Maternity & Womens Health Care Ch. 8
The nurse is responsible for providing health teaching regarding the side effects of COCs. These side effects are attributed to estrogen, progesterone, or both. Which side effects are related to the use of COCs? (Select all that apply.) a. Gallbladder disease b. Myocardial infarction and stroke c. Hypotension d. Breast tenderness and fluid retention e. Dry skin and scalp
ANS: A, B, D Serious side effects include stroke, myocardial infarction, hypertension, gallbladder disease, and liver tumors. More common side effects include nausea, breast tenderness, fluid retention, increased appetite, oily skin and scalp, and chloasma. DIF: Cognitive Level: Understand REF: p. 184
The nurse is reviewing the educational packet provided to a client about tubal ligation. Which information regarding this procedure is important for the nurse to share? (Select all that apply.) a. It is highly unlikely that you will become pregnant after the procedure. b. Tubal ligation is an effective form of 100% permanent sterilization. You wont be able to get pregnant. c. Sterilization offers some form of protection against STIs. d. Sterilization offers no protection against STIs. e. Your menstrual cycle will greatly increase after your sterilization.
ANS: A, D A woman is unlikely to become pregnant after tubal ligation. However, sterilization offers no protection against STIs and is not 100% effective. Typically, the menstrual cycle remains the same after a tubal ligation. DIF: Cognitive Level: Apply REF: p. 190
20. Importantly, the nurse must be aware of which information related to the use of IUDs? a.Return to fertility can take several weeks after the device is removed. b.IUDs containing copper can provide an emergency contraception option if inserted within a few days of unprotected intercourse. c.IUDs offer the same protection against STIs as the diaphragm. d.Consent forms are not needed for IUD insertion.
ANS: B The woman has up to 5 days to insert the IUD after unprotected sex. The return to fertility is immediate after the removal of the IUD. IUDs offer no protection against STIs. A consent form is required for insertion, as is a negative pregnancy test.
18. Which contraceptive method best protects against STIs and the HIV? a.Periodic abstinence b.Barrier methods c.Hormonal methods d.Same protection with all methods
ANS: B Barrier methods, such as condoms, protect against STIs and the HIV the best of all contraceptive methods. Periodic abstinence and hormonal methods, such as birth control pills, offer no protection against STIs or the HIV. DIF: Cognitive Level: Apply REF: p. 177 TOP: Nursing Process: Planning
3. A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice. What is the nurses best response? a.Oral contraceptives are a highly effective method, but they have some side effects. b.Your current medications will reduce the effectiveness of the pill. c.Oral contraceptives will reduce the effectiveness of your seizure medication. d.The pill is a good choice for a woman of your age and with your personal history.
ANS: B Because the liver metabolizes oral contraceptives, their effectiveness is reduced when they are simultaneously taken with anticonvulsants. Stating that the pill is an effective birth control method with side effects is a true statement, but this response is not the most appropriate. The anticonvulsant reduces the effectiveness of the pill, not the other way around. Stating that the pill is a good choice for a woman of her age and personal history does not teach the client that the effectiveness of the pill may be reduced because of her anticonvulsant therapy. DIF: Cognitive Level: Apply REF: p. 184 TOP: Nursing Process: Planning
8. An unmarried young woman describes her sex life as active and involving many partners. She wants a contraceptive method that is reliable and does not interfere with sex. She requests an intrauterine device (IUD). Which information is most important for the nurse to share? a.The IUD does not interfere with sex. b.The risk of pelvic inflammatory disease will be higher with the IUD. c.The IUD will protect you from sexually transmitted infections. d.Pregnancy rates are high with the IUD.
ANS: B Disadvantages of IUDs include an increased risk of pelvic inflammatory disease (PID) in the first 20 days after insertion, as well as the risks of bacterial vaginosis and uterine perforation. The IUD offers no protection against sexually transmitted infections (STIs) or the human immunodeficiency virus (HIV), as does a barrier method. Because this woman has multiple sex partners, she is at higher risk of developing an STI. Stating that an IUD does not interfere with sex may be correct; however, it is not the most appropriate response. The typical failure rate of the IUD is approximately 1%. DIF: Cognitive Level: Apply REF: p. 187 TOP: Nursing Process: Planning
15. Which benefit regarding FAMs makes it an appealing choice for some women? a.Adherence to strict recordkeeping b.Absence of chemicals and hormones c.Decreased involvement and intimacy of partner d.Increased spontaneity of coitus
ANS: B The absence of chemicals or hormones to alter the natural menstrual flow is extremely important to some women. The strict recordkeeping with FAMs may be difficult and creates a potential risk for failure. These methods require increased involvement by the partner; however, they also reduce the spontaneity of coitus.
