A nurse is leading a discussion about contraception with a group of 14-year-old clients. After the presentation, a client asks the nurse which method would be best for her to use. Which of the following responses should the nurse make?

Choice A: Encourage her to turn, cough, and deep breathe at frequent intervals. This intervention is appropriate for the nurse to include in the client's plan of care at this time because it can help prevent respiratory complications such as atelectasis (collapse of lung tissue) or pneumonia after surgery. Turning, coughing, and deep breathing can help expand the lungs, clear the airways, and improve oxygenation.

Choice B: Ask the client how she feels about having her breast removed. This intervention is not appropriate for the nurse to include in the client's plan of care at this time because it may be too intrusive or insensitive. Asking the client how she feels about having her breast removed may trigger emotional distress or anxiety in the client who has just undergone a major surgery that affects her body image and self-esteem. The nurse should wait until the client is more stable and ready to talk about her feelings and concerns.

Choice C: Attach a sign above her bed to have BP, IV lines, and lab work in her right arm. This intervention is not appropriate for the nurse to include in the client's plan of care at this time because it is incorrect and potentially harmful. Attaching a sign above her bed to have BP, IV lines, and lab work in her right arm may cause injury or infection to the arm that has undergone surgery and lymph node removal. The nurse should attach a sign above her bed to have BP, IV lines, and lab work in her left arm instead.

Choice D: Position her right arm below heart level. This intervention is not appropriate for the nurse to include in the client's plan of care at this time because it is incorrect and potentially harmful. Positioning her right arm below heart level may impair the blood circulation and lymphatic drainage of the arm that has undergone surgery and lymph node removal. The nurse should position her right arm above heart level instead.

Choice A: A 26-year-old client who has migraine headaches at the start of each menstrual cycle is not the correct answer because they do not have a contraindication for receiving oral contraceptives. Oral contraceptives are pills that contain synthetic hormones (estrogen and progestin) that prevent ovulation and pregnancy. They can also help reduce menstrual cramps, bleeding, and migraines in some women. However, oral contraceptives may increase the risk of stroke in women who have migraines with aura (visual disturbances), so they should be used with caution and under medical supervision.

Choice B: A 28-year-old client who has a history of pelvic inflammatory disease is not the correct answer because they do not have a contraindication for receiving oral contraceptives. Pelvic inflammatory disease is an infection that affects the female reproductive organs, such as the uterus, fallopian tubes, or ovaries. It can be caused by various bacteria, such as chlamydia or gonorrhea, and can lead to infertility, ectopic pregnancy, or chronic pelvic pain if left untreated. Oral contraceptives can help prevent pelvic inflammatory disease by creating a thick cervical mucus that blocks the entry of bacteria into the uterus.

Choice C: A 32-year-old client who has benign breast disease is not the correct answer because they do not have a contraindication for receiving oral contraceptives. Benign breast disease is a term that refers to various noncancerous conditions that affect the breast tissue, such as fibrocystic changes, fibroadenomas, or mastitis. They can cause symptoms such as breast pain, tenderness, or lumps. Oral contraceptives can help reduce the symptoms of benign breast disease by regulating the hormonal fluctuations that influence breast tissue growth.

Choice D: A 38-year-old client who reports smoking one pack of cigarettes every day is the correct answer because they have a contraindication for receiving oral contraceptives. Smoking is a habit that involves inhaling tobacco smoke, which contains harmful substances such as nicotine, tar, or carbon monoxide. Smoking can increase the risk of various diseases such as lung cancer, chronic obstructive pulmonary disease (COPD), or cardiovascular disease. Oral contraceptives can further increase the risk of cardiovascular disease in smokers, especially those who are over 35 years old, by increasing blood pressure, cholesterol levels, and clotting factors. Therefore, oral contraceptives are not recommended for smokers and alternative methods of contraception should be used instead.