A nurse is teaching a patient about the use of spermicide.

Which of the following is an adverse effect of some spermicides that contain nonoxynol-9 (N-9)?

The correct answer is choice B.The patient should receive the injection withinsevendays after delivery if breastfeeding, not five.Injectable progestins are a type of hormonal contraception that prevent ovulation and thicken cervical mucus.They are given by a health professional every 12 weeks.

Choice A is wrong because injectable progestins may cause bone mineral loss with long-term use, so the patient should be aware of this risk.

Choice C is wrong because injectable progestins may cause decreased bleeding or amenorrhea in some women, which is not harmful but may be unexpected.

Choice D is wrong because injectable progestins are given every three months, not four times per year.

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.