During a postpartum follow-up, a woman with a history of deep vein thrombosis (DVT) asks about starting birth control pills.
What is the nurse's best response?
Estrogen-containing contraceptives are contraindicated due to your history of blood clots.
Birth control pills will actually lower your risk of another blood clot.
The barrier method such as condoms is the only safe option with your history.
You can safely use any oral contraceptive.
The Correct Answer is A
Choice A rationale
Estrogen-containing contraceptives significantly increase the risk of venous thromboembolism (VTE), which includes DVT, by altering the balance of the coagulation cascade. Estrogen promotes the synthesis of clotting factors while simultaneously decreasing the levels of antithrombin, thereby creating a hypercoagulable state. For women with a prior history of DVT, this elevated VTE risk makes all estrogen-containing contraceptives absolutely contraindicated to prevent recurrence.
Choice B rationale
This statement is scientifically incorrect and potentially harmful. Estrogen-containing birth control pills increase, not lower, the risk of DVT, typically 3-to-9-fold compared to non-users, especially in individuals with pre-existing risk factors like a DVT history. The synthetic estrogen component directly contributes to blood hypercoagulability by increasing liver production of pro-thrombotic proteins.
Choice C rationale
While barrier methods like condoms are safe as they have no systemic hormonal effects, they are not the only safe contraceptive option. Progestin-only contraceptives (e.g., progestin-only pills, depot injection, hormonal IUDs) and non-hormonal IUDs are also considered safe and effective alternatives because progestins alone do not carry the same significant thrombogenic risk as estrogen.
Choice D rationale
This is a dangerous and incorrect statement. A personal history of DVT is a definitive contraindication for the use of any combined oral contraceptive (COC) or any method containing estrogen, due to the high risk of VTE recurrence. The potential for a life-threatening pulmonary embolism outweighs the benefits, necessitating the exclusive use of non-estrogen methods. —. ##
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Newborns, especially breastfed ones, need to feed frequently, usually 8 to 12 times in 24 hours or every 2 to 3 hours, not every 4-6 hours. Frequent feeding is essential because breast milk is easily digested, and the newborn's stomach capacity is small. Delaying feedings can lead to insufficient caloric intake, potentially causing hypoglycemia, inadequate weight gain, and lower milk supply development. —.
Choice B rationale
Keeping a baby swaddled during breastfeeding can hinder feeding by restricting arm and hand movement. This restriction prevents the infant from using their hands for self-attachment or tactile stimulation, which are cues that promote effective latch and suckling. The baby should be unwrapped to allow this sensory input and maximize the opportunity for an optimal feeding experience. —.
Choice C rationale
Demand feeding or cue-based feeding, which involves feeding the infant whenever they exhibit signs of hunger (e.g., rooting, sucking, hand-to-mouth movements), is the recommended practice for successful breastfeeding. This approach ensures the baby receives adequate nutrition and stimulates the mother's breasts to produce a milk supply that matches the baby's individual needs, following the principle of supply and demand. —.
Choice D rationale
Fussiness or perceived dissatisfaction should not automatically lead to formula supplementation or switching, as this can interfere with the establishment of the mother's milk supply and the baby's ability to regulate intake. Instead, the mother should ensure a proper latch and continue to offer the breast frequently, seeking professional lactation support before introducing formula. —. ##
Correct Answer is C
Explanation
Choice A rationale
Palpating the fundus 2 cm above the symphysis pubis is typically found immediately following birth or within the first 12 hours postpartum. The uterus begins the process of involution immediately after birth, rapidly descending into the pelvis. By 24 hours postpartum, the fundus should be roughly at the level of the umbilicus, making this choice incorrect for 24 hours postpartum.
Choice B rationale
Finding the uterine fundus 2 cm above the umbilicus is a finding that is expected immediately after birth, usually within the first hour. The fundus rapidly descends to the level of the umbilicus by 24 hours postpartum, due to the sustained uterine contractions that decrease its mass and volume through the catabolic process of autolysis.
Choice C rationale
The uterine fundus is expected to be at the level of the umbilicus or 1 to 2 cm below the umbilicus approximately 24 hours after birth. Involution, the process of the uterus returning to its non-pregnant state, causes the fundus to descend by about 1 cm or one finger breadth each day.
Choice D rationale
While the fundus is often at the level of the umbilicus at 24 hours postpartum, it's more precise to say it may be slightly lower, 1 to 2 cm below it. This rapid descent is due to uterine contractions reducing the size of the myometrium, driven by oxytocin release from the posterior pituitary gland in response to breastfeeding or administration. —.
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