Ch. 25: Family Planning

Which of the following is a potential disadvantage for the patient who wishes to use an intrauterine device (IUD) as a method of birth control? a. Insertion of the device prior to coitus resulting in decreased spontaneity b. Ectopic pregnancy c. Protection against STDs d. Decrease in dysmenorrhea

b. Ectopic pregnancy The insertion of an IUD is performed in a health care provider's office. An ectopic pregnancy can occur as a possible complication of the IUD. An IUD does not offer protection against STDs. A decrease in dysmenorrhea would be an advantage of using an IUD.

A patient has had a prior history of endometriosis and comes to the clinic asking about which method of birth control might be helpful to alleviate her symptoms. Which birth control method would provide the greatest benefit to this patient? a. Withdrawal method b. Oral contraceptives c. Depo-Provera d. Intrauterine device (IUD)

b. Oral contraceptives A patient who has a history of endometriosis may gain additional benefit from using an oral contraceptive as her birth control method because hormone levels will be more uniformly regulated with this type of treatment. The withdrawal method and Depo-Provera will not provide any additional benefit relative to a history of endometriosis. An IUD may cause further irritation to the endometrial lining so it would not be a prudent choice.

The method of contraception that is considered the safest for women is a(n) a. IUD. b. diaphragm. c. male condom. d. oral contraceptive.

c. male condom. A male condom does not have any side effects or risk factors for the woman. Oral contraception, an IUD, and the diaphragm all have significant side effects or risk factors for the woman.

Which response by the nurse is most appropriate when a client asks, "What contraceptive do you think I should use?" a. "Ask your doctor. She will know what is best for you." b. "The male condom is probably the easiest for you to use." c. "Because you are younger than 40, you should use oral contraceptives." d. "I can discuss the various methods with you so you can decide what is best."

d. "I can discuss the various methods with you so you can decide what is best." The nurse should provide the woman with all the necessary information to make an informed decision but should not make the decision for her. The nurse can educate the woman about contraception; she does not have to ask the doctor. The nurse should provide information about contraception, not tell her which one to choose. The nurse should educate the woman about different types of contraception, not make the choice for her.

A woman is being counseled concerning the calendar method type of natural family planning. The woman states that her cycles run from 27 to 29 days. The nurse teaches the woman that ovulation will probably occur on about days: A. 16 to 18. B. 18 to 20. C. 10 to 12. D. 13 to 15.

D. 13 to 15. Ovulation occurs approximately 14 days before the onset of menses.

To increase the effective rate of male condoms, the female partner may: A. use a female condom. B. use an oil-based lubricant. C. use an oil-based lubricant. D. use a spermicide.

D. use a spermicide. Using spermicides with condoms increases lubrication, which decreases the risk of condom breakage. Effectiveness is increased when spermicides are used with condoms.

A pregnant woman has requested a tubal ligation for contraception. The nurse is aware that this surgery can occur: (Select all that apply.) A. During the postpartum period prior to being discharged from the hospital. B. 6 months postpartum. C. 6 weeks postpartum. D. During pregnancy.

A. During the postpartum period prior to being discharged from the hospital. B. 6 months postpartum. C. 6 weeks postpartum. A tubal ligation can be performed soon after birth. It can be done at the same time as a cesarean birth or planned before discharge or at any other time.

Nurses working with adolescent women should include questions regarding sexuality when gathering data for a reproductive health history. Which one(s) of the following principles should guide the nurse when interviewing the adolescent? A. Misconceptions and inaccurate information expressed by the adolescent should be corrected promptly. B. Sexual histories are optional. C. An in-depth exploration of specific sexual practices should be included for this patient. D. Questions regarding the patient's sexual relationship are unnecessary if she is monogamous.

A. Misconceptions and inaccurate information expressed by the adolescent should be corrected promptly. Misinformation and erroneous beliefs cause adolescents to use ineffective methods of contraception or none at all. Opportunities to provide counseling and information must not be missed.

When counseling teenagers about contraception, it is important to teach them methods that do not require a clinic visit. Which one(s) of the following methods do not require a clinic appointment or prescription? (Select all that apply.) A. Spermicides B. Intrauterine device C. Condoms D. Vaginal ring E. Diaphragm

A. Spermicides C. Condoms Spermicides and condoms may be purchased over-the-counter and do not require a prescription or clinic visit.

