A nurse is collecting data from a client who requests a prescription for a diaphragm.
Which of the following findings should the nurse identify as a contraindication to the client’s use of a diaphragm?

Rationale for Choice A:
It is accurate that scheduling the NST when the baby is usually active is beneficial. This is because fetal movement is expected to cause accelerations in the fetal heart rate, which is a positive sign of fetal well-being.
By scheduling the test during a time of typical fetal activity, the chances of obtaining a reactive NST (a normal result) are increased.
Therefore, this statement does not indicate a need for further teaching.

Rationale for Choice B:
Lying on the back during the NST is not recommended.
This position can cause the weight of the uterus to compress the major blood vessels (the inferior vena cava and aorta), potentially reducing blood flow to the placenta and fetus.
Reduced blood flow can, in turn, lead to a decrease in fetal heart rate and movement.
To avoid this, the recommended position for NST is a semi-Fowler's position, which involves being partially reclined with the head and upper body elevated.
This position helps to promote uterine perfusion and prevent supine hypotension.

Rationale for Choice C:
It is accurate that the baby's heart rate will be monitored during the NST.
This is the primary purpose of the test: to assess the fetal heart rate response to fetal movement. Therefore, this statement does not indicate a need for further teaching.

Rationale for Choice D:
It is accurate that the client will be able to go to the bathroom during the NST if necessary. The test is noninvasive and does not require strict immobility.
The client can move around and use the bathroom as needed, as long as the fetal heart rate monitor is not disconnected.
Therefore, this statement does not indicate a need for further teaching.

The correct answers are Choices D

Choice A rationale: Constipation is a common symptom during pregnancy due to hormonal changes and the pressure of the growing uterus on the intestines. It generally does not warrant immediate reporting to the provider unless it is severe or accompanied by other concerning symptoms.

Choice B rationale: Low back pain is also a typical complaint during pregnancy, especially in the third trimester. It is often due to the additional weight and changes in posture. While it can be uncomfortable, it is usually not an urgent concern unless it is severe or associated with other symptoms.

Choice C rationale: Leukorrhea, or increased vaginal discharge, is common during pregnancy and is generally not a cause for concern. It helps protect the birth canal from infection and is typically not something that requires immediate reporting unless it is accompanied by itching, foul odor, or unusual color.

Choice D rationale: Blurred vision is a potential sign of preeclampsia, a serious condition that can develop during pregnancy and pose risks to both the mother and baby. This symptom warrants immediate reporting to the provider for further evaluation.