A nurse is collecting data from a client who requests a prescription for a diaphragm.
Which of the following findings should the nurse identify as a contraindication to the client’s use of a diaphragm?

Choice A:
It is inaccurate to state that urinary frequency will continue throughout pregnancy in most cases. While it is a common symptom, it typically resolves by the end of the first trimester.
Suggesting that poor bladder tone is the cause of ongoing urinary frequency is not supported by evidence. This response may unnecessarily alarm a client who is already experiencing discomfort.

Choice B:
It is not recommended to advise a pregnant woman to decrease her fluid intake, especially during the first trimester when adequate hydration is crucial.
Restricting fluids can lead to dehydration, which can have negative consequences for both the mother and the fetus. While reducing fluid intake before bedtime might lessen nighttime urination, it does not address the underlying cause of urinary frequency.

Choice C:
While it is true that the duration of urinary frequency can vary among individuals, providing such an uncertain response may not be helpful to the client.
It is important to offer information that is both accurate and reassuring.

Choice D:
This response accurately conveys that urinary frequency is a common early pregnancy symptom that typically resolves by the end of the first trimester.
It also acknowledges that the symptom may return later in pregnancy, which helps to prepare the client for potential discomfort.
This response provides accurate information in a reassuring manner, making it the most appropriate choice.

Choice A: Severe nausea and vomiting

While nausea and vomiting can be common in early pregnancy, including ectopic pregnancies, they are not specific indicators of an ectopic pregnancy.

Approximately 70-80% of pregnant women experience nausea and vomiting, regardless of the location of the pregnancy. Hence, the presence of severe nausea and vomiting alone would not definitively point towards an ectopic pregnancy.

Choice B: Uterine enlargement greater than expected for gestational age

In an ectopic pregnancy, the fertilized egg implants outside the uterus, typically in the fallopian tube. This means the uterus would not be expected to enlarge as it would in a normal intrauterine pregnancy. In fact, uterine size might be smaller than expected for gestational age in cases of ectopic pregnancy.

Choice C: Copious vaginal bleeding

While vaginal bleeding can occur in ectopic pregnancies, it's not always present and is not the most common initial symptom. When bleeding does occur, it's often lighter than a normal menstrual period and may be brown or dark in color.

Copious vaginal bleeding is more likely to occur in cases of miscarriage or other pregnancy complications.

Choice D: Pelvic pain

Pelvic pain is the most common and characteristic symptom of an ectopic pregnancy.

The pain is often described as sharp, stabbing, or cramping, and it may be localized to one side of the abdomen. The pain can be intermittent or constant, and it may worsen with activity or movement.

The pain is caused by the stretching of the fallopian tube as the ectopic pregnancy grows. In some cases, the pain can be severe enough to cause nausea and vomiting.

Therefore, pelvic pain is the most reliable finding that the nurse should expect in a client with a possible ectopic pregnancy at 8 weeks of gestation.