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
Explanation
Choice A rationale
A BUN level of 25 mg/dL is above the normal range of 10 to 20 mg/dL for pregnant clients. Elevated BUN can indicate impaired renal function, which can be a complication of pregnancy, particularly in conditions like preeclampsia or underlying kidney disease. This finding, especially in a client with a history of anemia, warrants further investigation as it suggests potential kidney compromise affecting waste product excretion.
Choice B rationale
A hemoglobin (Hgb) level of 10.2 mg/dL is slightly below the normal range of 11 to 16 mg/dL for pregnant clients. Given the client's history of anemia, this finding is consistent with their known condition and, while it indicates mild anemia, it might not necessarily represent a new acute prenatal complication requiring immediate report unless there is a significant drop or associated symptoms. Iron supplementation is typically initiated for this level.
Choice C rationale
A fasting blood glucose of 70 mg/dL is within the normal range of 70 to 110 mg/dL. This indicates adequate glucose regulation and does not suggest a prenatal complication such as gestational diabetes. Maintaining a normal fasting blood glucose is a positive indicator for maternal and fetal well-being, especially for a client without a history of diabetes.
Choice D rationale
A hematocrit (Hct) level of 32% is slightly below the normal range of 33 to 47% for pregnant clients. Similar to hemoglobin, a slightly low hematocrit is common in pregnancy due to hemodilution, where plasma volume increases more significantly than red blood cell mass. While it indicates mild physiological anemia, it is often managed with dietary adjustments or iron supplements and does not typically signify an acute prenatal complication requiring immediate report.
Correct Answer is B
Explanation
Choice A rationale
Monitoring blood pressure every 30 minutes following epidural placement is insufficient. Epidural anesthesia often causes sympathetic blockade, leading to vasodilation and a rapid drop in blood pressure. Frequent monitoring, typically every 2-5 minutes initially, is critical to detect and manage hypotension promptly, ensuring adequate placental perfusion.
Choice B rationale
Administering a lactated Ringer's 500 mL bolus intravenously prior to epidural placement is a crucial prophylactic measure. This fluid bolus expands intravascular volume, counteracting the vasodilation and subsequent hypotension that can occur with sympathetic blockade from epidural anesthesia, thereby maintaining maternal blood pressure and placental perfusion.
Choice C rationale
Administering oxygen via nasal cannula at 2 L/min prior to epidural placement is generally not indicated as a routine prophylactic measure. Oxygen supplementation is typically reserved for instances where maternal oxygen saturation is low or there is fetal distress, not as a standard pre-epidural intervention for normoxic clients.
Choice D rationale
Repositioning the client every 2 hours following epidural placement is not frequent enough. To promote even distribution of the anesthetic and prevent prolonged pressure on specific areas, the client should be repositioned more frequently, typically every 30-60 minutes, from side to side, especially during active labor.
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