Ch. 6- Nursing Care for the Family in Need of Reproductive Life Planning

A nurse is preparing a client for intrauterine device (IUD) insertion. Which education will the nurse provide to the client?

*"Checking the strings is recommended following insertion."* The nurse should instruct the client to check the strings/threads regularly to make sure that the IUD is in place. Current recommendations are to check the strings monthly after insertion, but some clients may be instructed to check less frequently after the first 3 months following insertion because expulsion of the IUD is less common after that time. An IUD does not protect against STIs, and the insertion procedure may involve mild to moderate cramping pain; however, the client should not expect to have continuous cramping pain following insertion.

A client is 6 weeks' postpartum and preparing to receive a depot medroxyprogesterone acetate injection. Which statement by the client requires follow up by the nurse?

*"I need to be patient as it will take a few weeks before I can get pregnant again."* The client needs to understand that this injection is to prevent pregnancy for up to 3 months. In addition, fertility is delayed after stopping the injections. The client statement, "I need to be patient as it will take a few weeks before I can get pregnant again," does not clearly indicate whether the client understands the length of action of the injection. Therefore, the nurse should follow up to confirm the client understands that, if pregnancy is desired within a year, another form of birth control might be more appropriate.

A female client has been trying to conceive for 3 months. She tells the nurse, "I just know something is wrong with me." Which response by the nurse is best?

*"It can take up to 1 year of regular, unprotected intercourse to conceive."* The nurse would first provide accurate information by informing the client that 3 months is not an adequate time frame to indicate a problem is present. Most couples conceive within 1 year when they have regular intercourse without the use of contraceptives. There is no reason to assess for infertility issues with the female or with the couple's families. It is true that subfertility issues can be related to the man, woman, or both; however, it is not appropriate to indicate there is concern by stating "we will explore all possibilities."

A client expresses interest in having an intrauterine device (IUD) placed for contraception. Which finding noted in the health history would indicate to the nurse that this would not be an appropriate contraceptive option?

*bicornuate uterus* The client has an abnormally shaped uterus, which could be a contraindication for the use of an IUD due to increased risk for uterine wall perforation. All other findings would not contraindicate the device.

A woman in the 15th week of gestation is planning on terminating the pregnancy. The procedure done for second-trimester terminations is which of the following?

*dilation and extraction* Most second-trimester terminations (12 to 16 weeks' gestation) are done by dilatation and vacuum extraction. A dilatation and curettage are done when a pregnancy is less than 13 weeks. If the gestational age for a pregnancy is more than 16 weeks, a hysterotomy is done. A menstrual extraction is the simplest of all and is performed on the basis of 5 to 7 weeks after the last menstrual period.

The nurse is caring for a woman who had a dilatation and curettage (D&C) 1 hour prior. What assessment finding would alert the nurse to immediately intervene?

*pulse rate of 122 beats/min* The nurse would further assess the client for a hemorrhage when noting an elevated pulse rate. One of the risk following a D&C is vaginal hemorrhage. The client's blood pressure would be low, not high, if the client were hemorrhaging vaginally. The client's temperature is normal at 98.6° F (37° C) and is an expected finding within an hour of the procedure. Abdominal cramping is an expected finding.

A couple has chosen fertility awareness as their method of contraception. The nurse explains that the unsafe period for them during the menstrual cycle would be at which time?

*three days before and three days after ovulation* Typically, the unsafe period during the menstrual cycle is approximately 3 days before and 3 days after ovulation. An ovum is released from the ovary 14 days before the next menstrual period.

A young woman says she needs a temporary contraceptive but has a latex allergy. She mentions that she has had a papillomavirus infection. Also, she says she is terrible about remembering to take pills. Which method should the nurse recommend?

*transdermal contraception* The fact that this woman has a latex allergy rules out the cervical cap and diaphragm. Moreover, the diaphragm is contraindicated in her case due to her papillomavirus infection. The best choice for her is transdermal contraception, which involves wearing a patch for a week at a time and does not require taking pills daily.

A nurse is conducting education classes at the local high school on reproductive life planning. Which would be appropriate for the nurse to implement during the teaching? Select all that apply.

encouragement of abstinence proper condom application sexually transmitted infection statistics