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.
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Methylergonovine is an uterotonic agent that acts on the smooth muscle of the uterus to stimulate strong, sustained contractions, which are essential for compressing the intramyometrial blood vessels and achieving hemostasis to stop postpartum hemorrhage, especially from uterine atony.
Choice B rationale
While oxygen is important for hypoxia secondary to blood loss, administering it at 2 L/min via nasal cannula is typically insufficient for a client experiencing significant hemorrhage. High-flow oxygen, such as 10 to 15 L/min via nonrebreather mask, is usually required to maximize oxygen saturation.
Choice C rationale
Starting an IV bolus of Dextrose 5.
Choice D rationale
The knee-chest position is generally used to relieve cord compression or help with the manual rotation of the fetus, but it is not an established intervention for managing postpartum hemorrhage. The client should be positioned flat with legs elevated to promote venous return and manage shock.
Correct Answer is C
Explanation
Choice A rationale
A transvaginal fetal Doppler probe is an internal device used early in pregnancy to confirm fetal viability or heart rate in the first trimester, not an appropriate method for continuous intrapartum monitoring in a full-term client with intact membranes.
Choice B rationale
The DeLee-Hillis fetoscope is an external acoustic device used for intermittent auscultation of the fetal heart rate, providing a listening assessment rather than the prescribed continuous electronic tracing required for this client.
Choice C rationale
An external ultrasound transducer monitor (or tocodynamometer for contractions) uses non-invasive Doppler technology placed on the client's abdomen to detect and continuously monitor the fetal heart rate and uterine contractions when membranes are intact, satisfying the continuous monitoring prescription without internal access.
Choice D rationale
An internal fetal scalp electrode (FSE) requires the rupture of membranes and sufficient cervical dilation for placement onto the fetal scalp to provide a precise electrocardiogram of the fetal heart, which is not applicable since the client's membranes are intact.
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