A nurse is providing discharge instructions to a client who has just received her first medroxyprogesterone injection for contraception.

Which of the following information should the nurse include in the teaching?

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 C.Foul-smelling vaginal discharge is a sign of a possible infection, which can be a complication of using a copper IUD.

The nurse should instruct the client to report this symptom and seek medical attention.

Choice A is wrong because increased menstrual pain and bleeding are common side effects of copper IUDs, especially in the first 3-6 months after insertion.

They are not necessarily signs of a complication.

Choice B is wrong because irregular spotting or bleeding are also common side effects of copper IUDs.

They are not necessarily signs of a complication.

Choice D is wrong because a change in string length is not a sign of a complication.

The string length may vary depending on the position of the cervix and uterus.The client should check the string length regularly and report any missing or protruding strings, which could indicate displacement of the IUD.