Chapter 6: Nursing Care for the Family in Need of Reproductive Life Planning
25. The nurse instructs a patient on the use of a vaginal estrogen/progestin rings for contraception. Which patient statement indicates that additional instruction is needed? A) "I am to take the ring out overnight." B) "I will leave the ring in place for 3 weeks." C) "I leave the ring in place during intercourse." D) "I am to use other birth control if I take the ring out for 4 hours."
Ans: A Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Analyze Page: 117 Feedback: If the ring is removed for 4 hours for any purpose, it should be replaced with a new ring and a form of barrier protection is to be used for the next 7 days. The ring is not removed overnight. The ring is left in place for 3 weeks and then removed for menstruation during the ring-free week. The ring does not need to be removed for intercourse.
13. For which patient assessment finding would an intrauterine device (IUD) be contraindicated? A) Misshapen uterus B) Multiple sexual partners C) Diagnosis of hypertension D) History of thromboembolic disease
Ans: A Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Analyze Page: 120 Feedback: Use of an IUD may be contraindicated for a woman whose uterus is distorted in shape because the device might perforate the uterine wall. The device is not contraindicated for multiple sexual partners, hypertension, or history of thromboembolic disease. Infection is no longer a concern because the vaginal string no longer conducts fluid. The device does not impact hormone levels and will not influence blood pressure or blood flow.
32. A postpartum patient asks the nurse when the subdermal hormone implant for contraception can be inserted. What should the nurse respond to this patient? A) In 6 weeks B) In 1 month C) 1 week after your next menstrual cycle D) Before being discharged after this delivery
Ans: A Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Page: 113 Feedback: The subdermal hormone implant can be placed 6 weeks after the birth of a baby. One month is too soon for the implant to be placed after the birth of a baby. Typically, the rod is inserted during menses or no later than day 7 of a menstrual cycle to be certain that the patient is not pregnant at the time of insertion. The implant will not be placed immediately after the delivery of a baby.
31. A patient received a scheduled dose of depot medroxyprogesterone acetate (DMPA) 6 weeks ago. Today, the patient reports that a regular menstrual cycle is 2 weeks late. What is the first thing that should be done for this patient? A) Perform a pregnancy test. B) Provide prenatal counseling. C) Discuss pregnancy termination options. D) Explain side effects of the contraceptive.
Ans: A Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Page: 127 Feedback: Because the patient is receiving a contraceptive that could cause amenorrhea, and the patient's menstrual cycle is 2 weeks late, the first thing that should be done is a pregnancy test to determine if the patient is pregnant. The results of this test will determine the next course of action. Depot medroxyprogesterone acetate (DMPA) is a pregnancy category X medication, which means it should not be administered to someone who is pregnant. It is unclear if the patient was already pregnant when the last dose was provided 6 weeks prior to the current situation. It is premature to provide prenatal counseling. Depending on the results of the pregnancy test, the nurse may need to explain side effects of the contraceptive which include amenorrhea.
29. An Rh-negative woman at 6 weeks' gestation is scheduled for a medically induced termination. Which outcomes should the nurse identify as appropriate for this patient? Select all that apply. A) Attended contraceptive counseling B) Received Rho (D) immune globulin C) Scheduled postprocedure sonogram D) Avoided strenuous activity for 3 weeks E) Experienced menstrual cycle in 2 months
Ans: A, B, C Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Page: 127 Feedback: A medically induced termination should be performed within 63 days of gestation. Once the termination medication has been provided, the patient should receive Rho (D) immune globulin, schedule a postprocedure sonogram, and attend contraceptive counseling. The patient should avoid strenuous activity for 3 days and have a return of a menstrual cycle within 2 to 4 weeks.
14. A male patient is considering a vasectomy. Which information should the nurse instruct the patient about this procedure? Select all that apply. A) Sexual intercourse can resume in a week. B) The procedure can be done as an outpatient. C) An opioid analgesic will be prescribed for pain control. D) Use a birth control method until a negative sperm reports occur. E) Spermatozoa present in the vas deferens will be viable for 2 weeks.
Ans: A, B, D Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Page: 121 Feedback: After a vasectomy, sexual intercourse can resume after 1 week. The procedure can be completed as an outpatient. The patient may experience a small amount of local pain afterward, which can be managed by taking a mild analgesic and applying ice to the site. An additional birth control method should be used until two negative sperm reports at about 6 and 10 weeks have been obtained. Spermatozoa, which were present in the vas deferens at the time of surgery, can remain viable for as long as 6 months.
