The women's health nurse is caring for a 30-year-old client who wants to use the ethinyl estradiol and norelgestromin patch for contraception. Regarding this method of birth control, which finding should be most concerning to the nurse?

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11ecbb05_ccb9_ec35_b433_6d25f41bb376_MD0009_00 The transdermal contraceptive patch (ethinyl estradiol and norelgestromin) is a combined hormonal contraceptive (CHC) that is absorbed through the skin. The client applies a patch weekly for 3 weeks, then removes it for 1 hormone-free week. The patch has similar contraindications as other CHCs, and some research shows that the patch may have an increased risk of thromboembolism (compared with oral contraception) due to higher serum concentrations of estrogen. A history of deep venous thrombosis (DVT) is the most concerning finding because of the additional risk of thromboembolic events when using CHCs (Option C). (Option A) CHCs help regulate menstrual cycles, typically reducing the amount of bleeding during menses; therefore, heavy menses is not as concerning as the client's history of DVT. (Option B) A personal history of breast cancer or the breast cancer susceptibility gene (BRCA) is concerning because contraceptives may stimulate hormone-dependent tumor growth. The nurse should report the family history to the health care provider, but it is not more concerning than a personal history of DVT or breast cancer. (Option D) The patch may have a higher failure rate in obese clients who are approximately >200 lb (90.7 kg) and should be avoided. The nurse should counsel the client about diet and exercise, but this is not more important than the client's history of DVT. Educational objective: The transdermal contraceptive patch (ethinyl estradiol and norelgestromin) is a combined hormonal contraceptive (CHC). As with all CHCs, a client history of thromboembolic events should concern the nurse because it may increase the risk of thromboembolic events while using the patch.

The Women's Health Nurse Is Caring for a 30-Year-Old Client