Contraceptive Options Flashcards
A patient using the calendar method for contraception has determined that her shortest cycle last 28 days, her longest cycle last 32 days, and that her cycle starts on day five of the month. During which range of days of the month should she abstain from intercourse to best avoid pregnancy? A. Day 14- day 27 B. Day 21- day 27 C. Day 15- day 28 D. Day 19- day 28
C.
A patient using the Calendar method whose cycle begins on day five of the month, who shortest cycle last 28 days and whose longest cycle last 32 days, should avoid intercourse between days 15 and 28 of the month to best avoid pregnancy. When using the calendar method, the patient should subtract 18 days from her shortest cycle and 11 days from her longest cycle. Both those totals should be added to the day of the month her cycle begins, counting that day as part of the totals, thus determining the window of fertility.
Which of the following statements is true regarding the use of condoms?
A. There is a higher reported failure rate of female condoms than male condoms.
B. Natural skin condoms give the most protection against sexually transmitted diseases.
C. The failure rate of condoms its lowest of all barrier contraceptives.
D. Leaving empty space at the end of the condom increases the risk of breakage.
A
The failure rate of the female condom is substantially higher than the failure rate of male condoms. Latex condoms provide the greatest degree of protection from sexually transmitted diseases, whereas natural skin condoms do not protect against STDs. Condoms do not have the lowest failure rates of the barrier contraceptives, which includes spermicides and the sponge. The sponge has the lowest possible failure rate of these, whereas spermicides used alone have a higher failure rate than male condoms. Leaving a half inch of space at the end of the condom decreases the risk of breakage.
A patient with an intrauterine device learns that she is pregnant. If the device is not removed, which of these complications is most likely to occur? A. Placenta previa B. Ectopic pregnancy C. Spontaneous abortion D. Abruptio placentae
C
In the event of pregnancy, spontaneous abortion occurs and up to 50% of all users of intrauterine devices if the device is left in the uterus. Ectopic pregnancies, on the other hand, occur in 5% of all pregnancies in IUD users. Pregnant patients with IUD‘s are at an increased risk for abruptio placentae compared to other pregnant patients, but this outcome does not occur in 50% of all such patients. Placenta previa is not associated with the use of an IUD.
An 18-year-old patient comes to your office to inquire about spermicides, and ask about the failure rate of spermicides when used alone. As a nurse practitioner, you tell her the typical first year failure rate is: A. Approximately 11% B. Approximately 16% C. Approximately 21% D. Approximately 32%
C
The typical first year failure rate of spermicides is approximately 21%. When combined with other barrier contraceptives such as condoms or diaphragms, the failure rate is reduced to approximately 5%. Male condoms have an estimated failure rate of 11%. The cervical cap has an estimated 16% failure rate in patients who have not given birth, and an estimated 32% failure rate in patients who have given birth.
Which of the following is the least likely undesirable effect to expect in a female patient using spermicides?
A. Incomplete dissolution of suppositories
B. Increased risk for candidiasis
C. Vaginal skin irritation
D. Unpleasant taste
B
Although spermicides may increase a patient’s risk of developing candidiasis, this risk is not significant compared to the risk of other undesirable effects. Instead, spermicides significantly increase a female patient’s risk for urinary tract infections. Vaginal or penile skin irritation, incomplete dissolution of suppositories, and unpleasant taste are other common undesirable effects of spermicides.
Which of these patients would most likely need to have her diaphragm refitted, given that all of these patients already have a diaphragm and want to continue to use one?
A. A patient who experiences an allergic reaction
B. A patient who has gained approximately 25 pounds
C. A patient who has lost approximately 8 pounds
D. A patient who has contracted herpes
B
Although guidelines may vary, it is often considered necessary to refit a diaphragm if the patient using it gains or loses weight an excess of 20 pounds. Whether or not a patient contracts a sexually transmitted infection would not directly affect whether the patient needs to have her diaphragm refitted. Although an allergic reaction may result from exposure to latex or spermicides, such reactions may require a change of formulation or removal of the diaphragm, not a refitting.
Patients are at an increased risk for what fungal infection when using the sponge? A. Toxic shock syndrome B. Candidiasis C. Skin irritation D. Urinary tract infections
B
The risk of candidiasis is increased when the sponge is used as a contraceptive. Toxic shock syndrome may ensue from leaving the sponge in for too long, but this condition is bacterial, not fungal, in nature. Although the sponge may produce vaginal irritations and urinary tract infections, these reactions are not typically fungal in nature.
Which of the following types of contraceptives maybe used to prevent the recurrence of Asherman’s syndrome? A. Injected contraception B. Cervical caps C. Disposable barriers D. Intrauterine devices
D
An intrauterine device can be used to prevent the recurrence of Asherman’s syndrome because of the availability to be placed in the uterine cavity to create a barrier between the walls of the uterus. Implantation after the initial removal of scar tissue in the uterus may help with healing and facilitate separation of the tissues. Injected contraceptive methods are not a form of physical barriers and would not help prevent Asherman’s syndrome. Cervical caps and disposable barriers are placed over the cervix to prevent sperm from entering the uterus, but there is no evidence of their effectiveness in preventing recurrences of Asherman’s syndrome.
