OB Ch. 4
15) A patient using the calendar rhythm method of birth control asks for assistance to calculate her most fertile period. She states that her shortest cycle is 22 days and her longest cycle is 40 days. Using this information, which day should the nurse identify as being the end of the patient's fertile period?
Answer: 29 Explanation: The calendar rhythm method (CRM) is based on the assumption that ovulation tends to occur 14 days (plus or minus 2 days) before the start of the next menstrual period. The fertile phase is calculated from 18 days before the end of the shortest recorded cycle through 11 days from the end of the longest recorded cycle. For this situation the where the cycle lasts from 22 to 40 days, the fertile phase would be calculated as day 4 (22-18) to day 29 (40-11). The last day of the fertile phase would be day 29. Page Ref: 54
19) The nurse is preparing to meet with a female patient to review the most appropriate contraceptive method. In which order should the nurse complete the steps of this process? 1. Emphasize actions if pregnancy occurs 2. Instruct on the use of the selected method 3. Review side effects and warning symptoms 4. Assess for medical contraindications to specific methods 5. Learn about lifestyle, attitudes, religious beliefs and plans for children
Answer: 4, 5, 2, 3, 1 Explanation: In addition to completing a history and assessing for any medical contraindications to specific methods, spend time with a woman learning about her lifestyle, personal attitudes about particular contraceptive methods, religious and cultural beliefs, personal biases, and plans for future childbearing. Once the woman chooses a method, help her learn to use it effectively. Review any possible side effects and warning symptoms related to the method chosen and counsel the woman about what action to take if she suspects she is pregnant. Page Ref: 53
28) A female college student comes into the student health clinic, concerned about being pregnant from unprotected intercourse the evening before. What should the school nurse counsel this student? A) "Take Plan B One Step now." B) "Take 1 pill of Plan B now and the second pill in 5 days." C) "Take one half of Plan B One Step now and the second half in 3 days." D) "Wait 5 days and take 1 pill of Plan B followed by the second pill in 2 days."
Answer: A Explanation: Plan B One-Step is one pill containing 1.5 mg of levonorgestrel which should be taken as one dose within 72 hours of unprotected intercourse. Plan B comes as two tablets of 0.75 mg levonorgestrel to be taken at once and should be taken as soon after coitus as possible. The pill in Plan B One-Step does not need to be split or taken days apart. The Plan B pills should be taken immediately and not after waiting for 5 days.
3) A client in the women's clinic asks the nurse, "How is the cervical mucus method of contraception different from the rhythm method?" The appropriate response by the nurse is that the cervical mucus method is which of the following? A) More effective for women with irregular cycles B) Not acceptable to women of many different religions C) Harder to work with than the rhythm method D) Requires an artificial substance or device
Answer: A Explanation: The cervical mucus method (Billings Ovulation Method) can be used by women with irregular cycles.
6) When assessing a client asking about birth control, the nurse knows that the client would not be a good candidate for Depo-Provera (DMPA) if which of the following is true? A) She wishes to get pregnant within 3 months. B) She is a nursing mother. C) She has a vaginal prolapse. D) She weighs 200 pounds.
Answer: A Explanation: A) Return of fertility after use may be delayed for an average of 10 months. A nursing mother can use Depo-Provera. Obesity and vaginal prolapse do not contraindicate the use of Depo-Provera. Page Ref: 65
29) A female client with an intrauterine device calls the clinic because she is unable to locate the strings after her last menstrual period. What should the nurse counsel this client? A) Schedule an appointment immediately B) Wait a few days and recheck for the strings C) Take a tub bath and then recheck for the strings D) Perform a douche and then recheck for the strings
Answer: A Explanation: A) Women with intrauterine contraception should contact their healthcare providers if the strings are missing. The client should not wait a few days, take a tub bath, or douche before rechecking for the strings.
33) The nurse is completing the health history for a client desiring the Essure method of permanent sterilization. What should the nurse specifically ask when assessing this client? A) "Are you allergic to any metals?" B) "How many children do you have?" C) "When was your last menstrual period?" D) "Is your spouse aware of the procedure?"
