A nurse in an obstetric clinic is caring for four clients. The nurse should identify that an intrauterine device is contraindicated for which of the following clients?
A client who smokes one pack of cigarettes per day
A client who has a history of gallbladder disease
A client who has a positive pregnancy test
A client who is nulliparous
The Correct Answer is C
(A) A client who smokes one pack of cigarettes per day:
While smoking is a significant risk factor for many health issues, including cardiovascular disease, it is not a direct contraindication for the use of an intrauterine device (IUD). However, smokers should be counseled about the risks of smoking and offered support to quit.
(B) A client who has a history of gallbladder disease:
A history of gallbladder disease does not contraindicate the use of an IUD. IUDs are primarily contraindicated in cases of active pelvic infection, certain uterine abnormalities, and confirmed pregnancy, but not gallbladder disease.
(C) A client who has a positive pregnancy test:
An IUD should not be inserted in a client who has a positive pregnancy test. Inserting an IUD during pregnancy can lead to complications such as infection, miscarriage, and preterm birth. It is crucial to confirm the absence of pregnancy before IUD insertion.
(D) A client who is nulliparous:
Being nulliparous (having never given birth) is not a contraindication for IUD use. IUDs can be safely used by nulliparous women, though some might have a slightly higher risk of expulsion or insertion-related discomfort compared to women who have given birth.
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Naxlex Comprehensive Predictor Exams
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Correct Answer is C
Explanation
(a) Avoid swaddling the newborn:
Swaddling is actually beneficial for newborns experiencing neonatal abstinence syndrome. It helps provide comfort and security, reducing irritability and promoting better sleep.
(b) Minimize holding the newborn:
Minimizing holding is not recommended. Holding and gentle handling are important as they provide comfort and can help soothe the newborn. Skin-to-skin contact and gentle rocking are beneficial practices for these infants.
(c) Decrease environmental noise:
Decreasing environmental noise is a key intervention for newborns with neonatal abstinence syndrome. These newborns are often hypersensitive to stimuli, and reducing noise helps create a calming environment that can reduce stress and overstimulation.
(d) Avoid using a pacifier:
Using a pacifier can be helpful for soothing a newborn experiencing neonatal abstinence syndrome. Sucking on a pacifier can provide comfort and help with self-regulation, reducing irritability and distress.
Correct Answer is A
Explanation
(A) Retained placental fragments:
Retained placental fragments can lead to postpartum hemorrhage (PPH) due to incomplete expulsion of the placenta or membranes, which can cause ongoing bleeding. Failure of the uterus to contract effectively after childbirth to compress blood vessels at the placental site can result in excessive bleeding. This is a significant risk factor for PPH and requires prompt intervention to prevent complications.
(B) Urinary tract infection:
While urinary tract infections (UTIs) can occur in the postpartum period, they are not typically considered significant risk factors for postpartum hemorrhage. UTIs are more commonly associated with symptoms such as dysuria, frequency, and urgency.
(C) Oligohydramnios:
Oligohydramnios, a condition characterized by decreased amniotic fluid volume, is not a direct risk factor for postpartum hemorrhage. Oligohydramnios may be associated with other pregnancy complications but is not directly related to the risk of postpartum hemorrhage.
(D) Breech presentation:
While breech presentation (when the baby's buttocks or feet are positioned to deliver first) may increase the risk of complications during labor and delivery, it is not specifically linked to postpartum hemorrhage. Breech presentation may necessitate interventions such as cesarean section delivery to reduce the risk of birth-related complications, but it is not a direct risk factor for postpartum hemorrhage.
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