A nurse is caring for a client who has a history of breast cancer and cardiovascular disease and is seeking advice on contraception.

Which of the following contraceptive methods should the nurse recommend as the safest option for this client?

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.

The correct answer is choice A. Elevated liver enzymes.Medroxyprogesterone injections can cause liver damage and impair its function.Elevated liver enzymes are a sign of liver injury and should be reported to the provider immediately.

Choice B is wrong because decreased hemoglobin is not a common side effect of medroxyprogesterone injections.

Decreased hemoglobin can indicate anemia, which can have many causes unrelated to medroxyprogesterone injections.

Choice C is wrong because increased platelets are not a common side effect of medroxyprogesterone injections.

Increased platelets can indicate inflammation, infection, or cancer, which can have many causes unrelated to medroxyprogesterone injections.

Choice D is wrong because decreased potassium is not a common side effect of medroxyprogesterone injections.

Decreased potassium can indicate dehydration, diarrhea, vomiting, or diuretic use, which can have many causes unrelated to medroxyprogesterone injections.