A nurse in a provider's office is reviewing the medical record of a client who is requesting a diaphragm. Which of the following findings in the client's history should the nurse identify as a contraindication for this type of contraception?
Deep-vein thrombosis.
Tobacco use.
Recurrent urinary tract infections.
History of positive group B streptococcus B-hemolytic.
The Correct Answer is A
Choice A rationale
Deep-vein thrombosis (DVT) is a contraindication for diaphragm use due to the increased risk of thromboembolic events with estrogen-based contraceptives.
Choice B rationale
Tobacco use, although a risk factor for cardiovascular disease, is not a direct contraindication for diaphragm use, which is a non-hormonal contraceptive method.
Choice C rationale
Recurrent urinary tract infections are a contraindication for diaphragm use due to the risk of infection exacerbation from device insertion.
Choice D rationale
History of positive group B streptococcus B-hemolytic is not a contraindication for diaphragm use; it typically relates to pregnancy and neonatal infection risk.
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Correct Answer is A
Explanation
Choice A rationale
A single crease in the palm, known as a simian crease, is a common characteristic seen in infants with trisomy 21 (Down syndrome) due to the unique hand structure associated with this condition.
Choice B rationale
A notch in the lip, such as a cleft lip, is not commonly associated with trisomy 21 and is more typically related to other genetic conditions or environmental factors during development.
Choice C rationale
An inversion of the foot, such as clubfoot, is not a specific characteristic of trisomy 21. This condition is more often seen in other congenital anomalies not related to Down syndrome.
Choice D rationale
Extra digits on the hand, or polydactyly, is not commonly associated with trisomy 21 but can be seen in other genetic disorders. Trisomy 21 has more specific physical features like the simian crease.
Correct Answer is B
Explanation
Choice A rationale
Disabling the driver-side airbags is not advisable as airbags provide crucial protection in the event of a collision. Proper seating position is a safer alternative.
Choice B rationale
Moving the seat as far away as possible from the steering wheel reduces the risk of injury from airbag deployment and allows ample space for the growing abdomen, providing better safety for both mother and baby.
Choice C rationale
Wearing the lap belt high across the abdomen is incorrect and dangerous as it can cause injury to the fetus. The belt should be low across the hips.
Choice D rationale
Placing the shoulder harness across the gravid uterus is incorrect. The harness should go between the breasts and to the side of the belly, not across it, to avoid compression injuries in the event of a crash.