Question
Ms. K, a 35-year-old woman, visits your pharmacy to refill her prescription for combined oral contraceptive pills. During the consultation, she mentions that she has a history of deep vein thrombosis (DVT) and is concerned about continuing the contraceptive pills. What would be the most appropriate advice for Ms. K?
A) Continue the pills, but monitor closely for symptoms of DVT
B) Switch to a progestin-only contraceptive pill
C) Discontinue the pills and switch to a barrier method
D) Lower the dose of the current contraceptive pills
E) Recommend an IUD instead
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Correct Answer: B) Switch to a progestin-only contraceptive pill
Explanation: Combined oral contraceptive pills are contraindicated in patients with a history of deep vein thrombosis due to the increased risk of blood clots. A progestin-only contraceptive would be safer in this case.
Question
Mr. R, a 28-year-old male, comes into the pharmacy asking about contraception options. He is specifically interested in learning about methods that would protect him and his partner from sexually transmitted infections (STIs). What method would you recommend to Mr. R?
A) Oral contraceptive pills
B) Male condom
C) Intrauterine device (IUD)
D) Diaphragm
E) Contraceptive ring
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Correct Answer: B) Male condom
Explanation: Male condoms are the only contraceptive method that also provides protection against sexually transmitted infections (STIs).
Question
A 25-year-old patient, Sarah, has missed 3 consecutive days of her combined oral contraceptive pills. She is now unsure what to do next. What should be the proper course of action for Sarah?
A) Continue taking one pill daily and use no additional contraception
B) Take two pills immediately and continue as scheduled
C) Discontinue the current pack and start a new pack after the next period
D) Start a new pack and use additional contraception, such as condoms, for 7 days
E) Take an emergency contraceptive pill and continue the pack as usual
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Correct Answer: D) Start a new pack and use additional contraception, such as condoms, for 7 days
Explanation: After missing 3 consecutive pills, Sarah should start a new pack and use backup contraception for 7 days to prevent pregnancy.
Question
A 21-year-old patient, Maria, is seeking emergency contraception after unprotected sex. She is unsure of which product to use. Which of the following would be the most appropriate option for her?
A) Levonorgestrel (Plan B)
B) Estrogen-only pill
C) Depo-Provera
D) Vaginal ring
E) Copper IUD
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Correct Answer: A) Levonorgestrel (Plan B)
Explanation: Levonorgestrel, commonly known as Plan B, is the most widely used emergency contraceptive to prevent pregnancy after unprotected sex or contraceptive failure.
Question
Anna, a 30-year-old woman, is concerned about the side effects of her estrogen/progestin oral contraceptive pills. She asks you which side effect is the least likely to occur with these pills. What should you inform her?
A) Nausea
B) Weight gain
C) Increased risk of venous thromboembolism
D) Bone density loss
E) Breast tenderness
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Correct Answer: D) Bone density loss
Explanation: Estrogen/progestin oral contraceptives are not typically associated with bone density loss, which is more common with long-term use of progestin-only methods like Depo-Provera.
Question
A 27-year-old woman comes to the pharmacy asking for emergency contraception (Plan B) after unprotected sex. She mentions that she has experienced some breast tenderness since taking Levonorgestrel in the past. What should you inform her about this side effect?
A) Breast tenderness is a common side effect of Levonorgestrel
B) Breast tenderness is an unusual side effect of emergency contraception
C) Breast tenderness indicates a possible allergic reaction to Levonorgestrel
D) She should stop using Levonorgestrel if she experiences breast tenderness
E) Breast tenderness suggests that the emergency contraception has failed
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Correct Answer: A) Breast tenderness is a common side effect of Levonorgestrel
Explanation: Breast tenderness is a known and common side effect of Levonorgestrel (Plan B) emergency contraception and typically resolves on its own.
Question
A 22-year-old woman with irregular periods comes to the pharmacy asking for emergency contraception. She is concerned that her irregular cycle may affect the effectiveness of the emergency contraception. What is the most appropriate action?
A) Provide Plan B immediately
B) Suggest she waits until her next period before using emergency contraception
C) Refer her to a doctor for evaluation before providing emergency contraception
D) Recommend using regular oral contraceptives instead of emergency contraception
E) Assure her that irregular periods have no impact on the effectiveness of emergency contraception
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Correct Answer: C) Refer her to a doctor for evaluation before providing emergency contraception
Explanation: Patients with irregular periods may need a doctor’s evaluation to rule out underlying conditions and to ensure appropriate management, especially when considering emergency contraception.