Postabortion instructions may differ among providers regarding tampon use and the resumption of intercourse. However, education should be provided regarding serious complications. When should the woman who has undergone an induced abortion be instructed to return to the emergency department? (Select all that apply.) a. Fever higher than 39 C b. Chills c. Foul-smelling vaginal discharge d. Bleeding greater than four pads in 2 hours e. Severe abdominal pain
ANS: B, C, E The client should report to a health care facility for any of the following symptoms: fever higher than 38 C, chills, bleeding more than two saturated pads in 2 hours or heavy bleeding lasting for days, foul-smelling discharge, abdominal tenderness or pain, and cramping or backache. DIF: Cognitive Level: Apply REF: p. 193
. If consistently and correctly used, which of the barrier methods of contraception has the lowest failure rate? a. Spermicides b. Female condoms c. Male condoms d. Diaphragms
ANS: C For typical users, the failure rate for male condoms may approach 18%. Spermicide failure rates are approximately 28%. The failure rate for female condoms is approximately 21%. The failure rate for diaphragms with spermicides is 12%. DIF: Cognitive Level: Remember REF: p. 179 TOP: Nursing Process: Planning
4. A woman who has just undergone a first-trimester abortion will be using oral contraceptives. To protect against pregnancy, the client should be advised to do what? a.Avoid sexual contact for at least 10 days after starting the pill. b.Use condoms and foam for the first few weeks as a backup. c.Use another method of contraception for 1 week after starting the pill. d.Begin sexual relations once vaginal bleeding has ended.
ANS: C If oral contraceptives are to be started within 3 weeks after an abortion, additional forms of contraception should be used throughout the first week to avoid the risk of pregnancy. DIF: Cognitive Level: Apply REF: p. 193 TOP: Nursing Process: Planning
10. A woman will be taking oral contraceptives using a 28-day pack. What advice should the nurse provide to protect this client from an unintended pregnancy? a.Limit sexual contact for one cycle after starting the pill. b.Use condoms and foam instead of the pill for as long as the client takes an antibiotic. c.Take one pill at the same time every day. d.Throw away the pack and use a backup method if two pills are missed during week 1 of her cycle.
ANS: C To maintain adequate hormone levels for contraception and to enhance compliance, clients should take oral contraceptives at the same time each day. If contraceptives are to be started at any time other than during normal menses or within 3 weeks after birth or an abortion, then another method of contraception should be used through the first week to prevent the risk of pregnancy. Taken exactly as directed, oral contraceptives prevent ovulation, and pregnancy cannot occur. No strong pharmacokinetic evidence indicates a link between the use of broad-spectrum antibiotics and altered hormonal levels in oral contraceptive users. If the client misses two pills during week 1, then she should take two pills a day for 2 days and finish the package and use a backup contraceptive method for the next 7 consecutive days. DIF: Cognitive Level: Apply REF: pp. 181-184 TOP: Nursing Process: Planning
What is the importance of obtaining informed consent for a number of contraceptive methods? a. Contraception is an invasive procedure that requires hospitalization. b. The method may require a surgical procedure to insert a device. c. The contraception method chosen may be unreliable. d. The method chosen has potentially dangerous side effects.
ANS: D Being aware of the potential side effects is important for couples who are making an informed decision about the use of contraceptives. The only contraceptive method that is a surgical procedure and requires hospitalization is sterilization. Some methods have greater efficacy than others, and this efficacy should be included in the teaching. DIF: Cognitive Level: Understand REF: p. 172
7. Which statement regarding emergency contraception is correct? a.Emergency contraception requires that the first dose be taken within 72 hours of unprotected intercourse. b.Emergency contraception may be taken right after ovulation. c.Emergency contraception has an effectiveness rate in preventing pregnancy of approximately 50%. d.Emergency contraception is commonly associated with the side effect of menorrhagia.
ANS: A Emergency contraception should be taken as soon as possible or within 72 hours of unprotected intercourse to prevent pregnancy. If taken before ovulation, follicular development is inhibited, which prevents ovulation. The risk of pregnancy is reduced by as much as 75%. The most common side effect of postcoital contraception is nausea. DIF: Cognitive Level: Understand REF: p. 186
13. Which term best describes the conscious decision concerning when to conceive or avoid pregnancy as opposed to the intentional prevention of pregnancy during intercourse? a.Family planning b.Birth control c.Contraception d.Assisted reproductive therapy
ANS: A Family planning is the process of deciding when and if to have children. Birth control is the device and/or practice used to reduce the risk of conceiving or bearing children. Contraception is the intentional prevention of pregnancy during sexual intercourse. Assisted reproductive therapy is one of several possible treatments for infertility. DIF: Cognitive Level: Understand REF: p. 171
The practice of the calendar rhythm method is based on the number of days in each menstrual cycle. The fertile period is determined after monitoring each cycle for 6 months. The beginning of the fertile period is estimated by subtracting 18 days from the longest cycle and 11 days from the shortest. If the womans cycles vary in length from 24 to 30 days, then her fertile period would be day _____ through day ______.
