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.
Which of the following is not a typical advantage of contraceptive rings?
A. Alleviation of depression symptoms
B. Lighter menstrual periods
C. Fewer mood swings than oral contraceptives
D. Decreased menstrual cramps
A
Although the NuvaRing may provide fewer Moodswings than oral contraceptives, it may worsen, not alleviate, symptoms of depression and should be used with caution in patients with pre-existing cases of the condition. The NuvaRing may also lead to lighter menstrual periods and decreased menstrual cramps.
Undesirable side effects of oral contraceptive such as depression, fatigue, and decreased libido usually primarily result from: A. Excessive estrogen B. Estrogen deficiency C. Excessive progesterone D. Progesterone deficiency
C
Excessive progesterone may produce depression, fatigue, and decreased libido through its androgenic properties. Undesirable effects that are related to estrogen use include nausea, hypertension, and increased propensity to develop deep vein thrombosis. Some adverse effects, such as breast tenderness, headaches, and hypertension, may be caused by a combination of both hormones.
In which of the following patients would the NuvaRing be contraindicated?
A. A 32-year-old female who has just undergone a first trimester abortion
B. A 33-year-old female who gave birth eight weeks ago and is not breast-feeding
C. A 34-year-old female who uses tampons
D. A 36-year-old female who smokes
D
NuvaRing is contraindicated in smokers 35 years of age and older, as these patients are at an increased risk for arterial or venous thrombotic diseases that may be exacerbated by the content of the NuvaRing. Females may start the NuvaRing within the first five days after a first trimester miscarriage or abortion, or after four weeks postpartum if not breast-feeding. Studies show that tampons do not affect the placement or hormonal agents of the NuvaRing.
What is the typical initial dosage of ethinyl estradiol for combined oral contraceptives? A. Dose of 35 mcg or less B. Dose of 40 mcg or less C. Dose of 45 mcg or less D. Dose of 50 mcg or less
A
The typical initial dose of ethinyl estradiol estrogen in a combined oral contraceptive is 35 mcg. Products containing less than 50 mcg of estrogen are considered “low-dose” and are considered less likely to cause significant adverse events. Higher doses do not typically invoke a higher efficacy rate in most women, but may cause more adverse effects associated with hormonal contraceptives; as such, initial doses greater than 35 mcg are not typically prescribed.
Which of these methods of natural family planning uses both the basal body temperature graph and cervical mucus test? A. Lactational amenorrhea method B. Symptothermal method C. Calendar method D. Billings test
B
The Symptothermal method of natural family planning uses both the basal body temperature graph and cervical mucus test as mechanisms. These two mechanisms are not typically used in either the calendar method, which records serial cycles, or the lactational amenorrhea method, in which patients rely on breast-feeding for natural family planning. Lastly, the Billings test is another name for the cervical mucus test.
If the sponge is left in place for too long, a patient is typically at serious risk for which of the following conditions? A. Toxic shock syndrome B. Trichomoniasis C. Anemia D. Amenorrhea
A
A patient is at serious risk for toxic shock syndrome if the sponge is left in place for too long. Using the sponge may also increase risk for candidiasis. Intrauterine devices, not the sponge, may increase the risk of anemia due to increased menstrual bleeding, whereas Depo-Provera can increase the risk of amenorrhea.
High amounts of estrogen may cost several adverse effects associated with oral contraceptive use. Which of the following adverse effects is NOT typically caused by high amounts of estrogen? A. Nausea B. Acne C. Edema D. Breast tenderness
B
The development of or worsening of facial acne is typically a result of excess androgens, not a higher dose of estrogen. Although earlier progestins commonly promoted adrogenic activity, some modern progestins have anti-adrenergic activity. These progestins are often used alongside estrogen to combat severe acne and other adverse adrogenic effects. High amounts of estrogen make cause nausea, edema, and breast tenderness.
Which of the following choices is NOT a standard advantage of using a diaphragm or cervical cap?
A. It is relatively safe and easy to use.
B. It provides immediate protection.
C. When used with spermicidal gel, it may protect against sexually transmitted diseases.
D. It remains in place during intercourse.
D
Remaining in place during intercourse is not a standard advantage of using either a diaphragm or a cervical cap, as both can be disturbed during the act; rather, it is an advantage of using the sponge contraceptive. The advantages of being relatively safe and easy to use, providing immediate protection, and guarding against sexually transmitted infections when used with spermicidal gel are advantages from using the diaphragm. Likewise the cervical cap is relatively safe, easy to use, and provides immediate protection. Although the cervical caps activity against STI’s is limited, it may provide some protection from gonorrhea and chlamydia.
