A nurse is providing discharge instructions to a client who has just received her first medroxyprogesterone injection for contraception.

Which of the following information should the nurse include in the teaching?

The correct answer is choiceD.

All of the above.

Here is why:

• Choice A is correct because obtaining informed consent from the client is a necessary step before any invasive procedure, including IUD insertion.
• Choice B is correct because performing a Pap smear and cervical culture can help screen for cervical cancer and sexually transmitted infections, which are contraindications for IUD use.
• Choice C is correct because administering an analgesic medication can help reduce the pain and discomfort associated with IUD insertion, especially in nulliparous women who have a smaller cervical diameter.
• Choice D is correct because it includes all of the above actions, which are recommended by the American College of Obstetricians and Gynecologists (ACOG) for IUD insertion in nulliparous women.
• Choice A is wrong if it is the only action taken, because it does not address the other aspects of IUD insertion such as screening and pain management.
• Choice B is wrong if it is the only action taken, because it does not ensure the client’s consent and comfort during the procedure.
• Choice C is wrong if it is the only action taken, because it does not verify the client’s eligibility and suitability for IUD use.

The correct answer is choice B. The client has a positive pregnancy test result.

This is a contraindication for bilateral tubal ligation because the procedure is a permanent form of contraception and should not be performed on a pregnant woman.

The client should be counseled about other options for birth control or termination of pregnancy.

Choice A is wrong because a history of pelvic inflammatory disease is not a contraindication for bilateral tubal ligation.It may increase the risk of complications from the surgery, such as infection or adhesions, but it does not prevent the procedure from being performed.

Choice C is wrong because a family history of breast cancer is not a contraindication for bilateral tubal ligation.It may affect the client’s decision to undergo the procedure, as some studies have suggested that tubal ligation may reduce the risk of ovarian cancer, which is associated with breast cancer.

However, this is not a medical reason to avoid the surgery.

Choice D is wrong because a history of endometriosis is not a contraindication for bilateral tubal ligation.

It may cause pelvic pain or infertility, but it does not affect the effectiveness or safety of the procedure.In fact, some studies have shown that tubal ligation may improve the symptoms of endometriosis by reducing retrograde menstruation.