A nurse is reviewing the medical record of a client who is requesting an oral contraceptive. Which of the following findings should the nurse identify as a contraindication to the use of oral contraceptives?

A. History of renal calculi: Kidney stones do not directly increase the risk of complications from oral contraceptives. While maintaining hydration is important, a history of renal calculi is not considered a contraindication to combined hormonal contraceptive use. B. Migraines with aura: Migraines with aura are associated with an increased risk of ischemic stroke, which is further elevated by estrogen-containing oral contraceptives. Because of this heightened vascular risk, migraines with aura are considered a contraindication to estrogen-based contraceptives, and alternative methods should be recommended. C. BMI of 26: A body mass index in the overweight range does not constitute a contraindication to oral contraceptives. While efficacy may be slightly reduced in higher BMI individuals, oral contraceptives are generally safe and can be used with routine monitoring. D. History of cholecystectomy: Removal of the gallbladder does not prevent safe use of oral contraceptives. Although estrogen can affect bile composition, past cholecystectomy does not increase the risk of serious complications from oral contraceptive therapy.