A woman is requesting information concerning contraception. She is sexually active with multiple partners and is concerned about sexually transmitted diseases. When doing patient teaching, the nurse should be aware that the contraceptive method that offers the most protection against sexually transmitted diseases is: A. a male condom. B. an intrauterine device. C. natural birth control. D. oral hormones.

A. a male condom. The male condom offers the best protection from sexually transmitted diseases because it is a barrier.

A woman comes to the clinic stating that she is going on a hiking trip that will last 2 months. She states, "I have heard there are things that can be done to prevent me from having a period during that time." The nurse's response should be based on the knowledge that: A. certain oral contraceptive pills may be taken consecutively for 2 months to delay menses. B. there is a surgery, similar to a dilation and curettage, which can be done prior to the hiking trip. C. there is a type of oral contraceptive pill that may result in an extended menses for 1 month and the next month's will be lighter. D. there is no healthy way to skip a menstrual period.

A. certain oral contraceptive pills may be taken consecutively for 2 months to delay menses. When women prefer extended cycles, in which menses is delayed for a few days for special occasions or for a longer time, they take two or more oral contraceptive pill packs without taking the placebo pills for several packs or indefinitely.

A woman has just been diagnosed as being 2 months pregnant. She is upset and states, "This is not possible, my husband had a vasectomy 3 months ago, and he should be sterile." The nurse should respond to this woman with the knowledge that a vasectomy: A. does not render a man sterile for about 3 months. B. is not effective in all men. C. can undo itself within the first 3 months after surgery. D. does result in sterility, so there should be another explanation concerning the pregnancy.

A. does not render a man sterile for about 3 months. Following a vasectomy, complete sterilization does not occur until sperm are no longer present in the semen. This may be 3 months or longer.

A woman calls the clinic early on a Monday morning stating that she needs a prescription for emergency contraception. On questioning by the nurse, the woman states that her boyfriend's condom was displaced during intercourse on Saturday night. The nurse should make an appointment for the woman: A. on Monday. B. no later than Friday. C. by Wednesday. D. by Thursday.

A. on Monday. The effectiveness of emergency contraception is greatest if used within 120 hours/5 days of unprotected intercourse.

Which of the following statements is correct regarding the use of contraception and the occurrence of sexually transmitted diseases (STDs)? a. As long as the oral contraception method is used correctly, there is no transmission of STDs during sexual activity. b. Oral contraceptives provide the greatest protection against getting STDs. c. Barrier methods, if used correctly, are more likely to protect individuals from STDs as compared with other contraceptive methods. d. It is less likely to see transmission of STDs if patients engage in oral sex as opposed to vaginal penetration.

ANS: C The correct use of barrier methods helps protect against the transmission of STDs compared with other methods of contraception. The use of oral contraceptives has no effect on the transmission of STDs. The effectiveness of oral contraceptives is increased related to the prevention of pregnancy compared with other methods with the exception of abstinence. The method of sexual activity does not affect the transmission of STDs.

In reviewing information related to the occurrence of pregnancies using a focus group discussion with women, concern was expressed that many of them had problems using their respective type of contraception. As a result of noncompliance issues several women became pregnant. Based on this information, the nurse would incorporate which of the following in a teaching plan for group members? a. Provide information relative to product recalls of contraceptive devices. b. Have the patients keep a contraceptive diary related to the consistency of using methods because it is apparent that they forgot to use their preferred method as directed. c. Have the patients consider switching to a different form of contraception because the contraception did not prevent pregnancy for them. d. Plan for assessing the patients' knowledge related to the contraception methods and provide information to increase the knowledge base so that the effectiveness rate would improve.

ANS: D A typical effectiveness rate refers to the occurrence of pregnancy while using a specific contraception method. If contraception is used correctly and consistently, pregnancy should not occur. A decreased effectiveness rate is associated with incorrect usage in terms of application or inconsistent use. Providing information relative to product recalls of contraceptive devices refers to an ideal effectiveness rate; the implication is that the contraception method, although used correctly, is at fault. There is no evidence to support this finding. Having the patient keep a contraceptive diary does not address the primary concerns related to the typical effectiveness rate. Having the patient switch methods may not be necessary because the primary focus is to determine the knowledge base and identify learning needs.

A woman who is 6 weeks postpartum and lactating is being counseled about contraception. She states that she desires to have a type of birth control that she does not have to "think about." She has three children, so it should be effective and she is in a monogamous relationship. She has a history of blood clots. One appropriate choice of birth control that the nurse can recommend is: A. male condoms. B. an intrauterine device. C. a combination pill. D. tubal ligation.

