A nurse is providing education to a patient about implantable progestin.

Which of the following statements made by the patient indicates a need for further teaching?

The correct answer is choice A. The nurse should assess for signs of pelvic inflammatory disease (PID), which is an infection of the female reproductive organs that can be caused by sexually transmitted bacteria.PID can cause abdominal pain during sexual intercourse, as well as other symptoms such as fever, unusual vaginal discharge, and bleeding between periods.PID can lead to serious complications such as infertility and ectopic pregnancy if left untreated.

Choice B is wrong because checking the string length of the IUD is not a priority action.The string length may change due to normal variations in the position of the uterus and cervix, and does not indicate a problem with the IUD.However, if the string is missing or longer than usual, it may suggest that the IUD has moved or expelled, and the client should see a provider.

Choice C is wrong because advising the client to use a backup contraceptive method is not a priority action.The IUD is a highly effective form of birth control that does not require additional methods unless the client wants to prevent STIs.However, if the client has an STI that causes PID, using a condom may help prevent further infection and transmission.

Choice D is wrong because scheduling an appointment for IUD removal is not a priority action.The IUD does not cause PID, but it may increase the risk of infection shortly after insertion, especially if the client has an STI.The risk of PID from IUD use is very low (less than 1%) and usually disappears after 3 weeks of placement.Removing the IUD may not cure PID and may expose the client to unwanted pregnancy.

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.