ANS: 6; 19 To avoid pregnancy, the couple must abstain from intercourse on days 6 through 19. Ovulation occurs on day 12 (plus or minus 2 days either way).
9. A woman is 16 weeks pregnant and has elected to terminate her pregnancy. Which is the most common technique used for the termination of a pregnancy in the second trimester? a.Dilation and evacuation (D&E) b.Methotrexate administration c.Prostaglandin administration d.Vacuum aspiration
ANS: A D&E can be performed at any point up to 20 weeks of gestation. It is more commonly performed between 13 and 16 weeks of gestation. Methotrexate is a cytotoxic drug that causes early abortion by preventing fetal cell division. Prostaglandins are also used for early abortion and work by dilating the cervix and initiating uterine wall contractions. Vacuum aspiration is used for abortions in the first trimester. DIF: Cognitive Level: Understand REF: p. 194
6. A client currently uses a diaphragm and spermicide for contraception. She asks the nurse to explain the major differences between the cervical cap and the diaphragm. What is the most appropriate response by the nurse? a.No spermicide is used with the cervical cap, so its less messy. b.The diaphragm can be left in place longer after intercourse. c.Repeated intercourse with the diaphragm is more convenient. d.The cervical cap can be safely used for repeated acts of intercourse without adding more spermicide later.
ANS: D The cervical cap can be inserted hours before sexual intercourse without the need for additional spermicide later. Spermicide should be used inside the cap as an additional chemical barrier. The cervical cap should remain in place for 6 hours after the last act of intercourse. Repeated intercourse with the cervical cap is more convenient because no additional spermicide is needed. DIF: Cognitive Level: Apply REF: p. 181 TOP: Nursing Process: Planning
1. A woman has chosen the calendar method of conception control. Which is the most important action the nurse should perform during the assessment process? a.Obtain a history of the womans menstrual cycle lengths for the past 6 to 12 months. b.Determine the clients weight gain and loss pattern for the previous year. c.Examine skin pigmentation and hair texture for hormonal changes. d.Explore the clients previous experiences with conception control.
ANS: A The calendar method of conception control is based on the number of days in each cycle, counting from the first day of menses. The fertile period is determined after the lengths of menstrual cycles have been accurately recorded for 6 months. Weight gain or loss may be partly related to hormonal fluctuations, but it has no bearing on the use of the calendar method. Integumentary changes may be related to hormonal changes, but they are not indicators for use of the calendar method. Exploring previous experiences with conception control may demonstrate client understanding and compliancy, but these experiences are not the most important aspect to assess for the discussion of the calendar method. DIF: Cognitive Level: Analyze REF: p. 174
12. Although reported in small numbers, toxic shock syndrome (TSS) can occur with the use of a diaphragm. If a client is interested in this form of conception control, then the nurse must instruct the woman on how best to reduce her risk of TSS. Which comment by the nurse would be most helpful in achieving this goal? a.You should always remove your diaphragm 6 to 8 hours after intercourse. Dont use the diaphragm during menses, and watch for danger signs of TSS, including a sudden onset of fever over 38.4 C, hypotension, and a rash. b.You should remove your diaphragm right after intercourse to prevent TSS. c.Its okay to use your diaphragm during your menstrual cycle. Just be sure to wash it thoroughly first to prevent TSS. d.Make sure you dont leave your diaphragm in for longer than 24 hours, or you may get TSS.
ANS: A The nurse should instruct the client on the proper use and removal of the diaphragm and include the danger signs of TSS. The diaphragm must remain against the cervix for 6 to 8 hours to prevent pregnancy, but it should not remain in place longer than 8 hours to avoid the risk of TSS. The diaphragm should not be used during menses. DIF: Cognitive Level: Apply REF: p. 180 TOP: Nursing Process: Planning
17. Which nonpharmacologic contraceptive method has a failure rate of less than 25%? a.Standard days variation b.Periodic abstinence c.Postovulation d.Coitus interruptus
ANS: A The standard days variation on the calendar method has a failure rate of 12% and is a variation of the calendar rhythm method with a fixed number of days for fertility in each cycle. The periodic abstinence method has a failure rate of 25% or higher. The postovulation method has a failure rate of 25% or higher. The coitus interruptus method has a failure rate of 27% or higher. DIF: Cognitive Level: Remember REF: p. 174
A male client asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide). Which response by the nurse is the most accurate? a.The lubricant prevents vaginal irritation. b.Nonoxynol-9 does not provide protection against STIs as originally thought; it has also been linked to an increase in the transmission of the HIV and can cause genital lesions. c.The additional lubrication improves sex. d.Nonoxynol-9 improves penile sensitivity.