Answer: A Explanation: The Essure® method of permanent sterilization uses a nickel-titanium alloy. The client should be asked about having an allergy to nickel. The number of children, last menstrual period, and spouse's knowledge about the procedure are not essential when completing the client's health history prior to this method of sterilization.
9) What issues should the nurse consider when counseling a client on contraceptive methods? Select all that apply. A) Cultural perspectives on menstruation and pregnancy B) Effectiveness of the method C) Future childbearing plans D) Whether the client is a vegetarian E) Age at menarche
Answer: A, B, C Explanation: A) Decisions about contraception should be made voluntarily with full knowledge of advantages, disadvantages, effectiveness, side effects, contraindications, and long-term effects. Many outside factors influence this choice, including cultural practices, religious beliefs, personality, cost, effectiveness, availability, misinformation, practicality of method, and self-esteem. B) Decisions about contraception should be made voluntarily with full knowledge of advantages, disadvantages, effectiveness, side effects, contraindications, and long-term effects. Many outside factors influence this choice, including cultural practices, religious beliefs, personality, cost, effectiveness, availability, misinformation, practicality of method, and self-esteem. C) Decisions about contraception should be made voluntarily with full knowledge of advantages, disadvantages, effectiveness, side effects, contraindications, and long-term effects. Many outside factors influence this choice, including cultural practices, religious beliefs, personality, cost, effectiveness, availability, misinformation, practicality of method, and self-esteem. D) Vegetarianism has no impact on contraceptive method use. E) Age at menarche has no impact on contraceptive method use.
35) A client at 10 weeks' gestation is scheduled for a surgical abortion. Which approaches may be used to dilate the cervix for the procedure? Select all that apply. A) Misoprostol B) Mifepristone C) Metal dilators D) Sterile seaweed E) Paracervical block
Answer: A, B, C, D Explanation: After 8 weeks' gestation, the cervix is dilated with misoprostol or mifepristone, mechanically with metal dilators, or osmotically with sterile seaweed. A paracervical block is used to anesthetize the cervix.
11) The nurse is discussing the use of contraception with a client who has just become sexually active. What factors should the nurse include when educating the client on contraceptive methods? Select all that apply. A) Contraindications in the client's health history B) Religious or moral beliefs C) Partner's belief in the effectiveness of the choice D) Personal preferences to use method E) Future childbearing plans
Answer: A, B, D, E Explanation: A) Decisions about contraception should take into consideration any contraindications the client might have. B) Religious or moral beliefs often impact which choices are acceptable. C) The partner's belief in the effectiveness has no bearing on the actual effectiveness. D) Personal preferences need to be considered when deciding on a contraceptive method. E) Plans for future children should be considered before determining whether sterilization should be performed. Page Ref: 53
34) A client is being prepared to take the oral mifepristone-vaginal misoprostol treatment for an abortion. For which reasons should the nurse instruct the client to contact the healthcare provider within 24 hours? Select all that apply. A) Nausea B) Itchy skin C) Weakness D) Stomach pain E) Bloody discharge
Answer: A, C, D Explanation: A woman who has taken the oral mifepristone-vaginal misoprostol regimen and within 24 hours develops nausea, weakness, or stomach pain should contact the healthcare provider immediately. Itchy skin and bloody discharge are not identified as needing to be reported to the healthcare provider.
24) The nurse suspects that a client is experiencing adverse effects from the progestin within a combined oral contraceptive. What did the nurse assess to make this clinical determination? Select all that apply. A) Pruritus B) Headache C) Hirsutism D) Weight gain E) Hypertension
Answer: A, C, D Explanation: Pruritus, hirsutism (facial hair), and weight gain are adverse effects of progestin within a combined oral contraceptive. Headache and hypertension are adverse effects of estrogen within a combined oral contraceptive.
