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. Refer the client to a provider for evaluation.Lower abdominal pain and fever for 2 days can indicate a serious complication of IUD use, such as pelvic inflammatory disease (PID) or perforation of the uterus.

These conditions require prompt medical attention and possible removal of the IUD.

Choice A is wrong because ibuprofen may not be enough to relieve the pain and may mask the signs of infection.

Choice B is wrong because avoiding sexual intercourse will not treat the underlying cause of the symptoms and may delay seeking medical help.

Choice C is wrong because a urine specimen may not be sufficient to diagnose the problem and may miss other possible causes of lower abdominal pain and fever, such as ectopic pregnancy or appendicitis.

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.