A nurse is gathering subjective data from a client seeking a prescription for an oral contraceptive. To identify risk factors associated with the use of an oral contraceptive, which question should the nurse ask?

• A. Are you dieting?
• B. Do you smoke cigarettes?
• C. Do you engage in strenuous exercise such as jogging?
• D. Do you normally have menstrual cramps with your periods?

Answer: (B)

Screening for cardiovascular risk with estrogen-containing contraceptives is essential. Smoking cigarettes markedly increases the risk of thromboembolism and other cardiovascular events when combined with estrogen in oral contraceptives. This risk rises with age and with the amount smoked, making smoking status the most important factor to identify before prescribing.

Other options don’t signal these safety concerns as directly. Dieting isn’t linked to the clotting risks of these pills, strenuous exercise is not a contraindication and can be beneficial, and menstrual cramps don’t indicate a cardiovascular risk related to the method. In short, asking about smoking helps determine whether an oral contraceptive is safe to use or whether an alternative method should be considered.