ANS: B Nonoxynol-9 does not provide protection against STIs as originally thought; it has also been linked to an increase in the transmission of the HIV and can cause genital lesions. Nonoxynol-9 may cause vaginal irritation, has no effect on the quality of sexual activity, and has no effect on penile sensitivity.
Nurses, certified nurse-midwives, and other advanced practice nurses have the knowledge and expertise to assist women in making informed choices regarding contraception. A multidisciplinary approach should ensure that the womans social, cultural, and interpersonal needs are met. Which action should the nurse first take when meeting with a new client to discuss contraception? a. Obtain data about the frequency of coitus. b. Determine the womans level of knowledge concerning contraception and her commitment to any particular method. c. Assess the womans willingness to touch her genitals and cervical mucus. d. Evaluate the womans contraceptive life plan.
ANS: B Determining the womans level of knowledge concerning contraception and her commitment to any particular method is the primary step of this nursing assessment and necessary before completing the process and moving on to a nursing diagnosis. Once the clients level of knowledge is determined, the nurse can interact with the woman to compare options, reliability, cost, comfort level, protection from STIs, and her partners willingness to participate. Although important, obtaining data about the frequency of coitus is not the first action that the nurse should undertake when completing an assessment. Data should include not only the frequency of coitus but also the number of sexual partners, level of contraceptive involvement, and the partners objections. Assessing the womans willingness to touch herself is a key factor for the nurse to discuss should the client express an interest in using one of the fertility awareness methods of contraception. The nurse must be aware of the clients plan regarding whether she is attempting to prevent conception, delay conception, or conceive. DIF: Cognitive Level: Analyze REF: pp. 171-172
2. A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs). Which response by the nurse is most appropriate? a.Theyre not very effective, and it is very likely that youll get pregnant. b.FAMs can be effective for many couples; however, they require motivation. c.These methods have a few advantages and several health risks. d.You would be much safer going on the pill and not having to worry.
ANS: B FAMs are effective with proper vigilance about ovulatory changes in the body and with adherence to coitus intervals. FAMs are effective if correctly used by a woman with a regular menstrual cycle. The typical failure rate for all FAMs is 24% during the first year of use. FAMs have no associated health risks. The use of birth control has associated health risks. In addition, taking a pill daily requires compliance on the clients part. DIF: Cognitive Level: Apply REF: pp. 173-174 TOP: Nursing Process: Planning
11. The lactational amenorrhea method (LAM) of birth control is popular in developing countries and has had limited use in the United States. As breastfeeding rates increase, more women may rely upon this method for birth control. Which information is most important to provide to the client interested in using the LAM for contraception? a.LAM is effective until the infant is 9 months of age. b.This popular method of birth control works best if the mother is exclusively breastfeeding. c.Its typical failure rate is 5%. d.Feeding intervals should be 6 hours during the day.
ANS: B The LAM works best if the mother is exclusively or almost exclusively breastfeeding. Disruption of the breastfeeding pattern increases the risk of pregnancy. After the infant is 6 months of age or menstrual flow has resumed, effectiveness decreases. The typical failure rate is 1% to 2%. Feeding intervals should be no greater than 4 hours during the day and 6 hours at night. DIF: Cognitive Level: Understand REF: p. 191
The client and her partner are considering male sterilization as a form of permanent birth control. While educating the client regarding the risks and benefits of the procedure, which information should the nurse include? (Select all that apply.) a. Sterilization should be performed under general anesthesia. b. Pain, bleeding, and infection are possible complications. c. Pregnancy may still be possible. d. Vasectomy may affect potency. e. Secondary sex characteristics are unaffected.
ANS: B, C, E Vasectomy is the most commonly used procedure for male sterilization and is performed on an outpatient basis under local anesthesia. Pain, bleeding, swelling, and infection are considered complications. Reversal is generally unsuccessful; however, it may take several weeks to months for all sperm to be cleared from the sperm ducts. Another form of contraception is necessary until the sperm counts are zero. Vasectomy has no effect on potency, and secondary sex characteristics are not affected. DIF: Cognitive Level: Understand REF: p. 190
5. Which client would be an ideal candidate for injectable progestins such as Depo-Provera (DMPA) as a contraceptive choice? a.The ideal candidate for DMPA wants menstrual regularity and predictability. b.The client has a history of thrombotic problems or breast cancer. c.The ideal candidate has difficulty remembering to take oral contraceptives daily. d.The client is homeless or mobile and rarely receives health care.
