A nurse is assessing a client who is taking ethinyl estradiol and norethindrone for contraception. Which of the following manifestations should the nurse identify as a potential adverse effect of this medication combination?

Choice A rationale Ethinyl estradiol and norethindrone, a common oral contraceptive combination, can sometimes lead to weight gain rather than weight loss. This is often attributed to fluid retention and changes in appetite or metabolism, rather than a catabolic effect causing weight reduction. Choice B rationale Easy bruising is not a typical manifestation of ethinyl estradiol and norethindrone use. While some hormonal contraceptives can affect coagulation factors, leading to an increased risk of thrombosis, they do not generally cause increased capillary fragility or platelet dysfunction manifesting as easy bruising. Choice C rationale Oral contraceptives containing estrogen, such as ethinyl estradiol, can actually cause a slight increase in blood pressure in some individuals due to their effects on the renin-angiotensin-aldosterone system, leading to sodium and water retention. Low blood pressure is not a common adverse effect. Choice D rationale Breakthrough bleeding, or irregular uterine bleeding that occurs during hormone therapy, is a common adverse effect of combined oral contraceptives like ethinyl estradiol and norethindrone, especially during the initial cycles of use. It results from an imbalance in the hormonal effects on the endometrium.