On vaginal examination of a 30-year-old woman, the nurse documents the following findings: profuse, thin, grayish-white vaginal discharge with a 'fishy' odor and complaints of pruritus. Based upon these findings, which condition would the nurse suspect?

Correct Answer: A

Rationale: In this scenario, the nurse would suspect bacterial vaginosis (BV) based on the symptoms described. BV is characterized by a thin, grayish-white vaginal discharge with a characteristic 'fishy' odor. The presence of pruritus also aligns with BV symptoms. Candidiasis (Option B) typically presents with a thick, white, curd-like vaginal discharge and is often associated with itching and redness, rather than a fishy odor. Trichomoniasis (Option C) is characterized by frothy, yellow-green vaginal discharge with a foul odor, not a 'fishy' odor. Gonorrhea (Option D) usually presents with purulent discharge and is often asymptomatic in women. Educationally, understanding the specific symptoms and diagnostic clues for different vaginal infections is crucial for healthcare providers to accurately diagnose and treat patients. This case highlights the importance of recognizing key clinical manifestations to differentiate between common vaginal infections.

Correct Answer: D

Rationale: In this scenario, option D, "Premature rupture of membranes (PROM) 24 hours or longer before the birth," is not a risk factor for neonatal GBS infection. This is the correct answer because GBS transmission to the baby primarily occurs during labor and delivery, especially when the amniotic sac has ruptured for an extended period, increasing the exposure time. Option A, "Positive prenatal culture," is a risk factor because it indicates the presence of GBS in the mother's genital tract, which increases the likelihood of transmission to the newborn during childbirth. Option B, "Preterm birth at 37 weeks or less of gestation," is a risk factor because preterm infants have underdeveloped immune systems, making them more vulnerable to infections like GBS. Option C, "Maternal temperature of 38°C or higher," is a risk factor as maternal fever during labor can be a sign of infection, including GBS, which can increase the risk of neonatal infection. Educationally, understanding these risk factors is crucial for healthcare providers to implement appropriate interventions to prevent neonatal GBS infection, such as intrapartum antibiotic prophylaxis for mothers with known GBS colonization or risk factors. This knowledge can help improve maternal and neonatal outcomes by reducing the incidence of GBS-related morbidity and mortality.

Correct Answer: C

Rationale: The correct answer is C) Ceftriaxone. In the United States, ceftriaxone is the drug of choice for the treatment of gonorrhea due to increasing antibiotic resistance. Gonorrhea has developed resistance to multiple classes of antibiotics, including penicillin and tetracycline. Penicillin (option A) is no longer recommended for the treatment of gonorrhea due to widespread resistance. Tetracycline (option B) is also not recommended as it is no longer effective against gonorrhea. Acyclovir (option D) is used to treat viral infections such as herpes simplex virus, not bacterial infections like gonorrhea. In the context of maternal health, it is crucial for healthcare providers to be well-informed about the appropriate treatment options for common infections like gonorrhea to prevent complications during pregnancy, such as preterm birth and neonatal infections. Understanding the rationale behind the choice of ceftriaxone as the preferred treatment for gonorrhea helps in effective management of maternal health issues and contributes to better outcomes for both the mother and the baby.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Use another method of contraception for 1 week after starting the pill. Rationale: When a woman starts taking oral contraceptives after a first-trimester abortion, it takes about 7 days for the pill to become fully effective in preventing pregnancy. Therefore, using another form of contraception during this initial week is crucial to ensure protection against unintended pregnancy. Why the other options are incorrect: A) Avoiding sexual contact for 10 days after starting the pill is not necessary if another form of contraception is used during this time. B) While using condoms and foam as a backup method is a good practice in general, it is not specifically required in this situation where oral contraceptives are being used. D) Waiting for vaginal bleeding to end before engaging in sexual relations does not ensure protection against pregnancy. It is important to use another method of contraception during the initial week of starting the pill. Educational context: This question highlights the importance of understanding the timeline for oral contraceptives to become effective and the necessity of using backup contraception during this period to prevent unintended pregnancies. It underscores the need for clear communication and education regarding contraceptive methods to ensure their optimal and safe use.

Correct Answer: B

Rationale: In this scenario, the most important information for the nurse to share is option B: "The risk of pelvic inflammatory disease will be higher with the IUD." This is crucial because the young woman's sexual behavior puts her at increased risk for sexually transmitted infections (STIs), which can lead to pelvic inflammatory disease (PID) if left untreated. Educating her about this risk is essential for her overall health and well-being. Option A is incorrect because while IUDs generally do not interfere with sex, this information is not the most critical in this context where the focus should be on the potential health risks associated with the device. Option C is incorrect because IUDs do not protect against STIs. It's important for the nurse to clarify this misconception to ensure the young woman understands the limitations of contraceptive methods in preventing STIs. Option D is incorrect because IUDs are actually highly effective in preventing pregnancy when used correctly. Pregnancy rates with IUDs are low, making this information less relevant compared to the risk of PID, especially given the young woman's sexual activity and multiple partners. In an educational context, it is vital for healthcare providers to provide comprehensive and accurate information to individuals seeking contraceptive methods, especially in cases where there may be increased risks due to the individual's sexual behavior. By addressing potential health risks associated with specific contraceptive methods, nurses can help individuals make informed decisions that promote their sexual and reproductive health.