Question
A 19-year-old woman is starting isotretinoin for severe acne. As the pharmacist, what would be your advice regarding contraception?
A) Recommend no contraception, as isotretinoin does not affect pregnancy
B) Recommend using a single form of contraception
C) Strongly advise using two forms of effective contraception to prevent pregnancy
D) Advise abstinence until the course of isotretinoin is complete
E) Recommend switching to progestin-only contraception
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Correct Answer: C) Strongly advise using two forms of effective contraception to prevent pregnancy
Explanation: Isotretinoin has a high teratogenic risk, and it is crucial for women of childbearing potential to use two forms of effective contraception to prevent pregnancy during and for a period after treatment.
Question
A 28-year-old woman is interested in using a diaphragm as her method of contraception. She asks how it works and how to use it correctly. What would you explain to her?
A) The diaphragm works by covering the cervix and preventing sperm from entering the uterus; it must be used with spermicide for effectiveness
B) The diaphragm releases hormones that prevent ovulation
C) The diaphragm is a one-time use contraceptive method and should be discarded after each use
D) The diaphragm can be used without spermicide if the user is sensitive to it
E) The diaphragm offers full protection against sexually transmitted infections (STIs)
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Correct Answer: A) The diaphragm works by covering the cervix and preventing sperm from entering the uterus; it must be used with spermicide for effectiveness
Explanation: Diaphragms are a non-hormonal contraceptive that physically blocks sperm from reaching the uterus and requires the use of spermicide for increased effectiveness. They must be inserted before intercourse and left in place for at least 6 hours after.
Question
A patient considering using a cervical cap asks how it differs from a diaphragm. Which of the following correctly describes the cervical cap and its usage?
A) The cervical cap does not require spermicide for effectiveness
B) The cervical cap is larger than the diaphragm and covers the entire vaginal area
C) The cervical cap can be left in place for up to 48 hours and is used with spermicide to block sperm from entering the uterus
D) The cervical cap is a disposable method of contraception that should be discarded after each use
E) The cervical cap provides strong protection against sexually transmitted infections (STIs)
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Correct Answer: C) The cervical cap can be left in place for up to 48 hours and is used with spermicide to block sperm from entering the uterus
Explanation: The cervical cap is a smaller, thimble-shaped device that fits tightly over the cervix. Like the diaphragm, it must be used with spermicide and can be left in place for up to 48 hours. It does not offer significant protection against STIs.
Question
Lisa, a 24-year-old college student, has just taken Plan B emergency contraception after a condom broke during intercourse. She is concerned about potential side effects. Which of the following side effects is Lisa most likely to experience?
A) Nausea
B) Increased appetite
C) Weight gain
D) Depression
E) Hair loss
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Correct Answer: A) Nausea
Explanation: Nausea is a common side effect of Plan B emergency contraception due to the high dose of levonorgestrel.
Question
A 32-year-old woman, Caroline, comes to the pharmacy to refill her oral contraceptive pills. She asks about the mechanism of action of combined oral contraceptives. Which of the following is an incorrect statement about their mechanism?
A) Inhibits ovulation by suppressing luteinizing hormone (LH)
B) Thickens cervical mucus to prevent sperm entry
C) Alters the endometrium to prevent implantation
D) Increases the thickness of the uterine lining
E) Reduces follicle-stimulating hormone (FSH) levels
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Correct Answer: D) Increases the thickness of the uterine lining
Explanation: Combined oral contraceptives thin the endometrial lining, making it less suitable for implantation, rather than increasing its thickness.
Question
A 30-year-old woman is interested in using NuvaRing as her contraceptive method. She wants to know how the ring works and how to use it correctly. What would be the most appropriate explanation?
A) The NuvaRing is inserted into the vagina and must be replaced daily
B) The NuvaRing releases hormones that prevent ovulation and thickens cervical mucus; it should be left in place for 3 weeks, followed by a ring-free week
C) The NuvaRing must be inserted into the uterus by a healthcare provider and replaced every 6 months
D) The NuvaRing must be inserted only during the time of ovulation and removed after intercourse
E) The NuvaRing provides protection against sexually transmitted infections (STIs)
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Correct Answer: B) The NuvaRing releases hormones that prevent ovulation and thickens cervical mucus; it should be left in place for 3 weeks, followed by a ring-free week
Explanation: The NuvaRing is a combined hormonal contraceptive that is inserted into the vagina for 3 weeks. It releases estrogen and progestin to prevent ovulation and thicken cervical mucus. After 3 weeks, the ring is removed for a 1-week ring-free period, during which withdrawal bleeding typically occurs.
