A nurse is caring for a client who is receiving an epidural block with an opioid analgesic. The nurse should identify which findings as an adverse effect of the medication?

Rationale:

A. Administering methylergonovine is not appropriate for a fourth-degree perineal laceration.

Methylergonovine is typically used to prevent or treat postpartum hemorrhage by promoting uterine contractions.

B. Applying povidone-iodine to the client's perineum is not indicated for the management of a perineal laceration. Povidone-iodine is an antiseptic solution used for wound cleansing, but it may be too harsh for the perineal area.

C. Providing the client with a cool sitz bath is appropriate for managing discomfort and promoting healing after a fourth-degree perineal laceration. A sitz bath helps to soothe the perineal area and reduces inflammation.

D. Applying a moist, warm compress to the perineum is not recommended for a fourth-degree perineal laceration, as it may increase the risk of infection and discomfort.

Rationale:

A. "You should use an oil-based vaginal lubricant when inserting your diaphragm." Incorrect.

Oil-based lubricants can weaken latex diaphragms, increasing the risk of breakage. Water-based lubricants are recommended instead.

B. "You should keep the diaphragm in place for at least 4 hours after intercourse." Incorrect.

Diaphragms should be left in place for at least 6 hours after intercourse but not longer than 24 hours.

C. "You should have your provider refit you for a new diaphragm."

Correct answer. After childbirth, the size and shape of the cervix may change, affecting the fit of the diaphragm. Therefore, it's important to have the diaphragm refitted by a healthcare provider.

D. "You should store your diaphragm in sterile water after each use." Incorrect. Diaphragms should be cleaned and dried thoroughly after each use and stored in a cool, dry place, not in sterile water.