A nurse in a family planning clinic is reviewing the health histories for several clients. Which of the following clients should the nurse notify the provider as having a potential contraindication to combined oral contraceptives?

A. A client who has a history of menorrhagia: Combined oral contraceptives can actually help manage menorrhagia by regulating menstrual cycles and reducing blood loss, making this condition a therapeutic indication rather than a contraindication. B. A client who is scheduled for orthopedic surgery in 3 weeks: Combined oral contraceptives increase the risk of thromboembolism. Surgery and postoperative immobility further elevate this risk, so the provider should be notified, and the medication may need to be discontinued before surgery. C. A client who is 4 months postpartum: By 4 months postpartum, the risk of thromboembolism has decreased significantly, and combined oral contraceptives can typically be used safely, especially if the client is not breastfeeding. D. A client who has a history of renal disease: While renal disease requires careful monitoring, it is not an absolute contraindication to combined oral contraceptive use. The primary concern remains the increased risk of clot formation in high-risk situations such as surgery or immobility.