A nurse is providing client teaching regarding an intrauterine device (IUD). Which of the following statements should the nurse include in the teaching?

Choice A rationale

A single dose of the rubella vaccine is typically sufficient to confer immunity. A second dose is not routinely recommended after postpartum administration. The primary goal is to prevent congenital rubella syndrome in future pregnancies by ensuring the mother develops adequate antibody titers to the virus.

Choice B rationale

The rubella vaccine contains live attenuated virus, which carries a theoretical risk of congenital rubella syndrome if the vaccine virus crosses the placenta during pregnancy. Therefore, clients are advised to avoid conception for at least 1 to 3 months, commonly stated as 4 months, after vaccination to minimize any potential fetal exposure.

Choice C rationale

The rubella immunization typically provides long-lasting immunity. It is not necessary to receive an additional rubella immunization during the first trimester of a subsequent pregnancy. Antibody titers are usually maintained, protecting against future rubella infection and subsequent fetal harm.

Choice D rationale

The rubella vaccine is considered safe for breastfeeding mothers and their infants. The live attenuated virus is not shed in breast milk in significant amounts that would pose a risk of infection to the infant. Therefore, breastfeeding can continue without interruption after rubella immunization.

Choice A rationale

The client's fundus is boggy and elevated above the umbilicus, deviating to the right, which indicates uterine atony. This, coupled with the saturated perineal pad and voiding of only 50 mL of urine initially, followed by 700 mL of pink-tinged urine after catheterization, suggests significant blood loss. These findings are classic signs of postpartum hemorrhage, which is often caused by uterine atony preventing effective uterine contraction and vessel compression. Normal postpartum fundal height should decrease daily.

Choice B rationale

Postpartum infection, such as puerperal sepsis, typically presents with fever, chills, uterine tenderness, and foul-smelling lochia. While the client is experiencing discomfort, there is no mention of fever or purulent discharge. The primary signs observed relate to excessive bleeding and uterine displacement, not infectious processes. A normal temperature range is 36.5°C to 37.5°C (97.7°F to 99.5°F).

Choice C rationale

Endometritis is an infection of the uterine lining, often occurring postpartum. Symptoms include fever, lower abdominal pain, uterine tenderness, and foul-smelling lochia. The client's symptoms of a boggy fundus, heavy bleeding, and fundal deviation are more indicative of a bleeding issue rather than an infection confined to the endometrium. White blood cell count would typically be elevated in infection, with a normal range being 4,500 to 11,000 cells/mm³.

Choice D rationale

A urinary tract infection (UTI) is characterized by dysuria, urgency, frequency, and sometimes hematuria. While the client reports an urge to urinate and voided a small amount, the primary and more concerning findings are related to the uterine status and excessive bleeding, which are not typical signs of a UTI. A urine culture would show bacterial growth in a UTI, with a normal urinalysis showing no or few bacteria.

Choice E rationale

Uterine inversion is a rare but severe complication where the uterus turns inside out, often presenting with sudden, severe pain, vaginal hemorrhage, and a mass protruding from the vagina. While hemorrhage is present, the description of the fundus being boggy and 2 finger breaths above the umbilicus, rather than inverted or prolapsed, makes uterine inversion less likely. The primary issue is uterine atony leading to blood loss.