Which risk factors associated with an intrauterine device (IUD) use would the nurse include in the discussion of an IUD with a client based on the information in the history and physical? Select all that apply.
Risk for infection during insertion.
Delay of return to fertility.
Ectopic pregnancy.
Risk for perforation of the uterus.
Correct Answer : A,C,D
Choice A rationale
The insertion of any foreign object into the uterus, such as an intrauterine device (IUD), carries a risk of introducing pathogenic microorganisms, potentially leading to pelvic inflammatory disease (PID) or endometritis, particularly in the first few weeks after insertion. Strict aseptic technique is mandatory to minimize this transient risk, which stems from the passage of the device through the cervix.
Choice B rationale
One of the major benefits of IUDs is their immediate reversibility. Upon removal of the device, fertility returns quickly, often within the first menstrual cycle. This is a point of education that contrasts with hormonal methods, such as the injectable depot medroxyprogesterone acetate (DMPA), which can cause a delay in the return to fertility.
Choice C rationale
An intrauterine device prevents uterine implantation, but it does not prevent fertilization. If pregnancy occurs with an IUD in place, there is a significantly increased risk that the fertilized ovum will implant outside the uterus, most commonly in the fallopian tube, resulting in a potentially life-threatening ectopic pregnancy for the woman.
Choice D rationale
Uterine perforation is a rare but serious complication, occurring most often at the time of insertion when the sound or the IUD itself punctures the uterine wall, which can lead to intra-abdominal placement or damage to adjacent organs. Risk factors include a recently postpartum or lactating uterus, which is softer and more pliable.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","D","F"]
Explanation
Choice A rationale
Amniocentesis is generally a brief, outpatient procedure performed under sterile conditions, and hospitalization for 48 hours is unnecessary. The client is usually monitored for a short time after the procedure for complications like bleeding or leaking amniotic fluid, then discharged home with instructions for rest and monitoring for signs of infection or labor.
Choice B rationale
Amniocentesis is a diagnostic procedure where a sterile needle is inserted transabdominally into the amniotic sac under ultrasound guidance. The purpose is to aspirate a small amount of amniotic fluid, which contains fetal cells and biochemical substances, for genetic, chromosomal, or biochemical analysis to assess fetal health and maturity.
Choice C rationale
Changing of abdominal curvature is a normal finding throughout pregnancy as the uterus grows and the fetus develops. However, it is not a specific, expected finding immediately following an amniocentesis procedure, which involves minimal abdominal trauma from a fine-gauge needle puncture, and the curvature change is gradual and related to gestation.
Choice D rationale
Ultrasound guidance is a critical safety measure during an amniocentesis. It is used to precisely locate the placenta, fetus, and pockets of amniotic fluid, ensuring the needle avoids the fetus, umbilical cord, and placenta, thereby minimizing the risk of fetal trauma or maternal complications during the aspiration process.
Choice E rationale
A fever is a sign of infection (e.g., chorioamnionitis or local wound infection) and is not an expected or normal finding after an amniocentesis. Clients are instructed to report any signs of infection, such as fever (greater than 100.4°F or 38°C), chills, uterine tenderness, or unusual vaginal discharge, to the healthcare provider immediately.
Choice F rationale
Amniocentesis carries a small risk of fetomaternal hemorrhage (fetal red blood cells entering the maternal circulation) across the placental barrier. For Rh-negative clients, this exposure can lead to Rh sensitization. Therefore, a dose of RhoGAM (Rh immune globulin) is administered prophylactically to prevent the production of maternal anti-Rh antibodies.
Correct Answer is C
Explanation
Choice A rationale
Maternal uterine contractions are utilized during a Contraction Stress Test (CST) to assess fetal response to the stress of decreased placental perfusion. However, a Nonstress Test (NST) is a non-invasive procedure monitoring FHR response to fetal movement without inducing contractions. The NST is deemed reactive/non-reactive based on the FHR acceleration patterns, which are largely indicative of fetal physical activity and reserve.
Choice B rationale
Fetal gestational age is a key determinant for the criteria of a reactive NST. Before 32 weeks, an acceleration is defined as an increase of ≥ 10 bpm lasting ≥ 10 seconds. After 32 weeks, the criteria are ≥ 15 bpm lasting ≥ 15 seconds, as seen in this scenario. However, the reason for the reactive result itself is the healthy response of the FHR to fetal physical activity, indicating a healthy central nervous system.
Choice C rationale
A reactive Nonstress Test (NST) is one that meets specific criteria, indicating adequate oxygenation and a healthy central nervous system. The criteria for ≥ 32 weeks gestation is two or more FHR accelerations of ≥ 15 beats per minute above the baseline, each lasting ≥ 15 seconds, within a 20-minute period, usually associated with fetal physical activity. This demonstrates good fetal reserve.
Choice D rationale
Maternal blood pressure is monitored during the NST as part of the overall assessment, but it is not the reason for a reactive interpretation. Fetal bradycardia or decelerations may be linked to maternal hypotension (e.g., from supine positioning), but the core finding for reactivity is the transient FHR accelerations, which reflect a healthy autonomic nervous system responding to fetal physical activity.
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