Maternal & Child Health Nursing Chapter 6

A 22-year-old female client asks about forms of chemical barrier contraception. The nurse tells the client that which is a form of a chemical barrier contraceptive? A) Vaginal foam B) Diaphragm C) Cervical cap D) Female condom

A) Vaginal foam Vaginal foam is a chemical barrier contraceptive. It offers added contraceptive protection when used with mechanical barriers. Cervical caps, diaphragms, and female condoms are physical, not chemical, barriers.

The nurse has assessed several clients who have arrived for routine appointments. The nurse predicts the health care provider will prioritize a bone density scan for which client? A) a 55-year-old Caucasian smoker, family history of osteoporosis B) a 45-year-old Hispanic with a vitamin D deficiency C) a 40-year-old African American, 5 ft 4 in (1.62 m) tall, 172 lbs (78 kg), inactive lifestyle D) a 25-year-old Asian, 5 ft 7 in (1.7 m) tall, 129 lbs (58.5 kg), with two children

A) a 55-year-old Caucasian smoker, family history of osteoporosis Risk factors for osteoporosis include female gender, Caucasian or Asian ethnicity, slender build, advanced age, estrogen deficiency because of menopause, low bone mass density, family history of osteoporosis, personal history of fracture as an adult, smoking, excessive alcohol intake, low dietary intake of calcium, vitamin D deficiency, inactive lifestyle, and use of glucocorticoids and anticonvulsants. The more of these risk factors an individual has, the higher the risk for osteoporosis. The 55-year-old Caucasian smoker with a family history of osteoporosis should be referred for bone scan or density testing. The other individuals have fewer overall risk factors.

The nurse discusses various contraceptive methods with a client and her partner. Which method would the nurse explain as being available only with a prescription? A) diaphragm B) spermicide C) basal body temperature D) condom

A) diaphragm The diaphragm is available only by prescription and must be professionally fitted by a health care provider. Condoms and spermicides are available over the counter. Basal body temperature requires the use of a special thermometer that is available over the counter.

A young woman comes to the free clinic asking for birth control pills. Which factor best indicates that another type of contraception would be better for this client? A) history of noncompliance with medications B) age of her partner C) frequency of sexual encounters D) cost of the pills

A) history of noncompliance with medications If a woman has a history of poor compliance with medication, it might not be realistic for her to plan on taking an oral contraceptive every day

The school nurse is counseling a sexually active 16-year-old adolescent about the various forms of contraception. She is afraid of getting pregnant or contracting a sexually transmitted infection because her boyfriend refuses to use a condom. In answering the client's questions as to which option will be best suit her needs, which form should the nurse recommend? A) Coitus interruptus B) Female condom C) Tubal ligation D) Oral contraceptive

B) Female condom The female condom would be the best choice for this client, as it provides protection against both STIs and conception. A tubal ligation would not be recommended for a 16-year-old girl, as it is a permanent measure and she may decide to have children in the future. Neither an oral contraceptive nor coitus interruptus would provide protection against STIs.

A nurse is explaining the use of an IUD to a female patient interested in obtaining contraception. Which information would the nurse most likely include in the explanation? A) The intrauterine device (IUD) is an object that is placed by the patient within the uterus to prevent implantation of a fertilized ovum B) IUDs seem to affect the way the sperm or egg moves C) IUDs are small devices made of flexible plastic that provide irreversible birth control D) IUDs do not prevent fertilization of the egg

B) IUDs seem to affect the way the sperm or egg moves IUDs seem to affect the way the sperm or egg moves. IUDs are small devices made of flexible plastic that provide reversible birth control. The intrauterine device (IUD) is an object that is placed by a physician or nurse practitioner within the uterus to prevent implantation of a fertilized ovum. IUDs usually prevent fertilization of the egg, but the precise mechanism by which it works is unknown.

The nurse is preparing to teach a client how to conduct the BBT method to determine her fertile window. Which instruction should the nurse prioritize? A) It is the best method for predicting ovulation. B) Temperature should be taken prior to any activity every morning. C) It depends on the average temperature taken each morning. D) Avoid intercourse only on the days the temperature drops.

