OB Chapter 31 Practice Questions

A woman taking an oral contraceptive as her birth control method of choice should notify her health care provider immediately, if she notes which of the following? a. Breast tenderness and swelling b. Weight gain c. Swelling and pain in one of her legs d. Mood swings

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

To increase the effective rate of male condoms, the female partner may: a. douche after intercourse. b. use a spermicide. c. use a female condom. d. use an oil-based lubricant.

B 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: a. during pregnancy. b. during the postpartum period prior to being discharged from the hospital. c. 6 weeks postpartum. d. 6 months postpartum.

B 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.

A woman comes to the clinic stating 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 for that time frame." The nurse's response should be based on the knowledge that: a. there is no healthy way to skip a menstrual period. b. there is a surgery, similar to a dilation and curettage, that can be done prior to the hiking trip. c. certain oral contraceptive pills may be taking consequently for 2 months to delay menses. d. there is a type of oral contraceptive pill that may give an extended menses for 1 month and the next month's will be lighter.

C 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 calls the clinic and reports that she forgot to take her birth control pill yesterday. She is taking a progestin only pill (minipill). The nurse should instruct her to: a. continue to take the pill as prescribed. b. take two pills this morning and then continue to take the pill as prescribed. c. continue to take the pill as prescribed, but use another form of birth control for the rest of the cycle. d. stop taking the pills, wait for the withdrawal bleeding, and then start a new cycle of pills.

C With the minipill if a woman misses any pills or does not take them at the same time each day, her chances of pregnancy increase. If any minipills are missed, the woman should continue to use the pills but use an additional method of contraception for the rest of the cycle.

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

B 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 woman is being admitted to the outpatient surgical unit for a tubal ligation. 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. inform the woman that the surgery unit has already been prepared and that it would be expensive to cancel the surgery at this time. b. inform the woman that the surgery can be reversed at a later date if she should change her mind. c. inform the surgeon of the woman's feelings. d. document the conversation and continue to prepare the woman for surgery.

C Sterilization should be considered 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 proceed with the surgery.

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

C The male condom offers the best protection from sexually transmissible diseases because it's a barrier.

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

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

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 remember to insert the device every morning. b. feelings about having to insert the device before sexual intercourse. c. comfort level on self-insertion of the ring every 3 weeks. d. ability to return to the clinic once a month for reinsertion.

C The woman must remove the ring after 3 weeks and insert a new ring 1 week later. The woman must be comfortable inserting the device into the vagina.

A woman who is 6 weeks postpartum and lactating is being counseled about contraception. She states 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. combination pill. b. male condoms. c. tubal ligation. d. intrauterine device.

D Once they are inserted, IUDs provide long-term, continuous contraception without the need to take pills, have injections, or perform other tasks before or during intercourse. They are appropriate for many women who cannot use hormonal contraception 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.

When counseling teenagers about contraception, it is important to teach them methods that do not require a clinic visit to obtain. One method that does not require a clinic appointment or prescription is: a. vaginal ring. b. intrauterine device. c. diaphragm. d. spermicides.

D Spermicides may be purchased over-the-counter and do not require a prescription or clinic visit.

A lactating woman asks the nurse about contraception. She states she has always used a combination pill and would like to continue with that method. The nurse should advise the woman: a. that oral contraceptives are contraindicated during the lactation period. b. that progestin-only contraceptives may be started 6 weeks after birth. c. that combination contraceptive pills may be started 3 to 4 weeks after birth. d. only barrier methods are recommended during the lactation period.

B 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 6 weeks after birth.

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 decision making concerning this method of contraception, the nurse would tell her that Depo-Provera: a. is inserted subcutaneously into the upper inner arm. b. would require that she return to the clinic every 3 months. c. should not be used if she has a history of estrogen-sensitive cancer. d. is effective for 3 years.

B Depo-Provera is an injectable progestin that prevents ovulation for 12 weeks. This requires the woman to return to the clinic every 3 months for the injection.

A woman is being counseled concerning the calendar method type of natural family planning. The woman states her cycles run from 27 to 29 days. The nurse teaches the woman that ovulation will probably occur on about days: a. 12 to 14. b. 14 to 16. c. 16 to 18. d. 18 to 20.

B Ovulation occurs approximately 14 days before the onset of menses.

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. immediately b. within 5 days after her next menstrual period. c. prior to her next menstrual period. d. at the time of ovulation.

B The injection is best given within 5 days of the menstrual period. If given later in the cycle, an additional form of contraception should be used for the first week.

The nurse evaluates a client teaching about contraceptives to be effective when the client states: a. "The more the contraceptives cost, the more effective they will be." b. "The birth control pill has a medication in it to prevent most STDs." c. "Condoms have very few side effects." d. "I will use the contraceptive method that my husband prefers."

C 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 her choice is crucial.

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. is not effective in all men. b. can undo itself within the first 3 months after surgery. c. does not render a man sterile for about 3 months. d. does produce sterility; therefore there should be another explanation concerning the pregnancy.

C Following a vasectomy, complete sterilization does not occur until sperm are no longer present in the semen. This may be 3 months or more.

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

C Misinformation and erroneous beliefs cause adolescents to use ineffective methods of contraception or no method at all. Opportunities to provide counseling and information must not be missed.

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

A The effectiveness of emergency contraception is greatest if used within 72 hours of unprotected intercourse.