B. an intrauterine device. Once they are inserted, IUDs provide long-term, continuous contraception without the need to take pills, have injections, or do something else before or during intercourse. They are appropriate for many women who cannot use hormonal contraception because of other problems, such as a history of blood clots. They are safe for use during lactation. Tubal ligation should be considered a permanent procedure; the woman did not request that type of contraception.

A woman is being admitted to the outpatient surgical unit for a tubal sterilization. She states to the nurse, "I know I have to go through with the surgery since I have already signed all the papers, but I was thinking this morning how wonderful it would be to have another baby." The nurse's next action should be to: A. document the conversation and continue to prepare the woman for surgery. B. inform the surgeon of the woman's feelings. C. inform the woman that the surgery unit has already been prepared and that it would be expensive to cancel the surgery at this time. D. inform the woman that the surgery can be reversed at a later date if she should change her mind.

B. inform the surgeon of the woman's feelings. Sterilization should be considered as a permanent end to fertility because reversal surgery is difficult, expensive, not always successful, and often not covered by insurance. The nurse should act as an advocate for the woman by informing the surgeon that the woman is having second thoughts about the surgery. Even though the consent forms have been signed, the woman does not have to go through with it if she has changed her mind.

During a breast exam, the midwife notes that the woman has a transdermal contraceptive patch applied to her breast. The midwife should: A. document the appropriate use of the patch. B. inform the woman that the patch should not be applied to the breast. C. remove the patch to complete the breast exam. D. question the woman on her satisfaction with the patch.

B. inform the woman that the patch should not be applied to the breast. The patch can be applied to the abdomen, buttocks, upper torso, or upper arm. It should not be applied to the breast area or areas that are rubbed by straps or waistbands.

A lactating woman asks the nurse about contraception. She states that she has always used a combination pill and would like to continue with that method. The nurse should advise the woman that: A. only barrier methods are recommended during the lactation period. B. combination contraceptive pills may be started 3 to 4 weeks after birth. C. progestin-only contraceptives may be started 4 weeks after birth. D. oral contraceptives are contraindicated during the lactation period.

C. progestin-only contraceptives may be started 4 weeks after birth. Combination oral contraceptives reduce milk production in lactating women, and very small amounts may be transferred to the milk. Progestin-only contraceptives may be a better choice if a woman wishes to use a hormonal contraceptive because they do not affect milk production. They are often started 4 to 6 weeks after birth.

A woman called the clinic desiring to start on medroxyprogesterone acetate (Depo-Provera) for contraception. The nurse should make an appointment for the woman A. prior to her next menstrual period. B. at the time of ovulation. C. within 7 days of the beginning of a menstrual period. D. immediately.

C. within 7 days of the beginning of a menstrual period. The injection is best given within 7 days of the beginning of a menstrual period. If given later in the cycle, an additional form of contraception should be used for the first week.

The nurse determines that teaching about contraceptives is effective when the patient makes which statement? A. "I will use the contraceptive method that my husband prefers." B. "The more the contraceptives cost, the more effective they will be." C. "The birth control pill has a medication in it to prevent most STDs." D. "Condoms have very few side effects."

D. "Condoms have very few side effects." Condoms will have local side effects only, such as allergic reaction. They will not produce systemic effects, as will the hormone type of contraception. Cost does not alter the effectiveness of a method. Oral hormone contraceptives do not contain other medications. The woman usually makes the final decision about her contraceptive method, and her satisfaction with the choice is crucial.

A woman taking an oral contraceptive as her birth control method of choice should notify her health care provider immediately if she notes which one(s) of the following? A. Weight gain B. Breast tenderness and swelling C. Mood swings D. Swelling and pain in one of her legs

D. Swelling and pain in one of her legs Leg pain and swelling (edema) may indicate thrombophlebitis and should be reported immediately. The other choices are all expected side effects of oral contraceptive pills, temporary in nature, and usually subside within a few cycles.

A woman asks the nurse about the "new vaginal ring everyone is talking about for birth control." When counseling the woman about this method of contraception, the nurse should assess for the woman's: A. ability to return to the clinic once a month for reinsertion. B. ability to remember to insert the device every morning. C. feelings about having to insert the device before sexual intercourse. D. comfort level about self-insertion of the ring every 3 weeks.

D. comfort level about self-insertion of the ring every 3 weeks. The woman must remove the ring after 3 weeks and insert a new ring 1 week later.

