A nurse is teaching a client who is starting medroxyprogesterone injections for contraception.

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

The correct answer is choice B and E.Bilateral tubal ligation (BTL) is a permanent form of contraception that involves cutting, tying or blocking the fallopian tubes to prevent pregnancy.It can be performed within 24 hours following childbirthand it is immediately effective.

Choice A is wrong because BTL does not provide protection against sexually transmitted infections (STIs).

People who have BTL should still use condoms to prevent STIs.

Choice C is wrong because BTL does not increase the risk for an ectopic pregnancy.

An ectopic pregnancy is when a fertilized egg implants outside the uterus, usually in the fallopian tube.

BTL prevents fertilization by blocking the passage of eggs and sperm.

Choice D is wrong because BTL does not require abdominal surgery with general anesthesia.

BTL can be done using different methods, such as laparoscopy, minilaparotomy, or hysteroscopy.

These methods use small incisions or no incisions at all and can be done with local or regional anesthesia.

All of the above.

This is because IUDs have multiple mechanisms of action that prevent fertilization and implantation of the ovum.According to the search results, some of these mechanisms are:

• IUDs immobilize sperm and interfere with their migration from the vagina to the fallopian tubes.This is because copper ions released from copper IUDs are toxic for spermatozoa and impair their motility and viability.Hormonal IUDs also thicken the cervical mucus, which blocks sperm from entering the uterus.
• IUDs speed up the transport of the ovum through the fallopian tube.This is because IUDs induce a local inflammatory reaction in the endometrium, which affects the signaling between the uterus and the ovary and alters the tubal motility.This reduces the chances of fertilization by shortening the time window for sperm-egg interaction.
• IUDs inhibit fertilization and cause lysis of the blastocyst.This is because IUDs affect the function or viability of gametes, decreasing the rate of fertilization and lowering the chances of survival of any embryo that may be formed.IUDs also interfere with implantation of the fertilized ovum by creating a hostile environment in the uterine cavity.

Choice A is wrong because it only describes one mechanism of action of IUDs, not all of them.

Choice B is wrong because it only describes another mechanism of action of IUDs, not all of them.

Choice C is wrong because it only describes yet another mechanism of action of IUDs, not all of them.