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?

Choice A rationale

Instructing the client to apply anesthetic spray to the site three to four times a day is incorrect. While anesthetic sprays can help with pain relief, it's more important to manage swelling and discomfort with a combination of methods, including ice packs and perineal care.

Choice B rationale

Encouraging the client to change perineal pads at least three times a day is insufficient. Pads should be changed more frequently to maintain hygiene and prevent infection.

Choice C rationale

Assisting the client to fill the squeeze bottle with cold water to perform perineal care is incorrect. While perineal care is important, cold water is not typically recommended as it may not provide comfort and might even cause discomfort.

Choice D rationale

Alternating warm and ice packs to the site every 2 hours for the first 24 hours postpartum is correct. This method helps manage pain and swelling effectively, promoting healing and comfort for the client.

An ectopic pregnancy is most likely due to the combination of symptoms: dizziness, pale skin, cool extremities, low blood pressure (86/48 mm Hg), and high heart rate (120/min). The soft and non-tender abdomen with no palpable contractions also suggests an ectopic pregnancy rather than other conditions. The low hematocrit (25%) and hemoglobin (9 g/dL) indicate significant blood loss, a hallmark of ectopic pregnancy.

Administer methotrexate is important to stop the growth of the embryo in an ectopic pregnancy. Insert a large-bore peripheral IV catheter to manage blood loss and prepare for potential surgery.

Monitoring beta human chorionic gonadotropin (hCG) levels is crucial to confirm the diagnosis and monitor treatment response. Platelet count should be monitored due to the risk of bleeding associated with an ectopic pregnancy.

Placenta previa usually presents with painless vaginal bleeding, which is absent in this case. Chorioamnionitis is typically associated with infection signs like fever, uterine tenderness, and elevated white blood cell count, not primarily dizziness and low blood pressure. Cervical insufficiency usually presents with painless cervical dilation, leading to preterm birth, not the acute signs seen here. Vaginal bleeding is a symptom, not a diagnosis, and this client reports no vaginal bleeding.