A woman is to have an Essure procedure performed to produce sterilization. The nurse should include in the patient teaching that A. the woman should rest for 24 hours after the procedure and should not lift heavy objects for a week. B. the woman should use another form of birth control for 3 months after the procedure. C. this procedure requires minor surgery and will be done in the outpatient surgical unit. D. narcotic analgesics will be prescribed for pain control after the procedure.

D. narcotic analgesics will be prescribed for pain control after the procedure. With the Essure procedure, a tiny coil is inserted into each fallopian tube. The tubes become permanently blocked during the next 3 months as tissue grows into the inserts. During this time, another contraceptive method is used. The procedure can be performed in the physician's office. It is a nonsurgical method of sterilization.

A 26-year-old woman is considering medroxyprogesterone acetate (Depo-Provera) as the form of contraception that is best for her. To assist this woman with making a decision concerning this method of contraception, the nurse would tell her that Depo-Provera: A. is effective for 3 years. B. is inserted subcutaneously into the upper inner arm. C. should not be used if she has a history of estrogen-sensitive cancer. D. would require that she return to the clinic every 3 months. Rationale:

D. would require that she return to the clinic every 3 months. Depo-Provera is an injectable progestin that prevents ovulation for 15 weeks. This requires the woman to return to the clinic every 3 months for the injection.

The most appropriate statement for introducing the topic of family planning in the postpartum setting is a. "What are your plans for future pregnancies?" b. "Do you plan on being sexually active in the future?" c. "Let's talk about birth control, because breastfeeding is not 100% effective for preventing pregnancy." d. "Here are some pamphlets on available methods of birth control. I'll come back later and discuss them with you."

a. "What are your plans for future pregnancies?" Discussing future pregnancy plans opens the conversation to ways of preventing pregnancy from occurring before the woman is ready to have another child. "Do you plan on being sexually active in the future?" will only provide a yes or no answer and not allow for conversation. The family needs to be ready to talk about birth control; the effect of breastfeeding on birth control is applicable only to the woman. Pamphlets are not always the best form of teaching. The patient is usually too tired and overwhelmed to read more information in the immediate postpartum period.

A patient is using Depo-Provera as her method of birth control. Which clinical finding warrants immediate intervention by the nurse? a. Mid-cycle bleeding b. Nausea c. Temperature of 37.8°C (100°F) d. Irregular periods

a. Mid-cycle bleeding When using Depo-Provera, the major side effect is irregular bleeding. The presence of mid-cycle bleeding warrants further investigation at this time. Nausea, fever, and irregular periods are not the result of Depo-Provera.

A woman who has a successful career and a busy lifestyle will most likely look for which type of contraceptive? a. Requires extensive education to use b. Is the easiest and most convenient to use c. Costs the least d. Is permanent

b. Is the easiest and most convenient to use A woman who has a busy lifestyle will probably have less time to devote to contraceptive use, therefore she requires something that is easy and convenient. Extra time for education would not be acceptable for this woman. Cost would probably not be a problem. There is no indication that a woman who has a successful career and a busy lifestyle wants contraception to be permanent, simply convenient.

Which symptom in a patient using oral contraceptives should be reported to the physician immediately? a. 5-lb weight gain b. Leg pain and edema c. Decrease in menstrual flow d. Increased pigmentation of the face

b. Leg pain and edema Oral contraceptives increase clotting factors, which place the woman at risk for thrombophlebitis. Leg pain and edema are symptoms of thrombophlebitis. A 5-lb weight gain can be expected. A decrease in menstrual flow is an expected finding. Increased pigmentation of the face is a common finding.

A patient presents to the Women's Health Clinic for continuation of her contraceptive method. She has been using Depo-Provera (medroxyprogesterone acetate) for 24 months. In preparation for instituting a plan of care, the nurse would consider which option as a priority? a. Schedule the patient for follow-up baseline diagnostic testing to confirm that the patient is not pregnant. b. Obtain information for an alternate contraception method. c. Ask the patient for additional information related to her menstrual cycle. d. Inspect the skin for site selection of contraceptive method.

b. Obtain information for an alternate contraception method. According to WHO (World Health Organization) guidelines, women should not be on Depo-Provera for more than 2 years due to loss of bone density. Therefore, the nurse should include assessments for other types of contraception methods for this patient. Although it may prove to be important to rule out possible pregnancy, based on the provided information, discontinuation of this method is the priority intervention. Depo-Provera can cause menstrual irregularities, but this is not the priority intervention. The nurse can follow up on this issue later. Because the current method of contraception should no longer be used, this option is not necessary.