8. A nurse is working with a woman who is using the calendar method to determine her safe days. The nurse would instruct the woman to subtract: A) 14 from 28. B) 18 from her shortest period and 11 from her longest. C) The length of her average period from the ideal of 28. D) 18 from the longest period and 11 from her shortest.
Ans: B Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 107 Feedback: The days surrounding ovulation (3 days before and 3 days after) are the most fertile days. To plan, the woman keeps a diary of about six menstrual cycles. To calculate "safe" days, she subtracts 18 from the shortest cycle she documented. This number predicts her first fertile day. She then subtracts 11 from her longest cycle. This represents her last fertile day. If she had six menstrual cycles ranging from 25 to 29 days, her fertile period would be from the 7th day (25 [the shortest cycle] - 18) to the 18th day (29 [the longest cycle] - 11). To avoid pregnancy, she would avoid coitus during those days
2. A woman calls the clinic to report that she has had some cramping and spotting since the insertion of her IUD three days ago. Which instruction would be most appropriate? A) "Come to the clinic as soon as possible." B) "Consider this normal, because your IUD is newly inserted." C) "Take your blood pressure daily for the rest of the month." D) "You'll have to change your method of birth control."
Ans: B Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Page: 120 Feedback: A woman may notice some spotting or uterine cramping the first 2 or 3 weeks after IUD insertion.. Ibuprofen, a prostaglandin inhibitor, is helpful in relieving the pain.
21. A patient wants to calculate fertile days using the calendar method. What will the nurse instruct the patient to subtract when making this calculation? A) 14 from 28 B) 18 from the shortest period and 11 from the longest C) 18 from the longest period and 11 from the shortest D) The length of the average period from the ideal of 28
Ans: B Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Page: 107 Feedback: To calculate "safe" days, the patient should subtract 18 from the shortest cycle. This number predicts the first fertile day. Then subtract 11 from the longest cycle. This represents the last fertile day. The other calculations are incorrect to determine fertile days.
24. A patient asks the nurse if a cervical cap is better than a diaphragm for contraception. What should the nurse explain is the advantage of a cervical cap? A) No initial fitting is required. B) It can be left in place longer. C) It needs no spermicidal jelly. D) It does not need to be refitted after pregnancy.
Ans: B Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Page: 112 Feedback: Caps can be kept in place longer—up to 48 hours—because they do not put pressure on the vaginal walls or urethra. A fitting is needed for a cervical cap. They are used with spermicidal jelly, and they do need to be refitted after pregnancy.
19. A 40-year-old woman who smokes desires a reliable contraceptive method. Which should the nurse recommend to this patient? A) An ovulation suppressant B) A condom and spermicide C) A spermicidal suppository D) The rhythm (calendar) method
Ans: B Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Page: 115 Feedback: Women who are 40 years of age and smoke should not take ovulation suppressants. Irregular menstrual cycles make natural methods difficult. Women older than the age of 40 may have vaginal dryness, so a spermicidal suppository would not be effective. The best option is for the patient to use a condom and spermicide.
10. What is an advantage of a cervical cap over a diaphragm? A) No initial fitting is required. B) It can be left in place longer. C) It needs no spermicidal jelly. D) It does not need to be refitted after pregnancy.
Ans: B Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 112 Feedback: Because a cervical cap does not press against the sides of the vagina, possibly interfering with blood supply, it can be left in place longer.
11. A nurse is teaching a woman how to use the basal body temperature method of contraception. The nurse determines that the teaching was successful when the woman identifies that she should refrain from having sexual intercourse at which time? A) 4 days after she notices her temperature rise. B) 7 days after noting a slight increase followed by a dip in her temperature. C) 3 days after she records a slight drop in her temperature followed by an increase. D) 14 days after the last day of her menstrual period.
Ans: C Client Needs: Health Promotion and Maintenance Cognitive Level: Analyze Page: 108 Feedback: Ovulation occurs after a slight drop in temperature followed by an increase. The ovum has a life span of 3 days. As soon as a woman notices a slight dip in temperature followed by an increase, she knows she has ovulated. She refrains from having coitus (sexual relations) for the next 3 days (the possible life of the discharged ovum).
