A nurse is reviewing contraception options for four clients. The nurse should identify that which of the following clients has a contraindication for receiving oral contraceptives.

Choice A: African American women have the BRCA 1 and BRCA 2 gene is not the correct answer because it is not a fact but a misconception. BRCA 1 and BRCA 2 are genes that normally help prevent breast and ovarian cancer by repairing DNA damage. However, mutations in these genes can increase the risk of developing these cancers. BRCA mutations are not exclusive to African American women, but they can affect any race or ethnicity. According to the National Cancer Institute, about 12% of American white women and 10% of African American women have a BRCA mutation.

Choice B: American white women respond better to breast cancer treatment is not the correct answer because it is not a fact but a disparity. Breast cancer treatment can include surgery, radiation, chemotherapy, hormone therapy, or targeted therapy. The response to treatment can vary depending on various factors such as tumor type, stage, grade, or molecular profile. However, some studies have shown that American white women have better survival rates and outcomes than African-American women after breast cancer treatment. This disparity may be due to differences in access to care, quality of care, socioeconomic status, or biological factors.

Choice C: Breast cancer is more advanced in African American women when found is the correct answer because it is a fact and a disparity. Breast cancer is a disease that occurs when abnormal cells grow and invade the breast tissue or other parts of the body. The stage of breast cancer describes how far the cancer has spread and how serious it is. Breast cancer can be detected by screening tests such as mammograms or clinical exams such as breast self-exams. However, some studies have shown that African American women are more likely than American white women to be diagnosed with breast cancer at later stages. This disparity may be due to differences in screening rates, awareness, symptoms, or tumor biology.

Choice D: More Hispanic women smoke, which increases their risk is not the correct answer because it is not a fact but a misconception. Smoking is a risk factor for breast cancer, as it can damage the DNA of breast cells and increase the levels of hormones that stimulate cell growth. However, smoking rates are not higher among Hispanic women than other racial or ethnic groups. According to the Centers for Disease Control and Prevention, about 14% of Hispanic women smoke cigarettes compared to 16% of American white women and 14% of African American women.

Choice A: Reports of itching, tingling and pain in genital area are the correct answer because they are common symptoms of genital herpes. Genital herpes is a sexually transmitted infection (STI) caused by the herpes simplex virus (HSV). It can cause outbreaks of painful blisters or sores on or around the genitals, anus, or mouth. The blisters or sores usually heal within a few weeks, but the virus remains in the body and can reactivate at any time. Before an outbreak, some people may experience prodromal symptoms such as itching, tingling, or pain in the affected area.

Choice B: Painful urination with a penile discharge present is not the correct answer because it is more likely a symptom of another STI, such as gonorrhea or chlamydia. Gonorrhea and chlamydia are bacterial infections that can affect the urethra, cervix, rectum, or throat. They can cause symptoms such as burning or pain during urination, abnormal discharge from the penis or vagina, or bleeding between periods.

Choice C: Wart-like flesh-colored lesions on the scrotal area are not the correct answer because they are more likely a symptom of another STI, such as human papillomavirus (HPV). HPV is a viral infection that can cause genital warts or cervical cancer. Genital warts are small, soft, flesh-colored growths that can appear on or around the genitals, anus, or mouth. They may be flat, raised, or cauliflower-shaped.

Choice D: A chancre on the penis is not the correct answer because it is more likely a symptom of another STI, such as syphilis. Syphilis is a bacterial infection that can affect various organs and systems of the body. It has four stages: primary, secondary, latent, and tertiary. In the primary stage, syphilis causes a painless sore called a chancre that can appear on or around the genitals, anus, or mouth. The chancre usually heals within a few weeks, but the infection can progress to the next stages if left untreated.