A nurse is caring for a client.

Click to highlight the findings that are contraindications to the use of a combined oral contraceptive. To deselect a finding, click on the finding again.

History and Physical

1 year ago:

33-year-old client here for routine physical examination and is requesting contraception until they attempt to conceive in about a year. Client has diabetes mellitus, diagnosed 24 years ago. Care is managed by an endocrinologist, has an insulin pump. States HbA1c was 6.7% last month. Client also has migraine headaches with aura and gastroesophageal reflux disease.

Client is a lifetime nonsmoker, reports rarely drinking alcohol. Client is a law enforcement officer and works full time. Reports exercising three or four times per week, usually walking for 2 to 3 miles or riding a stationary bike. Client had a tonsillectomy at 6 years of age. Also had a deep vein thrombosis while travelling internationally 5 years ago.

Client has diabetes mellitus, diagnosed 24 years ago

Client also has migraine headaches with aura

Client is a lifetime nonsmoker, reports rarely drinking alcohol

Also had a deep vein thrombosis while travelling internationally 5 years ago

Answer and Explanation

The Correct Answer is ["A","B","D"]

Rationale for correct choices

• Migraine headaches with aura: Combined oral contraceptives (COCs) increase the risk of ischemic stroke in individuals with migraine with aura. Estrogen-containing contraception can exacerbate cerebrovascular risk, making it a contraindication regardless of age or other vascular risk factors. Even with good glycemic control, the presence of aura elevates stroke risk significantly.

• History of deep vein thrombosis: COCs increase the risk of venous thromboembolism (VTE). A previous DVT is a strong contraindication because estrogen-containing contraceptives can trigger recurrence. Even if the event occurred years ago, the risk remains elevated, particularly in the presence of other risk factors such as immobility or hypercoagulable states.

• Diabetes mellitus (long-standing): Although the client currently has well-controlled blood sugar (HbA1c 6.7%), the duration of diabetes (24 years) significantly increases the risk of cardiovascular disease. Estrogen-containing contraceptives further elevate cardiovascular and thrombotic risk, making long-standing diabetes a relative contraindication.

Rationale for incorrect choices

• Lifetime nonsmoker / Rare alcohol use: Non-smoking status reduces cardiovascular risk, which is protective rather than contraindicating. Alcohol use in small amounts does not increase risk significantly.

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Free Nursing Study Resources

Correct Answer is A

Explanation

A. 0.9% normal saline: Initial fluid resuscitation in diabetic ketoacidosis (DKA) requires isotonic fluids like 0.9% normal saline to restore intravascular volume, improve perfusion, and correct electrolyte imbalances. This is the first-line intervention before initiating insulin therapy.

B. 0.45% saline: Half-normal saline is hypotonic and may be used later in DKA management if the client is stable and serum sodium is elevated. It is not appropriate as the initial continuous infusion because it does not provide adequate intravascular volume replacement.

C. Glargine insulin: Glargine is a long-acting insulin used for basal glucose control, not for acute management of DKA. Continuous IV insulin is required to rapidly reduce blood glucose and ketone levels.

D. NPH insulin: NPH is an intermediate-acting insulin administered subcutaneously. It is not suitable for continuous IV infusion in DKA, as IV insulin is preferred for rapid and controlled glucose reduction.

A. "Avoid consuming dairy products." B. "Eat something every 3 hours while awake." C. "Avoid drinking carbonated beverages." D. "Eat a high-protein snack at bedtime." E. "Drink liquids between, rather than with, meals."

Correct Answer is ["B","D","E"]

Explanation

A. "Avoid consuming dairy products.": Dairy products are not contraindicated in hyperemesis gravidarum unless the client experiences intolerance or triggers nausea. Eliminating dairy entirely is unnecessary and may reduce nutritional intake.

B. "Eat something every 3 hours while awake.": Frequent, small meals help prevent an empty stomach, which can worsen nausea and vomiting in hyperemesis gravidarum. This strategy promotes more consistent nutrient intake and reduces episodes of vomiting.

C. "Avoid drinking carbonated beverages.": Carbonated beverages are not universally contraindicated and may sometimes help settle nausea for some clients. Blanket avoidance is not required unless the client identifies carbonation as a personal trigger.

D. "Eat a high-protein snack at bedtime.": Consuming protein before bed can help maintain blood glucose levels overnight and reduce nausea upon waking, which is especially beneficial in managing hyperemesis gravidarum.

E. "Drink liquids between, rather than with, meals.": Drinking fluids between meals prevents the stomach from becoming too full during eating, which can exacerbate nausea and vomiting. This approach helps improve hydration without worsening gastrointestinal discomfort.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is admitting a client who has diabetic ketoacidosis. Which of the following types of continuous infusions should the nurse initiate?

Correct Answer is A

Explanation

The nurse has reviewed the Nurses' Notes from 5 days ago. The nurse is providing discharge teaching to the client. Select the 3 statements the nurse should make.

Correct Answer is ["B","D","E"]

Explanation

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