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 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.

The correct answer is choice D. Choice D is wrong because it implies that the IUD affects fertility, which is not true.According to the NHS website, “Your fertility will return to normal as soon as the IUD is taken out.” The other choices are correct because:

• Choice A is correct because the copper IUD does not contain any hormones and can be used by people who cannot or do not want to use hormonal methods of contraception.
• Choice B is correct because a pregnancy test is needed before inserting an IUD to make sure that the person is not already pregnant.
• Choice C is correct because the hormonal IUD can reduce menstrual pain and heavy bleeding by thinning the lining of the uterus and thickening the cervical mucus.

Therefore, choice D indicates a need for further teaching.