Question
A 35-year-old woman who is a smoker is considering switching to the Evra Patch as her contraceptive method. She asks if this is a good option for her. What is the most appropriate advice?
A) The Evra Patch is safe for smokers of any age
B) The Evra Patch is not recommended for women who smoke and are over 35 due to the increased risk of blood clots
C) The Evra Patch provides protection against sexually transmitted infections (STIs)
D) The Evra Patch should be used with additional contraception for better protection
E) The Evra Patch is not effective for women who weigh more than 90 kg
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Correct Answer: B) The Evra Patch is not recommended for women who smoke and are over 35 due to the increased risk of blood clots
Explanation: The Evra Patch delivers higher levels of estrogen, which increases the risk of blood clots, stroke, or heart attack, particularly in women over 35 who smoke.
Question
A 28-year-old woman is using NuvaRing and is concerned because it fell out during intercourse. It had been out for about 2 hours before she noticed. What is the correct course of action?
A) She should discard the ring and use emergency contraception
B) She should rinse the ring with cool or lukewarm water and reinsert it as soon as possible
C) She should wait until her next cycle to reinsert a new ring
D) She should leave the ring out for 24 hours and then reinsert it
E) She must start a new cycle of oral contraceptives to maintain protection
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Correct Answer: B) She should rinse the ring with cool or lukewarm water and reinsert it as soon as possible
Explanation: If the NuvaRing falls out for less than 3 hours, it can be rinsed with cool or lukewarm water and reinserted. Protection against pregnancy remains intact as long as it is reinserted within 3 hours.
Question
A 24-year-old woman is using the Evra Patch for contraception. She accidentally removed the patch and forgot to reapply it for 26 hours. What is the best advice for her?
A) Reapply the patch immediately and continue as usual
B) Apply a new patch immediately and use backup contraception for 7 days
C) Wait until her next cycle to start a new patch
D) Use emergency contraception and apply a new patch after 7 days
E) No action is needed as the patch is effective for 48 hours after removal
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Correct Answer: B) Apply a new patch immediately and use backup contraception for 7 days
Explanation: If the patch has been off for more than 24 hours, a new patch should be applied immediately, and backup contraception, such as condoms, should be used for 7 days to ensure protection against pregnancy.
Question
Hannah, a 29-year-old woman, asks for advice on what category her oral contraceptive pills fall into. What is the correct classification?
A) Estrogen-only
B) Progestin-only
C) Hormonal contraceptives
D) Non-hormonal contraceptives
E) Barrier contraceptives
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Correct Answer: C) Hormonal contraceptives
Explanation: Oral contraceptive pills are classified as hormonal contraceptives because they contain synthetic forms of estrogen and/or progestin.
Question
Michelle, a 33-year-old woman, is unsure about the side effects of Plan B emergency contraception. She asks you which of the following is not a common side effect. What would you tell her?
A) Nausea
B) Breast tenderness
C) Vomiting
D) Severe mood swings
E) Dizziness
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Correct Answer: D) Severe mood swings
Explanation: While nausea, breast tenderness, and vomiting are common side effects of Plan B, severe mood swings are not typically associated with its use.
Question
John and Mary, a couple in their early 30s, are trying to avoid pregnancy using non-hormonal methods. They ask you which of the following is a non-contraceptive method. What would you advise?
A) Male condom
B) Intrauterine device (IUD)
C) Diaphragm
D) Fertility awareness method
E) Contraceptive patch
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Correct Answer: D) Fertility awareness method
Explanation: Fertility awareness methods involve tracking the menstrual cycle to avoid intercourse during the fertile window and do not involve any physical or chemical contraceptive devices.
Question
A 52-year-old woman is experiencing severe vasomotor symptoms during menopause, such as frequent hot flashes and night sweats. Which of the following would be the most appropriate treatment?
A) Oral contraceptives
B) Estrogen replacement therapy
C) Non-hormonal supplements
D) Progesterone-only pills
E) Antidepressants
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Correct Answer: B) Estrogen replacement therapy
Explanation: Estrogen replacement therapy is the most effective treatment for severe vasomotor menopausal symptoms such as hot flashes and night sweats.
Question
A 24-year-old woman is about to start oral contraceptive pills for the first time and is unsure when to begin taking them. What is the most appropriate advice regarding the timing to start her oral contraceptive pills?
