A nurse is assessing a client to identify contraindications of hormonal contraceptive use. Which of the following Questions should the nurse ask the client? (Select All that Apply.)

Choice A rationale A personal or family history of breast cancer is a significant contraindication for hormonal contraceptive use due to the potential for exogenous hormones to stimulate hormone-sensitive cancers. Estrogen and progesterone can influence the growth of certain breast cancer types, making a thorough assessment of this history critical before prescribing hormonal contraception. Choice B rationale Numerous medications can interact with hormonal contraceptives, affecting their efficacy or increasing adverse effects. For instance, certain anticonvulsants, antibiotics, and antiretrovirals can accelerate the metabolism of hormonal contraceptives, reducing their effectiveness and increasing the risk of unintended pregnancy. Therefore, a comprehensive medication history is essential. Choice C rationale Smoking, especially in women over 35 years old, significantly increases the risk of serious cardiovascular adverse events such as myocardial infarction, stroke, and thromboembolism when combined with hormonal contraceptive use. Nicotine constricts blood vessels and promotes hypercoagulability, which is exacerbated by exogenous hormones. Choice D rationale Hypertension is a contraindication for many hormonal contraceptives, particularly those containing estrogen, as they can exacerbate elevated blood pressure and increase the risk of cardiovascular events. Hormonal contraceptives can affect the renin-angiotensin-aldosterone system, leading to fluid retention and increased vascular tone, thus worsening hypertension. Choice E rationale While excessive alcohol consumption can have various health consequences, it is not a direct contraindication to hormonal contraceptive use itself. It may, however, indirectly affect adherence to medication regimens or exacerbate other health issues. The primary concern with alcohol would be if it leads to liver impairment, which could affect hormone metabolism.