A nurse is completing a health history and assessment for a client who reports they are pregnant.
Which of the following findings is a presumptive sign of pregnancy?

Choice A rationale

Terbutaline is a beta-adrenergic agonist that can cause significant cardiovascular side effects, including tachycardia. A heart rate of 132/min is significantly elevated above the normal range (60-100/min) and indicates a potentially dangerous adverse effect, increasing myocardial oxygen demand and risk of cardiac complications.

Choice B rationale

Headache is a common side effect of terbutaline due to its vasodilatory effects. While uncomfortable, it is generally not life-threatening and is considered less urgent than significant cardiac or respiratory compromise. Management often involves supportive care and pain relief.

Choice C rationale

Nasal congestion is a less common and generally benign side effect of terbutaline. It is typically related to generalized vasodilation and does not pose a significant threat to maternal or fetal well-being, thus not being the priority for immediate reporting.

Choice D rationale

Tremors are a common and expected side effect of terbutaline due to its beta-agonist activity on skeletal muscle. While bothersome, they are typically self-limiting and do not indicate a severe adverse reaction requiring immediate reporting unless they are excessively severe or debilitating.

Choice A rationale

Prior to IUD insertion, screening for sexually transmitted infections (STIs) is crucial to prevent the introduction of pathogens into the upper reproductive tract. An untreated STI, particularly chlamydia or gonorrhea, can lead to pelvic inflammatory disease (PID) when an IUD is placed, as the device might facilitate the ascent of bacteria.

Choice B rationale

The duration of effectiveness for intrauterine devices varies depending on the type. Hormonal IUDs typically last for 3 to 8 years, while copper IUDs can remain effective for up to 10 years. Therefore, the statement that the device must be replaced every 2 years is incorrect and misleading for most available IUDs.

Choice C rationale

Irregular spotting and changes in menstrual bleeding patterns are common side effects during the initial months following IUD placement, particularly with hormonal IUDs. This is due to the local endometrial effects of progesterone release or the inflammatory reaction induced by copper, as the uterus adapts to the foreign body.

Choice D rationale

There is no medical contraindication to using tampons with an IUD. The IUD resides in the uterus, while tampons are inserted into the vaginal canal. There is no physical interaction or risk of dislodgement of the IUD by tampon use. Clients can continue their preferred menstrual hygiene products.

Choice E rationale

Informed consent is a fundamental ethical and legal requirement before any medical procedure, including IUD insertion. The client must be provided with comprehensive information regarding the procedure, including its benefits, risks, alternatives, and potential side effects, to make an autonomous and voluntary decision.