Epidural anesthesia decreases the urge to void and sensation of a full bladder. A full bladder will decrease the progression of labor. Under the influence of epidural analgesia, patients may not feel the urge to urinate, which can result in urinary retention and bladder overdistension. Overfilling of the bladder can stretch and damage the detrusor muscle. For example, the use of lumbar epidural analgesia for labor and delivery has frequently been implicated as a causative factor for postpartum urinary retention. This is supported by the fact that these patients demonstrate a difficulty voiding.

Option A: The medication used for the epidural does not have a diuretic effect. Spinal and epidural opioid administration influence the function of the lower urinary tract by direct spinal action on the sacral nociceptive neurons and autonomic fibres. Long-acting local anesthetics administered intrathecally rapidly block the micturition reflex. Detrusor contraction is restored approximately 7-8 hours after spinal injection of bupivacaine. For this reason, bladder catheterization is a common practice in patients with spinal or epidural anesthesia.
Option B: An epidural does not create a trancelike state for the client. Acute urinary retention is one of the most common complications after surgery and anesthesia. It can occur in patients of both sexes and all age groups and after all types of surgical procedures. It is linked to several factors including increased intravenous fluids, postoperative pain, and type of anesthesia. Micturition depends on coordinated actions between the detrusor muscle and the external urethral sphincter.
Option D: Embarrassed or not, the client would still need to have a French catheter inserted to manage her voiding. The risk of infection with a single catheterization is 1-2% and can rise by 3 to 7 % for every additional day with an indwelling catheter. Traumatic or prolonged catheterization may lead to urethritis and to urethral strictures. There has yet been no consensus for appropriate catheterization strategy during regional anesthesia.

Luteinizing hormone released by the pituitary is responsible for ovulation. At about day 14, the continued increase in estrogen stimulates the release of luteinizing hormone from the anterior pituitary. The LH surge is responsible for ovulation, or the release of the dominant follicle in preparation for conception, which occurs within the next 10–12 hours after the LH levels peak.

Option A: Estrogen levels are high at the beginning of ovulation. At about day 14 in the menstrual cycle, a sudden surge in luteinizing hormone causes the ovary to release its egg. The egg begins its five-day travel through a narrow, hollow structure called the fallopian tube to the uterus. As the egg is traveling through the fallopian tube, the level of progesterone, another hormone, rises, which helps prepare the uterine lining for pregnancy.
Option C: The endometrial lining is thick, not thin. The blastocyst then attaches itself to the lining of the uterus (the endometrium). This attachment process is called implantation. Release of the hormones estrogen and progesterone causes the endometrium to thicken, which provides the nutrients the blastocyst needs to grow and eventually develop into a baby.
Option D: The progesterone levels are high, not low. As cells continue to divide — some developing into the baby, others forming the nourishment and oxygen supply structure called the placenta — hormones are released that signal the body that a baby is growing inside the uterus. These hormones also signal the uterus to maintain its lining rather than shedding it.

The success of the rhythm method of birth control is dependent on the client’s menses being regular. Women are only fertile (an egg is present) for a few days each month. Women using the rhythm method monitor their body and analyze their past menstrual cycles to try to determine when their fertile days are. They can then either choose to not have sex during those days, or can use a “barrier” form of birth control, such as condoms or spermicide.

Option A: The rhythm method is not dependent on the age of the client. The rhythm method works best for women whose cycles are consistent because it is easier to predict when she ovulates (releases an egg from her ovaries).
Option B: Rhythm method is not successful when based entirely on the frequency of intercourse. Most women will have a period 14 to 16 days after ovulation, regardless of the length of their overall cycle. Counting backward from the day their period begins can be a good way to know when they ovulated.
Option D: Basal temperature method relies on the client’s temperature during ovulation period. The basal body temperature method is a method of natural family planning that requires only the purchase of a very accurate thermometer. The method, which calls for tracking the woman’s body temperature on a daily basis, helps to determine which days of the month she is fertile.

The best method of birth control for the client with diabetes is the diaphragm. The diaphragm is a birth control (contraceptive) device that prevents sperm from entering the uterus. The diaphragm is a small, reusable rubber or silicone cup with a flexible rim that covers the cervix. Before sex, the diaphragm is inserted deep into the vagina so that part of the rim fits snugly behind the pubic bone. The diaphragm is effective at preventing pregnancy only when used with spermicide.

Option A: Permanent intrauterine device can cause a continuing inflammatory response in diabetics that should be avoided. Fibrinolytic activity is due in part to prostaglandin synthetase activation which was thought to be required for the efficacy of the copper IUD. Its absence was thought to be a possible reason why copper IUDs were less effective in diabetics (and in nondiabetics who became pregnant).
Option B: Oral contraceptives tend to elevate blood glucose levels. Choice of contraception should be made on the preference of the woman and individual risk factors identified such as the presence of vascular, nephropathy, neuropathy, or retinal disease. Choosing a safe and reliable method of contraception for a woman with DM needs careful consideration and practitioners need to make reference to the WHO Medical Eligibility Criteria for Contraceptive Use.
Option C: Contraceptive sponges are not good at preventing pregnancy. The contraceptive sponge is a type of birth control (contraceptive) that prevents sperm from entering the uterus. It is soft and disk-shaped, and made of polyurethane foam. The contraceptive sponge contains spermicide, which blocks or kills sperm.

The signs of an ectopic pregnancy are vague until the fallopian tube ruptures. The client will complain of sudden, stabbing pain in the lower quadrant that radiates down the leg or up into the chest. Patient’s presenting with vaginal bleeding would likely benefit from a pelvic exam to assess for infections as well as assess the cervical os. Bimanual pelvic exams additionally allow for palpation of bilateral adnexa to assess for any abnormal masses/structures or to elicit adnexal tenderness.

Option A: Painless vaginal bleeding is a sign of placenta previa. Painless vaginal bleeding during the second or third trimester of pregnancy is the usual presentation. The bleeding may be provoked from intercourse, vaginal examinations, labor, and at times there may be no identifiable cause.
Option B: Abdominal cramping is a sign of labor. Women will often self-present to obstetrical triage with concern for the onset of labor. Common chief complaints include painful contractions, vaginal bleeding/bloody show, and leakage of fluid from the vagina. It is up to the clinician to determine if the patient is in labor, defined as regular, clinically significant contractions with an objective change in cervical dilation and/or effacement.
Option C: Throbbing pain in the upper quadrant is not a sign of an ectopic pregnancy. After obtaining a thorough history, an attentive physical exam is the next step. Evaluation of vital signs to assess for tachycardia and hypotension is pivotal in determining the patient’s hemodynamic stability. When examining the abdomen and suprapubic regions, attention should focus on the location of tenderness as well as any exacerbating factors.