21) The nurse is reviewing the spermicidal agent nonoxynol-9 (N-9) with a client planning to use the barrier method to prevent pregnancy. What should the nurse emphasize when teaching about this preparation? Select all that apply. A) It does not cause toxicity. B) It is inserted after intercourse. C) It has no systemic side effects. D) It can be purchased over-the-counter. E) It reduces the risk of sexually transmitted infections.
Answer: A, C, D Explanation: The major advantages of spermicidal preparations include low local toxicity, lack of systemic side effects, and ease of obtaining through an over-the-counter purchase. Spermicides are inserted before intercourse. Nonoxyol-9 does not offer protection against the organisms that cause gonorrhea, chlamydia, or HIV/AIDS and may actually increase a woman's risk of HIV infection.
10) Extended use of combined oral contraceptives (COCs) reduces the side effects of COCs such as which of the following? A) Cramping B) Hypertension C) Breast tenderness D) Bloating
Answer: B Explanation: A) Extended use of COCs reduces the side effects of COCs such as bloating, headache, breast tenderness, cramping, and swelling. B) Complications of COCs include: myocardial infarction, stroke, blood clots, and hypertension. C) Extended use of COCs reduces the side effects of COCs such as bloating, headache, breast tenderness, cramping, and swelling. D) Extended use of COCs reduces the side effects of COCs such as bloating, headache, breast tenderness, cramping, and swelling. Page Ref: 63
16) A female patient comes into the community clinic with the following chart and asks the nurse for help understanding what needs to be done. Which method of birth control should the nurse review with the patient? A) Two-day method B) Basal body temperature C) Calendar rhythm method D) Billings ovulation method
Answer: B Explanation: B) The basal body temperature (BBT) method provides an objective record of fertile days and is used to detect ovulation by an increase in the basal temperature during the menstrual cycle. It requires that the woman take her temperature every morning upon awakening (before any activity) and record the findings on a temperature graph. This method is based on the fact that the temperature almost always rises and remains elevated after ovulation because of the production of progesterone. The calendar rhythm method (CRM) is based on the assumption that ovulation tends to occur 14 days (plus or minus 2 days) before the start of the next menstrual period. The two-day method is based on a woman's ability to distinguish the difference between progesterone-mediated and estrogen-mediated cervical mucus that is present at her introitus before she urinates, preferably in the afternoon and evening. The Billings Ovulation Method involves the assessment of cervical mucus changes that occur during the menstrual cycle. Page Ref: 55
20) After reviewing approaches for contraception with a female client, the nurse is concerned that barrier methods will not achieve the client's goal to prevent pregnancy. What did the client say to cause the nurse to draw this conclusion? A) "My partner doesn't mind wearing condoms." B) "I don't want to have to put anything in myself." C) "We should use a condom even with a diaphragm." D) "I know that spermicides are inserted before intercourse."
Answer: B Explanation: The client's request to not have to insert anything to prevent pregnancy indicates that the barrier method of a female diaphragm would not be an appropriate method of birth control because the client will not be motivated to use it. Wearing condoms and appropriately using spermicides indicates that the client would adhere to the use of a barrier method.
27) A female client comes into the clinic for a pregnancy test because she took the morning after pill immediately after having unprotected intercourse 3 days ago and has not had a menstrual period. What should the nurse respond to this client? A) "I'll make sure you have one during this visit." B) "You should wait for two weeks before having a pregnancy test." C) "It's unlikely that you are pregnant. Wait a few days and then take a pregnancy test." D) "How long did you wait to take the morning after pill after having unprotected intercourse?"
Answer: B Explanation: The woman should have her normal menses 2 weeks after taking emergency contraception. If she does not, she should follow up with a pregnancy test. A pregnancy test is not needed during this visit. The nurse has no way of knowing if the client is pregnant. The morning after pill should ideally be taken within 72 hours after having unprotected intercourse but can be taken up to 5 days after unprotected intercourse.
