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 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.

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.