A nurse is reinforcing teaching with a client who has an intrauterine device (IUD) in place and asks how it prevents pregnancy.

Which of the following responses should the nurse make?

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 A. Perform a pregnancy test.An IUD is a form of birth control that is inserted into the uterus to prevent pregnancy, but it is not 100% effective.If a client with an IUD misses a menstrual period, the first action the nurse should take is to rule out pregnancy by performing a pregnancy test.This is because pregnancy with an IUD can have serious complications, such as ectopic pregnancy, infection, miscarriage or preterm labor.

Choice B is wrong because palpating for uterine enlargement is not a reliable way to diagnose pregnancy, especially in the early stages.It can also cause discomfort or bleeding for the client.

Choice C is wrong because assessing for signs of ectopic pregnancy is not the first action the nurse should take.

Ectopic pregnancy is a possible complication of pregnancy with an IUD, but it is not very common.The nurse should first confirm if the client is pregnant before looking for signs of ectopic pregnancy, such as abdominal pain, vaginal bleeding or shoulder pain.

Choice D is wrong because instructing the client to remove the IUD is not appropriate or safe.

The client should not attempt to remove the IUD by themselves, as this can cause injury or infection.The nurse should refer the client to an OB-GYN if they are pregnant with an IUD or if they want to remove the IUD for any reason.