You are teaching a group of adolescents regarding myths and facts related to contraception. Which statement indicates that additional teaching is needed for this group? a. Adolescents are more likely to become pregnant even if they use available contraception methods correctly. b. The withdrawal technique provides a higher likelihood that a teen will not get pregnant. c. Pregnancy can occur in the presence or absence of orgasm. d. Pregnancy can occur even if a teen is menstruating at the time of coitus.

b. The withdrawal technique provides a higher likelihood that a teen will not get pregnant. The withdrawal technique does not decrease the likelihood of becoming pregnant for any woman including a teen. Withdrawal is a highly unreliable method of birth control. Even without penetration, ejaculation may result in pregnancy. Based on current clinical evidence, adolescents are more likely to become pregnant even if they correctly use available contraception methods. Pregnancy can occur in the presence or absence of orgasm, and also if the teen is menstruating at the time of coitus.

When instructing a patient in the use of spermicidal foam or gel, it is important to include the information that a. effectiveness is about 85%. b. douching should be avoided for at least 6 hours. c. it should be inserted 1 to 2 hours before intercourse. d. one application is effective for several hours.

b. douching should be avoided for at least 6 hours. Douching within 6 hours of intercourse would remove the spermicide and increase the risk of pregnancy. Effectiveness of spermicidal foam or gel is only 72% when used alone. The spermicidal foam or gel should be inserted 15 minutes before intercourse. One application is effective for approximately 1 hour.

Which contraceptive method should be contraindicated in a patient with a history of toxic shock syndrome? a. Condom b. Spermicide c. Cervical cap d. Oral contraceptives

c. Cervical cap The cervical cap should not be used in women with a history of toxic shock syndrome. A condom, spermicide, or oral contraceptives are not contraindicated with a history of toxic shock syndrome.

Which contraceptive method provides protection against sexually transmitted diseases? a. Oral contraceptives b. Tubal ligation c. Male or female condoms d. Intrauterine device (IUD)

c. Male or female condoms Because latex condoms provide the best protection available, they should be used during any potential exposure to a sexually transmitted disease (STD). Only the barrier methods provide some protection from STDs. A tubal ligation is considered a permanent contraceptive method; however, does not offer any protection against sexually transmitted diseases. IUDs are inserted into the uterus and provide no protection from STDs.

The major difference between the diaphragm and the cervical cap is that the diaphragm a. is more effective. b. requires spermicide. c. applies pressure on the urethra. d. has no contribution to toxic shock syndrome.

c. applies pressure on the urethra. The diaphragm is made to fit snugly in the vaginal area and contains a hard rim that may exert pressure on the urethra. The cervical cap is smaller and fits around the cervix. The cervical cap is not more effective than a diaphragm. The diaphragm does not require spermicide. Both methods may contribute to the onset of toxic shock syndrome.

The patient who has had an intrauterine device (IUD) inserted should be instructed to a. use a vinegar douche weekly for 4 weeks. b. have the IUD replaced every 2 to 4 years. c. check the placement of the string once a week for 4 weeks. d. use another method of contraception for 2 weeks after insertion.

c. check the placement of the string once a week for 4 weeks. Checking the placement of the string is necessary to determine whether the IUD is still correctly positioned. If the string is shorter or longer than when checked previously, the patient should contact her physician. A vinegar douche weekly for 4 weeks is not necessary. An IUD can be left in place for up to 10 years. A second method of contraception is not required after insertion of the IUD; it is effective immediately.

A patient is 27 years old and delivered her first baby yesterday. She and her husband do not want to have another baby for at least 3 to 4 years. The most appropriate method of birth control to meet their needs is a. withdrawal. b. fertility awareness method. c. combination of condoms and foam. d. vasectomy with a reversal in 3 years.

c. combination of condoms and foam. Of the methods listed, condoms and foam would be the best for this couple. Withdrawal is the least effective form of birth control. Fertility awareness is not that effective and an unwanted pregnancy could result. They want another child, therefore a vasectomy with a reversal would not be an appropriate option.

Informed consent concerning contraceptive use is important since some of the methods a. may not be reliable. b. require a surgical procedure to insert. c. have potentially dangerous side effects. d. are invasive procedures that require hospitalization.

c. have potentially dangerous side effects. It is important for couples to be aware of potential side effects in order for them to make an informed decision regarding the use of contraceptives. Even if a method is less reliable, it still carries with it side effects that require informed consent. A written consent is required if the contraceptive choice involves a surgical procedure. Some contraceptive procedures are invasive; however, do not require hospitalization for insertion.

