A client requests to have a copper intrauterine device (IUD) inserted for contraception. Which of the following should the nurse recognize as a contraindication to IUD insertion?

Rationale:

A. Paradoxical chest movement: Paradoxical chest movement is typically associated with flail chest, where multiple rib fractures cause a segment of the chest wall to move in the opposite direction during breathing. It is not a characteristic finding of tension pneumothorax, which involves intrathoracic pressure buildup rather than rib instability.

B. Bilateral crackles: Bilateral crackles are usually indicative of fluid in the alveoli, such as in pulmonary edema or pneumonia. Tension pneumothorax generally causes decreased or absent breath sounds on the affected side, not crackles, due to lung collapse.

C. Asymmetry of the chest: Tension pneumothorax often causes visible asymmetry of the chest because the affected side may appear distended while the other side may appear sunken. The increased intrathoracic pressure pushes mediastinal structures toward the unaffected side, making chest asymmetry a hallmark sign.

D. Blood-tinged sputum: Blood-tinged sputum is more commonly seen with pulmonary infections, trauma to the airway, or pulmonary embolism. It is not a primary manifestation of tension pneumothorax, which is primarily characterized by respiratory distress and unilateral findings.

Rationale:

A. The nurse should dispose of the ampule in the trash can: Glass ampules are considered sharps and must be disposed of in a designated sharps container to prevent injury and maintain safety. Throwing them in regular trash is unsafe and violates standard precautions.

B. The nurse should use the same needle to draw up and inject the client: Using the same needle can introduce glass particles or contamination into the client’s tissue. A new sterile needle should be used for injection after withdrawing the medication to ensure safety and sterility.

C. The nurse should use a filter needle to withdraw the medication: A filter needle is designed to prevent small glass shards from being drawn into the syringe when breaking the ampule. This action protects the client from injury and ensures that the medication administered is free from particulate matter.

D. The nurse should break the neck of the ampule toward their body: The ampule should always be broken away from the body to prevent injury from glass shards. Breaking it toward oneself increases the risk of cuts and contamination, making it an unsafe practice.