A nurse is caring for a client who had a vaginal delivery 2 hr ago and is reporting increasing perineal pain and pressure. The nurse examines the client's perineum and sees a 4 cm (1.6 in) area of purplish discoloration with swelling.
The nurse should interpret these findings as which of the following?

Choice A rationale: Screening for sexually transmitted infections (STIs) prior to IUD placement is essential to reduce the risk of pelvic inflammatory disease (PID). The insertion process can introduce bacteria from the cervix or vagina into the uterine cavity, increasing infection risk if an STI is present. Guidelines recommend screening high-risk patients or those with recent STI history. Identifying infections before insertion allows treatment, preventing serious reproductive complications, including infertility.

Choice B rationale: Most intrauterine devices (IUDs) have a lifespan longer than 2 years; copper IUDs last up to 10 years, and hormonal IUDs typically last between 3 and 7 years depending on the type. Replacing the device every 2 years is unnecessary and not evidence-based. Premature removal or replacement increases risk of procedure-related complications without added contraceptive benefit.

Choice C rationale: Irregular spotting or breakthrough bleeding during the first few months after IUD insertion is common due to endometrial adjustment to the foreign body and hormonal changes (for hormonal IUDs). This occurs as the endometrial lining remodels, and bleeding usually decreases with time. Patient education about this transient effect improves adherence and reduces anxiety related to unexpected bleeding.

Choice D rationale: There is no contraindication to tampon use while an IUD is in place. Tampons do not interfere with IUD function or position. Although some clinicians advise caution initially post-insertion to prevent infection, scientific evidence does not support a permanent restriction on tampon use during menstruation after proper healing.

Choice E rationale: Signing informed consent before IUD insertion is legally and ethically required. It ensures the client understands benefits, risks, potential complications (such as expulsion or perforation), and alternative contraceptive methods. This process protects patient autonomy and supports shared decision-making, critical components of safe clinical practice.

Choice A rationale: Tocolytic medications such as terbutaline, a beta-2 adrenergic agonist, commonly cause nervous system stimulation, leading to side effects like jitteriness, tremors, and anxiety. This occurs because beta-2 receptor activation increases sympathetic nervous system activity, resulting in heightened neuromuscular excitability. These symptoms are transient and expected during therapy, reflecting systemic beta-2 receptor effects beyond uterine muscle relaxation.

Choice B rationale: Terbutaline and similar beta-2 agonist tocolytics increase heart rate by stimulating beta-adrenergic receptors in cardiac tissue. This causes positive chronotropic effects, increasing the rate of sinoatrial node firing. Tachycardia is a common adverse effect and is closely monitored as excessive cardiac stimulation can precipitate arrhythmias, especially in clients with underlying cardiac conditions.

Choice C rationale: Tocolytics like terbutaline typically do not increase blood pressure; in fact, beta-2 agonists cause vasodilation leading to decreased peripheral vascular resistance and often lower blood pressure. An increase in blood pressure is not a typical pharmacologic effect and would be unusual. Hypertensive responses are more commonly associated with other drug classes, such as alpha-agonists or corticosteroids.

Choice D rationale: The primary pharmacologic goal of tocolytics is to relax uterine smooth muscle by decreasing intracellular calcium levels, thus inhibiting contractions. Terbutaline, as a beta-2 agonist, activates adenylate cyclase increasing cAMP, which reduces contractility. Therefore, a decrease in contraction frequency and intensity is an expected therapeutic outcome.

Choice E rationale: Terbutaline is commonly administered subcutaneously, allowing for rapid absorption and onset of action. The subcutaneous route facilitates outpatient administration and easy titration of doses. Intramuscular or intravenous routes are less frequently used for this medication in preterm labor management. Patient education on injection technique and site care is essential to prevent complications.

Choice F rationale: Headaches can occur as a side effect of tocolytic therapy due to systemic vasodilation and fluid shifts. The medication-induced relaxation of vascular smooth muscle can cause mild cerebral vasodilation, leading to headaches. This side effect is generally manageable but should be monitored to differentiate from more serious adverse reactions.

Choice G rationale: Reflex monitoring is not a standard requirement for beta-2 agonist tocolytics like terbutaline. Reflex checks are more relevant for magnesium sulfate therapy, which can cause neuromuscular blockade and require frequent deep tendon reflex assessments to avoid toxicity. Therefore, frequent reflex monitoring is not indicated with terbutaline.