26) A client who has been using transdermal hormonal contraception comes in for a routine wellness visit. Which finding should cause the nurse to question if the client should continue to use this form of contraception? A) Body weight of 179 lb B) Skin breakdown at the site of the patch C) Drinks 2 cups of caffeinated coffee a day D) Bicycles at the gym three evenings a week
Answer: B Explanation: Women who have a skin disorder that may result in a reaction at the site of application may not be candidates for the patch. Body weight needs to be below 198 lbs. for the patch. Caffeine and exercise are not contraindications for using the patch for contraception.
25) During a follow-up wellness visit, the nurse determines that a female client is experiencing favorable outcomes after starting combined oral contraceptives. What data did the nurse use to determine this? Select all that apply. A) Reduced appetite B) Reduced menstrual flow C) Fewer menstrual cramps D) No pain with ovulation E) Cycle is regular at 28 days
Answer: B, C, D, E Explanation: Combined oral contraceptives have noncontraceptive benefits that include reduced menstrual flow, fewer menstrual cramps, mittelschmerz or pain with ovulation disappearing, and a more regular cycle. Combined oral contraceptives do not affect appetite.
8) When the nurse is teaching a woman about the use of a diaphragm, it is important to instruct her that the diaphragm should be rechecked for correct size how often? A) Every five years routinely B) When weight gain or loss beyond five pounds has occurred C) After each birth D) Only after significant weight loss
Answer: C Explanation: The diaphragm should be rechecked for correct size after each childbirth and whenever a woman has gained or lost 10 pounds or more.
4) A client who wants to use the vaginal sponge method of contraception shows that she understands the appropriate usage when she makes which statement? A) "I need to use a lubricant prior to insertion." B) "I need to add spermicidal cream prior to intercourse." C) "I need to moisten it with water prior to use." D) "I need to leave it in no longer than 6 hours."
Answer: C Explanation: A) Lubricant and spermicidal cream are not needed with the vaginal sponge. B) Lubricant and spermicidal cream are not needed with the vaginal sponge. C) To activate the spermicide in the vaginal sponge, it must be moistened thoroughly with water. D) The sponge can remain in place for 24 hours. Page Ref: 56
14) A client who was raped is extremely upset when a pregnancy test confirms that she is pregnant, and requests information regarding pregnancy termination. Which statement is best for the nurse to make? A) "Abortion is morally wrong, and should not be undertaken." B) "Hypertension is a risk with any abortion." C) "Surgical abortion in the first trimester is technically easier and safer than abortion in the second trimester." D) "The most accurate method to determine gestational age are the results of a pregnancy test."
Answer: C Explanation: A) Many nurses are strongly opposed to abortion for religious, ethical, cultural, or personal reasons. In order to be effective in a therapeutic relationship, the nurse must avoid being judgmental. B) Endometritis is a risk with any abortion. C) Second-trimester abortion (greater than 13 weeks' gestation up to 24 weeks or per state law) may be done medically or surgically. D) The most accurate method to determine gestational age is by sonographic determination. Page Ref: 68
13) The nurse is developing a teaching plan for a client undergoing a tubal ligation. What information should be included in the plan? A) The surgical procedure is easily reversible. B) Laparotomy is performed following a vaginal birth. C) Minilaparotomy is performed in the postpartum period soon after a vaginal birth. D) Tubal ligation can be done at any time the woman is either pregnant or not pregnant.
Answer: C Explanation: A) Reversal of a tubal ligation depends on the type of procedure performed. Although theoretically reversible, clients are advised that the method should be considered irreversible. B) Laparotomy is performed following a cesarean birth or other abdominal surgery. C) A tubal ligation minilaparotomy is performed in the postpartum period soon after a vaginal birth. D) Tubal ligation can be done at any time the woman is not pregnant. Page Ref: 66
1) A client asks the nurse, "Can you explain to us how to use the basal body temperature method to detect ovulation and prevent pregnancy?" What is the nurse's best response? A) "Take your temperature every evening at the same time and keep a record for a period of several weeks. A noticeable drop in temperature indicates that ovulation has occurred." B) "Take your temperature every day at the same time and keep a record of the findings. A noticeable rise in temperature indicates ovulation." C) "Take your temperature each day, immediately upon awakening, and keep a record of each finding. A noticeable rise in temperature indicates that ovulation is about to occur." D) "This is an unscientific and unproven method of determining ovulation, and is not recognized as a means of birth control."
