A nurse is reviewing the medical history of a client who is considering using COCs as a method of contraception.

The nurse should identify that which of the following conditions is a contraindication for using COCs?

The nurse should include all of the following information in the teaching:

• The typical failure rate for IUDs is 1% to 3% per year.
• This means that out of 100 women who use an IUD for a year, one to three may get pregnant.
• The risk of pelvic inflammatory disease (PID) is highest in the first 6 weeks after insertion.
• PID is an infection of the reproductive organs that can cause infertility, chronic pain, or ectopic pregnancy.
• The risk of PID is higher if the woman or her partner has multiple sexual partners or a sexually transmitted infection (STI).
• The IUD can be inserted at any time during the menstrual cycle.
• However, some doctors may prefer to insert it during or right after the period, when the cervix is more open and the chance of pregnancy is lower.

Choice A is wrong because it only states one piece of information that the nurse should include in the teaching.

Choice B is wrong because it only states one piece of information that the nurse should include in the teaching.

Choice C is wrong because it only statesone piece of information that the nurse should 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.