B) Temperature should be taken prior to any activity every morning. BBT is the basal body temperature method and requires the woman to take her temperature and record it every morning, first activity of the day before exiting the bed or other activities. To prevent conception avoid unprotected intercourse from the day the BBT drops through the fourth day of temperature elevation. The BBT alone is not a reliable method for predicting ovulation. Use BBT along with calendar or cervical mucus methods to increase effectiveness.

A couple is considering vasectomy as a contraception option. However, the husband is nervous about how such a procedure would affect his sexual functioning. Which information should the nurse mention to the man? A) The man will continue to ejaculate sperm. B) The man will still have full erection capacity. C) The man will no longer produce testosterone. D) The man will no longer ejaculate seminal fluid.

B) The man will still have full erection capacity. Some men resist the concept of vasectomy because they are not sufficiently aware of their anatomy to know exactly what the procedure will involve. They can be assured vasectomy does not interfere with the production of sperm; the testes continue to produce sperm as always, but the sperm simply do not pass beyond the plugged vas deferens and are absorbed at that point. The man will still have full erection capacity and continue to produce testosterone. Because he also continues to form seminal fluid, he will ejaculate seminal fluid; it will just not contain sperm.

The nurse is preparing a teaching session for a client considering tubal ligation. Which factor should the nurse prioritize in this session? A) The procedure is easy to perform and will be painless. B) This is a permanent and irreversible procedure for birth control. C) She must have signed consent from her partner. D) Wait several months after birth, and schedule the surgery as an outpatient.

B) This is a permanent and irreversible procedure for birth control. The procedure is considered permanent and irreversible. This is a procedure not for routine birth control but for permanent birth control. If the women elects for this procedure, it can be done immediately following the birth of the child, lessening the inconvenience or hospitalization of the client. The procedure is not painless, nor easy. A consent form from the partner is not always required.

A nurse is helping a couple choose a contraception method that is right for them. Which is the least likely factor the nurse should consider? A) whether the method will affect sexual enjoyment B) the popularity of the method among the couple's friends C) ability to use a method correctly D) financial factors

B) the popularity of the method among the couple's friends Important things to consider when helping a couple to choose a method that will be right for them include the following: personal values, ability to use a method correctly, whether the method will affect sexual enjoyment, financial factors, whether a couple's relationship is short-term or long-term, prior experiences with contraception, and future plans. The popularity of the method is the least likely factor the nurse should consider.

A pregnant woman who has four other children is scheduled for a cesarean birth. She does not want more children after this one. She also does not want to use oral contraceptives or devices to prevent pregnancy. Which of the following could the physician recommend for this patient at the time of her cc-section? A) diaphragm B) tubal ligation C) vasectomy D) IUD placement

B) tubal ligation Tubal ligation, which can be done easily at the time of a C-section, is a procedure by which the fallopian tubes are occluded by cautery, clamping, crushing, or blocking, thereby preventing the passage of both sperm and ova.

A nurse is preparing a client for intrauterine device (IUD) insertion. What should the nurse inform the client when educating her on IUDs? A) There is reduced menstrual flow after insertion. B) The insertion procedure is painless. C) A regular check of threads must be done. D) There are continuous cramps after insertion.

C) A regular check of threads must be done. The nurse should instruct the client to check the threads regularly to make sure that the IUD is in place. Menstrual flow may be heavier, or last longer than normal, after IUD insertion. It will not decrease. The client may feel a sharp pain when the IUD is inserted. The client may have cramps for a few days, but these should not continue.

A 26-year old mother of three children tells the nurse at her annual check-up that she does not want to have any more children; however, her religion forbids the use of contraceptive devices. Which of the following methods would be the best option for this client? A) Intrauterine device B) Diaphragm C) Rhythm method D) Hormonal method

C) Rhythm method Fertility awareness methods (FAMs) include the rhythm method, which involves limiting sexual intercourse to the time during the woman's menstrual cycle when she is most likely to be infertile. This method does not involve contraceptive devices. Barrier methods, such as diaphragms and IUDs interfere with conception by physically preventing sperm from fertilizing ova. Barriers work through mechanical and chemical means. Hormonal methods of birth control alter a woman's normal hormone level to prevent ovulation and thus the chances for conception.