When using the basal body temperature method of family planning, the woman should understand that a. she will remain fertile for 5 days after ovulation. b. she should take her temperature each night before going to bed. c. her temperature will increase about 0.2 to 0.4°C (0.4 to 0.8°F) after ovulation. d. her temperature is normally lower during the second half of her cycle.

c. her temperature will increase about 0.2 to 0.4°C (0.4 to 0.8°F) after ovulation. The basal body temperature will increase approximately 0.2 to 0.4°C (0.4 to 0.8°F) at the same time ovulation occurs. The woman is fertile for up to 18 days. She should take her temperature at the same time upon rising in the morning. A woman's temperature is usually higher in the second half of her cycle.

You are evaluating a patient in the clinic setting who has been taking oral contraceptives for several years, without side effects. Vital signs are stable and the patient denies any pain or tenderness. On examination, you note a small erythematous area of approximately 2 cm on her right lower leg. She denies any traumatic injury and says this is a recent onset of a few days. Based on this information you would a. instruct the patient to use warm compresses for several days and keep the leg elevated as much as possible. b. have the patient wear flats rather than heels to modify her gait and help alleviate this issue. c. refer the patient to the health care provider for additional diagnostic work up. d. have the patient take an over-the-counter (OTC) nonsteroidal antiinflammatory drug (NSAID) and return to the clinic if the problem persists.

c. refer the patient to the health care provider for additional diagnostic work up. Because the patient has a history of oral contraceptive use, the nurse must assess and evaluate findings relative to ACHES (warning signs of oral contraceptives). Thus the patient should be worked up for the possibility of a superficial or deep vein thrombosis (DVT). Warm compresses and elevation of the leg, wearing flats, and taking an OTC NSAID may lead to further problems if there is an underlying clot that is not addressed promptly.

A male patient asks, "Why do I have to use another contraceptive? I had a vasectomy last week." The best response is a. "A vasectomy is only 80% effective." b. "A vasectomy is not effective in all men." c. "Semen may contain sperm for 6 months following a vasectomy." d. "Complete sterilization doesn't occur until all sperm have left the system."

d. "Complete sterilization doesn't occur until all sperm have left the system." It may take a month or longer for all sperm to be removed from the system. During that time, an additional method of contraception must be used. A vasectomy is 99% effective. Vasectomies have a high success rate; however, it may take 1 month for all the sperm to be removed from the system.

Which patient is a safe candidate for the use of oral contraceptives? a. 39-year-old with a history of thrombophlebitis. b. 16-year-old with a benign liver tumor. c. 20-year-old who suspects she may be pregnant. d. 43-year-old who does not smoke cigarettes.

d. 43-year-old who does not smoke cigarettes. Heavy cigarette smoking is a contraindication to oral contraceptive use due to risk of stroke. Oral contraceptives are contraindicated with a history of thrombophlebitis. Liver tumors, benign or malignant, preclude the use of oral contraceptives. Pregnancy is also a contraindication.

A nurse is leading a discussion regarding options for birth control. Which of the following methods is considered the most reliable? a. Coitus interruptus b. Breastfeeding c. Natural family planning d. Intrauterine device

d. Intrauterine device IUDs are 99% effective. Although coitus interruptus is considered 78% effective, it requires great control by the man and may be unsatisfying for both partners. Women who exclusively breast feed (without formula or solid food supplementation) may avoid ovulation. Another method of birth control should be used when the frequency of breastfeeding decreases. At 6 months postpartum ovulation commences in most women, even if exclusively breastfeeding. Couples must be highly motivated to use natural family planning because they must abstain from sex for as much as half of the menstrual cycle. Errors in the forbidden time carry a very high risk of pregnancy.

The role of the nurse in family planning is to a. refer the couple to a reliable physician. b. decide on the best method for the couple. c. advise couples on which contraceptive to use. d. educate couples on the various methods of contraception.

d. educate couples on the various methods of contraception. The nurse's role is to provide information to the couple so that they can make an informed decision about family planning. The nurse can assist the couple; they do not need to be sent to a physician for contraceptive education. The nurse's role is to evaluate the couple's knowledge base and educate regarding birth control options, not to decide which is the best contraceptive method for them to utilize.