A client who uses transdermal contraceptive, calls to the clinic because she forgot to apply a new patch three days ago. Which instruction should the nurse provide to the client?

A. Apply the new patch today and use a backup method for 7 days: If a transdermal contraceptive patch is forgotten for more than 48 hours, a new patch should be applied immediately, and a backup method such as condoms should be used for the next 7 days to ensure protection against pregnancy due to the interruption in hormone delivery.

B. Wait until Sunday to apply the new patch and use the same site: Waiting until Sunday would leave the client unprotected for several more days, increasing the risk of pregnancy. Immediate action is needed rather than delaying application based on the day of the week.

C. If a pregnancy test is negative, apply the next patch immediately: While pregnancy testing may be warranted if a patch has been missed for a long period, the priority is to re-establish hormonal contraception immediately. Delaying application for testing first is not appropriate in this acute situation.

D. Wait until the last day of your next menstrual period to apply the patch: Delaying application until after the next menstrual period would leave the client unprotected and vulnerable to unintended pregnancy for an extended time, making this instruction inappropriate.

A. Take the medication during pregnancy: Methotrexate is highly teratogenic and absolutely contraindicated during pregnancy because it can cause severe fetal malformations or death. Clients must be instructed to avoid pregnancy while on methotrexate and for some time after discontinuing the drug, making this a critical point requiring immediate correction.

B. Use folic acid to protect the liver: Methotrexate interferes with folate metabolism, and folic acid supplementation is recommended to reduce some side effects such as liver toxicity, mucositis, and bone marrow suppression. This statement reflects appropriate understanding of supportive care during methotrexate therapy.

C. Store the medication at room temperature: Methotrexate should be stored at room temperature away from light and moisture, consistent with safe medication handling practices. This information is accurate and does not require additional instruction.

D. Obtain a platelet count weekly: Methotrexate can cause bone marrow suppression, increasing the risk of thrombocytopenia. Regular monitoring of blood counts, including platelets, is standard practice to detect toxicity early, so this action is appropriate and understood correctly.