The nurse is teaching a young couple, who desire to start their family, the various methods for determining fertility. After discovering the woman regulary travels internationally for work, deals with a lot of job anxiety and frequently uses an electric blanket at home, the nurse will discourage the use of which method? A) symptothermal method B) calendar method C) basal body temperature method D) cervical mucus method

C) basal body temperature method BBT is a method where the body temperature should be checked first thing in the morning and recorded, immediately after waking and before getting out of bed. It is important for the patient to maintain a normal bedtime routine. Use of the electric blanket, stress, and anxiety can cause a false elevation in the BBT. The calendar method would depend upon her schedule. Cervical mucus and symptothermal methodology would be viable options.

The nurse is assessing a 52-year-old perimenopausal female who is concerned about the changes occurring in her body. When questioned about the most serious changes, which effect should the nurse point out? A) pelvic support muscles lose tone B) the uterus and ovaries decrease in size C) bone mineral density decreases D) dense breast tissue is replaced with adipose tissue

C) bone mineral density decreases As women age, the decrease in hormone levels place women at increased risk for osteoporosis. This is a potential concern which can impact life, and bone mineral density should be monitored. There is no evidence of atrophy in the pelvic muscles, nor in the uterus or ovaries as related to menopause. Breast tissue changes at the same rate that all other tissue changes.

The nurse informs the client that a diaphragm is an example of which type of contraception? A) chemical barrier B) intrauterine C) mechanical barrier D) transdermal

C) mechanical barrier The diaphragm is an example of a mechanical barrier. It is a circular rubber disk placed over the cervix before intercourse.

A nurse is providing a client with information on hormonal contraception. Which could the nurse use as an example of hormonal contraception? A) tadalafil B) sildenafil C) medroxyprogesterone D) mifepristone

C) medroxyprogesterone The nurse should inform the client that medroxyprogesterone is a hormonal contraceptive. Sildenafil and tadalafil are medications designed to induce erection. Mifepristone causes abortion. They do not act as hormonal contraceptives.

A nurse is instructing a client on birth control methods. The client asks about the cervical mucus method. When should the nurse tell the client she is fertile in relation to her mucus? A) when it is thick B) Cervical mucus is not a reliable indicator. C) when it is thin, watery, and copious D) when it does not stretch

C) when it is thin, watery, and copious The cervical mucus method relies on the changes that occur naturally with ovulation. Before ovulation, cervical mucus is thick and does not stretch when pulled. With ovulation, the mucus becomes thin, copious, watery, transparent, and stretchy.

A client is seen in the clinic requesting an emergency postcoital contraception pill levonorgestrel. The client states that she had unprotected sex 3 ½ days ago. What is the most appropriate response by the nurse? A) "You should contact the local abortion clinic to set up an appointment." B) "You will need to also be treated with antibiotics for an ST" C) "The pill will cause you to begin menstruating within a day." D) "Unfortunately you are past the time frame to take that prescription."

D) "Unfortunately you are past the time frame to take that prescription." Levonorgestrel can be taken anytime within 72 hours (3 days) of unprotected sexual activity. There is a newer form of the pill, ulipristal acetate, that can be taken as late as 120 hours after unprotected intercourse, but this medication does require a prescription.

The nurse is meeting with a 36-year-old client who wishes to begin using contraceptives. The client reports being in a long-term, monogamous relationship, runs 2 miles per day, and smokes a pack of cigarettes each day. Which method will the nurse be least likely to suggest to the client? A) condoms B) coitus interruptus C) spermicides D) combination oral contraceptives

D) combination oral contraceptives Oral contraceptives are contraindicated for women who smoke; they would be at a higher risk for blood clots. Condoms, coitus interruptus, and spermicidals can be used at no risk.