A nurse is caring for a client who is at 14 weeks of gestation and has hyperemesis gravidarum. Which of the following medications should the nurse plan to administer?

Choice C rationale:

The nurse should first massage the client's fundus to address the excessive vaginal bleeding. Massaging the fundus helps the uterus contract and prevents further bleeding. Excessive postpartum bleeding may indicate uterine atony, which is a leading cause of postpartum hemorrhage. The nurse should apply gentle pressure to the fundus to promote uterine contractions and reduce bleeding.

Choice A rationale:

Elevating the client's legs to a 30° angle (Trendelenburg position) is not the priority action in this situation. Fundal massage takes precedence because it directly addresses the cause of the excessive bleeding. While Trendelenburg position might be used in some situations to increase blood flow to vital organs, it is not the first-line intervention for postpartum bleeding.

Choice B rationale:

Inserting an indwelling urinary catheter is not the priority action for excessive vaginal bleeding. While monitoring urine output is essential, the immediate concern is controlling the bleeding by massaging the fundus.

Choice D rationale:

Initiating an infusion of oxytocin may be indicated if fundal massage alone is insufficient to control bleeding. However, massaging the fundus should be the first action taken to promote uterine contractions. Oxytocin can be administered afterward, if needed, under the direction of a healthcare provider.

Choice A rationale:

The client's statement about needing to have the IUD replaced each year is incorrect. The lifespan of most IUDs is longer than a year. Copper IUDs can last up to 10 years, and hormonal IUDs can last between 3 to 7 years, depending on the brand.

Choice B rationale:

The client's statement about needing to apply a spermicide prior to intercourse is unrelated to the correct use of an intrauterine device (IUD) for contraception. Spermicides are not required when using an IUD.

Choice C rationale:

The client's statement about expecting periods to stop while having the IUD is incorrect. Hormonal IUDs can often lead to lighter periods, and in some cases, periods may stop altogether. However, with a copper IUD, periods usually remain the same.

Choice D rationale:

This is the correct choice. The client's statement indicates an understanding of the teaching. Checking for the string each month after menstruation is crucial because it confirms that the IUD is still in place, reducing the risk of unintended pregnancy.