34. A client decides to use the cervical mucus method as her contraceptive method. When describing this method, the nurse explains that the client can determine ovulation based on which characteristic of the mucus? A) thick consistency with clumping B) acidic odor and slightly yellow color C) thin and slippery D) transparent with the odor of eggs
Ans: C Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 108 Feedback: Before ovulation each month, the cervical mucus is thick and does not stretch when pulled between the thumb and finger. Just before ovulation, mucus secretion increases. On the day of ovulation (the peak day), it becomes copious, thin, watery, and transparent. It feels slippery (like egg white) and stretches at least 1 inch before the strand breaks, a property known as spinnbarkeit.
4. A woman telephones the nurse after taking an ovulation suppressant for 3 months to state that she has forgotten to take her pill two mornings in a row. What would be the best advice to give her regarding this? A) Start a new cycle of 21 pills immediately plus additional estrogen for the next 3 days. B) Take three pills immediately and avoid coitus for the remainder of the month. C) Take two pills now and use a second method of contraception for the remainder of the month. D) Take two pills a day for the rest of the month.
Ans: C Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Page: 115 Feedback: Failure to take two pills could have resulted in ovulation, so additional protection should be used for the remainder of the cycle.
1. After assessing a client, a nurse determines that an IUD as a method of contraceptive would be contraindicated based on a history of which finding? A) Smoking B) Hypertension C) Abnormal uterine shape D) Thromboembolic disease
Ans: C Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Page: 120 Feedback: Use of an IUD may be contraindicated for a woman whose uterus is distorted in shape (the device might perforate the uterine wall). The copper IUD use also is not advised for a woman with severe dysmenorrhea (painful menstruation) or menorrhagia (heavy bleeding) because use may increase the incidence of these conditions. Because use of a copper IUD can cause heavier than usual menstrual flow, a woman with anemia also may not be considered a good candidate for a copper IUD. The other findings are not contraindications. .
28. A patient who has unprotected intercourse has obtained the morning after pill but has not yet taken the prescribed dosage. What nursing diagnosis should the nurse identify as appropriate for the patient at this time? A) Powerlessness B) Spiritual distress C) Decisional conflict D) Readiness for enhanced knowledge
Ans: C Client Needs: Psychosocial Integrity Client Needs 2: Safe, Effective Care Environment: Management of Care Cognitive Level: Analyze Page: 102 Feedback: The patient has the morning after pill but has not yet taken the prescribed dosage. This indicates that the patient has not yet made a decision. Powerlessness would be applicable if the patient's planned contraceptive was ineffective. Spiritual distress would be appropriate if there were a conflict regarding contraceptive methods. Readiness for enhanced knowledge would be applicable if the patient was asking about different contraceptive types.
26. When should the nurse instruct a female patient using the basal body temperature method of contraception to refrain from having sexual intercourse? A) 4 days after noticing a temperature rise B) 14 days after the last day of the menstrual period C) 3 days after recording a slight drop in temperature followed by an increase D) 3 to 4 days after recording a slight increase followed by a dip in the temperature
Ans: C Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Page: 108 Feedback: As soon as a woman notices a slight dip in temperature followed by an increase that lasts for at least 72 hours, this indicates that ovulation has occurred. The patient should not be instructed to refrain from sexual intercourse 4 days after a temperature rise, 14 days after the last menstrual period, or 3 to 4 days after a slight increase followed by a dip in the temperature.
27. The nurse completes instructing a patient on the use of the contraceptive patch. Which patient response indicates that teaching has been effective? A) The patch is immediately effective after application. B) The patch should be applied to the breasts, hips, or back. C) The patch should be applied to the abdomen, buttocks, or back. D) The patch should be covered when swimming because of chlorine's effect on the adhesive.
Ans: C Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Page: 117 Feedback: The patch should be applied only to the buttocks, back, abdomen, or torso and never on the breasts. The patch is safe for wearing during swimming and bathing. The patch requires application for 1 week before becoming effective.
5. The estrogen content in the contraceptive pill performs which action? A) decreases the permeability of cervical mucus B) increases the level of luteinizing hormone (LH) C) interferes with endometrial proliferation D) suppresses follicle-stimulating hormone (FSH)
Ans: D Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Page: 113 Feedback: Estrogen has a direct effect on the pituitary gland suppressing FSH; progesterone increases permeability of cervical mucus and endometrial proliferation.