A) Start the pills on the first day of her period
B) Start the pills on the first day of the month
C) Start the pills immediately, regardless of her cycle
D) Start the pills after 7 days of abstaining from intercourse
E) Start the pills on the last day of her period
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Correct Answer: A) Start the pills on the first day of her period
Explanation: Starting oral contraceptive pills on the first day of her period ensures immediate contraceptive protection and aligns with the natural menstrual cycle.
Question
A woman on oral contraceptive pills misses two consecutive pills during the second week of therapy. What should she do next?
A) Take two pills immediately and use backup contraception for 7 days
B) Discontinue the pack and start a new one
C) Take the missed pills and continue without backup contraception
D) Take one pill and use emergency contraception
E) Stop taking the pills and wait for her next period to restart
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Correct Answer: A) Take two pills immediately and use backup contraception for 7 days
Explanation: If two pills are missed during the second week, she should take two pills immediately and use backup contraception for the next 7 days.
Question
Emily, a 40-year-old woman, asks about the effects of excessive estrogen use. She has heard conflicting information. Which of the following is not a potential side effect of excessive estrogen use?
A) Nausea
B) Breast tenderness
C) Weight gain
D) Hot flashes
E) Increased risk of blood clots
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Correct Answer: D) Hot flashes
Explanation: Hot flashes are not caused by excessive estrogen use. They are more commonly associated with low estrogen levels, particularly during menopause.
Question
Lisa, a 24-year-old college student, has just taken Plan B emergency contraception after a condom broke during intercourse. She is concerned about potential side effects. Which of the following side effects is Lisa most likely to experience?
A) Nausea
B) Increased appetite
C) Weight gain
D) Depression
E) Hair loss
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Correct Answer: A) Nausea
Explanation: Nausea is a common side effect of Plan B emergency contraception due to the high dose of levonorgestrel.
Question
Maria, a 35-year-old woman with a history of deep vein thrombosis, is considering switching to progestin-only oral contraceptives. Which of the following is a contraindication for progestin-only oral contraceptives?
A) History of thromboembolic disease
B) Migraines without aura
C) High blood pressure
D) History of ovarian cysts
E) Irregular menstrual cycles
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Correct Answer: A) History of thromboembolic disease
Explanation: Progestin-only contraceptives are contraindicated in women with a history of thromboembolic disease due to the increased risk of clotting.
Question
A 30-year-old woman asks how long her oral contraceptive pills will remain effective after discontinuation. Which of the following statements about the duration of contraceptive effectiveness is incorrect?
A) Oral contraceptive pills prevent pregnancy during the cycle they are used
B) Contraceptive effectiveness ends as soon as pills are discontinued
C) Oral contraceptives continue to protect against pregnancy for up to 3 months after discontinuation
D) Fertility typically returns quickly after discontinuation of oral contraceptives
E) Oral contraceptive pills do not provide protection against sexually transmitted infections
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Correct Answer: C) Oral contraceptives continue to protect against pregnancy for up to 3 months after discontinuation
Explanation: Oral contraceptive pills do not continue to provide protection after discontinuation, and fertility typically returns quickly once they are stopped.
Question
Mr. R, a 28-year-old male, comes into the pharmacy asking about contraception options. He is specifically interested in learning about methods that would protect him and his partner from sexually transmitted infections (STIs). What method would you recommend to Mr. R?
A) Oral contraceptive pills
B) Male condom
C) Intrauterine device (IUD)
D) Diaphragm
E) Contraceptive ring
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Correct Answer: B) Male condom
Explanation: Male condoms are the only contraceptive method that also provides protection against sexually transmitted infections (STIs).
Question
A 16-year-old girl approaches the pharmacy and asks for information about oral contraceptives. She seems nervous and mentions that she has been thinking about starting birth control but is worried about confidentiality and how to talk to her parents. As a pharmacist, how should you handle this situation, considering the ethical and legal implications of discussing contraception with a minor?
Question 1: What is the most appropriate way to handle the situation?
A) Refuse to provide any information due to her age
B) Provide her with information but recommend she talk to her parents
C) Discuss the options confidentially, as minors have legal rights to access contraception in many jurisdictions
D) Refer her to a physician without providing any information
E) Contact her parents before providing any advice
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Answer:
C) Discuss the options confidentially, as minors have legal rights to access contraception in many jurisdictions
Explanation:
In many jurisdictions, minors have the legal right to access contraceptive information and services confidentially. It is important to respect her privacy and provide her with accurate information while maintaining confidentiality, without pressuring her to involve her parents unless she chooses to do so.