Answer: C Explanation: A) Taking the temperature every evening at the same time would not provide information about when ovulation occurs. B) Taking the temperature every day at the same time would not necessarily provide accurate information about when ovulation occurs. C) The basal body temperature method is used to detect ovulation by an increase in the basal temperature during the menstrual cycle. It requires that the woman take her temperature every morning upon awakening (before any activity) and record the findings on a temperature graph, and is based on the fact that the temperature almost always rises and remains elevated after ovulation because of the production of progesterone, a thermogenic (heat-producing) hormone. D) Using basal body temperature to determine the timing of ovulation is a proven scientific method, and is recognized as an effective means of birth control. Page Ref: 55
12) The nurse is preparing educational materials at a family planning clinic. The client who is an appropriate candidate for using emergency contraception would be one who reports which of the following? A) Forgetting to start her pill pack yesterday B) Unprotected intercourse during her menses C) That a condom broke yesterday in the middle of her cycle D) Increased dysmenorrhea since IUC insertion
Answer: C Explanation: A) The client who forgot to start a new pill pack on time might not have had intercourse. B) Intercourse during menses does not lead to pregnancy. C) Research indicates that oral hormonal EC taken as soon as possible within 72 hours, but up to 5 days, can reduce the risk of pregnancy after a single act of unprotected intercourse by at least 74%. D) An IUC in place prevents conception, so emergency contraception is not indicated. Page Ref: 56
2) The nurse in the clinic instructs a client who is using the natural method of contraception to begin counting the first day of her cycle as which day? A) The day her menstrual period ceases B) The first day after her menstrual period ceases C) The first day of her menstrual period D) The day of ovulation
Answer: C Explanation: A) The day her menstrual period ceases is not an indicator of the first day of the cycle. B) The first day after her menstrual period ceases is not an indicator of the first day of the cycle. C) The first day of menstruation is the first day of the cycle. D) The day of ovulation is not an indicator of the first day of the cycle. Page Ref: 55
18) The nurse is reviewing the insertion of a diaphragm with a female patient. At which step in the process is the following diagram to be used? A) Before storing B) After removing C) Prior to inserting D) Determine leaking
Answer: C Explanation: C) The diagram demonstrates the application of jelly to the rim and center of the diaphragm which is done before insertion. The diaphragm should be washed and dried before storing. There is no reason to apply jelly after removing the diaphragm. Water or a light source is used to determine if the diaphragm is leaking. Page Ref: 59
30) A female client is disappointed to learn that intrauterine contraception is not an option. For what reason is this form of contraception contraindicated for this client? A) Diabetes B) Breast cancer C) Endometriosis D) Uterine surgery
Answer: C Explanation: Intrauterine contraception is contraindicated in endometriosis. Intrauterine contraception is an excellent contraceptive option for women with diabetes; it may also be used in women with a history of breast cancer or uterine surgery.
31) The nurse is teaching a client who is having the Skyla LNg-IUC device inserted for contraception. What should the nurse emphasize to the client about this device? A) This device will provide protection for 5 years B) This device will provide protection for 10 years C) This device should not be used with a copper allergy D) This device has a silver ring and could interfere with an MRI
Answer: D Explanation: The Skyla LNg-IUC device has a radiopaque silver ring at the top of the "T." The technician must be informed of this device if an MRI is required at any time. The Mirena levonorgestrel intrauterine system (LNg-IUC) provides protection for 5 years. The Copper IUC (ParaGard T 380A) provides protection for 10 years. The Skyla LNg-IUC device does not contain copper.
