a risk factor for cardiovascular disease, is not a direct contraindication for diaphragm use, which is a non-hormonal contraceptive method.
Choice C rationale
Recurrent urinary tract infections are a contraindication for diaphragm use due to the risk of infection exacerbation from device insertion.
Choice D rationale
History of positive group B streptococcus B-hemolytic is not a contraindication for diaphragm use; it typically relates to pregnancy and neonatal infection risk.
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Correct Answer is D
Explanation
Choice A rationale
This statement is incorrect because a Papanicolaou test, or Pap smear, is not used for the removal of uterine fibroids. Fibroid removal typically involves surgical procedures like myomectomy.
Choice B rationale
This statement is incorrect because a Pap smear is not used to determine ovulation status. Ovulation can be monitored through methods like basal body temperature tracking or hormone assays.
Choice C rationale
This statement is incorrect because a Pap smear does not detect endometriosis. Endometriosis is usually diagnosed through laparoscopy or imaging studies like ultrasound or MRI.
Choice D rationale
This statement is correct because a Papanicolaou test is specifically designed to detect the presence of cervical cancer and precancerous changes in the cervical cells.
Correct Answer is B
Explanation
Choice A rationale
Ensuring the client has a full bladder before the procedure is incorrect. A full bladder can cause discomfort during the pelvic examination and may obscure the pelvic organs, making the examination more challenging for the provider.
Choice B rationale
Instructing the client to bear down when the speculum is inserted is correct. Bearing down helps relax the pelvic muscles, making it easier to insert the speculum and perform the examination with minimal discomfort.
Choice C rationale
Encouraging the client to take rapid, shallow breaths during the procedure is incorrect. This can increase anxiety and tension in the pelvic muscles, making the examination more uncomfortable.
Choice D rationale
Applying povidone-iodine to the provider's fingers prior to bimanual examination is incorrect. The standard procedure involves using gloves and lubricant to prevent infection and ensure patient comfort, not povidone-iodine.