A nurse in a clinic is caring for a client who has been taking oral contraceptives for several months and reports frequent breakthrough bleeding during her cycle.
Which of the following actions should the nurse take?
Instruct the client to take two pills daily until bleeding stops
Advise the client to stop taking oral contraceptives immediately
Tell the client to avoid smoking while taking oral contraceptives
Suggest that the client switch to a higher-dose formulation
The Correct Answer is D
The correct answer is choice D. The client should switch to a higher-dose formulation of oral contraceptives. Breakthrough bleeding is a common side effect of low-dose birth control pills, especially in the first months of use. It may indicate that the estrogen dose is too low to suppress the growth of the endometrium.
A higher-dose formulation may reduce or eliminate breakthrough bleeding by providing more estrogen.
Choice A is wrong because taking two pills daily until bleeding stops is not a recommended way to manage breakthrough bleeding.
It may cause side effects such as nausea, headache, or breast tenderness. It may also increase the risk of blood clots.
Choice B is wrong because stopping oral contraceptives immediately is not advisable unless there is a medical reason to do so.
Stopping oral contraceptives may cause irregular bleeding, ovulation, and pregnancy.
The client should consult with their provider before discontinuing any medication.
Choice C is wrong because smoking does not cause breakthrough bleeding, but it does increase the risk of serious complications from oral contraceptives, such as stroke, heart attack, or blood clots. The client should avoid smoking while taking any hormonal contraceptive, regardless of whether they experience breakthrough bleeding or not.
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Naxlex Comprehensive Predictor Exams
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Correct Answer is D
Explanation
All of the above.
This is because IUDs have multiple mechanisms of action that prevent fertilization and implantation of the ovum.According to the search results, some of these mechanisms are:
- IUDs immobilize sperm and interfere with their migration from the vagina to the fallopian tubes.This is because copper ions released from copper IUDs are toxic for spermatozoa and impair their motility and viability.Hormonal IUDs also thicken the cervical mucus, which blocks sperm from entering the uterus.
- IUDs speed up the transport of the ovum through the fallopian tube.This is because IUDs induce a local inflammatory reaction in the endometrium, which affects the signaling between the uterus and the ovary and alters the tubal motility.This reduces the chances of fertilization by shortening the time window for sperm-egg interaction.
- IUDs inhibit fertilization and cause lysis of the blastocyst.This is because IUDs affect the function or viability of gametes, decreasing the rate of fertilization and lowering the chances of survival of any embryo that may be formed.IUDs also interfere with implantation of the fertilized ovum by creating a hostile environment in the uterine cavity.
Choice A is wrong because it only describes one mechanism of action of IUDs, not all of them.
Choice B is wrong because it only describes another mechanism of action of IUDs, not all of them.
Choice C is wrong because it only describes yet another mechanism of action of IUDs, not all of them.
Correct Answer is A
Explanation
The correct answer is choice A.History of migraine headaches with aura is a contraindication for using COCs because it increases the risk of stroke.
Some possible explanations for the other choices are:
- Choice B is wrong because history of dysmenorrhea and menorrhagia is not a contraindication for using COCs.In fact, COCs may help reduce menstrual pain and bleeding.
- Choice C is wrong because history of acne vulgaris and hirsutism is not a contraindication for using COCs.In fact, COCs may help improve acne and hirsutism by reducing androgen levels.
- Choice D is wrong because history of iron-deficiency anemia and fatigue is not a contraindication for using COCs.In fact, COCs may help prevent iron-deficiency anemia by reducing menstrual blood loss.
Normal ranges for relevant parameters are:
- Blood pressure: <140/90 mmHg
- Body mass index: 18.5–24.9 kg/m
- Hemoglobin: 12–16 g/dL for women
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