7) A couple asks the nurse what is the safest method of sterilization. What should the nurse reply? A) "Laparotomy tubal ligation." B) "Laparoscopy tubal ligation." C) "Minilaparotomy." D) "Vasectomy."
Answer: D Explanation: A) A laparotomy tubal ligation is a female sterilization procedure that involves more risks. B) A laparoscopy tubal ligation is a female sterilization procedure that involves more risks. C) Minilaparotomy is a female sterilization procedure that involves more risks. D) Vasectomy (male sterilization) is a relatively minor procedure. Page Ref: 66
5) A female client who is 36 years old, weighs 200 pounds, is monogamous, and does not smoke desires birth control. The nurse understands that which contraceptive method is inappropriate for this client? A) Intrauterine device B) Vaginal sponge C) Combined oral contraceptives D) Transdermal hormonal contraception
Answer: D Explanation: A) This client may use an intrauterine device. B) This client may use the vaginal sponge. C) This client may use combined oral contraceptives. D) Transdermal hormonal contraception is contraindicated because of the client's weight. Page Ref: 64—65
17) The nurse is coordinating educational materials in the patient training room. For which method of birth control should the nurse place the following diagram? A) Diaphragm B) Cervical cap C) Male condom D) Female condom
Answer: D Explanation: D) The female condom is inserted slowly by gently pushing the applicator toward the small of the back. The diaphragm is a barrier method that consists of a steel band that forms a ring and is covered with latex or silicone so that when the diaphragm is inserted, the ring lodges high in the vagina, covering the cervix. The cervical cap is reusable, looks like a small sailor's cap, and is made of soft silicone. The dome of the cap fits over the cervix, while the soft brim flares out slightly and conforms to the shape of the vagina. A strap placed over the dome permits easier removal. The cap is available in three sizes and should be used with a spermicide. The male condom is applied to the erect penis, rolled from the tip to the end of the shaft, before vulvar or vaginal contact. Page Ref: 57
23) A sexually active female asks why an HIV test is needed since she uses condoms with spermicidal agents when having intercourse. How should the nurse respond to this client? A) "Condoms do not protect against contracting HIV." B) "Spermicides only control bacteria and not viruses." C) "All sexually active people are at risk for contracting HIV." D) "The spermicide can make your vaginal cells more susceptible to HIV."
Answer: D Explanation: Research suggests that N-9 does not offer protection against the organisms that cause HIV/AIDS, and N-9 alone may actually increase a woman's risk of HIV infection because it has a negative effect on the integrity of vaginal cells, making them more susceptible to invasion by organisms such as HIV. Condoms do help reduce the risk of contracting HIV. Spermicides are prepared to render sperm inactive, not to kill bacteria or viruses. Although all sexually active individuals are at some risk for contracting HIV, this does not explain why the client should be tested for the virus.
32) A client scheduled to have a Mirena levonorgestrel intrauterine system (LNg-IUC) inserted asks how this device stops conception. What should the nurse say in response to this client? A) "It stops ovulation." B) "It slows sperm motility." C) "It shortens the menstrual cycle." D) "It causes the lining of the uterus to waste away."
Answer: D Explanation: The Mirena LNg-IUCs causes the lining of the uterus (endometrium) to become waste away. This device does not stop ovulation, slow sperm motility, or shorten the menstrual cycle.
22) A client is planning to use condoms with a spermicidal cream as contraception. What should the nurse include when reviewing this method with the client? A) Coat the condom with spermicide before using B) Insert the spermicide 1 hour before having intercourse C) Insert the cream high into the vagina and remain supine D) Wait 15 minutes after inserting the spermicide into the vagina
Answer: D Explanation: The spermicidal preparation is inserted into the vagina before intercourse. The nurse needs to instruct the woman to insert any of these spermicidal preparations high in the vagina as close to the cervix as possible. Maintaining a supine position after application will help keep the preparation in the vagina after it dissolves. The spermicide is not applied to the condom. The spermicide does not need to be inserted 1 hour before intercourse. Waiting 15 minutes is appropriate if the spermicide is a suppository.