ANS: C Advantages of DMPA include its contraceptive effectiveness, compared with the effectiveness of combined oral contraceptives, and the requirement of only four injections a year. The disadvantages of injectable progestins are prolonged amenorrhea and uterine bleeding. The use of injectable progestin carries an increased risk of venous thrombosis and thromboembolism. To be effective, DMPA injections must be administered every 11 to 13 weeks. Access to health care is necessary to prevent pregnancy or potential complications.
14. In the acronym BRAIDED, which letter is used to identify the key components of informed consent that the nurse must document? a.B stands for birth control. b.R stands for reproduction. c.A stands for alternatives. d.I stands for ineffective.
ANS: C In the acronym BRAIDED, A stands for alternatives and information about other viable methods. B stands for benefits and information about the advantages of a particular birth control method and its success rates. Rstands for risks and information about the disadvantages of a particular method and its failure rates. I stands for inquiries and the opportunity to ask questions.
16. The nurse is providing contraceptive instruction to a young couple who are eager to learn. The nurse should be cognizant of which information regarding the natural family planning method? a.The natural family planning method is the same as coitus interruptus or pulling out. b.This contraception method uses the calendar method to align the womans cycle with the natural phases of the moon. c.This practice is the only contraceptive method acceptable to the Roman Catholic Church. d.The natural family planning method relies on barrier methods during the fertility phases.
ANS: C Natural family planning is the only contraceptive practice acceptable to the Roman Catholic Church. Pulling out is not the same as periodic abstinence, another name for natural family planning. The phases of the moon are not part of the calendar method or any method. Natural family planning is another name for periodic abstinence, which is the accepted way to pass safely through the fertility phases without relying on chemical or physical barriers. DIF: Cognitive Level: Understand REF: p. 173 TOP: Nursing Process: Planning
Which statement regarding the term contraceptive failure rate is the most accurate? a.The contraceptive failure rate refers to the percentage of users expected to have an accidental pregnancy over a 5-year span. b.It refers to the minimum rate that must be achieved to receive a government license. c.The contraceptive failure rate increases over time as couples become more careless. d.It varies from couple to couple, depending on the method and the users.
ANS: D Contraceptive effectiveness varies from couple to couple, depending on how well a contraceptive method is used and how well it suits the couple. The contraceptive failure rate measures the likelihood of accidental pregnancy in the first year only. Failure rates decline over time because users gain experience.
Which statement is the most complete and accurate description of medical abortions? a.Medical abortions are performed only for maternal health. b.They can be achieved through surgical procedures or with drugs. c.Medical abortions are mostly performed in the second trimester. d.They can be either elective or therapeutic.
ANS: D Medical abortions can be either elective (the womans choice) or therapeutic (for reasons of maternal or fetal health) and are performed through the use of medications rather than surgical procedures. Medical abortions are usually performed in the first trimester.
A woman is using the basal body temperature (BBT) method of contraception. She calls the clinic and tells the nurse, My period is due in a few days, and my temperature has not gone up. What is the nurses mostappropriate response? a.This probably means that youre pregnant. b.Dont worry; its probably nothing. c.Have you been sick this month? d.You probably didnt ovulate during this cycle.
ANS: D The absence of a temperature decrease most likely is the result of a lack of ovulation. Pregnancy cannot occur without ovulation, which is being measured using the BBT method. A comment such as, Dont worry; its probably nothing, discredits the clients concerns. Illness is most likely the cause of an increase in BBT. DIF: Cognitive Level: Apply REF: pp. 175-176
19. Nurses should be cognizant of what information with regard to the noncontraceptive medical effects of combination oral contraceptives (COCs)? a.COCs can cause TSS if the prescription is wrong. b.Hormonal withdrawal bleeding is usually a little more profuse than in normal menstruation and lasts a week for those who use COCs. c.COCs increase the risk of endometrial and ovarian cancers. d.Effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements.
ANS: D The effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements. TSS can occur in some who use the diaphragm, but it is not a consequence of taking oral contraceptive pills. Hormonal withdrawal bleeding usually is lighter than in normal menstruation and lasts a couple of days. Oral contraceptive pills offer protection against the risk of endometrial and ovarian cancers. DIF: Cognitive Level: Understand REF: p. 184 TOP: Nursing Process: Planning