A nurse is reinforcing teaching with a client who has an intrauterine device (IUD) in place and asks how it prevents pregnancy.

Which of the following responses should the nurse make?

The correct answer is choice A.A history of toxic shock syndrome (TSS) is a contraindication for the use of a diaphragm.

TSS is a rare but serious condition caused by a bacterial infection that can occur when using a diaphragm for too long or not cleaning it properly.

Choice B is wrong because a history of uterine fibroids is not a contraindication for the use of a diaphragm.

Uterine fibroids are benign tumors that grow in the uterus and usually do not affect the cervix or the fit of the diaphragm.

Choice C is wrong because a history of irregular menstrual periods is not a contraindication for the use of a diaphragm.

Irregular periods may be caused by various factors such as stress, hormonal imbalance, or medical conditions, but they do not affect the effectiveness or safety of the diaphragm.

Choice D is wrong because a history of breast cancer is not a contraindication for the use of a diaphragm.

Breast cancer is not related to the use of barrier methods of contraception such as the diaphragm.

However, some hormonal methods of contraception may increase the risk of breast cancer or be contraindicated for women who have or had breast cancer.

The correct answer is choiceD.

All of the above.

Here is why:

• Choice A is correct because obtaining informed consent from the client is a necessary step before any invasive procedure, including IUD insertion.
• Choice B is correct because performing a Pap smear and cervical culture can help screen for cervical cancer and sexually transmitted infections, which are contraindications for IUD use.
• Choice C is correct because administering an analgesic medication can help reduce the pain and discomfort associated with IUD insertion, especially in nulliparous women who have a smaller cervical diameter.
• Choice D is correct because it includes all of the above actions, which are recommended by the American College of Obstetricians and Gynecologists (ACOG) for IUD insertion in nulliparous women.
• Choice A is wrong if it is the only action taken, because it does not address the other aspects of IUD insertion such as screening and pain management.
• Choice B is wrong if it is the only action taken, because it does not ensure the client’s consent and comfort during the procedure.
• Choice C is wrong if it is the only action taken, because it does not verify the client’s eligibility and suitability for IUD use.