A nurse is reviewing laboratory results for a female client who takes oral contraceptives (OCs).

Which of the following findings should indicate to the nurse that OCs are having an adverse effect on this client?

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 A.A history of toxic shock syndrome (TSS) is a contraindication for the use of a diaphragm.

TSS is a rare but serious condition caused by a bacterial infection that can occur when using a diaphragm for too long or not cleaning it properly.

Choice B is wrong because a history of uterine fibroids is not a contraindication for the use of a diaphragm.

Uterine fibroids are benign tumors that grow in the uterus and usually do not affect the cervix or the fit of the diaphragm.

Choice C is wrong because a history of irregular menstrual periods is not a contraindication for the use of a diaphragm.

Irregular periods may be caused by various factors such as stress, hormonal imbalance, or medical conditions, but they do not affect the effectiveness or safety of the diaphragm.

Choice D is wrong because a history of breast cancer is not a contraindication for the use of a diaphragm.

Breast cancer is not related to the use of barrier methods of contraception such as the diaphragm.

However, some hormonal methods of contraception may increase the risk of breast cancer or be contraindicated for women who have or had breast cancer.