A nurse is collecting information from a new client who is seeking prenatal care.
Which of the following findings should the nurse identify as a risk factor that increases the risk of pregnancy complications?

Choice A rationale

At 16 weeks of gestation, the uterine fundus has not yet reached the umbilicus. The umbilicus is typically reached around 20 weeks of gestation. Palpating the fundus at the umbilicus at 16 weeks would suggest a discrepancy in gestational age or a potential complication such as polyhydramnios or multiple gestation, warranting further investigation.

Choice B rationale

The uterine fundus is palpable at 16 weeks of gestation. By this stage, the uterus has grown significantly and ascended out of the pelvis, making it accessible to abdominal palpation. Failure to palpate the fundus at this stage could indicate an inaccurate gestational age, ectopic pregnancy, or other uterine abnormalities, requiring clinical correlation.

Choice C rationale

At 16 weeks of gestation, the uterine fundus is typically palpable approximately halfway between the symphysis pubis and the umbilicus. This anatomical landmark serves as a reliable indicator of gestational age during the second trimester. The fundus ascends by approximately 1 cm per week after 12 weeks of gestation, providing a consistent growth pattern.

Choice D rationale

At 16 weeks of gestation, the uterine fundus is well above the pubic bone. It typically becomes palpable just above the pubic bone around 12 to 14 weeks of gestation as it rises out of the pelvic cavity. Finding the fundus only just above the pubic bone at 16 weeks would suggest a lag in uterine growth or an inaccurate gestational age assessment.

Choice A rationale

A personal or family history of breast cancer is a significant contraindication for hormonal contraceptive use due to the potential for exogenous hormones to stimulate hormone-sensitive cancers. Estrogen and progesterone can influence the growth of certain breast cancer types, making a thorough assessment of this history critical before prescribing hormonal contraception.

Choice B rationale

Numerous medications can interact with hormonal contraceptives, affecting their efficacy or increasing adverse effects. For instance, certain anticonvulsants, antibiotics, and antiretrovirals can accelerate the metabolism of hormonal contraceptives, reducing their effectiveness and increasing the risk of unintended pregnancy. Therefore, a comprehensive medication history is essential.

Choice C rationale

Smoking, especially in women over 35 years old, significantly increases the risk of serious cardiovascular adverse events such as myocardial infarction, stroke, and thromboembolism when combined with hormonal contraceptive use. Nicotine constricts blood vessels and promotes hypercoagulability, which is exacerbated by exogenous hormones.

Choice D rationale

Hypertension is a contraindication for many hormonal contraceptives, particularly those containing estrogen, as they can exacerbate elevated blood pressure and increase the risk of cardiovascular events. Hormonal contraceptives can affect the renin-angiotensin-aldosterone system, leading to fluid retention and increased vascular tone, thus worsening hypertension.

Choice E rationale

While excessive alcohol consumption can have various health consequences, it is not a direct contraindication to hormonal contraceptive use itself. It may, however, indirectly affect adherence to medication regimens or exacerbate other health issues. The primary concern with alcohol would be if it leads to liver impairment, which could affect hormone metabolism.