Chapter 8 Flashcards
- A woman has chosen the calendar method of conception control. Which is the most important action the nurse should perform during the assessment process?
a. Obtain a history of the woman’s menstrual cycle lengths for the past 6 to 12 months.
b. Determine the client’s weight gain and loss pattern for the previous year.
c. Examine skin pigmentation and hair texture for hormonal changes.
d. Explore the client’s previous experiences with conception control.
ANS: A
The calendar method of conception control is based on the number of days in each cycle, counting from the first day of menses. The fertile period is determined after the lengths of menstrual cycles have been accurately recorded for 6 months. Weight gain or loss may be partly related to hormonal fluctuations, but it has no bearing on the use of the calendar method. Integumentary changes may be related to hormonal changes, but they are not indicators for use of the calendar method. Exploring previous experiences with conception control may demonstrate client understanding and compliancy, but these experiences are not the most important aspect to assess for the discussion of the calendar method.
- A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs). Which response by the nurse is most appropriate?
a. “They’re not very effective, and it is very likely that you’ll get pregnant.”
b. “FAMs can be effective for many couples; however, they require motivation.”
c. “These methods have a few advantages and several health risks.”
d. “You would be much safer going on the pill and not having to worry.”
ANS: B
FAMs are effective with proper vigilance about ovulatory changes in the body and with adherence to coitus intervals. FAMs are effective if correctly used by a woman with a regular menstrual cycle. The typical failure rate for all FAMs is 24% during the first year of use. FAMs have no associated health risks. The use of birth control has associated health risks. In addition, taking a pill daily requires compliance on the client’s part.
- A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice. What is the nurse’s best response?
a. “Oral contraceptives are a highly effective method, but they have some side effects.”
b. “Your current medications will reduce the effectiveness of the pill.”
c. “Oral contraceptives will reduce the effectiveness of your seizure medication.”
d. “The pill is a good choice for a woman of your age and with your personal history.”
ANS: B
Because the liver metabolizes oral contraceptives, their effectiveness is reduced when they are simultaneously taken with anticonvulsants. Stating that the pill is an effective birth control method with side effects is a true statement, but this response is not the most appropriate. The anticonvulsant reduces the effectiveness of the pill, not the other way around. Stating that the pill is a good choice for a woman of her age and personal history does not teach the client that the effectiveness of the pill may be reduced because of her anticonvulsant therapy.
- A woman who has just undergone a first-trimester abortion will be using oral contraceptives. To protect against pregnancy, the client should be advised to do what?
a. Avoid sexual contact for at least 10 days after starting the pill.
b. Use condoms and foam for the first few weeks as a backup.
c. Use another method of contraception for 1 week after starting the pill.
d. Begin sexual relations once vaginal bleeding has ended.
ANS: C
If oral contraceptives are to be started within 3 weeks after an abortion, additional forms of contraception should be used throughout the first week to avoid the risk of pregnancy.
- Which client would be an ideal candidate for injectable progestins such as Depo-Provera (DMPA) as a contraceptive choice?
a. The ideal candidate for DMPA wants menstrual regularity and predictability.
b. The client has a history of thrombotic problems or breast cancer.
c. The ideal candidate has difficulty remembering to take oral contraceptives daily.
d. The client is homeless or mobile and rarely receives health care.
ANS: C
Advantages of DMPA include its contraceptive effectiveness, compared with the effectiveness of combined oral contraceptives, and the requirement of only four injections a year. The disadvantages of injectable progestins are prolonged amenorrhea and uterine bleeding. The use of injectable progestin carries an increased risk of venous thrombosis and thromboembolism. To be effective, DMPA injections must be administered every 11 to 13 weeks. Access to health care is necessary to prevent pregnancy or potential complications.
- A client currently uses a diaphragm and spermicide for contraception. She asks the nurse to explain the major differences between the cervical cap and the diaphragm. What is the most appropriate response by the nurse?
a. “No spermicide is used with the cervical cap, so it’s less messy.”
b. “The diaphragm can be left in place longer after intercourse.”
c. “Repeated intercourse with the diaphragm is more convenient.”
d. “The cervical cap can be safely used for repeated acts of intercourse without adding more spermicide later.”
ANS: D
The cervical cap can be inserted hours before sexual intercourse without the need for additional spermicide later. Spermicide should be used inside the cap as an additional chemical barrier. The cervical cap should remain in place for 6 hours after the last act of intercourse. Repeated intercourse with the cervical cap is more convenient because no additional spermicide is needed.
- Which statement regarding emergency contraception is correct?
a. Emergency contraception requires that the first dose be taken within 72 hours of unprotected intercourse.
b. Emergency contraception may be taken right after ovulation.
c. Emergency contraception has an effectiveness rate in preventing pregnancy of approximately 50%.
d. Emergency contraception is commonly associated with the side effect of menorrhagia.
ANS: A
Emergency contraception should be taken as soon as possible or within 72 hours of unprotected intercourse to prevent pregnancy. If taken before ovulation, follicular development is inhibited, which prevents ovulation. The risk of pregnancy is reduced by as much as 75%. The most common side effect of postcoital contraception is nausea.
- An unmarried young woman describes her sex life as “active” and involving “many” partners. She wants a contraceptive method that is reliable and does not interfere with sex. She requests an intrauterine device (IUD). Which information is most important for the nurse to share?
a. “The IUD does not interfere with sex.”
b. “The risk of pelvic inflammatory disease will be higher with the IUD.”
c. “The IUD will protect you from sexually transmitted infections.”
d. “Pregnancy rates are high with the IUD.”
