A nurse is caring for a client who is taking COCs and reports nausea.

The nurse should advise the client to

The correct answer is choice B. The client should start taking oral contraceptives (OCs) on day one of their menstrual cycle, which is the first day of their period.This way, they will be protected from pregnancy right away and do not need to use a back-up contraceptive method.

Choice A is wrong because starting OCs on Sunday after the period begins may leave a gap of several days when the client is not protected from pregnancy.They would need to use a back-up method for the first seven days of taking OCs.

Choice C is wrong because starting OCs on day five of the menstrual cycle may also leave a gap of unprotected days.The client would need to use a back-up method for the first seven days of taking OCs.

Choice D is wrong because starting OCs on day fourteen of the menstrual cycle is too late and may not prevent ovulation.The client would need to use a back-up method for the first seven days of taking OCs.

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.