7. A woman is 40 years old and a heavy smoker. She has a single sexual partner but has very irregular menstrual cycles. She wants a highly reliable contraceptive. Which method would be the best recommendation? A) an ovulation suppressant B) a spermicidal suppository C) the rhythm (calendar) method D) a diaphragm and spermicide
Ans: D Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Page: 111 Feedback: Women over 40 who smoke should not take ovulation suppressants; irregular menstrual cycles make natural methods difficult; women over 40 may have vaginal dryness, so a spermicidal suppository would not be activated.
15. A patient comes into the family planning clinic and requests a prescription for birth control pills. Which assessment finding indicates that an ovulation suppressant would not be the best contraceptive method for the patient? A) Age 30 years B) Allergy to foreign protein C) Irregular menstrual cycles D) History of thromboembolism
Ans: D Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Page: 129 Feedback: Combination oral contraceptives are not routinely prescribed for patient with a history of thromboembolic disease. The patients' age would not be a contraindication for this type of contraceptive. An allergy to foreign protein would impact the patient's ability to use condoms. Irregular menstrual cycles would be an indication for combination oral contraceptives.
22. The nurse instructs a patient on cervical mucus changes that occur during ovulation. Which statement indicates that teaching has been effective? A) "During ovulation, the mucus is thick." B) "Ovulation makes the mucus more acidic." C) "The mucus is white because of more white blood cells." D) "When the mucus is thin and watery, then ovulation is occurring."
Ans: D Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Analyze Page: 108 Feedback: On the day of ovulation, the cervical mucus becomes copious, thin, watery, and transparent. During ovulation, the mucus is not thick, not acidic, and not white.
17. The nurse is planning an educational session on contraceptives for a group of adolescent high school students. What does the nurse need to do when planning this session? A) Argue that encouraging abstinence is unrealistic during the teenage years. B) Discuss that the application of a condom should occur after penile-vulvar contact. C) Explain that the combination oral contraceptive approach is the best for adolescents. D) Teaching about contraceptive options while avoiding indirect encouragement of sexual activity.
Ans: D Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Page: 102 Feedback: The nurse can help the nation achieve the 2020 National Health Goals by teaching adolescents about contraceptive options while being cautious to avoid indirectly encouraging sexual activity among teens. A 2020 National Health Goal is to increase the number of adolescents being instructed on abstinence. A condom should be applied before penile-vulvar contact. Oral contraceptives are not the contraceptive of choice for adolescents.
20. An adolescent female who has recently started menstruating asks for a highly reliable birth control method. Which method should the nurse discuss with the patient? A) Postcoital douching B) An intrauterine device C) An ovulation suppressant D) Vaginal foam for her and a condom for her partner
Ans: D Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Page: 113 Feedback: For many adolescent couples, use of a dual method, such as a vaginally inserted spermicide by the girl and a condom by her partner, is a preferred method of birth control. Postcoital douching is not a method of birth control. Intrauterine devices are rarely used for early adolescents because the uterus may still be small. Ovulation suppressants are not recommended until a female has been menstruating for at least 2 years.
16. A female patient has forgotten to take an ovulation suppressant for two mornings in a row. What should the nurse advise the patient to do? A) Take two pills a day for the rest of the month. B) Take three pills immediately and avoid coitus for the remainder of the month. C) Start a new cycle of 21 pills immediately plus additional estrogen for the next 3 days. D) Take two pills now and use a second method of contraception for the remainder of the month.
Ans: D Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Page: 115 Feedback: If two consecutive active pills are missed, the patient should be advised to take two pills immediately. Then the patient should continue the following day with the usual schedule. Missing two pills may allow ovulation to occur, so an added contraceptive such as a spermicide should be used for the remainder of the month. The patient does not need to take two pills every day for the rest of the month, take three pills and abstain from coitus, or start a new cycle of 21 pills.
33. After reviewing the various types of contraception available and discussing the pros and cons about each with the nurse, a young woman decides to use a spermicidal cream. When teaching the woman about this type of contraception, the nurse would instruct the woman to insert the cream at which time frame before intercourse? A) 1 hour B) 1.5 hours C) 2 hours D) 3 hours
Ans: A Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Page: 110 Feedback: Spermicidal gels or creams are easily inserted into the vagina before coitus with the provided applicator. The woman should do this no more than 1 hour before coitus.