A patient starting the contraceptive patch place is her first patch on the first Sunday of the month. Assuming she maintains the recommended schedule, she would replace this patch with a new one on each of the following Sundays except: A. Second Sunday B. Third Sunday C. Fourth Sunday D. Fifth Sunday
C
Proper use of the patch requires changing the patch out once each week on the same day of the week it was first applied; on the fourth “change day, “ however, the patch is removed and not replaced until one week later. The patch would be replaced on the second and third change day, and the fifth change day would mark a new administration of the patch and the start of a new cycle.
What effect does Depo-Provera have specifically on the endometrium?
A. Creates a thin, atrophic lining
B. Thickens the cervical mucus
C. Promotes local foreign body inflammatory responses
D. Causes lysis of implanted blastocysts
A
Depo-Provera alters the endometrium by creating a thin, atrophic lining. Depo-Provera also thickens the cervical mucus, but this mechanism of action does not directly alter the endometrium; rather, it interferes with sperm transport and penetration. Intrauterine devices, not Depo-Provera, prevent implantation either by causing lysis of the blastocyst before it implants or by promoting local foreign body inflammatory responses.
Depo-Provera and NuvaRing share all the following mechanisms of action except:
A. Release of synthetic estrogen and progestin
B. Thickening of the cervical mucus
C. Suppression of follicle-stimulating hormone
D. Suppression of luteinizing hormone
A
Although NuvaRing acts by releasing synthetic estrogen and progestin, Depo-Provera is a progestin-only formulation. Both methods of contraception act to prevent fertilization via suppression of the follicle stimulating hormone and luteinizing hormone, as well as promote thickening in the cervical mucus.
For which of the following types of condoms is use of oil-based lubricants most strongly discouraged? A. Synthetic condoms B. Polyurethane condoms C. Natural membrane condoms D. Latex condoms
D.
Oil-based lubricant, such as baby oil, lotion, and petroleum jelly, should not be used with latex condoms, as these can increase the risk of kind of breakage. The other types of condoms, such as synthetic, natural membrane, and polyurethane, do not significantly weekend when exposed to oil-based lubricants as compared to latex.
Although progestin-only contraceptive pills are not as effective in suppressing unscheduled bleeding, these are a more viable option for patients with certain conditions that are exacerbated by estrogen. Which of these conditions does not usually warrant the need for progestin-only pills? A. Migraine headaches B. Hypertension C. Endometriosis D. Obesity
C
A combination of estrogen and progestin contraceptives actually decreases the pain resulting from endometriosis; therefore, the use of estrogen is often recommended for endometriosis. Patients who have migraine headaches, hypertension, or obesity would most likely benefit from progestin.
Which of these most strongly reflects the theory behind natural family planning?
A. Pregnancy is less likely when the cervical mucus is thin.
B. Pregnancy is less likely when the females temperature drops and rises prior to ovulation.
C. Pregnancy is less likely when there are “strawberry patches” on the cervix.
D. Pregnancy is less likely when the female is lactating.
D
The lactational amenorrhea method of natural family planning holds that the pregnancy is less likely when the female is not menstruating and is fully breast-feeding her infant. The cervical mucus method indicates that the pregnancy is more likely when there is a lot of clear, stretchy mucus; fertility is low when there is scant amount of thick, white mucus. The basal body temperature method of contraception instructs couples seeking to prevent pregnancy to obstain from sexual intercourse during expected rises and drops in the basal body temperature. Lastly, “strawberry patches” on the cervix usually indicate trichomoniasis and are not used in natural family planning.
All of the following are definitive reasons to re-examine and possibly replace a diaphragm as a contraceptive method except: A. Use of oil-based lubricants B. Wear and tear C. Being diagnosed with vulvovaginitis D. Gaining weight exceeding 20 pounds
C
Although use of a diaphragm may increase the risk of contracting vulvovaginitis, contraction of the disease is not an absolute reason to re-examine or replace the device. Diaphragms should regularly be checked for tears and holes resulting from repeated use. Furthermore, latex diaphragms should be examined and possibly replaced following the use of oil-based lubricants, as such lubricants may weaken the latex. Finally, although precise figures vary, diaphragms should also be examined for refitting if a patient gains or loses weight in excess of 20 pounds.
Which of the following contraceptives has two products commonly named ParaGard and Mirena? A. Diaphragm B. Disposable barriers C. The patch D. Intrauterine device
D ParaGard (copper-releasing) and Mirena (progestin– releasing) are two brands of intrauterine devices. Diaphragms, disposable barriers, and the patch do not have to products with these names.
