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: Bleeding between menses is not the correct answer because it is not a specific clinical manifestation of endometrial polyps. Bleeding between menses is a condition that causes spotting or bleeding at any time other than during the normal menstrual period. It can be caused by various factors such as hormonal imbalance, infection, or pregnancy. It can also occur in some women with endometrial polyps, but it is not a definitive sign of them.

Choice B: Bleeding after intercourse is not the correct answer because it is not a specific clinical manifestation of endometrial polyps. Bleeding after intercourse is a condition that causes bleeding from the vagina or cervix after sexual activity. It can be caused by various factors such as trauma, infection, or cancer. It can also occur in some women with endometrial polyps, but it is not a definitive sign of them.

Choice C: Metrorrhagia is the correct answer because it is a specific clinical manifestation of endometrial polyps. Metrorrhagia is a condition that causes irregular or excessive bleeding from the uterus that is unrelated to the menstrual cycle. It can be caused by various factors such as polyps, fibroids, or cancer. It is a common symptom of endometrial polyps, which are benign growths of the endometrium (the lining of the uterus) that can protrude into the uterine cavity and cause bleeding.

Choice D: Vaginal discharge is not the correct answer because it is not a specific clinical manifestation of endometrial polyps. Vaginal discharge is a fluid that comes out of the vagina and varies in color, consistency, and odor depending on the phase of the menstrual cycle, sexual activity, or health status. It can be caused by various factors such as normal secretions, infection, or inflammation. It is not a common symptom of endometrial polyps, which do not usually affect the vaginal flora or pH.