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. Contact: Contact precautions are used for infections transmitted by direct or indirect contact with the client or their environment, such as MRSA or C. difficile. Erythema migrans, associated with Lyme disease, is not spread through contact.

B. Droplet: Droplet precautions are for infections transmitted through large respiratory droplets, such as influenza or pertussis. Lyme disease does not spread via respiratory secretions, so droplet precautions are unnecessary.

C. Airborne: Airborne precautions apply to infections transmitted via small particles that remain suspended in the air, such as tuberculosis or measles. Lyme disease is not airborne, so this precaution is not required.

D. Standard: Standard precautions are appropriate for Lyme disease, including erythema migrans. These precautions involve routine hand hygiene, use of gloves when in contact with body fluids, and proper handling of contaminated materials, which are sufficient since the disease is transmitted via tick bites, not person-to-person.

Rationale:

A. Oliguria: Clients with end-stage kidney disease (ESKD) often experience oliguria or significantly reduced urine output due to severe loss of nephron function. This contributes to fluid retention, electrolyte imbalances, and accumulation of waste products in the body.

B. Hypotension: ESKD more commonly leads to hypertension rather than hypotension because of fluid overload and activation of the renin-angiotensin-aldosterone system. Hypotension may occur only during dialysis or with certain medications but is not an expected finding in untreated ESKD.

C. Edema: Fluid retention caused by decreased glomerular filtration and impaired renal excretion leads to peripheral and sometimes generalized edema. Edema is a classic sign of ESKD and indicates compromised fluid balance.

D. Anemia: Impaired kidney function reduces erythropoietin production, leading to decreased red blood cell synthesis and resultant anemia. Clients often require erythropoiesis-stimulating agents or supplemental iron to manage this complication.

E. Bradypnea: Respiratory rate is not typically decreased in ESKD. If present, bradypnea would suggest a separate neurologic or respiratory issue rather than a direct effect of kidney failure. Clients may develop Kussmaul respirations if metabolic acidosis is severe, but bradypnea is not expected.