A nurse is caring for a client who requests information about female sterilization (bilateral tubal ligation).

Which of the following statements by the nurse is appropriate? (Select all that apply.).

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.

The correct answer is choice B. The client has a positive pregnancy test result.

This is a contraindication for bilateral tubal ligation because the procedure is a permanent form of contraception and should not be performed on a pregnant woman.

The client should be counseled about other options for birth control or termination of pregnancy.

Choice A is wrong because a history of pelvic inflammatory disease is not a contraindication for bilateral tubal ligation.It may increase the risk of complications from the surgery, such as infection or adhesions, but it does not prevent the procedure from being performed.

Choice C is wrong because a family history of breast cancer is not a contraindication for bilateral tubal ligation.It may affect the client’s decision to undergo the procedure, as some studies have suggested that tubal ligation may reduce the risk of ovarian cancer, which is associated with breast cancer.

However, this is not a medical reason to avoid the surgery.

Choice D is wrong because a history of endometriosis is not a contraindication for bilateral tubal ligation.

It may cause pelvic pain or infertility, but it does not affect the effectiveness or safety of the procedure.In fact, some studies have shown that tubal ligation may improve the symptoms of endometriosis by reducing retrograde menstruation.