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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.

A.

Client has diabetes mellitus, diagnosed 24 years ago

B.

Client also has migraine headaches with aura

C.

Client is a lifetime nonsmoker, reports rarely drinking alcohol

D.

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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Related Questions

Correct Answer is {"A":{"answers":"A"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"B"},"E":{"answers":"A"}}

Explanation

Rationale:

• Encourage the client to turn from side to side: Epidural anesthesia can cause hypotension and decreased uteroplacental perfusion due to sympathetic blockade. Frequent position changes help promote venous return, enhance circulation, and optimize fetal oxygenation during active labor.

• Assist the client with ambulation: Epidural anesthesia causes motor and sensory block in the lower extremities. The client will likely have reduced strength and sensation in her legs, making walking extremely dangerous due to the high risk of falls.

• Assess for urinary retention: Epidural anesthesia reduces bladder sensation and the urge to void, increasing the risk of urinary retention. A distended bladder can interfere with fetal descent and labor progress, making ongoing assessment necessary.

• Inform the client to expect drowsiness: Epidurals are local/regional anesthetics, not systemic sedatives. While the client may feel relaxed because the pain has subsided, drowsiness is not an expected side effect of an epidural. If a patient becomes drowsy or lethargic, it could indicate a complication like systemic toxicity or a profound drop in blood pressure.

• Monitor for elevated temperature: Epidural anesthesia is associated with an increased risk of maternal fever. Ongoing temperature monitoring helps identify infection or epidural-related hyperthermia early to protect both the client and fetus.

Correct Answer is B

Explanation

A. A 25-gauge needle: Small-gauge needles like a 25-gauge are not suitable for accessing implanted venous ports because they may not provide sufficient flow for infusion and can increase the risk of needle bending or damage.

B. A noncoring needle: Noncoring needles, such as a Huber needle, are specifically designed for accessing implanted ports. They prevent coring of the septum, preserving the integrity of the port and reducing the risk of damage or infection while allowing safe infusion of medications and fluids.

C. A butterfly needle: Butterfly needles are designed for peripheral venous access and are not appropriate for implanted ports. Using them could damage the port septum and compromise long-term functionality.

D. An angiocatheter: Angiocatheters are intended for peripheral or central line insertion and are not designed for repeated access of the septum in implanted ports. Their use could increase the risk of leakage, infection, or port damage.

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