6. A woman uses a diaphragm for contraception. The nurse would instruct her to return to the clinic to have her diaphragm fit checked after which occurrence? A) cervical infection B) a weight gain of 10 lb (4.5 kg) C) a vaginal infection D) six months of nonuse
Ans: B Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Page: 111 Feedback: A substantial weight gain or weight loss of 10 pounds (4.5 kilograms) or more may shift the relationship of pelvic organs enough that the diaphragm no longer fits correctly.
9. Which information is important for a woman to understand before undergoing a scheduled tubal ligation? A) She will have lessened dysmenorrhea following the procedure. B) She must think of the procedure as irreversible. C) The procedure will reduce her menstrual flow in amount. D) She should schedule it to be done just before a menstrual flow.
Ans: B Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 121 Feedback: Sterilization by fallopian tube obstruction does not alter menstrual symptoms or flow. Ectopic pregnancy could result if it is done following ovulation; reversing the process is difficult.
12. When using the contraceptive patch, a client should understand that it: A) should be applied to the breasts, hips, or back. B) should be covered when swimming in a pool because of chlorine's effect on the adhesive. C) is immediately effective after application. D) should be applied to the abdomen, buttocks, or back.
Ans: D Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Page: 117 Feedback: The patch should be applied only to the buttocks, back, abdomen, or torso (never the breasts). The patch is safe for wearing during swimming and bathing. The patch requires application for 1 week before becoming effective.
3. A woman visits the family planning clinic to request a prescription for birth control pills. Which factor would indicate that an ovulation suppressant would not be the best contraceptive method for her? A) She is 30 years old. B) She has irregular menstrual cycles. C) She has a history of allergy to foreign protein. D) She has a family history of thromboembolism.
Ans: D Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Page: 109 Feedback: The estrogen content of birth control pills may lead to increased blood clotting, leading to an increased incidence of thromboembolism. Women who already are prone to this should not increase their risk further.
18. The nurse is teaching a patient on the use of a diaphragm for contraception. Which patient statement indicates that instruction has been effective? A) "I need to use my finger to remove the diaphragm." B) "I should remove the diaphragm 6 hours after intercourse." C) "I should stop using a diaphragm if I get an infection of my cervix." D) "I need to have the diaphragm checked if my weight changes by 30 lb."
Ans: D Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Analyze Page: 111 Feedback: The patient should be instructed to have the size of the diaphragm checked if weight changes by 15 lb. The patient does need to use the finger to remove the diaphragm. The diaphragm should be removed 6 hours after intercourse. The diaphragm should not be used if the patient is experiencing a cervical infection.
23. The nurse is planning instruction for a patient desiring to have a tubal ligation. Which information should the nurse emphasize when teaching the patient? A) She must think of the procedure as irreversible. B) The procedure will reduce her menstrual flow in amount. C) She should schedule it to be done just before a menstrual flow. D) She will have lessened dysmenorrhea following the procedure.
Ans: A Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Page: 121 Feedback: People considering tubal ligation should think of this procedure as permanent before having it done. Although reversal of the procedure can be done, the success rate is between 70% and 80%. Tubal ligation does not alter the menstrual flow or affect dysmenorrhea. Ectopic pregnancy could result if it is done following ovulation.
30. A patient recovering from a surgical pregnancy termination returns for a postprocedure examination. The patient tells the nurse that she is relieved that the procedure is over but that she is feeling sad. What should the nurse do to assist the patient at this time? A) Suggest the patient talk with a counselor. B) Ask the patient to identify the source of the sadness. C) Recommend the patient attend contraceptive counseling sessions. D) Discuss the need for an antidepressant with the health care provider.
Ans: A Client Needs: Psychosocial Integrity Client Needs 2: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 127 Feedback: After a surgical pregnancy termination, most women report to be relieved with the decision; however, those who express sadness and guilt may need to be referred for professional counseling so they can integrate and accept this event in their lives. Asking the patient to identify the source of the sadness will not help the patient work through feelings caused by the procedure. Recommending the patient attend contraceptive counseling sessions does not focus on the source of the patient's sadness. Discussing antidepressant use may be premature for this patient.