A nurse is receiving a telephone prescription for a client and documents it as metformin 500 mg PO BID. Which of the following elements should the nurse identify is missing from the prescription?

Choice A reason: A 32-year-old client who has benign breast disease does not have a contraindication for receiving oral contraceptives. Benign breast disease is not associated with an increased risk of breast cancer or thromboembolic events. However, the nurse should advise the client to perform regular breast self-examinations and report any changes.

Choice B reason: A 26-year-old client who has migraine headaches at the start of each menstrual cycle does not have a contraindication for receiving oral contraceptives. Migraine headaches that are related to the menstrual cycle may actually improve with oral contraceptives, as they can regulate the hormonal fluctuations. However, the nurse should monitor the client for any signs of stroke or hypertension, as these are rare but serious complications of oral contraceptives.

Choice C reason: A 28-year-old client who has a history of pelvic inflammatory disease does not have a contraindication for receiving oral contraceptives. Pelvic inflammatory disease is an infection of the reproductive organs that can cause infertility, chronic pain, and ectopic pregnancy. Oral contraceptives can reduce the risk of pelvic inflammatory disease by creating a thick cervical mucus that prevents the entry of bacteria. However, the nurse should remind the client that oral contraceptives do not protect against sexually transmitted infections, and that barrier methods should be used in addition.

Choice D reason: A 38-year-old client who reports smoking one pack of cigarettes every day has a contraindication for receiving oral contraceptives. Smoking increases the risk of cardiovascular diseases, such as myocardial infarction, stroke, and peripheral vascular disease. Oral contraceptives also increase the risk of these diseases, especially in women older than 35 years. Therefore, the combination of smoking and oral contraceptives can have a synergistic effect and cause serious harm. The nurse should recommend other methods of contraception for this client, such as intrauterine devices, implants, or injections.

Choice A reason: Increased intestinal peristalsis is not an effect of adrenergic agonist drugs, but rather of cholinergic drugs, which stimulate the parasympathetic nervous system. Adrenergic agonist drugs activate the sympathetic nervous system, which decreases intestinal motility.

Choice B reason: Bronchial constriction is also not an effect of adrenergic agonist drugs, but rather of cholinergic drugs, which cause bronchoconstriction and increased secretions. Adrenergic agonist drugs cause bronchodilation and decreased secretions.

Choice C reason: Increased heart rate is an effect of adrenergic agonist drugs, which stimulate the beta-1 receptors in the heart, causing increased cardiac output and blood pressure. This is why adrenergic agonist drugs are used to treat conditions such as shock, cardiac arrest, and heart failure.

Choice D reason: Constricted pupils is not an effect of adrenergic agonist drugs, but rather of cholinergic drugs, which cause miosis or pupil constriction. Adrenergic agonist drugs cause mydriasis or pupil dilation.