ANS: B
Disadvantages of IUDs include an increased risk of pelvic inflammatory disease (PID) in the first 20 days after insertion, as well as the risks of bacterial vaginosis and uterine perforation. The IUD offers no protection against sexually transmitted infections (STIs) or the human immunodeficiency virus (HIV), as does a barrier method. Because this woman has multiple sex partners, she is at higher risk of developing an STI. Stating that an IUD does not interfere with sex may be correct; however, it is not the most appropriate response. The typical failure rate of the IUD is approximately 1%.
- A woman is 16 weeks pregnant and has elected to terminate her pregnancy. Which is the most common technique used for the termination of a pregnancy in the second trimester?
a. Dilation and evacuation (D&E)
b. Methotrexate administration
c. Prostaglandin administration
d. Vacuum aspiration
ANS: A
D&E can be performed at any point up to 20 weeks of gestation. It is more commonly performed between 13 and 16 weeks of gestation. Methotrexate is a cytotoxic drug that causes early abortion by preventing fetal cell division. Prostaglandins are also used for early abortion and work by dilating the cervix and initiating uterine wall contractions. Vacuum aspiration is used for abortions in the first trimester.
- A woman will be taking oral contraceptives using a 28-day pack. What advice should the nurse provide to protect this client from an unintended pregnancy?
a. Limit sexual contact for one cycle after starting the pill.
b. Use condoms and foam instead of the pill for as long as the client takes an antibiotic.
c. Take one pill at the same time every day.
d. Throw away the pack and use a backup method if two pills are missed during week 1 of her cycle.
ANS: C
To maintain adequate hormone levels for contraception and to enhance compliance, clients should take oral contraceptives at the same time each day. If contraceptives are to be started at any time other than during normal menses or within 3 weeks after birth or an abortion, then another method of contraception should be used through the first week to prevent the risk of pregnancy. Taken exactly as directed, oral contraceptives prevent ovulation, and pregnancy cannot occur. No strong pharmacokinetic evidence indicates a link between the use of broad-spectrum antibiotics and altered hormonal levels in oral contraceptive users. If the client misses two pills during week 1, then she should take two pills a day for 2 days and finish the package and use a backup contraceptive method for the next 7 consecutive days.
- The lactational amenorrhea method (LAM) of birth control is popular in developing countries and has had limited use in the United States. As breastfeeding rates increase, more women may rely upon this method for birth control. Which information is most important to provide to the client interested in using the LAM for contraception?
a. LAM is effective until the infant is 9 months of age.
b. This popular method of birth control works best if the mother is exclusively breastfeeding.
c. Its typical failure rate is 5%.
d. Feeding intervals should be 6 hours during the day.
ANS: B
The LAM works best if the mother is exclusively or almost exclusively breastfeeding. Disruption of the breastfeeding pattern increases the risk of pregnancy. After the infant is 6 months of age or menstrual flow has resumed, effectiveness decreases. The typical failure rate is 1% to 2%. Feeding intervals should be no greater than 4 hours during the day and 6 hours at night.
- Although reported in small numbers, toxic shock syndrome (TSS) can occur with the use of a diaphragm. If a client is interested in this form of conception control, then the nurse must instruct the woman on how best to reduce her risk of TSS. Which comment by the nurse would be most helpful in achieving this goal?
a. “You should always remove your diaphragm 6 to 8 hours after intercourse. Don’t use the diaphragm during menses, and watch for danger signs of TSS, including a sudden onset of fever over 38.4 C, hypotension, and a rash.”
b. “You should remove your diaphragm right after intercourse to prevent TSS.”
c. “It’s okay to use your diaphragm during your menstrual cycle. Just be sure to wash it thoroughly first to prevent TSS.”
d. “Make sure you don’t leave your diaphragm in for longer than 24 hours, or you may get TSS.”
ANS: A
The nurse should instruct the client on the proper use and removal of the diaphragm and include the danger signs of TSS. The diaphragm must remain against the cervix for 6 to 8 hours to prevent pregnancy, but it should not remain in place longer than 8 hours to avoid the risk of TSS. The diaphragm should not be used during menses.
- Which term best describes the conscious decision concerning when to conceive or avoid pregnancy as opposed to the intentional prevention of pregnancy during intercourse?
a. Family planning
b. Birth control
c. Contraception
d. Assisted reproductive therapy
ANS: A
Family planning is the process of deciding when and if to have children. Birth control is the device and/or practice used to reduce the risk of conceiving or bearing children. Contraception is the intentional prevention of pregnancy during sexual intercourse. Assisted reproductive therapy is one of several possible treatments for infertility.
- In the acronym BRAIDED, which letter is used to identify the key components of informed consent that the nurse must document?
a. B stands for birth control.
b. R stands for reproduction.
c. A stands for alternatives.
d. I stands for ineffective.
ANS: C
In the acronym BRAIDED, A stands for alternatives and information about other viable methods. B stands for benefits and information about the advantages of a particular birth control method and its success rates. R stands for risks and information about the disadvantages of a particular method and its failure rates. I stands for inquiries and the opportunity to ask questions.
- Which benefit regarding FAMs makes it an appealing choice for some women?
a. Adherence to strict recordkeeping
b. Absence of chemicals and hormones
c. Decreased involvement and intimacy of partner
d. Increased spontaneity of coitus
ANS: B
The absence of chemicals or hormones to alter the natural menstrual flow is extremely important to some women. The strict recordkeeping with FAMs may be difficult and creates a potential risk for failure. These methods require increased involvement by the partner; however, they also reduce the spontaneity of coitus.
