A nurse is providing teaching to a female client regarding an intrauterine device (IUD) in the outpatient clinic.
Which of the following statements should the nurse include in the teaching?
“You might have to have cultures for sexually transmitted infections prior to placement of the device.”
“The device will have to be replaced every 2 years.”
“You might experience irregular spotting the first few months after placement of the device.”
“You will need to avoid using tampons during menstrual cycles.”
“You will need to sign informed consent prior to the procedure.”
Correct Answer : A,C,E
Choice A rationale: Screening for sexually transmitted infections (STIs) prior to IUD placement is essential to reduce the risk of pelvic inflammatory disease (PID). The insertion process can introduce bacteria from the cervix or vagina into the uterine cavity, increasing infection risk if an STI is present. Guidelines recommend screening high-risk patients or those with recent STI history. Identifying infections before insertion allows treatment, preventing serious reproductive complications, including infertility.
Choice B rationale: Most intrauterine devices (IUDs) have a lifespan longer than 2 years; copper IUDs last up to 10 years, and hormonal IUDs typically last between 3 and 7 years depending on the type. Replacing the device every 2 years is unnecessary and not evidence-based. Premature removal or replacement increases risk of procedure-related complications without added contraceptive benefit.
Choice C rationale: Irregular spotting or breakthrough bleeding during the first few months after IUD insertion is common due to endometrial adjustment to the foreign body and hormonal changes (for hormonal IUDs). This occurs as the endometrial lining remodels, and bleeding usually decreases with time. Patient education about this transient effect improves adherence and reduces anxiety related to unexpected bleeding.
Choice D rationale: There is no contraindication to tampon use while an IUD is in place. Tampons do not interfere with IUD function or position. Although some clinicians advise caution initially post-insertion to prevent infection, scientific evidence does not support a permanent restriction on tampon use during menstruation after proper healing.
Choice E rationale: Signing informed consent before IUD insertion is legally and ethically required. It ensures the client understands benefits, risks, potential complications (such as expulsion or perforation), and alternative contraceptive methods. This process protects patient autonomy and supports shared decision-making, critical components of safe clinical practice.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C"]
Explanation
Choice A rationale
Tachycardia is a common finding in hyperemesis gravidarum due to fluid volume deficit. Significant and persistent vomiting leads to hypovolemia, which triggers a compensatory increase in heart rate to maintain cardiac output and tissue perfusion. The body attempts to compensate for reduced circulating blood volume by increasing the rate at which blood is pumped.
Choice B rationale
Dry mucous membranes are a direct clinical sign of dehydration, which is a hallmark of hyperemesis gravidarum. Prolonged and severe vomiting leads to significant fluid loss, depleting the body's water content. This desiccation is visibly manifested in the oral cavity as dry and sticky mucous membranes, indicating intracellular and extracellular fluid deficit.
Choice C rationale
Poor skin turgor, characterized by skin that remains tented when pinched, is another objective indicator of dehydration. The loss of interstitial fluid due to excessive vomiting reduces the elasticity and plumpness of the skin. This finding reflects a significant depletion of fluid volume within the subcutaneous tissues.
Choice D rationale
Polyuria, meaning excessive urination, is not a typical finding in hyperemesis gravidarum. Instead, severe vomiting and dehydration would lead to oliguria (decreased urine output) as the kidneys attempt to conserve fluid to compensate for the significant fluid losses. The body's priority is fluid retention.
Choice E rationale
Hypertension is generally not associated with hyperemesis gravidarum. Due to significant fluid loss and dehydration, clients with hyperemesis gravidarum are more likely to experience orthostatic hypotension or even profound hypotension as a result of hypovolemia. The decreased circulating blood volume leads to reduced vascular resistance and blood pressure.
Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"B"}
Explanation
The nurse should anticipate the provider will prescribe terbutaline and betamethasone.
Rationale for correct answers:
Terbutaline is a beta-2 adrenergic agonist that relaxes uterine smooth muscle by increasing intracellular cyclic AMP, reducing calcium influx, and thus inhibiting contractions. It is commonly used as a tocolytic to delay preterm labor, allowing time for fetal maturation. Betamethasone is a corticosteroid given to accelerate fetal lung maturity by stimulating surfactant production in the fetal lungs, which significantly reduces the risk of respiratory distress syndrome in neonates born between 24 and 34 weeks gestation. The normal fetal fibronectin level is ≤0.05 mcg/mL; a value above this, as in this client (0.09 mcg/mL), indicates increased risk of preterm birth, supporting the use of these medications.
Rationale for incorrect answers:
Oxytocin (Response 1) stimulates uterine contractions via oxytocin receptors, promoting labor induction or augmentation. Administering oxytocin before term or in preterm labor is contraindicated because it can worsen contractions, precipitating early delivery.
Betamethasone (Response 1) is not used to stop contractions but to promote fetal lung maturity. It does not act as a tocolytic; thus, it is not prescribed alone to delay labor.
Misoprostol (Response 1) is a prostaglandin E1 analog that promotes cervical ripening and uterine contractions, making it inappropriate in preterm labor management, where delaying labor is the goal.
Oxytocin (Response 2) serves no purpose in fetal lung maturation and instead promotes contractions; thus, it is contraindicated here.
Ondansetron (Response 2) is an antiemetic without effects on uterine activity or fetal lung maturity; its use is unrelated to preterm labor management.
Misoprostol (Response 2) induces labor and cervical changes and is contraindicated in preterm labor where prolonging pregnancy is desired.
Take-home points:
- Terbutaline delays preterm labor by relaxing uterine muscles, buying critical time for fetal development.
- Betamethasone accelerates fetal lung maturity by stimulating surfactant production, reducing neonatal respiratory complications.
- Oxytocin and misoprostol induce labor and are contraindicated in preterm labor management aiming to delay delivery.
- Fetal fibronectin levels above 0.05 mcg/mL indicate increased risk of preterm birth, guiding tocolytic and steroid therapy.
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