chap 31: Contraception

Question 1

1. Women who are taking an oral contraceptive containing the progesterone drospirenone may require monitoring of:
2. Hemoglobin
3. Serum calcium
4. White blood count
5. Serum potassium

Answer 1

4. Serum potassium

Question 2

2. The mechanism of action of oral combined contraceptives that prevents pregnancy is:
3. Estrogen prevents the luteinizing hormone surge necessary for ovulation.
4. Progestins thicken cervical mucus and slow tubal motility.
5. Estrogen thins the endometrium making implantation difficult.
6. Progestin suppresses follicle stimulating hormone release.

Answer 2

2. Progestins thicken cervical mucus and slow tubal motility.

Question 3

3. To improve actual effectiveness of oral contraceptives women should be educated regarding:
4. Use of a back-up method if they have vomiting or diarrhea during a pill packet
5. Doubling pills if they have diarrhea during the middle of a pill pack
6. The fact that they will have a normal menstrual cycle if they miss two pills
7. The fact that mid-cycle spotting is not normal and the provider should be contacted immediately

Answer 3

1. Use of a back-up method if they have vomiting or diarrhea during a pill packet

Question 4

4. A contraindication to the use of combined contraceptives is:
5. Adolescence (not approved for this age)
6. A history of clotting disorder
7. Recent pregnancy
8. Being overweight

Answer 4

2. A history of clotting disorder

Question 5

5. Obese women may have increased risk of failure with which contraceptive method?
6. Combined oral contraceptives
7. Progestin-only oral contraceptive pill
8. Injectable progestin
9. Combined topical patch

Answer 5

4. Combined topical patch

Question 6

6. Ashley comes to the clinic with a request for oral contraceptives. She has successfully used oral contraceptives before and has recently started dating a new boyfriend so would like to restart contraception. She denies recent intercourse and has a negative urine pregnancy test in the clinic. An appropriate plan of care would be:
7. Recommend she return to the clinic at the start of her next menses to get a Depo Provera shot.
8. Prescribe oral combined contraceptives and recommend she start them at the beginning of her next period and use a back-up method for the first 7 days.
9. Prescribe oral contraceptives and have her start them the same day as the visit with a back-up method used for the first 7 days.
10. Discuss the advantages of using the topical birth control patch and recommend she consider using the patch.

Answer 6

3. Prescribe oral contraceptives and have her start them the same day as the visit with a back-up method used for the first 7 days.

Question 7

7. When discussing with a patient the different start methods used for oral combined contraceptives, the advantage of a Sunday start over the other start methods is:
8. Immediate protection against pregnancy the first week of using the pill
9. No back-up method is needed when starting
10. Menses occur during the week
11. They can start the pill on the Sunday after the office visit

Answer 7

3. Menses occur during the week

Question 8

8. The topical patch combined contraceptive (Ortho Evra) is:
9. Started on the first day of the menstrual cycle
10. Recommended for women over 200 pounds
11. Not as effective as oral combined contraceptives
12. Known to have more adverse effects, such as nausea, than the oral combined contraceptives

Answer 8

1. Started on the first day of the menstrual cycle

Question 9

9. Progesterone-only pills are recommended for women who:
10. Are breastfeeding
11. Have a history of migraine
12. Have a medical history that contradicts the use of estrogen
13. All of the above

Answer 9

4. All of the above

Question 10

10. Women who are prescribed progestin-only contraception need education regarding which common adverse drug effects?
11. Increased migraine headaches
12. Increased risk of developing blood clots
13. Irregular vaginal bleeding for the first few months
14. Increased risk for hypercalcemia

Answer 10

3. Irregular vaginal bleeding for the first few months

Question 11

11. An advantage of using the NuvaRing vaginal ring for contraception is:
12. It does not require fitting and is easy to insert.
13. It is inserted once a week, eliminating the need to remember to take a daily pill.
14. Patients get a level of estrogen and progestin equal to combined oral contraceptives.
15. It also provides protection against vaginal infections.

Answer 11

1. It does not require fitting and is easy to insert.

Question 12

12. Oral emergency contraception (Plan B) is contraindicated in women who:
13. Had intercourse within the past 72 hours
14. May be pregnant
15. Are taking combined oral contraceptives
16. Are using a diaphragm

Answer 12

2. May be pregnant