A nurse is caring for a patient who uses a contraceptive vaginal ring.

Which of the following symptoms should the nurse instruct the patient to report immediately?

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.

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.