A nurse is reviewing the medical record of a client who is requesting an oral contraceptive for birth control.
The nurse should identify which of the following findings as a contraindication for the use of oral contraceptives for this client?

Migraine with aura.

Hypotension.

Dysmenorrhea.

History of ovarian cysts.

Answer and Explanation

The Correct Answer is A

Choice A rationale

Migraine with aura is considered a Category 4 contraindication (unacceptable health risk) for the use of combined hormonal contraceptives (CHCs), including oral contraceptives. The estrogen component in CHCs increases the risk of ischemic stroke, and this risk is substantially amplified in clients who experience migraine headaches with focal neurological symptoms (aura), necessitating the selection of an alternative birth control method.

Choice B rationale

Hypotension (low blood pressure) is typically not a contraindication for oral contraceptive use. In fact, some studies suggest a potential, though often clinically insignificant, increase in blood pressure with CHC use due to a potential increase in circulating angiotensinogen, the precursor to the vasoconstrictive hormone angiotensin II. The use of CHCs is not restricted based on hypotension.

Choice C rationale

Dysmenorrhea (painful menstruation) is often significantly improved or resolved by the use of combined oral contraceptives (COCs). COCs work by suppressing ovulation and thinning the endometrial lining, which typically reduces prostaglandin production, thus decreasing the cramping and pain associated with the menstrual cycle, making it an indication, not a contraindication.

Choice D rationale

A history of ovarian cysts is generally not a contraindication for combined oral contraceptive use, provided the cysts were non-malignant and resolved or are benign. In fact, COCs can be used to treat or prevent the recurrence of functional ovarian cysts by suppressing the hormonal stimulation of the ovaries that leads to their formation, making it a potential therapeutic benefit.

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Correct Answer is ["A","E","F"]

Explanation

Body System	Finding	Interpretation	Report to Provider?
Neurologic	Irritability	Can be normal if mild, but persistent irritability may indicate hypoglycemia, hypocalcemia, withdrawal, or infection → concerning	✅ Yes
	Pupil response (brisk, equal)	Normal neuro finding	❌ No
Integumentary	Milia on nose/cheeks	Benign, normal newborn finding	❌ No
	Lanugo on shoulders	Normal in preterm/term newborns	❌ No
Cardiopulmonary	Axillary temperature 36.2°C (97.2°F)	Low temp (normal 36.5–37.5°C). Hypothermia can indicate infection, poor thermoregulation	✅ Yes
	Respiratory rate 80/min	Tachypnea (normal 30–60/min). May indicate respiratory distress, sepsis, metabolic issue	✅ Yes
	Apical heart rate 158/min	Normal (110–160/min)	❌ No
	Lung findings (clear)	Normal	❌ No
Gastrointestinal	Stool characteristics (meconium, normal)	Normal	❌ No
	Abdomen findings (not abnormal)	Normal	❌ No

🧾 Explanation

Irritability: While some fussiness is expected, persistent irritability is a red flag for metabolic or infectious causes.
Temperature 36.2°C: Below normal → newborn hypothermia, which can worsen quickly.
Respiratory rate 80/min: Markedly elevated → tachypnea, possible respiratory distress or sepsis.
Other findings (milia, lanugo, brisk pupils, HR 158, clear lungs, normal stool) are expected newborn variations and do not require reporting.

✅ Final Answer: The nurse should report:

Neurologic: Irritability
Cardiopulmonary: Axillary temperature 36.2°C
Cardiopulmonary: Respiratory rate 80/min

A. Nonreactive nonstress test. B. The fetus had four limb movements in 30 minutes. C. The fetus had 20 seconds of sustained breathing movements in 30 minutes. D. Amniotic fluid index of 1 cm.

Correct Answer is B

Explanation

Choice A rationale

A nonreactive nonstress test (NST), defined by having fewer than two accelerations of at least 15 beats per minute (BPM) above baseline, lasting at least 15 seconds, within a 20-minute window, indicates potential fetal compromise or sleep state, leading to a maximum score of 0 on this component, thus not indicating well-being.

Choice B rationale

The biophysical profile (BPP) scores fetal movement with a maximum of 2 points for three or more discrete body or limb movements within a 30-minute period. The finding of four limb movements clearly meets this criterion and earns the full 2 points, reflecting an intact central nervous system and adequate fetal oxygenation, which is a sign of fetal well-being.

Choice C rationale

The BPP criterion for fetal breathing movements requires at least one episode of sustained movements for 30 seconds within the 30-minute observation period to score 2 points. The finding of 20 seconds is insufficient to meet this 30-second threshold, resulting in a score of 0 points for this component and thus not indicating full well-being.

Choice D rationale

The amniotic fluid index (AFI) measures the sum of the deepest vertical pockets of amniotic fluid in the four quadrants of the uterus. An AFI of 1 cm is significantly below the normal range of 5 cm to 25 cm, indicating oligohydramnios (low fluid). This finding scores 0 points on the BPP and suggests potential chronic fetal compromise or renal issues.

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A nurse is reviewing the medical record of a client who is requesting an oral contraceptive for birth control. The nurse should identify which of the following findings as a contraindication for the use of oral contraceptives for this client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is ["A","E","F"]

Explanation

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Correct Answer is B

Explanation

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A nurse is reviewing the medical record of a client who is requesting an oral contraceptive for birth control.
The nurse should identify which of the following findings as a contraindication for the use of oral contraceptives for this client?