A nurse is caring for a client who has an intrauterine device (IUD) in place and reports lower abdominal pain and fever for 2 days.

Which of the following actions should the nurse take?

The correct answer is choice D.“You should wait until your baby is 6 weeks old before starting the injections.” This is because medroxyprogesterone may pass into breast milk and cause side effects in a child who is breastfed.The product labeling states that it should be started no sooner than 6 weeks postpartum, based on data submitted for product approval.

The World Health Organization also recommends that injectable depot medroxyprogesterone acetate should not be used before 6 weeks postpartum.

Choice A is wrong because starting the injections immediately after delivery could interfere with the exclusivity or duration of lactation, and could affect the newborn infant adversely because of slower metabolism of the drug than older infants.

Choice B is wrong because waiting until the baby is 6 months old is unnecessary and could expose the mother to a higher risk of unintended pregnancy.

Choice C is wrong because medroxyprogesterone has not been known to cause any decrease in milk supply while using the injections

The correct answer is choice D. Refer the client to a provider for evaluation.Lower abdominal pain and fever for 2 days can indicate a serious complication of IUD use, such as pelvic inflammatory disease (PID) or perforation of the uterus.

These conditions require prompt medical attention and possible removal of the IUD.

Choice A is wrong because ibuprofen may not be enough to relieve the pain and may mask the signs of infection.

Choice B is wrong because avoiding sexual intercourse will not treat the underlying cause of the symptoms and may delay seeking medical help.

Choice C is wrong because a urine specimen may not be sufficient to diagnose the problem and may miss other possible causes of lower abdominal pain and fever, such as ectopic pregnancy or appendicitis.