Follow-Up Question 1: If the pharmacist has religious beliefs that conflict with providing contraceptives, how should they handle the request?
A) Refuse the request and ask the patient to leave
B) Refer the patient to another pharmacist or pharmacy without judgment
C) Provide the contraceptives despite personal beliefs
D) Inform the patient that contraceptives are not available without explaining the reason
E) Offer counseling on natural family planning methods instead
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Answer:
B) Refer the patient to another pharmacist or pharmacy without judgment
Explanation:
Suppose the pharmacist has personal beliefs that conflict with providing contraceptives. In that case, they should refer the patient to another pharmacist or pharmacy who can fulfill the request, while maintaining professionalism and respecting the patient’s rights and needs – Conscience clause.
Follow-Up Question 2: The patient mentions that she is unsure about the different types of contraceptives and wants to know which option would best suit her. How should the pharmacist proceed?
A) Recommend oral contraceptives without discussing other options
B) Refer her to a website for information
C) Provide a detailed explanation of the different contraceptive options, including effectiveness, side effects, and how they work
D) Suggest she ask her friends for advice
E) Only discuss hormonal methods and avoid non-hormonal options
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Answer:
C) Provide a detailed explanation of the different contraceptive options, including effectiveness, side effects, and how they work
Explanation:
It is important to provide the patient with comprehensive information about all available contraceptive options, including both hormonal and non-hormonal methods, so she can make an informed decision based on her preferences and lifestyle.
Question
A 28-year-old woman is seeking emergency contraception and asks about ulipristal (Ella). What would you explain about the mechanism of ulipristal and the optimal timing for its use?
A) Ulipristal prevents ovulation and should be taken within 24 hours
B) Ulipristal works by thickening cervical mucus and must be taken within 48 hours
C) Ulipristal delays ovulation and is effective up to 120 hours (5 days) after unprotected sex
D) Ulipristal alters the endometrium and should be taken within 72 hours
E) Ulipristal prevents sperm from reaching the egg and is effective for up to 7 days
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Correct Answer: C) Ulipristal delays ovulation and is effective up to 120 hours (5 days) after unprotected sex
Explanation: Ulipristal (Ella) works by delaying ovulation and is effective for up to 120 hours (5 days) after unprotected sex, making it a good option for emergency contraception.
Question
A 30-year-old woman who weighs 85 kg asks for Plan B emergency contraception. She is concerned that her weight may affect the dosage. What should you tell her?
A) She may need a double dose of Plan B
B) Plan B is ineffective for women over 80 kg, and she should seek another option
C) Plan B is still effective, but its efficacy may be reduced at her weight
D) Weight does not affect the effectiveness of Plan B
E) Plan B is only effective for women under 60 kg
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Correct Answer: C) Plan B is still effective, but its efficacy may be reduced at her weight
Explanation: While Plan B may have reduced efficacy in women with higher body weight (over 80 kg), it can still be taken as emergency contraception. Patients should be counseled on the potential for reduced effectiveness and other options like ulipristal or a copper IUD.
Question
A woman comes to the pharmacy asking for Plan B emergency contraception. She had unprotected sex 18 hours ago. When is the latest she can take Plan B for it to be effective?
A) Within 24 hours
B) Within 48 hours
C) Within 72 hours
D) Within 5 days
E) Within 7 days
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Correct Answer: D) Within 5 days
Explanation: Plan B is most effective within 72 hours (3 days) but can still be used up to 5 days after unprotected sex, though its effectiveness decreases over time.
Question
A 35-year-old woman who is a smoker frequently forgets to take her oral contraceptive pills. Which of the following contraceptive methods would be more suitable for her?
A) Combined oral contraceptive pills
B) Progestin-only pills
C) Copper IUD
D) Contraceptive patch
E) Vaginal ring
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Correct Answer: C) Copper IUD
Explanation: A copper IUD would be a better option for a forgetful smoker because it doesn’t require daily dosing and avoids the increased risk of cardiovascular events associated with estrogen-containing methods in smokers.
Question
A patient using progestin-only contraceptives reports spotting between periods. How should you manage this side effect?
A) Advise discontinuation of the contraceptive
B) Reassure the patient that spotting is a common side effect and typically improves over time
C) Switch the patient to a combined oral contraceptive
D) Recommend taking an iron supplement
E) Suggest increasing the dose of progestin
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Correct Answer: B) Reassure the patient that spotting is a common side effect and typically improves over time
Explanation: Spotting is a common side effect of progestin-only contraceptives and usually improves with continued use. Patients should be reassured and monitored for any significant changes.