The patient who has a positive human chorionic gonadotropin test tells the nurse, “I don’t understand how this happened! I take my combined hormonal contraceptive (CHC) pill every single day at the exact same time!” The nurse asks the patient which question(s)? Select all that apply.

“Do you take St. John’s Wort?”, “Have you been prescribed antibiotics recently?”. St. John’s Wort and some antibiotics can both decrease circulating estrogen levels leading to an increased risk for contraceptive failure. Smoking cigarettes, although not recommended while taking hormonal birth control, does not increase the risk for contraceptive failure. Breakthrough bleeding and vitamin C supplementation are not associated with increased risk for contraceptive failure.