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 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 B.Spotting and irregular bleeding are potential adverse effects of the copper IUD.The copper IUD works by creating a toxic environment for sperm and eggs in the uterus and cervix, but it does not affect the hormones that regulate the menstrual cycle.Therefore, it can cause changes in bleeding patterns, such as heavier, longer or more painful periods.

Choice A is wrong because decreased bone density is not a side effect of the copper IUD.It is a possible side effect of hormonal IUDs that contain progestin, which can lower estrogen levels and affect bone health.

Choice C is wrong because mood changes are not a side effect of the copper IUD.They are more likely to occur with hormonal methods of birth control that affect the levels of estrogen and progesterone in the body.

Choice D is wrong because headaches are not a side effect of the copper IUD.They are also more common with hormonal methods of birth control, especially those that contain estrogen.