A nurse in a provider’s office is caring for a client who asks about using acupuncture to manage his osteoarthritis pain.

The nurse should identify which of the following conditions is a contraindication for receiving this treatment.

The correct answer is choice D: A client who is taking warfarin and has an INR of 1.8.

Choice A rationale:

A Mantoux test with an induration after 48 hours can be a normal reaction, especially if the induration is within the expected size range for a positive result, depending on the individual’s risk factors and history. It does not necessarily require follow-up care unless the induration is significantly large or there are other concerning symptoms.

Choice B rationale:

A client scheduled for a colonoscopy and taking sodium phosphate does not typically require follow-up care for the sodium phosphate intake itself. Sodium phosphate is commonly used as a bowel prep medication to clear the intestines prior to the procedure.

Choice C rationale:

A potassium level of 3.6 mEq/L is within the normal range (3.5-5.0 mEq/L), so a client taking bumetanide with this potassium level would not typically require follow-up care for the potassium level alone.

Choice D rationale:

A client taking warfarin with an INR of 1.8 requires follow-up care because the therapeutic range for warfarin is typically between 2.0 and 3.0 for most indications. An INR of 1.8 may indicate that the blood is not “thin” enough, increasing the risk of thrombotic events, and the warfarin dose may need adjustment.

Placenta previa is a condition where the placenta implants in the lower part of the uterus, partly or completely covering the cervical opening.

This can cause painless, bright red vaginal bleeding, usually in the third trimester. Spotting is a sign of placenta previa and should be reported to the provider immediately. Choice A is wrong because nausea is not a specific finding of placenta previa.

Nausea can occur in normal pregnancy or in other conditions such as hyperemesis gravidarum or preeclampsia.

Choice B is wrong because polyhydramnios is not a finding of placenta previa.

Polyhydramnios is a condition where there is too much amniotic fluid in the uterus, which can cause complications such as preterm labor, cord prolapse, or fetal malformations.

Choice C is wrong because uterine tenderness is not a finding of placenta previa.

Uterine tenderness is a sign of abruptio placentae, which is a condition where the placenta separates from the uterine wall before delivery.

This can cause severe abdominal pain, dark red vaginal bleeding, and fetal distress.