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. Inability to concentrate: Hypoglycemia reduces glucose availability to the brain, leading to cognitive changes such as difficulty concentrating, confusion, or irritability. This neurologic symptom is an early and common indicator of low blood glucose.

B. Tremors: Trembling or shakiness occurs due to autonomic nervous system activation in response to low blood glucose. Catecholamine release stimulates muscle activity, making tremors a classic sign of hypoglycemia.

C. Acetone breath odor: Acetone or “fruity” breath is associated with diabetic ketoacidosis (DKA), a complication of hyperglycemia rather than hypoglycemia. It indicates fat metabolism due to insulin deficiency, not low blood glucose.

D. Diaphoresis: Profuse sweating is a sympathetic nervous system response to hypoglycemia. It often accompanies other adrenergic symptoms such as palpitations, anxiety, and tremors, signaling low blood sugar.

E. Polydipsia: Excessive thirst is a symptom of hyperglycemia and is not associated with hypoglycemia. It occurs when high blood glucose leads to osmotic diuresis and fluid loss.

Rationale:

A. Cheese: Aged and fermented cheeses contain high levels of tyramine, which can interact with MAOIs and cause a hypertensive crisis. Clients taking MAOIs must avoid foods rich in tyramine to prevent sudden and dangerous increases in blood pressure. This dietary restriction is a critical safety consideration when prescribing these medications.

B. Eggs: Eggs are low in tyramine and do not interact with MAOIs. They are safe to consume and provide a good source of protein for clients on this medication. No dietary restrictions are required regarding eggs.

C. Potatoes: Potatoes are low in tyramine and do not pose a risk for hypertensive crisis when taken with MAOIs. They can be included safely in the diet of clients receiving this medication.

D. Grapefruit: Grapefruit interacts with certain medications by affecting CYP450 metabolism, but it does not contain significant tyramine and is not contraindicated with MAOIs. While clients may need to avoid grapefruit with other drugs, it is not a concern specifically for MAOI therapy.