A nurse is caring for a client who desires an intrauterine device (IUD) for contraception.

Which of the following findings is a contraindication for the use of this device?

The correct answer is choice C. Copper intrauterine device.This is because copper intrauterine devices do not contain hormones and are therefore safe for women with a history of breast cancer and cardiovascular disease.

Some possible explanations for the other choices are:

• Choice A. Injectable progestins.This is wrong because injectable progestins may increase the risk of breast cancer in women with the BRCA1 geneand may also worsen hypertension and dyslipidemia.
• Choice B. Contraceptive vaginal ring.This is wrong because contraceptive vaginal rings contain estrogen and progestin, which may increase the risk of thromboembolic events, stroke, and myocardial infarction in women with cardiovascular disease.
• Choice D. Combined oral contraceptives.This is wrong because combined oral contraceptives also contain estrogen and progestin, which have the same risks as contraceptive vaginal rings for women with cardiovascular disease.Additionally, combined oral contraceptives may interact with some medications used to treat chronic conditions and reduce their effectiveness.

The correct answer is choice A.The nurse should tell the client that if she misses one pill, she should take the missed pill as soon as possible and continue with the next pill at the usual time.This will ensure that she maintains a continuous hormonal exposure and does not extend the hormone-free interval beyond 7 days.She does not need to use extra contraception.

Choice B is wrong because taking two pills at once and skipping the next pill will disrupt the hormonal balance and may cause side effects such as nausea or breakthrough bleeding.Choice C is wrong because discarding the missed pill and taking the next pill at the usual time will shorten the duration of hormonal exposure and increase the risk of ovulation.Choice D is wrong because stopping taking the pills for the rest of the cycle and using a backup method of contraception will expose the client to an unnecessary hormone-free interval and may compromise her contraceptive efficacy.

COCs are combined oral contraceptives that contain synthetic estrogen and progestin hormones that prevent ovulation and thicken cervical mucus to inhibit sperm penetration.The normal range of COCs dosage is 20 to 35 micrograms of estrogen and 0.1 to 3 milligrams of progestin per pill.