The patient has smoked a pack of cigarettes per day for 20 years. The patient also takes oral contraceptives. In implementing a teaching plan, what is the most important information for the nurse to include?
1. "You are at a higher risk for a heart attack than nonsmokers."
2. "The nicotine will decrease the effectiveness of your birth control pills."
3. "You are at a higher risk for developing diabetes than smokers who do not use birth control pills."
4. "You are at a higher risk for emphysema than nonsmokers."
Correct Answer: 1
Rationale: Cardiovascular effects can be particularly serious in patients taking oral contraceptives if they also smoke. The risk of a fatal heart attack is five times greater in smokers who also use oral contraceptives than in nonsmokers. There is no evidence to support that nicotine decreases the effectiveness of oral contraceptives. Smokers are at higher risk for emphysema, but this has nothing do with the patient's use of oral contraceptives. There is no evidence to support a correlation between diabetes, smoking, and oral contraceptives.
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