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 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.

The correct answer is choice B. The nurse should advise the client to take the pill at bedtime or with food.This can help reduce nausea, which is a common side effect of COCs.Nausea usually diminishes with continued use of the same method.

Choice A is wrong because taking the pill with a glass of water on an empty stomach may increase nausea.

Choice C is wrong because switching to a different brand of COCs is not effective in treating nausea.There are no significant differences among various COCs in terms of nausea.

Choice D is wrong because stopping the pill and using another method of contraception is not necessary unless the client prefers it.Nausea is not harmful and can be managed with simple measures.