A nurse in an obstetric clinic is caring for four clients.The nurse should identify that an intrauterine device is contraindicated for which of the following clients?
A client who has a positive pregnancy test.
A client who has a history of gallbladder disease.
A client who smokes one pack of cigarettes per day.
A client who is nulliparous.
The Correct Answer is A
Choice A rationale
An intrauterine device (IUD) is contraindicated for a client who has a positive pregnancy test. Inserting an IUD during pregnancy can lead to complications such as infection, miscarriage, and preterm birth. It is crucial to confirm the absence of pregnancy before IUD insertion.
Choice B rationale
A history of gallbladder disease does not contraindicate the use of an IUD. IUDs are primarily contraindicated in cases of active pelvic infection, certain uterine abnormalities, and confirmed pregnancy, but not gallbladder disease.
Choice C rationale
While smoking is a significant risk factor for many health issues, including cardiovascular disease, it is not a direct contraindication for the use of an IUD. However, smokers should be counseled about the risks of smoking and offered support to quit.
Choice D rationale
Being nulliparous (having never given birth) is not a contraindication for IUD use. IUDs can be safely used by nulliparous women, though some might have a slightly higher risk of expulsion or insertion-related discomfort compared to women who have given birth.
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Correct Answer is A
Explanation
Choice A rationale
Retained placental fragments are a significant risk factor for postpartum hemorrhage. If parts of the placenta remain attached to the uterine wall, it can prevent the uterus from contracting properly, leading to excessive bleeding.
Choice B rationale
Breech presentation is not a direct risk factor for postpartum hemorrhage. While it can complicate delivery, it does not directly cause hemorrhage.
Choice C rationale
Urinary tract infection is not a risk factor for postpartum hemorrhage. It can cause other complications but does not directly lead to hemorrhage.
Choice D rationale
Oligohydramnios, or low amniotic fluid, is not a risk factor for postpartum hemorrhage. It can cause complications during pregnancy but does not directly lead to hemorrhage.
Correct Answer is C
Explanation
Choice A rationale
Nursing the baby for 5 to 10 minutes on each breast may not be sufficient for the baby to receive the hindmilk, which is rich in fat and essential for growth.
Choice B rationale
Applying vitamin E oil to the nipples after each feeding is not recommended as it can cause irritation and is not necessary for nipple care.
Choice C rationale
Laying the baby on a pillow at the level of the breast helps ensure proper positioning and latch, which is crucial for effective breastfeeding and preventing nipple soreness.
Choice D rationale
Ensuring that just the nipple is in the baby’s mouth is incorrect. The baby should latch onto the areola, not just the nipple, to ensure effective milk transfer and prevent nipple pain.